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ALTERNATIVE THERAPIES .,_:nt.tJtiv,. Therapies in Health and
A riiR· RlVIlWff) IO tiRNAt NIN I I I HAR OI r uftii~AII0 "- ft.,fftiWc Medicus and Science Citation
1•~ 11 " ' '''Ill ~II I H \ II. I 1'\l:ll ~\• liON\~.\ I'IUN<. 1r11 P.ltllllC IRIC\tlllll)\ Ill !t l llfi'Hl fl 1 h.,"II< 1 ~RTIIRIII' lilllalliftllvjoumal (6 issues/yr) is led by exec- -\'1\llt\ 1111> I'll"\· ~~~ 'Ill' 1)\11 ' l• l" \ ~r-.1 Ill. t 11. 1.0.1 Ml -. 1' GIN~Oil\ W kUPhlRN.O.UII .O.·> Why do more people subscribe to Alternative Therapies than any other CAM journal? Because not only is it the # l source of information about current research and new breakthroughs in the field, 1t's the very best source of inspiration and information about the philosophy and community on which the alternative medicine movement is based. Visit the website at http://www.alternative-thera pies.com. 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To learn more, please contact Wayne Silverman, PhD, at [email protected], or 800/373-7105 xl20. advisory board Each issue of Herba/Gram is peer reviewed by members of our Advisory Board and other qualified experts before publication. Cindy K. Angerhofer, Ph .D. Hardy Eshbaugh, Ph.D Joseph E. Piuorno, Jr., N.D. Director of Botanical Research, Aveda Institute, Professor of Botany & Assistant Curator, Willard Sherman Turrell President Emeritus, Bastyr University, Seattle, Washington, and Minneapolis, Minnesota Herbarium, Miami University, Oxford, Ohio Editor, Integrative Medicine: AClinician's Journal John Thor Arnason, Ph.D. Adriane Fugh-Berman, M.D. Mark J. Plotkin, Ph.D. Professor of Biology, Department of Biology, Author, Assistant Clinical Professor, George Washington University Author, Executive Director, Amazon Conservation Team, University of Ottawa, Ontario, Canada School of Medicine, Washington, DC Arlington, Virginia Dennis V. C. Awang , Ph.D., F.CI.C. Joe Graedon, M.S. John M. Riddle, Ph.D. MediPiant Natural Products Consulting Services, Author, syndicated columnist, radio host, Durham, North Carolina Professor of History, Department of History, White Rock, B.C.. Canada North Carolina State University, Raleigh Mary H~rdy, M.D. Manuel F. Balandrin, R.Ph., Ph.D. Director, Cedars-Sinai Integrative Medicine Medical Group, Eloy Rodriguez, Ph.D. Research Scientist, NPS Pharmaceuticals, Salt Lake City, Utah Los Angeles, California James Perkins Professor of Environmental Studies, School of Agriculture & Life Sciences, Cornell University, Ithaca, New York Bruce Barrett, M.D., Ph.D. Christopher Hobbs, LAc., AHG Assistant Professor of Family Medicine, University of Herbalist, botanist, licensed acupuncturist, Davis, California Victor Sierpina, M.D. Wisconsin-Madison Medical School Associate Professor of Family Praciice Medicine, David Hoffmann, B.Sc., M.N.I.M.H University ofTexas Medical Branch, Galveston Marilyn Barrett, Ph .D. Medical herbalist, author, Santa Rosa, California Pharmacognosy Consulting Service, San Carlos, California James E. Simon, Ph .D. Maurice M.lwu, Ph .D. Professor of New Use Agriculture, Director of the Center for New Use Bradley C. Bennett, Ph.D. Bioresources Development and Conservation Program, Senior Agriculture and Natural Plant Products, Rutgers University, Associate Professor of Biology, Florida International University, Research Associate at the Division of Experimental Therapeutics, New Brunswick, New Jersey Miami Walter Reed Army Institute of Research, Washington, D.C. Beryl Simpson, Ph.D. Joseph M. Betz, Ph.D. Timothy Johns, Ph.D. C. L Lundell Professor of Botany, Department of Botany, Director of the Dietary Supplements Methods and Reference Professor, School of Dietetics and Human Nutrition; Centre for University ofTexas at Austin Materials Program, Office of Dietary Supplements, National IndigenousPeople's Nutrition and the Environment, McGill Institutes of Health, Bethesda, Maryland University, Montreal, Canada S. H. Sohmer, Ph.D. President and Director, Botanical Research Institute ofTexas, Francis Brinker, N.D. Steven King, Ph .D. Fort Worth Lead Instructor on Botanical Medicine for Associate Fellows, Vice President, PS Pharmaceuticals, In c., Program for Integrative Medicine, University of Arizona, Tucson South San Francisco, California Barbara N. Timmermann, Ph.D. Professor of Pharmacology and Toxicology, College of Pharmacy, Donald J. Brown, N.D. Tieraona Low Dog, M.D. University of Arizona, Tucson Director, Natural Products Research Consultants, Seattle,Washington Chair: United States Pharmacopoeia Dietary Supplements/Botani cals Expert Panel Clinical Asst. Professor, Dept. of Family and G. H. Neil Towers, Ph.D. Thomas J.S. Carlson, M.S., M.D. Community Medicine, University of New Mexico Professor Emeritus, F. R. S.C.. Botany Department, Associate Adjunct Professor, University of British Columbia, Vancouver, Canada Department of Integrative Biology; Director, Center for Health, Tom Mabry, Ph .D. Ecology, Biodiversity, & Ethnobiology; Curator of Ethnobotany, Professor of Plant Biochemistry, Department of Botany, Arthur 0. Tucker, Ph.D. University and Jepson Herbaria; University of Ca lifornia, Berkeley University ofTexas at Austin Research Professor of Agriculture and Natural Resources, Delaware State University, Dover Jean Carper Gail B. Mahady, Ph.D. Author and syndicated columnist, Washington, D.C. Research Assistant Professor, Department of Medical Chemistry & Nancy Turner, Ph.D. Pharmacognosy, College of Pharmacy, University of Illinois, Chicago Professor and Ethnobotan ist, Environmental Studies Program, Jerry Cott, Ph.D. University of Victoria, British Columbia, Canada Pharmacologis~ U.S. Food and Drug Administration, Robin J. Maries, Ph.D. Center for Drug Evaluation and Research, Rockville, Maryland Director of the Bureau of Research and Science, Natural Health Daniel T. Wagner, R.Ph., MBA, Pharm.D. Products Directorate, Health Products and Food Branch, Owner, Nutri-Farmacy, Wildwood, Pennsylvania Paul Alan Cox, Ph .D. Health Canada, Ottawa Director, National Tropical Botanical Garden, Kauai, Hawaii Andrew T. Wei I, M.D. Dennis J. McKenna, Ph.D. Author, Director of the Program in Integrative Medicine and Lyle E. Craker, Ph.D. Executive Director, Institute for Natural Products Research; Associate Director of the Division of Social Perspectives in Medicine, Professor, Department of Plant and Soil Sciences, Senior Lecturer, Center for Spirituality and Healing, University of College of Medicine, University of Arizona, Tucson University of Massachusetts, Am herst Minnesota, Minneapolis · Bernd Wollschlaeger, M.D. Edward M. Croom, Jr., Ph.D. Daniel E. Moerman, Ph.D. Family practice physician; Clinical Assistant Professor of Medicine Scientific and Regulatory Affairs Manager, lndena USA East, Inc., William E.Sti rton Professor of Anthropology, and Family Practice, University of Miami, School of Medicine, Florida Oxford, Mississippi University of Michigan/Dearborn Wade Davis, Ph.D. William Obermeyer, Ph.D. Explorer-in-Residence, National Geographic Society Vice-President of Research and Technology, Consumerlab.com, ad hoc advisor: Washington, D.C. Annapolis, Maryland David M. Eisenberg, M.D. Steven Dentali, Ph.D. Samuel W. Page, Ph.D. Director, Center for Alternative Vice President of Scientific and Technical Affairs, American Herbal Director, Division of Natural Products, Center for Food Safety Medicine Research, Beth Israel Products Association, Silver Spring, Maryland and Applied Nutrition, U.S.Food and Drug Administration, Hospital/Harvard Medical School, Boston, Massachusetts Washington, D.C. 4 I HerbaiGram60 www.herbalgram.org dear reader his issue marks Herba!Gram's 20th anniversary. some botanicals with which most of us here in the U.S. are Our first issue was published in the Summer of unfamiliar. Dr. Marian Addy reviews the science support 1983 as an 8-page newsletter, which grew to 12 ing the use of cryptolepis root for the treatment of malaria t pages, then 16, then eventually to 24. Five years in Ghana. Of interest is the use of teas made from the later in 1988, Jim Duke, Norman Farnsworth, and I actual root - not an isolated chemical from the herb, as founded ABC initially as a vehicle to take Herba!Gram in the case of antimalarial drugs quinine and artemisinin from the newsletter format to the colorful magazine yo u from cinchona bark and sweet wormwood, respectively. In hold today. During this past 15 years Herbal- nearby Cameroon, Charly Facheux and his Gram has evolved into a leading voice for colleagues discuss the market success of some science-based herbal medicine in the U.S. and specific medicinal plants and the efforts to beyond. ensure long-term availability of popular local The articles in Herba!Gram promote the species by developing sustai nable cultivation of educational goals of ABC: to provide science various herbs, particularly the antimalarial and based information on the rational use of herbs yellow fever remedy used locally, African white and phytomedicines in self-care and healthcare, wood. while honoring the rich ethnobotanical tradi This past spring and summer there was addi tions of the cultures from which modern herbal tional media