Author + information
- Steven Dentali, PhD⁎ ()
- ↵⁎American Herbal Products Association, 8630 Fenton Street, Suite 918, Silver Spring, Maryland 20910
The American Herbal Products Association agrees with the importance Tachjian et al. (1) placed on doctor-patient communication and education. Since 2001, the American Herbal Products Association has recommended that consumers tell their doctors which herbs they are taking and that doctors become sufficiently informed to provide useful advice for their patients who use herbs (2). It is therefore unfortunate that the Tachjian et al. (1) report was not more accurate and failed to discern between actual safety risks, theoretical ones, and false reports.
Although the investigators presented important information (e.g., that St. John's Wort extracts and grapefruit juice affect the metabolism of many drugs used by cardiologists), the bulk of the report appears to be a collection of medical database “hits”; one-third of the herbs identified are rarely or never present in the U.S. marketplace. The investigators also stray from their central purpose by opining on diverse topics outside the scope of their expertise, such as quality control, advertising, and basic dietary supplement regulation.
Reported problems regarding botanicals include, for example, that “colchicine has been found in the placenta of women taking ginkgo” (1), an erroneous finding that has been soundly discredited (3–5). Similarly, in their discussion of ginseng, the investigators state that “neonatal death has been related to maternal use” (1). However, the material consumed in this case of neonatal androgenization (not death) was reported in the cited reference as not a true ginseng, not “Siberian ginseng” (as stated in the original report), but confirmed by Canadian government researchers as Chinese silk vine (6,7).
Additionally, although the investigators claim in an unreferenced statement that products made from the herb black cohosh “inhibit CYP3A4 and potentially increase the risk of adverse effects from some drugs” (1), the fact is that although 1 in vitro study indicated this possibility, 3 others, including 2 human studies, have confirmed that no such inhibition is associated with this herb (8–10).
Clinically significant information about how herbs affect drug metabolism, particularly patients on digoxin or warfarin, is important to cardiologists. However, the investigators do not provide references for dozens of their assertions in this area, and they get the facts wrong in several places in which they do provide references.
Although the investigators' intent is appreciated, it is important that the review and dissemination of safety information on herbs be held to the same standards found in any other field of scientific endeavor (11). In the interest of patient safety and provider education, the American Herbal Products Association published the Botanical Safety Handbookin 1997 (12). A thoroughly revised edition will be available in the near future, with the hope that it will be recognized as a valuable tool for credible and up-to-date information on the safety of herbs.
- American College of Cardiology Foundation
- Tachjian A.,
- Maria V.,
- Jahangir A.
- American Herbal Products Association
- Therapeutic Goods Administration
- Bone K.
- McGuffin M.,
- Hobbs C.,
- Upton R.,
- Goldberg A.