TY - JOUR
AB - Physicians have come to expect the Physicians' Desk Reference (PDR) to provide all the information essential for intelligent and informed decision making. But the PDR for Herbal Medicines does not meet such expectations. No brand-name particulars are given, so that prescribers can evaluate crucial data about herbal efficacy, quality, and safety. The text does cover generic information about more than 600 phytomedicines, and its focus on Latin names gives it a scientific aura. But the latinophilia becomes a nuisance when one tries to look up popular natural remedies by their common names. Cats claw, dong quai, kudzo, and grape seed extract are not mentioned, nor are any fixed-combination herbal products. Even Saint John's wort is hard to find because it appears unalphabetically, 45 pages beyond where "saint" should be (under "St"). Physicians could also question why detailed discussions are given about 300-odd botanicals that the German Commission E either disapproved of or ignored (see accompanying review). The PDR actually prides itself on discussing not only "Scientifically verified applications but also uninvestigated folk uses with varying degrees of promise." How poison hemlock (Conium maculatum) was used in folk medicine might interest some readers, for example, but a book that also gives its imprimatur to hemlock by describing what the daily dose "should" be runs the risk of becoming an encyclopedia of misinterpretable messages. The authors, however, view inclusion of such details differently. They see their text as "the product of one of the most thorough and inclusive examinations of the herbal literature ever undertaken." Perhaps they are not aware of the Lawrence Review of Natural Products, a more comprehensive compendium that backs up its statements with several specific reference citations. In comparison, the PDR's bibliographies are more like ornamental displays: they do not really cite articles or clearly document the points made. Furthermore, the PDR's "publisher does not guarantee that every possible hazard, adverse effect, contraindication, precaution, or consequence of overdose is included." This admonition is stated with good reason, because much more is known1 about herbal toxicology than is provided here. The PDR's drug-herb interaction index, for example, only lists two herbs that interact with warfarin. Yet, at least 11 such herbs are known to so interact,2 and still other botanicals either contain coumarin constituents, inhibit platelet aggregation, or exhibit hemolytic activity.3 This PDR, to be sure, does have many positive features. It contains a superb identification guide with clearly labeled, full-color photographs of 380 medicinal plants. Seventy different botanicals that have caused fatalities in humans are detailed, along with their lethal doses. And appropriate caution is also expressed about 27 other possibly lethal botanicals. Perhaps best of all, this book challenges currently held rubrics about single-molecule drugs and ultraspecific receptors. Garlic, for example, is here said to help not just one but 15 different conditions. Such "indication pluralism" tweaks the reader by contradicting conventional ideas about how drugs work. In the absence of a data-driven editorial perspective, however, use of herbal medicine, as outlined here, lacks credibility. More research and perhaps more regulation of phytomedicinals are needed. References 1. Miller LGMurray WJ Herbal Medicinals: A Clinician's Guide. New York, NY Pharmaceutical Products Press1998; 2. Miller LG Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;1582200- 2211Google ScholarCrossref 3. Newall CAAnderson LAPhillipson JD Herbal Medicines: A Guide for Health Care Professionals. London, England The Pharmaceutical Press1996;214563282
TI - Herbal Medicines: PDR for Herbal Medicines
JF - JAMA
DO - 10.1001/jama.281.19.1853-JBK0519-3-1
DA - 1999-05-19
UR - https://www.deepdyve.com/lp/american-medical-association/herbal-medicines-pdr-for-herbal-medicines-QHg3NXmuLq
SP - 1853
EP - 1854
VL - 281
IS - 19
DP - DeepDyve
ER -