interest in the controversial herb medicine derives, and preserving natural habi ephedra and the issue of its safety, including a tats of medicinal plants and promoting sustain congressional hearing this summer. Some of the able sourcing of herbal materials. Herba!Gram media accounts referenced an analysis of the reflects the blending of traditional ethnobotany and American Association of Poiso n Control Center's ethnomedicine and modern science. (AAPCC) analys is of adverse event reports (AERs) related An excellent example of the juncture of traditional to herbs, in which ephedra was incorrectly reported to medicine and modern technology can be seen in our cover comprise a disproportionate share of the AERs compared story, "Classic Herbal Texts Brought to the Digital Age." to its market sales. Rick Kingston and I provide an analy This feature article was written by our summer 2003 sis of the AAPCC's AER reporting system and its limita intern, Sarah Jackson, who has contributed numerous tions, concluding that information fro m it cannot short articles for this and two previous issues. This is her currently be used as a basis for making safety evaluations first published feature-length article and deals with the or regulatory policy. Speaking of policy, Canadian attorney interesting project at the Missouri Botanical Garden of Joel Taller provides an in-depth review of the new regula electronically scanning rare herbal manuscripts for viewing tions for Natural Health Products in Canada, a new by a wider audience via the Internet. Sarah's article also system where herbs and related materials have a separate underscores the fact that ABC is not only a center for legal standing on the same level as foods and drugs. --"" herbal education; we are blessed with interns who also learn other skills (e.g., journalism). As usual, there is way more going on the herb world than we can possibly cover in the pages of one issue. Nevertheless, we have some interesting articles covering board of trustees Michael J. Balick, Ph.D., Vice President and Chair. Fredi Kronenberg. Ph.D., Director. Rosenthal Center Research and Training Director and Philecology for Complementary and Alternative Medicine, Curator. Institute of Economic Botany. The New York Columbia University College of Physicians and Botanical Garden, Bronx, New York Surgeons, New York Peggy Brevoort, President, Brevoort, LLC, Seattle, Thomas L. Kurt, M.D., M.P.H., Clinical Professor of Washington Internal Medicine, University ofTexas Southwestern, Dallas,Texas James A. Duke, Ph.D., Economic Botanist (USDA, ret.) Author, Fulton, Maryland Morris Shriftman, CEO, Mozart. Inc., Ponte Vedra Beach, Florida Norman R. Farnsworth, Ph.D., Research Professor of Pharmacognosy. Program for Collaborative Research in Mark Blumenthal, Founder and Executive Director Educating the the Pharmaceutical Sciences, University of (ex officio member) Public on the Illinois at Chicago Use of Herbs & Steven Foster, President, Steven Foster Group, Inc., Phytomedicines Brixey. Missouri www.herbalgram.org 2003 HerbaiGram 60 I 5 HERBAIGRAM ® The Journal of the American Botanical Council Mark Blumenthal Editor I Publisher Karen Robin Managing Editor Sean Barnes Art Director Steven Foster Associate Ed1tor Maureen Jablinske Proofreader Sarah Jackson Editorial Intern Jon Lucks inger Editorial Intern Advertising Sales Lance Lawhon Rector-Duncan & Associates Inc. 5121832-1889 [email protected] American Botanical Council Wayne Silverman, Ph.D. Chief Administrative Officer Kathleen Coyne Sales Coord1nator Cheryl Dipper Execut1ve Assistant Stacy Elliott Receptionist Gayle Engels Education Coordinator Lori Glenn HerbCiip Managing Editor Tara Hall Special Projects Coordinator George Solis HerbCiip Production Assistant Nathanael Sponseller Gardener Cecelia Thompson Finance Coordinator Kim West Membership/Development Coordinator Margaret Wright Accounting Coordinator Subscriptions are a benefit of membership at every level. One year memberships: lndiv1dual $50; AcademiC $100: Professional $150. Organization $250; Corporate: Sponsor. Add $20 for memberships outside of the U.S. Student Semor. and Busi ness Memberships also available, see ad in th1s issue.© 2003 Amencan Botan1cal Council. ISSN #0899-5648. Pnnted 1n the U.SA The Information 1n HerboiGmm® 1s Intended for educational purposes only and 1s not a substitution for the advice of a qualified healthcare professional. Although we attempt to ensure that advertising 1n Herbo/Gmm 1s truthful and not misleading. the publication of an ad for a product or company 1n Herbo/Gmm does not consti tute an endorsement by ABC of the product or the company be1ng advertised. Publication of an ad that makes a health claim or structure-function cla1m does not necessanly constitute an approval of that claim by ABC. Further. ABC has not reviewed any manufacturer's Good Manufacturing Practices. HerboiGrom 1s pnnted on recycled paper at Branch-Smrth Pnnting. Ft Worth. Texas abc news ABC Helps Visually Impaired Students to Learn Gardening, Business or two days this past June, ABC ous smells and textures of the plants and Smith and her class agreed the gardens Fworked with the Austin-based Texas learning about what they were used for," and staff are well suited for teaching. School for the Blind and Visually Impaired said Tish Smith, who taught the class at "[ABC] has fabulous facilities," she said. (TSBVI) to help educate a group of high TSBVI, and contacted ABC to arrange the "One of the girls mentioned that Gayle school-aged students on the use, care, and visi t to the gardens. [Engels) was a really good teacher, which is importance of herbs and medicinal plants. These outreach programs provide some pretry good coming from a high school T heir time in the ABC gardens was part of the most integral lessons TSBVI instruc student." of a larger program des igned to help the tors can offer to their students. Visually students learn a coordinated set of skills impaired students often miss out on inci and lesso ns such as teamwork, time dental learning that children with normal management, and operating in a business vision pick up simply through watching environment. This program helps provide others, Smith said. Educational programs them with skills and knowledge they will that get these students out of the class room need in future employment opportunities. to interact with the world help them master these skills and gai n confidence. ABC offers its facilities as a place where students can learn useful informatio n concerning herbs and gardening while incorporating important life lesso ns. ABC hosted another group of students this pas t July from the Texas Alliance for ABC Education Coordinator, Gayle Engels (left), intro Human Needs (TAHN). The group from duces TSBVI students to the herbs in the Women's TAHN, called Green Teens, visi ted the and Men's Reproductive Garden. Photo ©2003 ABC. gardens to learn about organic gardening and other environmentall y sensitive gardening practices. Much like the student Yet, because of economic downturns in project from TSBVI, the TAHN students the herbal market, ABC has had to cut used the information they gained at ABC recurring community programs due to to complete class projects, which involved budget constraints, thus delaying opportu Hauling plant material to the compost pile. Photo the design of a communiry garden and nities to form a comprehensive educational ©2003 Tracy Betty. organic and vegetable gardens. curriculum. "The Case Mill Homestead is great for T he class, made up of students from working with the communiry," Engels across Texas, decided on products they said, "but we don't have the time or the wished to create for sale and then went reso urces for such outreach programs." through the necessary steps to move from Engels notes that under present financial raw materials to a finished, marketable conditions, funding for outreach educa item. Since the students chose herbs, tional projects must come from third particularly aromatic herbs, ABC offered parties, because state- and communiry-run the use of its gardens and facilities so they entities such as TSBVI and local schools could learn about different species and also lack the necessary funds to support their uses, and plan products that could be regular ventures for their students. made from them and then sold. Despite these constraints, ABC contin Gayle Engels, ABC's education coordi ues to interact with the communiry, and nator, helped arrange the visit and was develop limited partnerships with local impressed with the motivation of the educational entities. And in that spirit, participating students. TSBVI stu dents working in ABC's greenhouse. Photo from August to May of 2004 ABC will "The students were so engaged during ©2003 Tracy Betty. host another group of TSBVI students both visits," she said. "You could tell they who will work in the ABC gardens. This were interested in learning about the plants When ABC moved its operations to the project will be more comprehensive than by their attention and questions." Case Mill Homestead in 1998, there were the most recent visit, as the students will They were most interested in