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Am Fam Physician. 1999;59(5):1114-1120

to the editor: The “it can't hurt me” attitude many people have toward botanical remedies is widespread,1 yet the medical literature records more than 100 fatal encounters with herbs (Table 1).

Citronella oil
Eucalyptus oil
Indian tobacco
Herbs contaminated with lead
Mildewed sugarcane
Angel's Trumpet
Tree tobacco
Thornapple or Jimson weed
Ephedrine containing Herbal products
Yellow oleander
Pink oleander
South American “mutis”
Chan-su aphrodisiac (also known as “rock hard,” “stone,” “love stone” and “black stone”)
Mail-order diet pills
Mistletoe (possibly)
Lupin beans
Mate′ tea
White chameleon
Pennyroyal oil
Huan glian
“Spiritual water”
Thread-leafed groundsel
Chinese herbal remedies
Crotalaria spp
Skullcap (possibly)
Rhubarb leaves
Squirting cucumber
South African traditional remedies containing Liliiflorae sona
Cantharidin beetle powders
Gastrointestinal tract
Jequirity seeds or rosary peas
Castor beans
Clove cigarettes
Golden seal
Alfalfa (listeriosis)
Royal Jelly (anaphylaxis)
Akee (hypoglycemia)
Tanning tablets [beta- carotene and canthaxanthin] (aplastic anemia)
Wintergreen oil
Black pepper
Hemlock water dropwort
Apple seed (cyanide poisoning)
Apricot kernels (cyanide poisoning)
Climbing lily

Were it not for liver transplantation,24 renal transplantation,3 dialysis58 and other heroic medical measures,9 many more people might have died as a result of using natural remedies and green plants. Because natural remedies pose as dietary supplements, these products currently escape systematic study by the U.S. Food and Drug Administration. In South Africa, 51.7 percent of fatal poisonings result from the use of traditional herbal preparations.10 Recently in the United States, the proportion of deaths from outpatient medication errors and “undetermined poisonings” has more than doubled.11

Like the flourishing sales of botanicals, there is increasing recognition that herbs can be toxic. Ellenhorn's Medical Toxicology, for example, lists 86 references published prior to 1980, 164 articles between 1980 and 1989, and 248 papers between 1990 and 1995. Clearly, plants can kill as well as cure. Patients who choose to self-medicate with natural remedies should not be told that “it probably can't hurt you” (Table 2).1,12 The facts must be checked first.

Look at the label on the medication for scientific names of ingredients, quantity of active ingredients, name and address of producer, batch and lot numbers, date of manufacture and date of expiration.
Learn about the efficacy and toxicity of the product and the reliability of the producer. Distrust information from those who gain from its sales. Seek out objective, credible information.
Avoid use in infants and young children, avoid use if pregnant, lactating or trying to conceive, and avoid abuse or overdosage.
Be wary of variations from batch to batch and of other ways (misidentification, substitution, contamination, adulteration) that commonly cause a mismatch between what the label claims and what the product actually contains.
Inform your doctor about all of your self-medications.
Stop taking the medication if an adverse reaction occurs.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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