RISK-BENEFIT PROFILE OF COMMONLY USED HERBS - LEGAL & OTHERWISE

Physicians And Consumers Need Reliable Information On Medical Herbs.

The popularity of such therapy in the US is growing rapidly but the science
is not progressing as rapidly as sales.

In the January 1st, 2002 Annals of Internal Medicine, Dr. Edzard Ernst
(from the UK) wrote The Risk-Benefit Profile of Commonly Used Herbal
Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and
Kava. The Annals has a history of conservative politics (for example, they
oppose the Oregon Death With Dignity Act and have written scathing
half-truths about the medical use of marijuana). With those conservative
politics in mind, I have provided the following review of Dr. Ernst's article.

The seven top selling legal herbal medicines are ginkgo biloba, St. John's
wort, ginseng, garlic, echinacea, saw palmetto, and kava. Dr. Ernst looked
for the best scientific articles he could find and graded them as to how
well they answered questions such as, "Are objectives of the study clearly
stated", "Are the data sources stated", and "Are inclusion and exclusion
criteria stated?". Readers are welcome to review the scientific abstract at
PubMed www.ncbi.nlm.nih.gov/entrez/.

Ginkgo is mostly used for memory impairment, dementia, tinnitus (ringing
ears), and intermittent claudication (legs hurt when walking because of
clogged arteries). In persons with memory impairment and dementia, ginkgo
is superior to placebo but in normal persons, ginkgo does not enhance
normal function. Ginkgo may help with ringing ears but there is
insufficient data to make any consistent claims.

Ginkgo is just as effective as the allopathic drug company competitor,
pentoxifylline, for intermittent claudication but the best treatment is to
stop smoking and to start walking exercise.

Ginkgo is generally safe but inhibits clotting (like aspirin does) so may
interact with other medicines such as warfarin blood thinners.

St. John's wort is used almost exclusively as an herbal antidepressant. Its
mechanisms of actions appear similar to drug company products like
imipramine. St. John's wort is more effective than placebo in the treatment
of mild to moderate depression and is similar in effect to moderate doses
of drug company products.

My experience is that no antidepressant drug works all the time and that
persons with severe and/or recurring depression usually benefit more from
talk therapy plus chemical treatment rather than either treatment alone.

St. John's wort can cause sensitivity to sunlight and can interact with
other drugs such as blood thinners and oral contraceptives. Because of drug
interactions, all of your doctors should know if you are taking this herb.

Ginseng is a confusing herb looking for a home in allopathic circles.

The studies are poor and conclusions are not reliable.

Sold as an ergogenic (energy giving) booster or an aphrodisiac or "other",
the reviews do not show ginseng to enhance performance. It does interact
with warfarin blood thinners.

Echinacea preparations contain many potentially active ingredients but no
single active constituent has been found.

The best-researched indications are prevention and treatment of
uncomplicated upper respiratory infections. In prevention trials, the
results were not conclusive but suggested that groups receiving echinacea
received benefit compared to control groups.

In treatment trials, most groups showed benefit with echinacea compared to
placebo. Dr. Ernst states, "Echinacea (particularly E. purpurea) may be
efficacious, but the trial data are weak and inconclusive". Side effects
from echinacea are rare. I use echinacea during high-risk settings (like
air travel) to prevent a cold. It seems to help and there is no alternative
because antibiotics are ineffective and dangerous in this setting.

Saw palmetto is almost exclusively used to treat benign prostatic
hyperplasia, a condition of aging men when the prostate grows and
interferes with normal urinary flow. The results show superiority of saw
palmetto over placebo in terms of urination frequency and peak flow and
suggest similar effectiveness to finasteride (the drug company competitor).
In some European countries, saw palmetto is considered first-line therapy
over finasteride. Side effects are rare but long-term studies are lacking.

Kava is mainly used for its anti-anxiety effects and short-term
administration of kava appears to be effective.

Unfortunately, several cases of toxic liver damage requiring liver
transplants have been reported.

Kava also interacts with other drugs, including alcohol, that impair the
central nervous system.

A skin condition can occur with long-term use of kava at high doses.

Garlic was reported on by Dr. Ernst in a prior Annals article (19 Sept
2000). Garlic was reported to be superior to placebo in decreasing
cholesterol levels.

However, the impact was small (around 5% compared to the drug company
"statins" impact of about 20% or more). About 20% of garlic users
complained of indigestion and odor.