aromatic plans for regular communiry outreach visit on a regular basis to help with various herbs, as they intended to use such plants programs that would interact with local projects and gain a more in-d~th knowl for their project to make teas, bath teas, schools to teach children how to grow and edge of herbs and gardening. A and other herb-based products to advertise use medicinal plants. Such projects fit and sell. squarely under ABC's miss ion of educating -Jon Lucksinger "The students really enjoyed all the vari- the public about herbs and their uses. 8 I HerbaiGram 60 2003 www.herbalgram .org abc news Herbal Information Specialist Certification Now Available to Retailers mployees in retail settings where purchasing decisions and to help base their learning in various trades and professions. Edietary supplements are sold often find choices on information from published NTI originally approached ABC about themselves in an awkward situation. literature and clinical studies. parrnering to provide the retailer certifica Customers approach them with questions A post-test after each part assesses the tion course. that they have no answers for or that they degree to which objectives of each section T he regular cost to individuals is $99.95 are unsure about how to answer. Questions are met. Achieving these objectives will for the course and certification. However, can include which herb is appropriate to demonstrate knowledge of the material the introductory special is $69.95 (a 30% take for a particular condition, safety of a and result in the candidate receiving the savings). Discounts are available for given herb, or possible interactions with Herbal Information Specialist (HIS) companies wanting to train multiple drugs the consumer may be taking. certificate. employees. For more information, contact Frequently, retail employees are unaware The online course will be available at ABC at 800/373-7105, What You Didn't Know about www.HerbaiGram.org o you thought beautiful issues of Herba!Gram were all you got nal, has been published since 1983. The searchable database, Swith membership in ABC. But wait! There's more! available to all ABC members, contains Herba!Gram archives ABC has incorporated an extensive collection of educational back to 1990. The table of contents of the most current issue, resources into its website, 10 I HerbaiGram 60 2003 www.herbalgram .org abc news "Approved Herbs Uses and Indicati ons" index, then "Respira database on whi ch the abstract resides (e.g., PubMed). This tory," and then "so re throat." Sixteen herb monographs are program is for users who need deeper and higher levels of listed for this indication; and the viewer may read them all. evidence in their work. • Expanded Commission E Online - In 2000, ABC published All visitors to ABC's website have access to the following elec Herbal Medicine: Expanded Commission E Monographs, which tronic resources: focuses on 107 of the most popular herbs from the 380 mono • Botanical Booklet Series - A coll ection of 15 "e-booklets" graphs in the previous book and provides "expanded" infor each covering a single herb with a thumbnail photo. T he read mation on each herb. This new information includes detail ed ing level is moderate and the sections include history, safety, overviews, clinical research, references, and expanded sections use, cautions, and other topics. In their printed versions, these in dosage, administration, pharmacology, and chemistry. The booklets are eight pages each and are ava il able in sets, in large online version permits ABC members to select any herb and quantity for "third party literature, " or for resale or giveaways quickly jump to the section of their choice. in retai l stores or other educational uses. • H erbCiip"'' Online- HerbCiip has been a paper-based se rv • Herb Reference G uide-A therapeutic illustrated summary of ice of ABC for more than 10 years. ABC searches for se minal 26 common herbs. The five "bullet" points covered are: articles on herbal dosage, uses , contraindications, side effects, and interactions. medicine in the Common Herbs - A brief summary of 29 common herbs popular and scien with illustrations, written in consumer-friendly language, tific literature from includes the use of each herb and what scientific studies have around the world revealed. This is also ava ilable as a full-color pamphl et in large (English language quantity for free distribution. More than 5 million of these only with some brochures have been distributed by ABC and its members. occasional transla • News Archive- All press rel eases from ABC and letters writ tions from some ten by ABC to the editors of va rious newspapers, magazines, foreign language and journals are archi ved here. journals). ABC HerbalGram Online Samples - This section of HerbalGram selects those that l., contains sample articles from almost every department. In are most impor addition, viewers may select the "Department" index on the tant, creates a one Expanded Commission E database. HerbalGram page to access the entire archive of the following to two-page critical http://wwwherbalgram.org/ default.a sp?c=herba l departments: ABC review of the article medic ine News, Market which provides a Reports, Book summary of the original article, links to other topics, and, at Reviews, Dear times, criticism of the original article. Sponsor members Reader, and In .. receive a packet in the mail twice a month consisting of 12 crit Memoriam. Over ------·-·-_-----____ _·-·------·- ical reviews and the original article when poss ible. The Online all, hundreds of version displays the 12 critical reviews from the most current articles are open to "mailing" and has a powerful and fl exible search engine built all visitors, who in. For example, to search for information on "diabetes," may use the search search res ults would point to HerbClip reviews of articles engine to garn er where this was the main topic, or all H erbC iips that mention all of the res ulting the word. citations. • H erbMedProTM - This database is an herbal link to • Educational Links Herba/Gram database. http://wwwherbalgram.org/default.asp7c=herb PubMed TM , the online medical database at the National Library - Hundreds of medpro of Medicine, and other public domain databases. This database links to other was developed and is updated by the Alternative Medicine commercial and non-commercial websites are avail able and are Foundation (AMF) 12 I HerbaiGra m 60 2003 www.herbalgram.org organization news New "Fast-Track" for American Herbalists Guild Professional Membership he American Herbalists Guild (AHG), naturopathic programs specializing in from a primary herbal teacher. Ta nonprofit organization of profes botanical medicine. Applicants are still charged a non sional herbal medicine practitioners, is The former procedure required for refundable application fee: $50 for AHG now offering a "fast-track" application professional membership included a signed members and $60 for non-members. process for clinical herbalists seeking and dated copy of the AHG Code of Upon acceptance, the new members wi ll professional membership. Ethics, and personal and professional biog be charged annual professional dues of This new process is available for those raphies outlining training and experience. $120, or $ 130 for members outside the that have training in botanical medicine Documents such as certificates, diplomas, United States. that meets the requirements for AHG educational transcripts, a li st of any publi While licensing for clinical herbalists professional membership, such as cations, and a list of programs attended does not ex ist in the United States, members of the National Institutes for were expected. Applicants also needed membership in the AHG does carry with it Medical Herbalists (UK), those certified in three case histories and three letters of the understanding that the holder has a Chinese herbal medicine by the National recommendation. co re level of knowledge and experi ence Certification Commission for Acupunc Under the "fast-track" process, appli with botanical medicine. _. ture and Oriental Medicine (NCCAOM), cants are only required to submit a letter of -Sarah Jackson those ce rtified or licensed as herbalists in intent, a resume, proof of certification, and [Source: American Herbalist Guild. AHG other countries, and graduates of four-year a letter of recommendati on, preferably Announces Expedi ted Process for Professional Membership (press release). July I, 2003 .] Sage Mountain Health and Well ness Clinic Creates Community Healers erbalist, author, and visionary, Rose and even massage or body work. Herbal advanced herbal training programs, work H mary Gladstar, founder of the Sage therapies are a primary fo cus and the ing in the clinic enables herbali sts to gain Mountain Retreat Center & Native Plant herbalists donate a start-up kit and refer confidence and ex perience as we ll as Preserve , wanted to create an herbal clients to purchase and co ntinue the herbal develop a professional support sys tem that program that would produce community protocol. may aid them throughout thei r careers. healers and herbal practitioners, become