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Am Fam Physician. 2001;63(3):580-582

Book Reviews

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, as helpful sources of information about the usefulness and toxicity of natural products. It will complement, although not replace, these other references.

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