Botanical Influences on Illness: A Sourcebook of Clinical Research.
The obtuse title of this volume may cause many interested readers to underestimate or even overlook its extreme utility. The Food and Drug Administration (FDA) is currently promoting the use of the word botanical because it believes an herb must be a leafy product. Reference to the dictionary would soon correct that misimpression. The volume's subtitle is more explanatory of its contents, but in the best of all possible worlds, the book would have been designated Clinical and Pharmacological Studies of Herbs and Phytomedicinals -- An Annotated Bibliography, because that is what it is. In the introduction, following a general overview of herbs and herbal products, the authors present a concise data summary of 236 important herbs. A number of statements found in this section do not appear to be validated by references subsequently noted in the book. For example, it is stated that detailed information is lacking regarding the optimal dose of Aloe vera juice [sic], and consequently "no more than one quart [should] be consumed in any one day." The term Aloe vera "juice" is consistently misused throughout the book. Technically, it refers to the contents of the lactiferous pericyclic tubules of the leaf, not the contents of the mucilage-bearing parenchyma cells. Assuming the authors mean diluted Aloe vera "gel" because the juice is a very vigorous laxative even in small amounts, one searches in vain in the subsequent reference section for information on the long-term safety of daily consumption of one quart of the product. Subsequently, it is stated, "The broad antibiotic [sic] effects of berberine, combined with its anti-ineffective and immune stimulating actions [emphasis mine]," support the use of goldenseal in treating infections. Disregarding the obvioUs misuse of the term antibiotic, which in medicine refers to products produced by microorganisms, the statement about immune stimulating actions aroused my interest immediately. I had long wondered why goldenseal was combined with echinacea in some herbal mixtures because I had never seen any definitive evidence of goldenseal's purported beneficial action on the human immune system. Consequently, I turned to the seven reference sections of the volume where goldenseal is discussed. None of the clinical references found there provided any substantial support for the effectiveness of goldenseal as an immunostimulant. The references themselves, useful as they may be, must also be approached with a critical eye because they are taken from the worldwide medical and pharmacological literature (mostly 1970s to date), which is very uneven in quality. Compounding this need for caution are the rather optimistic interpretations given to many of the studies by the authors. The word "may" is used with great frequency in interpreting the therapeutic utility of herbs. Oftentimes, the number of subjects participating in a study is not given nor is it always stated whether the study was randomized, double-blind, and involved crossover with a control group. I personally would have preferred a more methodical approach involving a numbered reference (for easy retrieval) followed by a list of significant parameters and how each of those was fulfilled by the particular investigation. Finally, the conclusions of those who conducted the study, stated in their own words, would have been useful. Nevertheless, I have a small section on the right-hand portion of my desk where I keep a small number of books that I view as the most valuable ready references for information on herbal products and which I use most frequently. In spite of the kinds of interpretive flaws previously noted, Werbach and Murray's book joined that section as soon as I received a copy and will probably remain there for the indefinite future. It is an extremely useful book and I refer to it frequently. The FDA's present insistence on randomized clinical trials as the only kind of evidence deemed valid in safety and efficacy testing of herbs and phytomedicinals causes me to use it constantly. Now when people call and ask, "But have there ever been any double-blind studies with saw palmetto for BPH?" I can turn to pages 76-77 and say, "Here's a positive one with 168 patients, another with 30, another with 50, one with 110, and so on". Article copyright American Botanical Council. ~~~~~~~~ By Varro E. Tyleby Melvin R. Werbach, M.D., and Michael T. Murray, N.D. 1994. Third Line Press, Tarzana, CA. Hardcover. 344 pp. $39.95. ISBN