a The herbalists also benefit from the "The Sage Mountain Health and Wellness resource for Central Vermont, and create a program. Rebecca White, one of the Clinic also gives back to the greater human model for herbalists to gain clinical experi herbalists at the clinic, explained that the co mmunity, " White said, "by offering ence and develop an herbal practice. setting offers a prime learning practice, as health care in a more wholisic and personal That hope came to fruition in Barre , herbalists collaborate and see a wide array se tting." _. Vermont, a small working-class town, at of health indications. In addition to the -Sarah Jackson the beginning of the summer of 2001 years of study, apprenticeships, and when 10 dedicated herbalists began meet ing with clients. The Sage Mountain Health and Wellness Clinic has been AHPA President McGuffin Appointed to FDA successfully running for two years now, Food Advisory Subcommittee offering alternative health care to the greater Vermont communities. The herbal he U.S. Food and Drug Administration (FDA) has filled its positions for current ists offer free consultation and local plant Tterms on its Food Advisory Committee (FAC) and six FAC subcommittees. Among medicines every other week. the appointees is American Herbal Products Association President Michael McGuffin as On their first visit, clients meet with two the industry representative for the Dietary Supplement Subcommittee. or three herbalists at one time for an hour The FAC is a technical and scientific committee that provides advice primarily to the and a half to discuss the client's health Director of the Center for Food Safety and Applied Nutrition (CFSAN) and, as needed, concerns. The herbalists discuss many to the FDA Commissioner and other appropriate officials. The Committee and Subcom aspects of the client's wellbeing: lifestyle, mittees' focus is on emerging food safety, food science, nutrition, and other food-related diet, exercise, health history, and primary health issues the FDA considers of primary importance for its food and cosmetics health concerns. This enables the client to programs. be seen as a whole being. The herbalists The Committee may also review matters relating to the safety of new foods and ingre then confer to determine treatment dients, the labeling of foods and cosmetics, nutritional adequacy, safe exposure limits for options. Many healing modalities are food contaminants, and other broad technical food or cosmetic-related issues. Along suggested and discussed with the client. with these duties the Committee can also provide advice on ways of communicating to Follow-up sessions are scheduled for two the public the potential risks associated with these issues and on approaches that might weeks and one month later. be considered for addressing them._. The treatment options vary from teas -Jon Lucksinger and tinctures, dietary and lifestyle changes, [Source: American Herbal Products Association. AHPA President McGuffin Appointed to FDA to dietary supplement recommendations, Food Advisory Subcommittee (press release) . August 29, 2003] www.herbalgram.org 2003 HerbaiGram 60 I 13 research & world news Liquid Medical Marijuana Awaiting Approval in Britain he Medicines Control Agency, the market the medicine for cancer pain and dispense, medical marijuana. T British counterpart of the U.S. Food MS, if approval is granted. Meanwhile, MPP is considering what and Drug Administration, is considering GW h as a li sting of the trials and the approval in the Netherl ands and poss i approval for a liquid cannabis- based research it has used to support claims ble approval in the U.K. could mean for medical extract (CBME) made by GW for the b en e fits of cannabis- or their efforrs in the United States. Pharmaceuticals, of Salisbury, England. cannabino id-derived m edicines at one "I wish I had a crys tal ball , so I could tell T he medicine would be sold under the of its webpages, 14 I HerbaiGram 60 2003 www.herbalgram .org research & world news Survey Shows that Australians Generally Do Not Reveal Herb Use to Chiropractors ustralians are taking herbal supple and whether they had informed their chiropractor, and of the 39 taking gi nkgo A ments more than ever, but not very chiropractor of the practice. extract (Ginkgo biloba L., Ginkgoaceae) many of them have taken the time to The most common supplements only 6 revealed its use . Also, of the 96 inform their respective chiropractors of reported were vitamins, with 40 percent taking vitamin E, only 16 made it known, their new habits. A case study of 758 claiming regular usage. Anti-inflammatory and only 18 of the 136 who took garlic Australian chiropractic patients shows that products also showed strong popularity, (Allium sativum L. , Liliaceae) told their although consumer confidence is very high especially with women over 45 years old, chiropractor. in herbal supplements, patients are often along with minerals. Patients were also The study concluded that chiropractors reticent about telling their chiropractors more likely, on average, to have started must rake the responsibility of being more about their regular use, which can some taking the supplements of their own voli aware of what remedies their patients are times lead to adverse reactions when tion than on the advice of a healthcare consuming and warn them of the possible combined with such physical therapies. professional. risks involved , as their patients are The study was spread out over 21 clinics Though not as universally popular with unlikely to volunteer the information in five different states, along with the study participants as the more "tradi themselves. A Australian Capital Territory, and asked tional" vitamins and minerals, herbal -Jon Lucksinger those polled what rypes of supplements remedies displayed great popularity - [So urce: Jamieson JR. Herbal and nutrient they used and whether their use of such though patients were very unlikely to have supplementation practices of chiropractic supplements had been self-initiated or if told their chiropractor of any use of herbal patients: an Australian case study. journal of Manipulative and Physiological Therapeutics their doctor had recommended it. Partici supplements. Of the 7 4 participants 2003 May;26(4):242.] pants listed a wide assortment of herbal or taking ginger (Zingiber officina/is Rose., "natural" medications they regularly used Zingiberaceae) only 7 informed their Canadian Hemp Trade Alliance Forms upporters of Canada's burgeoning "A national group to represent the best "We are grateful for the public and Sindustrial hemp sector have formed an interests of this innovative sector is neces private sector support of this initiative," association made up of industry profes sary to move Canada's hemp industry Hanks says. "Strong associations build sionals to help fuel commer- forward, " says Arthur strong industri es; the formation of the cial growth for hemp prod Hanks, the executive direc CHTA will play a role in ensuring that the ucts and foods. Named the CANADIAN HEMP tor of CHTA. "One of our hardworking pioneers active in the sector Canadian Hemp Trade TRADE ALLlANCE major activities this year will today will reap the rewards of this growth Alliance/ Alliance Commer be to raise awareness of the tomorrow." ciale Canadienne du Chan health benefits of hemp Hemp is the industrial variety of vre (CHTA/ACCC), the foods in Canada and the Cannabis sativa L., Cannabinaceae. Some nonprofit organization is United States, through trade times also referred to as industrial hemp, it composed of farmers, shows, print media and the contains very low or no levels of delta-9- processors, marketers, and web." tetrahydrocannabinol, the primary researchers. The CHTA has Hemp seed foods are psychoactive agent in marijuana, which is members drawn from across attracting nutritional inter also the same species. Marijuana for the country and is open to est as they are shown to be medical purposes is legal in Canada and is all companies active in the high in digestible protein grown and distributed by the Canadian Canadian hemp sector. and also rich so urces of government. It is not legal to grow hemp The CHTA's initial activi omega-3 and omega-6 in the United States because of its botani ties will include market essential fatty aci ds. This cal relationship to marijuana. development and advocacy, corresponds with the For C HTA membership inquiries, information creation and C HTA's long-term vision of AGM registration and other information distribution, and forming an spurring growth in both the about CHTA/ACCC please contact: effective national network. A hemp fiber and seed sectors. Arthur H anks, CHTA Executive Director, relatively yo ung industry, ALLIANCE COMMERCIAL£ C HTA's projects for Tel: 306/757-HEMP (4367); Email: hemp has been grown CANADIENNE DU CHANVRE 2003-2004 have been made eviewed: Liske E, Hanggi W, Henneicke-von Zepelin H, RBoblitz N, Wi.istenberg P, Rahlfs V. Physiological investigation of a unique extract of black cohosh ( Cimicifugae racemosae rhiwma): a 6-month clinical study demonstrates no systematic estrogenic effect. journal oJWomen's Health & Gender-Based