General Findings

It is encouraging that we know this much about the best-selling legal
herbal remedies. Some herbs demonstrate attractive risk-benefit profiles,
particularly ginkgo (for dementia and intermittent claudication), St.
John's wort (for mild to moderate depression), and saw palmetto (for benign
prostatic hyperplasia). Echinacea appears to have modest benefits.

Claims for ginseng appear to be more myth than fact. Kava and garlic are
superior to placebo but inferior to other pharmaceutical options when
treating severe anxiety or elevated cholesterol levels.

Dr. Ernst concludes, "trials of herbal medicine products have been too few,
too small, and too short". This limits our abilities to predict drug
interactions and yields inadequate information to consumers or doctors.

In my opinion, though he didn't say it, Dr. Ernst's caution may be applied
equally to allopathic drug company products.

Pharmaceutical drugs are often recalled after severe events (liver failure,
kidney failure, gastrointestinal bleeding, and death). Consumers and
doctors can never know too much about any drug. Finally, choices should be
made on scientific merit rather than dogmatic viewpoints shaped by profit
motives, our country's War on Drugs, or bigotry against certain types of
medical practitioners.

The 8th Herb: Medicinal Marijuana

What would happen if we took an enlightened pro-patient approach and
applied the same risk-benefit profile to medical cannabis/marijuana as was
applied to the previous seven herbs?

Towards that end, addictions specialist nurse, Mary Lynn Mathre, from the
University of Virginia, and her nonprofit group, Patients Out of Time
(www.MedicalCannabis.com/) presented The Second National Clinical
Conference on Cannabis Therapeutics on May 3 & 4, in Portland. The
conference theme was Analgesia and Other Indications and was co-sponsored
by the Oregon Department of Human Services, Oregon Nurses Association,
Mothers Against Misuse and Abuse, and the Portland Community College (PCC)
Institute of Health Professionals.* Patients Out of Time presented their
first conference at the University of Iowa in 2000.

Cannabinoids are the scientific name for the natural agents found uniquely
in the cannabis plant but includes the synthetic compounds indomethacin
(Indocin). To have a drug that would control pain like morphine, cool off
joints without the bleeding risk of most anti-inflammatory drugs, and still
allow one to drive a car or work crossword puzzles sounds almost too good
to be true. My recommendation is to be cautiously optimistic and stay tuned.

Finally, Professor Mathre moderated a panel for questions and answers.

Prescription: Sane Public Policy

This conference shows what can happen when health care professionals and
others apply the same risk-benefit analysis to cannabis and cannabinoids
that we apply to other medicines, whether complex herbs or space-age
designer drugs.

Ideally, if everyone was in the same business to practice safe medicine and
protect consumers/patients, we could use science to break through the
bigotry and propaganda that clouds all herbal drug discussion but
especially the medical use of the ancient herb cannabis.

There will never be enough information to satisfy some people.

Some persons will always oppose medical access to cannabis for reasons
unrelated to science. This includes those who are committing senseless
violations of constitutional rights while enriching the huge drug testing
industry.

This includes most law enforcement and the prison industrial complex, which
has become a major political force and needs a steady stream of "customers"
(prisoners) to satisfy its profit quota driven by shareholder expectations.
Private industry entering the prison business is especially scary.

But most of all, this includes the barbarians in the current Bush
Administration such as Attorney General Ashcroft and his cronies at the
Drug Enforcement Administration (DEA) and the Office of National Drug
Control Policy (ONDCP). Doesn't US Justice, DEA, and ONDCP have better
things to do than raid medical cannabis clubs in California, take medicine
from dying and suffering patients, block medical research, convolute
administrative rules concerning controlled drugs and threaten doctors?

Their War on Drugs is a war on good American citizens whose crime is
"illness" and it must stop. Americans must stand up for our fellow citizens
who are chronically and terminally ill. This is an issue of personal choice
for them and, after all, we may be sick someday and want the same choices
available to us. In spite of the harsh reality of the "War on Drugs" and
the "War to Make Money", common sense must prevail and patient advocacy
must come first.
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Dr. Bayer is board-certified in internal medicine, a fellow in the American
College of Physicians - American Society of Internal Medicine, and
practiced in Lake Oswego for many years.

He is co-author of Is Marijuana the Right Medicine For You? A Factual Guide
to Medical Uses of Marijuana. He was a chief petitioner for the Oregon
Medical Marijuana Act in 1998 and manages the website www.omma1998.org that
includes a medical bibliography with referenced scientific books and
articles on medical use of cannabis and cannabinoids.