Stop the herb bashing - comments on an article in the February 8, 1995, Journal of the American Medical Association by Raymond Koff, M.D - Editorial

Vegetarian Times, May, 1995 by Toni Apgar

Many of us use herbs and botanicals to help cure everything from indigestion to insomnia, as well as to help combat more serious ailments like cancer and hypertension. As more people turn to herbal remedies as alternatives to prescription or over-the-counter drugs, the remedies are undergoing closer scrutiny by the medical establishment. Close examination of herbs is fine. But unfounded bashing - exhibited in the editorial in the Feb. 8 Journal of the American Medical Association - is not. The author of the piece, Raymond Koff, M.D., most likely scared the daylights out of JAMA readers by irresponsibly associating the use of herbal remedies with liver damage.

Koff's editorial was prompted by a single case study described in the same issue. The study details one patient's need for a liver transplant after self-prescribing chaparral, which is made from the leaves of a desert shrub, for 10 months. The patient, who did not tell her doctors that she had been taking chaparral, nearly died. No one knows for sure what caused her liver damage, but the doctors who treated her assumed it was the chaparral. While chaparral has been linked to liver failure in the past, scientific analysis has not turned up anything in chaparral that would cause such damage.

Instead of focusing on chaparral, Koff confers guilt on afl herbal preparations, and he does so by association rather than by hard evidence. He says that up to 50 percent of severe liver disease "cannot be attributed to infection by hepatitis A, B, C, D or E viruses" and then asks, "Could some of these cases be due to unrecognized ingestion of hepatotoxic `alternative' herbal products ...?" By posing such a question - and not answering it - he is taking a stab in the dark at a whole category of generally safe treatments that don't deserve this kind assault. He administer another lethal shot from the hip when he says, "It seems possible that instances of mild or subclinical herbal product-associated hepatotoxicity are more common than the infrequent case reports of severe injury might indicate." Once again, guilt by vague association.

The idea of using herbs to treat serious illness offends Koff, and he's allowed his opinion, but it should be based on facts. I have some facts that will really turn his stomach. Such popular over-the-counter medicines as aspirin and acetaminophen, and such commonly prescribed drugs as Procardia, Dilantin, Erythromicin, tetracycline and a host of others have been directly linked with liver damage and, in some extreme cases, death. According to U.S. News & World Report, 140,000 people die each year from the side effects of prescription drugs.

Without question the efficacy and health claims of all forms of medicinals - herbal or pharmaceutical - need to be assessed and some common sense needs to be applied. Part of the problem is that doctors aren't asking their patients about their use of herbal medicines to determine possible side effects or interactions. Koff correctly encourages them to do so. Perhaps some patients' unwillingness to bring up their "alternative" remedies is that most M.D.s look upon such treatments with disdain. My advice to readers is to seek out a medical practitioner who will understand and support your desire to use safe herbal medicines. When asked what medicines you are taking, always mention nutritional supplements and herbal compounds. The information could be relevant and could save your life.

This issue is not going to go away. We understand that our readers want solid, well-balanced information on herbs, and we intend to bring it to you. Senior Editor Karin Sullivan will be directing our increased coverage of this important field, and she would like to find out specifically what you want to know. Please write to her at P.O. Box 570, Oak Park, IL 60303 or send her a note via E-mail at 74651.21 @compuserve.com. Your input is important to us. I