Medi cine 2002; 11 (2): 163-74. Hormone replacement therapy (HRT) has been used for decades to treat estrogen deficiency symptoms. Although HRT has some protective effects, there are also some adverse side effects, such as an increased risk for breast or ovarian cancer. Herbal treatments are gaining popularity due to their ability to relieve acute menopausal symptoms and low risk of side effects. In 1989 the German Commission E published a monograph approving the use of 40 mg/day of black cohosh (Actaea racemosa L., Ranunculaceae; syn. Cimicifuga racemosa (L.) Nutt.) as a nonprescription drug for premenstrual discomfort, dysmenorrhea (painful menstrual cramps), and menopause. The Commission's findings are based largely on studies using Remifemin® (Schaper & Bri.immer GmbH & Co. KG, Salzgitter, Germany). The goal of this study was to confirm the safety and efficacy of two doses of Remifemin and to determine if the extract has estrogenic effects. The randomized, double-blind, parallel group study included 152 perimenopausal and postmenopausal women with at least moderate symptoms. Study treatment consisted of an isopropano lic aqueous extract (40% v/v) from the rootstock of black cohosh (Remifemin). For 24 weeks, one group of subjects (n = 76) Black cohosh Actaea racemosa. Ph oto © 2003 stevenfoste r.com received 39 mg of Remifemin per day and another group (n = 76) received 127.3 mg of Remifemin per day. Efficacy was evaluated using the Kupperman Menopause Index, where symptoms are Both doses of black cohosh similarly decreased the median categorized as quasinormal through severe. Depression was evalu Kupperman Index score, which shows that the subject's ated on the Self-Rating Depression Scale. Clinical global impres menopausal symptoms improved. Both doses of black cohosh sion of efficacy and safety were also assessed. Physiological effects similarly improved the state of menopausal depression. Both doses were evaluated via hormone levels and vaginal cytology (vaginal had good or very good tolerability ratings, and there were no cell proliferation). adverse events related to the test products. Neither dose of black cohosh caused an alteration in vaginal cytology, suggesting that there was no estrogenic effect. Likewise, black cohosh had no significant effect on hormone levels. The safety and efficacy of the standard dose was compared with that of a high dose to determine differences in speed of onset or level of therapeutic effect. No dose-response effect could be demonstrated, indicating that maximum effect occurs with the standard (40 mg/day) dose. The authors state that, based on the vaginal cytology data and hormone level data, prior claims that black cohosh extract has an estrogen-identical effect cannot be substantiated. Although black cohosh extract does not have estro gen-like effects on female reproductive organs, it may have an estrogenic affect on other tissues. The authors believe that the mode of action differs from that of estrogen and black cohosh extract may have a tissue-selective mechanism. The authors conclude that the preparation can be safely used for 24 weeks. Also, they conclude that this black cohosh formulation offers an alternative for menopausal complaints when HRT is either contraindicated or refused. It should be noted that the study did not have a placebo control group to validate the findings. _A - HeatherS. Oliff, PhD Black cohosh Actaea racemosa. Photo © 2003 stevenfoste r. com 16 I HerbaiGram 60 2003 www.herbalgram.org research reviews Survey Results of Cancer Patients' Alternative Medicine Use eviewed: Patterson R, Neuhauser M, Hedderson M, Schwartz Regarding the reasons and motivations for using CAM, the most RS, Standish L, Bowen D , Marshall L. Types of alternative frequently stated reason was for general health and well-being. medicine used by patients with breast, colon, or prostate cancer: More specifically, for each of the types of CAM (such as predictors, motives, and costs. journal ofAlternative and Comple mental/other therapies or alternative providers), over 80% of mentary Medicine 2002;8(4):477-85. CAM patients reported that they used that therapy for general According to the authors, the use of complementary and alter health and well-being. "Almost all patients reported that the ther native medicine (CAM) is widespread and growing. Research apy improved their well-being," the authors note; these percent suggests that cancer patients may be more likely than other people ages ranged from 67.6% to 97.4%. to use CAM. The authors conducted a telephone survey with For the individual CAM therapies, the percentages of patients patients who had primary breast, prostate, or colon cancer to who said they used the therapy for treatment of cancer or for gather information about the use of CAM. cancer-related symptoms were lower, ranging from 7.7% to Potential participants were identified though the Cancer Surveil 57.6%. A subgroup analysis showed that there was a significant lance System of the National Cancer Institute's Surveillance associati on between receivi ng multiple medical therapies and Epidemiology and End Results program. From the eligible poten taking dietary supplements for treatment of cancer or for cancer tial participants in one area of Washington state, a sample of 511 related symptoms. Patients also reported using CAM therapies for adult cancer patients was randomly selected. In this sample, the other diseases. numbers of people with breast, colon, and prostate cancer were Patient expenditures for CAM (all types combined) ranged from approximately equal. $4 to $14,659/year, with a median cost of $68/year. T he median A total of 356 patients, aged 20-79 years, completed the tele annual expenditures for specific types of CAM were $580 for alter phone interviews in 1999. Of these, 126 had breast cancer, 114 native providers, $58 for dietary supplements, and $46 for herbals. had prostate cancer, and 116 had colorectal cancer; 45% of the In discussi ng their findings, the authors note that 70% of the colorectal cancer patients were women. The ave rage age of the study patients used at least one CAM therapy, whereas 40% of study participants was 62.5 years, 37.1% had a college education, U.S. adults in general did so according to surveys done in 1993 91.3% were Caucasian, and half were women. and 1998. It is difficult to compare the current study with other For the purposes of the study, CAM was subdivided into three surveys of cancer patients because of differences in sampling and types: alternative providers (acupuncturists, naturopathic phys i methodology. "In particular, our estimates of dietary supplement cians, massage therapists, or spiritual advisors), mental/other ther use (67%) were considerably higher than some studies, . .. similar apies (meditation, prayer, group support, biofeedback, hypnotism, to others, ... and lower than a study of breast cancer survivo rs, " the guided imagery, crystals, or magnets), and dietary supplements authors explain. These discrepancies may be related to the lack of (vitamins, minerals , herbals, or others). Participants were asked a standard definition for CAM. whether they had used any of these therapies in the past 12 The data show some trends that should be interesting to health months. For each alternative therapy used, the participant was care providers. "First, given that most therapies were used for asked about their reasons for using it and whether it had improved general health and well-being, users would seem unlikely to substi his or her well-being. tute those therapies for conventional medicine," the authors write. The results showed that 70% of the participants had used at "In addition, medical providers should be wary of dismissing or least one type of CAM; specifically, 65% had taken a dietary discounting [CAM] given that patients overwhelmingly believed supplement, 20% had seen an alternative provider, and 20% had that the alternative therapies they used improved their well-being." used mental/other therapies. Women were five times more likely However, physicians should be aware that antioxidants in supple than men to see an alternative provider and twice as likely as men ments may interfere wi th chemotherapy, and drug- herb interac to use mental/other therapies or dietary supplements (P < 0.05 for tions can occur. The data also show that patient expenditures for all) . Older participants were significantly less likely to us e CAM were generally modest. The authors recommend further mental/other therapies than were yo unger participants. research to evaluate whether use of CAM is associated wi th quality Compared with participants who had a high school education or of life and survival. -"' less, those with a college education were about five times more -Christina Chase, MS, RD likely to use an alternative provider, three times more likely to use mental/other therapies, and twice as likely to use dietary supple ments. Income was not a strong predictor of CAM use. Patients with breast cancer were significantly more likely to take dietary supplements or see alternative providers than were pati ents wi th colorectal cancer (P < 0.01). The stage of the