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Herbal Renewal

Conventional medicine once dismissed botanicals out of hand. Now, a new round of studies says some of the remedies show promise.


A top executive in the dietary supplement industry concedes he was "a little concerned" upon learning that the powerful American Medical Assn. would scrutinize alternative medicines such as herbal therapies.

After all, organized medicine for years dismissed the acupuncturists, herbalists and naturopaths of the world as little more than charlatans. And the views of the two camps about what constituted "good medicine" were hardly similar.

But the slate of articles on herb therapies appearing this month in a half-dozen AMA specialty journals may represent something of a peace offering. The authors of nearly a dozen papers give a surprising nod of approval to the use of several popular herbs--although with reservations.

"I am delighted," said Loren Israelsen, executive director for the Utah Natural Products Alliance, an industry trade group. "I really think this is a breakthrough. It signals a change in understanding the role of herbs in U.S. health care. For the longest time, we have begged the medical community to take it seriously and become familiar with the scientific literature."

The articles may also meet what has become a shared goal between the two health-care forces: to persuade consumers to tell their doctors when they are taking herb and vitamin supplements. Many of the journal articles comment on the need for physicians to acknowledge their patients' use of herbs.

"Historically, people have been very cautious to share that information. Now, perhaps the doctor will say, 'I appreciate the value of vitamins and herbs.' The [recent publications] legitimize that conversation," Israelsen said.

Clearly, however, physicians want to know about their patients' use of herbs because of concerns they have over the safety of many products. Virtually all the studies-- published during the past two weeks in the AMA's family of specialty journals--call for more research on herbs, particularly on the optimal dosages, and more controls on the purity and quality of processed herbs.

Despite the pitfalls of using herbs, reports on such popular botanicals as milk thistle, ginkgo and saw palmetto were generally positive.

"On all of the most popular herbs, I think there is enough evidence to warrant more study," said Dr. Mary Ann O'Hara, who conducted a review of 12 of the most commonly used herbs. The report is published in the Archives of Family Medicine.

Conventional health practitioners might underestimate the effectiveness of herbs by not realizing just how much scientific literature exists on botanicals, she said.

"There are really misconceptions on both sides--patients and clinicians," said O'Hara, a Robert Wood Johnson clinical scholar at the University of Washington. "In general, the quality of research on herbs is a problem. But there is more research on herbs than [doctors] recognize."

Consumers, meanwhile, are enchanted with the idea that herbs are more "natural" than drugs. And yet, she noted, herbs contain chemicals in the same way that drugs contain chemicals.

"A common misperception among the public--that is exploited by the herb industry--is that drugs are chemicals and herbs are not. Herbs are clearly chemicals, but they are more raw. As chemicals, they may be helpful or dangerous," she said.

Echoing the idea that herbs can behave like drugs, several of the journal pieces warned that consumers should not use herbs and other medications together without telling their doctors.

Up to 70% of patients do not reveal their herb use to their doctors or pharmacists, said Lucinda G. Miller, author of a report on drug-herb interactions in the Archives of Internal Medicine.

"Not only is the potential for drug-herb interaction unmonitored, but the concomitant use may not even be acknowledged," she said. "This phenomenon is fraught with peril. . . ."

Another problem noted in all the studies is that herbs are not subject to any regulations governing the quality or purity of the products. Herbs can vary widely, based on how they are grown, harvested, stored, processed and handled, and whether the final product is in pill or liquid form, noted University of Colorado researchers Lisa Corbin Winslow and Dr. David J. Kroll in the Archives of Internal Medicine.

They even warn that additives might be used in herbs that are not listed on the product label. Unlisted additives--such as steroids, ibuprofen, antibiotics, sedatives and narcotics--could be responsible for the effect the product exhibits.

Finally, only a few herbs have been studied to the extent that experts agree on a recommended dose and on what active ingredient should be standardized. Standardization means that a particular amount of the active chemical is present.

Roundup of Popular Herbs

As for whether an herb is even worth buying, here is a summary of the recent data, analysis and opinion published in the AMA journals on the most popular herbs.


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