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Am Fam Physician. 2001 Feb 1;63(3):580-582.
Toxicology and Clinical Pharmacology of Herbal Products
Until about 1994, herbal products languished in the backwaters of medicine, far from the mainstream. Pharmacognosy—the branch of pharmacology focusing on natural products—was, at best, an obscure area of study. Clinicians generally had no knowledge of most natural remedies beyond perhaps the trivial information that digoxin was derived from the foxglove plant.
Under intense pressure from the public and the natural-products industry, Congress passed the Dietary Supplement Health and Education Act of 1994. This legislation essentially stripped the U.S. Food and Drug Administration of oversight of natural products and opened the floodgates for the marketing of herbal products. Under the Act, herbal and other products can be sold without standardization and proof of safety and efficacy as long as they are not labeled as products intended to cure a specific disease. However, the labeling can tout a physiologic effect. Thus, we have products that claim to “enhance mental well-being” without claiming to treat depression.
The result has been a tremendous increase in the use of herbal products, which caught many clinicians completely by surprise. It has resulted in a spate of books outlining the benefits and risks of herbal products. The goal of this book is to provide toxicologists and health care providers with an objective review of the available information on the pharmacology and toxicology of commonly used herbs. It does an admirable job of meeting that goal.
The opening chapter explains the legal and regulatory aspects of herbal products, including the profound lack of regulation of these products. The following 28 chapters address the history of herbs, their traditional and current uses, and the pharmacology, toxicology, drug interactions and chemical/toxicologic analyses of major herbal products. The topics include more commonly used products such as kava, ginkgo biloba and St. John's wort, and some older but mainstream products such as aloe and the laxatives senna and cascara sagrada. This reference does not purport or attempt to be exhaustive, and many products are not covered.
The third part of the book is a short chapter summarizing current knowledge of toxicity or drug interactions associated with herbal products.
The main thrust of the book is to describe the toxicology and pharmacology of herbal products. I found the background history of the herbals to be fascinating (for example, the classic “sweatsock” smell of valerian was considered to be a desirable perfume in the 16th century!). The book provides a good description of toxic effects of a class of medications that are often thought of as being harmless. It also gives a useful description of the regulatory status of herbals in other countries.
The monographs focus less on answering the question of whether these agents work. Current research data are presented, but no specific recommendations are offered regarding the therapeutic role of these agents. However, the reference list is more extensive than most other sources of information.
This book joins the PDR for Herbal Medicines and Varro Tyler's The Honest Herbal on my reference shelf (along with the Web-based National Medicines Comprehensive Database, www.naturaldatabase.com) as helpful sources of information about the usefulness and toxicity of natural products. It will complement, although not replace, these other references.
ABC's of Advanced Prostate Cancer
By Mark A. Moyad, M.PH. and Kenneth J. Pienta, M.D. Pp. 200. Price, $24.95. Sleeping Bear Press, 310 N. Main, Ste. 300, Chelsea, MI 48118, 2000. Phone: 734-475-4411. ISBN: 1-886947-68-6.
By Edward Humes. Pp. 429. Price, $25.00. Simon & Schuster, 1230 Avenue of the Americas, New York, NY 10020, 2000. Phone: 800-331-6531. ISBN: 0-864-86410.
Boys into Men: Staying Healthy Through the Teen Years
By Mark A. Goldstein, M.D. and Myrna Chandler Goldstein. Pp. 216. Price, $45.00. Greenwood Press, 88 Post Road West, Box 5007, Westport, CT 06881-5007, 2000. Phone: 203-226-3571. ISBN: 0-313-30966-3.
Childhood Cancer: A Handbook from St. Jude Children's Research Hospital
Edited by Grant Steen, Ph.D., and Joseph Mirro, M.D. Pp. 606. Price, $30.00. Persens Publishing, HarperCollins Publishers, 10 East 53rd St., New York, NY 10022, 2000. Phone: 212-207-7528. ISBN: 0-7382-0277-0.
Ethical Issues in Biomedical Publication
Edited by Anne Hudson Jones and Faith McLellan. Pp. 374. Price, $22.50. Johns Hopkins University Press, 2715 N. Charles St., Baltimore, MD 21218-4319, 2000. Phone: 410-516-6956. ISBN: 0-8018-6314-7.
Fast Facts: Anxiety, Panic and Phobias
By Malcolm H. Lader and Thomas W. Uhde. Pp. 56. Price, $19.95. Health Press, 870 Market St., Ste. 720, San Francisco, CA 94102, 2000. Phone: 800-538-1287. ISBN: 1-899541-41-1.
Fast Facts: Headaches
By Richard Peatfield and J. Keith Campbell. Pp. 68. Price, $19.95. Health Press, 870 Market St., Ste. 720, San Francisco, CA 94102, 2000. Phone: 800-538-1287. ISBN: 1-899541-91-8.
Fast Facts: Multiple Sclerosis
By George D. Perkin and Jerry S. Wolinsky. Pp. 68. Price, $19.95. Health Press, 870 Market St., Ste. 720, San Francisco, CA 94102, 2000. Phone: 800-538-1287. ISBN: 1-899541-28-4.
Fast Facts: Rheumatology Highlights 1999–2000
Edited by Paul Emery. Pp. 69. Price, $19.95. Health Press, 870 Market St., Ste. 720, San Francisco, CA 94102, 2000. Phone: 800-538-1287. ISBN: 1-899541-28-4.
Interpretation & Use of Medical Statistics, 5th ed
By Leslie E. Daly, M.Sc., Ph.D., HonM.F.P.H.M., and Geoffrey J. Bourke, M.A., M.D., F.R.C.P.I., F.F.P.H.M., F.F.P.H.M.I. Pp. 568. Price, $79.95. Blackwell Science, Inc., 350 Main St., Malden, MA 02148, 2000. Phone: 781-388-8250. ISBN: 0-632-04763-1.
Primer on Heart Disease for Patients and Their Families
By Joe R. Wise, M.D., F.A.C.C. Pp. 112. Price, $9.95. Peak Publishing Company, P.O. Box 710, Ouray, CO 81427, 2000. Phone: 800-993-4490. ISBN: 1-890437-28-X.
Saunders Manual of Medical Practice, 2d ed
By Robert E. Rakel, M.D. Pp. 1664. Price, $95.00. W. B. Saunders Company, The Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, 2000. Phone: 215-238-7800. ISBN: 0-7216-8002-X.
Syndrome X: Overcoming the Silent Killer
By Gerald Reaven, M.D. Pp. 284. Price, $25.00. Simon and Schuster, 1230 Avenue of the Americas, New York, NY 10020, 2000. Phone: 212-698-7533. ISBN: #0-684-86862-8.
Edited by Melanie Johns Cupp, Pharm.D., B.C.P.S. Pp. 325. Price, $79.50. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 2000. Phone: 973-256-1699. ISBN: 0-896-03791-6.
Copyright © 2001 by the American Academy of Family Physicians.
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