cancer at diag Support ABC nosis was not correlated with CAM use. Those participants being treated with multiple medical therapies were more than twice as Please consider giving an ABC likely as patients treated with surgery only to take supplements (P Membership as a gift to friends, for trend < 0.01 ). No significant differences in CAM use we re relatives, or health professionals. found between patients diagnosed with cancer in the past 12 months and those diagnosed 12-24 months before the study inter (See details on page 2) view. www.herbalgram.org 2003 HerbaiGram 60 I 17 research reviews Effects of Saw Palmetto Extract on Prostate Tissue of Men with BPH eviewed: Veltri R, Marks L, Miller C, et al. Saw palmetto alters structure of men with symptomatic BPH. Rnuclear measurements reflecting DNA content in men with Forty-four men (mean age 65 years) with chronic symptoms of symptomatic BPH: Evidence for a possible molecular mechanism. bladder outlet obstruction, prostate enlargement, and a positive Urology 2002;60(4):617-22. prostate symptom score participated in the trial. Patients received Saw palmetto (Serenoa repens (W. Bartram) Small, Arecaceae) either an inert fruit extract is one of the most widely used treatments for sympto placebo or matic benign prostatic hyperplasia (BPH). In many men, BPH SPHB. Both results in bothersome urinary symptoms. Based on the results of softgel two previously published papers, 1•2 a specific saw palmetto herbal capsu l es blend. (SPHB*) is associated with prostatic epithelial contraction looked identi (cells getting smaller) and decreases in tissue levels of dihy cal. Patients drotestosterone (DHT). (This is the third publication on the took one SPHB based on the same clinical trial that resulted in the two capsule 3 previous publications.) times daily Although the general mechanism of action is known, the molec with meals for ular mechanisms for these findings are not known. The authors 6 months. A hypothesize that the molecular basis for the action might be due to prostate alterations in DNA content and chromatin (genetic material in a biopsy was cell) structure and organization of prostate epithelial cells. One performed at way to measure genetic alterations in tissue is to determine the baseline and after 6 months of treatment. QNG was calculated by measuring 60 Saw palmetto Serenoa repens nuclear Ph oto © 2003 stevenfoster.com morphometric descriptors (NMDs). Examples ofNMDs are perimeter, area, and cell class. At baseline, there was no difference in the 60 NMDs between the placebo and SPHB treatment groups. After 6 months of placebo treatment, the NMDs did not significantly change. In contrast, after SPHB treatment, 25 of the 60 NMDs significantly changed. Therefore, according to the study, 6 months of SPHB treatment alters the DNA chromatin structure and organization in prostate epithelial cells. The authors conclude that the clear-cut chromatin alterations suggest a molecular basis for the proprietary saw palmetto blend's clinical effects. However, because of the multi-component nature of this herbal blend, it is not certain whether the benefits can be attributed solely to the saw palmetto extract or to the combined action of all the ingredients in the blend. __.- -HeatherS. Oliff, PhD References: I. Marks LS, Partin AW, Epstein JI, et a!. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Uro/2000;163: 1451-6. 2. Marks LS , Hess DL, Dorey FJ, et a!. Tissue effects of saw palmetto Saw palmetto Serenoa repens Photo© 2003 stevenfoster.com and fin as teride: use of biopsy cores for in situ quantification of prostatic androgens. Urology 2001;57:999-1005. quantitative nuclear grade (QNG). QNG is a biomarker that describes the nuclear size, shape, and chromatin structure and * SPHB: I 06 mg of standardized saw palmetto liposterolic extract organization. Changes in QNG may reflect alterations in gene combined with 80 mg nettle root extract ( Urtica dioica L. ssp. dioica, expression in response to treatment or changes in disease state. Urticaceae), 160 mg pumpkin seed extract ( Cucurbita pepo L., This randomized, double-blind, placebo-controlled clinical trial Cucurbitaceae), 33 mg lemon flavonoids, and 190 mg vitamin A examines the effects of SPHB on the epithelial nuclear chromatin (Nutrilite, Buena Park, CA). 18 I HerbaiGram 60 2003 www.herbalgram.org research reviews lsoflavones Linked to Anticancer Activity in Soy eviewed: Messina M, Flickinger B. Hypothesized anticancer risk reduction are fairly unimpressive and inconsistent, but this Reffects of soy: Evidence points to isoflavones as the primary does not necessarily contradict studies about soyfoods in humans. anticarcinogens. Pharmaceutical Biology 2002;40:S6-S23. "A prevailing theory, which has both animal and now epidemio Much recent research suggests that soyfoods have potential anti logic support, is that ea rly exposure to soy, because of the cancer effects, particularly for the prevention of breast and prostate isoflavones, reduces breast cancer ri sk later in life," the authors cancers. Epidemiological evidence shows that breast and prostate ex plain. Migration studies have supported this theory by showing cancer mortali ry rates are low in countries, such as Japan, where that diet in early life has a strong influence on breast cancer risk in soyfoods are commonly consumed. In addition, tumor suppression ad ulthood. One study showed that women who had consumed was achieved in animals consuming soy (Glycine max Merr. , tofu in their teenage years had reduced ri sk of both premenopausal Fabaceae) or soy constituents. Although many studies have found and postmenopausal breast cancer; the highes t quintile had half evidence of anticancer benefits, other studies have found either no (5 1 o/o) the ri sk of the lowest quintile. The amount of soy protective effect or an increased risk of cancer with soy consump consumed by the highest quintile was equivalent to approximately tion. 100 grams tofu per day. This review article discusses the For prostate cancer, the ex tent of supposed anticarcinogens in soy. epidemiological evidence regarding Several soy constituents have been a link between soy consumption identified as possible anticarcino and risk is limited. H owever, two gens. These constituents are pheno studies reported promising results. li c acids, phytosterols, inositol hexa Both found pronounced reductions phosphate, saponins, protease in prostate cancer ri sk with modest inhibitors (including the Bowman soy consumption. It should be Birk inhibitor, a compound that has noted that the numbers of subjects an anti-carcinogenic effect), alpha wi th prostate cancer in these studies linolenic acid, vitamin E, and we re small. The data from animal isoflavon es . Soy protein is also a resea rch are encouraging overall. potential anticarcinogen because of Some animal studies indicated that its low methionine content and the genistein may be even more potent characteristics of certain subfrac in vivo than in vitro, and other stud tions. "It is often suggested that ies showed that soy protein isolate protection is due not to one specific rich in isoflavones has a modest anticarcinogen, but to the inhibitory effect on both chemically combined action of one or more of induced and spontaneous prostate these bioactive components," the tumors. Ve ry little research has been authors note. done with human subjects. One However, in this article, the Soy Glycine max. Photo © 2003 stevenfoster.com important recent study found that authors argue that "if soy consump over half of 41 patients with uncon- tion contributes to the low Japanese troll ed growth of prostate cancer (and indirectly other Asian countries) breast and prostate cancer (indicated by rising serum prostate specific antigen, or PSA, levels) mortali ry rates, it is primarily, if not totally, because of the responded to iso fl avone supplements wi th a significant decrease in iso fl avones in soyfoods." Of al l the soy constituents with anti the linear increase of their PSA levels. These patients took 60 mg cancer potential, iso fl avones have been studied most intensively. isoflavones (aglycone units) daily for six months. The three isoflavones in soy are genistein, daidzein, and glycitein. T he authors conclude that "for prostate cancer, several lines of In Japan, the average isoflavone intake is 30-40 mg/day according evidence suggest soy may reduce risk." T hese lines of evidence are to several surveys cited by the authors. A I 00-gram se rving of tofu clinical, animal, and epidemiological. Fo r breas t cancer, soy supplies about 30 mg isoflavones (aglycone units). Isoflavon es are consumption early in life may have an important protective effect, absorbed efficiently and distributed to body tissues in such ways which would explai n why studies attempting to link soy consump that tiss ue concentrations often exceed serum concentrations. tion in adult wo men to reduced breast cancer risk have generally Isoflavones exert es trogenic effects and possibly also antiestroge nic yielded unimpressive results. T he anticancer constituents of soy effects. In vitro, genistein was found to inhibit the growth of many have not ye t been confirmed, but the preponderance of data points rypes of cancer cells, including hormone-dependent and hormone towards the isoflavones. It is still possible, however, that a combi independent cancers. These effects of genistein may result from its nation of soy constituents interacting together creates an anti abili ry to affect signal transducti on. Also, in vitro, genistein cancer effect, or that an as yet unidentified component protects reduced the activiry of many cellular factors and enzymes that against cancer. The latter possibiliry is less likely, in part because regulate cell growth. the current evidence strongly points to the iso fl avo nes, which The authors review the evidence regarding breast (o r mammary) alone have known biological effects in humans and anticancer cancer and prostate cancer in relation to soy and isoflavone intake. effects in animals and in in vitro research . ....- For mammary cancer in animals, the data linking isoflavones to -Christina Chase, MS, RD www.herbalgram .org 2003 HerbaiGram 60 I 19 research reviews Lack of Efficacy of Valepotriates from Valerian in Small Trial on Patients with Generalized Anxiety Disorder eviewed: Andreatini R, Sartori V, Sea bra M, Leite J. Effect of taken 3 times a day for 4 weeks. The dosing regimen was flexible. Rvalepotriates (valerian extract) in generalized anxiety disorder: At each dosing interval, three capsules were taken. The number of a randomized placebo-controlled pilot study. Phytotherapy Research capsules containing valepotriates or diazepam varied depending on 2002; 16:650-4. the patient's therapeutic response. If, after one week of treatment, Benzodiazepines are the most frequently used drugs to treat there was no clinical effect or too many side effects, the dose was generalized anxiety disorder (GAD). There are a growing number altered. Treatment responses were evaluated with the Hamilton of serotonergic drugs and antidepressants that are also used. These Anxiety Scale (HAM-A), a physician-rated scale, and the State drugs have some disadvantages such as dependence, tolerance, Trait Anxiety Inventory (STAI), a patient-rated scale. withdrawal, and initial increase in anxiety. Valerian root ( Valeriana At baseline, there were no differences between groups. There officina/is L., Valerianaceae) extracts are used as a hypnotic-sedative were no significant differences between the groups after treatment medication in some countries. According to some researchers, the as well. After 4 weeks of treatment, neither the valepotriates group main active components of valerian extracts are valepotriates nor the diazepam group differed from the placebo group. Because (valtrate, didrovaltrate, and acevaltrate). There are no published this was a preliminary study, there may not have been enough studies examining the isolated valepotriate fraction's effects on patient numbers for an effect to be seen. Other variables contribut GAD. This study is a preliminary investigation of the efficacy of ing to the lack of effect could have been too low dose or too short valepotriates in the treatment of patients with GAD. treatment duration. Both valepotriates and diazepam were well Thirty-six patients with GAD participated in this randomized, tolerated by the patients. There were no serious adverse effects. parallel, double-blind, placebo-controlled study. There were three This study needs to be repeated with a larger sample size, higher groups: placebo, valepotriates, and diazepam (a benzodiazepine fixed dose, longer drug administration, and more specific evalua commonly used to treat GAD). The valepotriates mixture contain tion of psychic symptoms in order to determine if valepotriates ing 50 mg of valepotriates had 80% dihydrova!trate, 15% valtrate, would be an effective treatment for GAD ...... and 5% acevaltrate (BYK-Gulden, Lemberg, Germany). Each - Heather 5. Oliff, PhD diazepam capsule contained 2.5 mg of drug. All capsules were Evaluation of a Frankincense-Turmeric Preparation for Managing Knee Osteoarthritis eviewed : Badria F, El-Farahaty T, Shabana A, Hawas S, El After one month of treatment, preparation-treated patients RBatoty M . Boswellia-curcumin preparation for treating knee showed a significant increase in pain-free walking time (P= 0.01). osteoarthritis. Alternative & Complementary Therapies 2002 After 2 months of treatment, preparation-treated patients had a December:341-8. significant decrease in severity of pain caused by passive (P = Osteoarthritis (OA) is a degenerative joint disease characterized 0.00 I) and active (P = 0.004) movement and in degree of tender by joint inflammation. Conventional medications can control OA ness (P = 0.001). After 3 months of treatment, preparation-treated symptoms effectively. However, because there are many potential patients had a significant decrease in knee effusion (P = 0.028) side effects, herbal medicines may be a safe and effective alterna along with a continued significant improvement in all other tive. Curcumin from the common spice turmeric (Curcuma longa parameters. Patients treated with placebo demonstrated no L., Zingiberaceae) and the oleo-gum-resin of Indian frankincense improvement. (Boswellia serrata Roxb. , Burseraceae) have anti-inflammatory After 3 months of treatment, there was a significant decrease in effects in animal models of inflammation, and curcumin has serum nitric oxide (NO) in the preparation-treated group antioxidant activity. The purpose of this study was to evaluate a compared to the placebo-treated group (P < 0.00 1) . Patients with boswellia-curcumin preparation for the management of knee OA. OA had higher NO levels than the individuals without OA, possi Sixty individuals participated in this double-blind, randomized, bly because of cartilage destruction. The improvement in NO may crossover study. There were three groups: 30 patients with OA be explained by curcumin's ability to reduce inflammation by were treated with the boswellia-curcumin preparation, 15 patients inhibiting production of inflammatory agents such as NO. There with OA were treated with placebo, and 15 individuals without was also a significant improvement in serum SOD (P < 0.001), OA served as controls. Patients took either the preparation or and a significant decrease in CD4+ and CD T-cells (P < 0.001). placebo every 8 hours after meals for 3 months. The preparation The decrease in T-cells may be due to the action of boswellia and contained extracts of boswellia (olibanum; 37.5% boswellic acid) turmeric as inhibitors ofleukotriene (a mediator of inflammation). and turmeric in 500 mg capsules. The authors provided no other The boswellia-curcumin preparation appears to be an effective information about this product. Blood was evaluated for antioxi treatment for knee OA. While the authors stated that this was a dant enzyme (superoxide dismutase, SOD), free-radical damage crossover study, no crossover is described. The findings of this markers (nitric oxide: nitrite and nitrate), and T-cell receptor flow study would be stronger if a crossover were included in addition to cytometry (CD4 and CD). Pain, tenderness, effusion (fluid in another group using a conventional drug used for OA...... joint), and pain-free walking time were assessed. - HeatherS. Oliff, Ph.D 20 I HerbaiGram 60 2003 www. herba lgram.org research reviews Efficacy of Butcher's Broom in Chronic Venous Insufficiency eviewed: Vanscheidr W, Josr V, Wolna P, er a!. Efficacy and The results showed that all parameters improved over rime in Rsafety of a butcher's broom preparation (Ruscus aculeatus L. the BB group. In contrast, baseline values were maintained in extract) compared to placebo in patients suffering from chronic general for all parameters in the placebo group. Significant differ venous insufficiency. Arzneimitte/forschung 2002;52(4) :243-50. ences between BB and placebo groups were found for volume Chronic venous insufficiency (CVI) is a condition characterized changes of the lower leg after 8 and 12 weeks of treatment, ankle by inadequate venous return in the lower leg and foot. This causes circumference after 4, 8, and 12 weeks, and lower leg circumfer symptoms such as congested veins of the foot and lower leg, ence after 8 and 12 weeks (P < 0.001 ). Two symptoms, heavy, tired edema, pain, itching, eczema, hyper- or depigmentation of the legs and sensation of tension, were significandy reduced in the BB skin, and the sensation of tired, heavy legs. Traditionally, CVI has group compared with the placebo group after 12 weeks (P < been treated with compression therapy (support stockings). For 0.001 ). patients who cannot tolerate consistent compression therapy, The global efficacy use of herbal medicines, such as extracts of horse chestnut of treatment was rated (Aesculus hippocastanum L., Hippocastanaceae) seed, is a new by the investigator as and promising alternative. Butcher's broom (Ruscus aculeatus L., very good, good, Liliaceae) extracts were classified as herbal edema protectants by moderate, or bad; the the German Commission E. difference between The main active ingredients in the rhizome of the butcher's groups was significant broom (BB) plant are the steroid saponins, ruscin and rusco (P = 0.0498). Ratings side. The current study evaluated BB extract to determine of quality of life were whether it would be effective and well tolerated for treating not significantly CVI. This multi-center, double-blind, randomized trial changed in either included 148 Caucasian women group from baseline to aged 30-89 years with CVI; the I 2 weeks. However, severity of their CVI was grade I the authors conclude or II, according to the Widmer that "improvement of classification system (these grades life quality may well be are equivalent to 3-4 in CEAP, presumed for these another classification system). patients" (i.e., BB The average duration of CVI was Photo© 2003 stevenfoster.com group) because of the approximately 15 years. All of the significant differences subjects had been told previously between the groups for to use compression therapy, but several symptoms (heavy, tired legs and sensation of either refused to try it, could not tension). The authors also note that improvements in qual tolerate it, or were noncompliant ity of life may be less noticeable in patients with milder CVI with the recommended treat (such as the study patients) than in patients with severe CVI. ment. Butcher's broom Ruscus oculeotus. Adverse events were reponed by 17 BB-group patients (22 The herbal treatment used in Photo © 2003 stevenfoste r.com events) and 20 placebo-group patients (26 events). Only one this study was an extract of BB event (calf cramps) in the BB group was assessed as possibly rhizome (Fagorurin® Ruscus Kapseln, GlaxoSmirhKline related to the treatment, and even for this event, a link to the treat Consumer Healthcare GmbH, Herrenberg, Germany). The daily ment was considered unlikely. Patients in the BB group rated the dosage of BB extract was 72-75 mg dry extract from BB rhizome; tolerability of the treatment as either very good (76.8%) or good this is the recommended dosage according to the Commission E (23.2%) ; ratings in the placebo group were similar. monograph. No standardization to active constituents such as The mechanism of action of BB extract appears to be a toning ruscgenins is given in the paper. effect on the veins. This toning effect apparendy results from post The study began with a two-week placebo run-in period. The synaptic activation of the alpha1- and alpha2-receptors of rhe subjects were then randomly assigned to rake either BB extract (77 smooth muscle and also from increased presynaptic noradrenaline women) or placebo (71 women) for a 12-week treatment period. release. Previous studies reported that BB extract had a much Some subjects in both groups had major deviations from the study stronger effect on vein tone than did horse chestnuts or witch hazel protocol and therefore their data were not used in the final analy (Hamamelis virginiana L. , Hamamelidaceae). sis. The final numbers of subjects with usable data were 56 women The authors conclude that BB extract was well tolerated and in the BB extract group and 54 in the placebo group. effective for CVI of Widmer grades I and II. "All considered, the The efficacy of the BB extract was evaluated by measuring leg therapeutic effect of ruscus extract, i.e. Rusci aculeati rhizoma et volume (indicative of edema), ankle circumference, lower leg radices [BB exract], as was well-established for centuries in the circumference, and four subjective symptoms. These subjective pharmacopoeia of the Mediterranean countries, is now clinically symptoms were ringling, pain, sensation of tension, and sensation established by irs scientifically proven pharmacodynamic proper of heavy, tired legs. Measurements were taken and symptoms were ties and clinical actions," the authors write. A rated after 4, 8, and 12 weeks of treatment. -Christina Chase, MS, RD www.herbalgram.org 2003 HerbaiGram 60 I 21 research reviews St. John's Wort and Drug Interactions eviewed: Henderson L, Yue Q, Bergquist C, Gerden B, Arlett (2) those potentiating serotonin concentrations. However, Herbal RP. Sr. John's wort (Hypericum perforatum): drug interactions Gram peer reviewers have stated that the authors are misinformed and clinical outcomes. British journal of Clinical Pharmacology and incorrect on the second proposed mechanism; there is not 2002;54:349-56. adequate evidence to support the idea that SJW potentiates sero The authors of this review article examined published literature tonin function, and in fact may be another example of a kinetic and case reports in order to determine which medicines are interaction. reported to interact with St. John's wort (SJW; Hypericum perfora The P450 enzyme system consists of a series of isozymes, some tum L., Clusiaceae) and the possible mechanisms. They briefly of which have been linked with the metabolism of specific drugs. discuss SJW's traditional uses and its regulatory status in the Induction (i.e., increased activity) of isozymes has the effect of United Kingdom and Sweden. reducing the blood serum levels of various drugs, thereby reducing SJW contains at least nine groups of compounds that may their activity and, in a few cases, rendering the drugs ineffective. contribute to its reported effects. The effects of many constituents While one study suggests that hypericin may induce activity of are unknown. SJW significantly affects the central nervous system, isozyme CYP1A2, several other studies show no effect of hypericin which may explain its usefulness in on this isozyme. Some evidence mild-to-moderate depression. Hyper suggests that hyperforin may induce forin is now considered the most isozyme CYP3A4. The long-term likely constituent responsible for effects of SJW constituents on various SJW's interaction potential. enzymes have not been studied. This SJW products are commonly stan may be particularly important as the dardized to hypericin, although there use of SJW for mild-to-moderate are several SJW products standard depression usually involves long-term ized to hyperforin, a totally different use. Interaction between SJW and the type of compound. Due to the vari blood-thinning drug warfarin ability of hypericin content in differ (phenoprocumon), identified from ent parts of the plant at different case reports, may be caused by induc times and under different conditions, tion of CYP2C9, however, direct a standard hypericin content may not studies found no effect on this indicate consistent levels of other enzyme. Interaction with the constituents; thus, different SJW immunosuppressant drug preparations may have different levels cyclosporin, identified from case of efficacy and/ or adverse reaction reports involving transplant patients, profiles. may be due to induction of both The most common adverse reac CYP3A4 and the transport protein P tions to SJW are gastrointestinal glycoprotein. All oral contraceptives upsets, allergic reactions, dizziness or (OCs) are metabolized by confusion, tiredness, and dry mouth cytochrome P450 enzymes. Several St. John's wort Hypericum perforatum. - all of which are considered mild, Photo © 2003 stevenfoster. com reports have been made of break- moderate, or transient. While poten through bleeding or unplanned preg tially serious, photosensitivity reac- nancy in women taking both OCs tions, with increased sensitivity reported at higher doses, have and SJW Induction of isozymes 2C9 and 3A4 by SJW are all mostly been observed in cattle which have eaten SJW plants and, implicated. The authors point out that, while most SJW-drug in rare cases, extremely light-skinned humans. Overall, SJW has interactions involve medications which require regular blood level produced few reported adverse reactions. Of 1,757 patients who monitoring, OCs do not, and this interaction is likely to affect took SJW in clinical trials, only 3 (0.8%) dropped out due to many people. There is no indication that the SJW-OC interactions adverse reactions, compared with 7 (3%) who took conventional occur with specific products, such as low dose or progesterone antidepressants in the same trials. Adverse reactions were reported only OCs. in only 19.8% of patients using SJW, compared with 52.8% of Interaction between SJW and theophylline, an alkaloid found in those taking conventional antidepressants. Adverse reactions were tea (Camellia sinensis (L.) Kuntze, T heaceae) formerly used in more likely to be reported in clinical trials comparing SJW with asthma patients identified from only one case, suggests the possi conventional antidepressants than in placebo-controlled trials; this ble induction of CYP1A2. Clinical pharmacology studies indicate may reflect patient preconceptions. that this is not the case, however. Interaction with digoxin, the Despite these relatively minor adverse reactions, SJW has been widely-used cardiac glycoside derived from foxglove leaves (Digi shown to have a number of potentially serious interactions with talis purpurea L., Scrophulariaceae, and D. lanata Ehrh.) identified prescription drugs. The authors write that these interactions fall in a pharmacokinetic study, is believed to be due to induction of into two general categories: (1) those indicating the induction of P-glycoprotein after multiple-dose treatment with SJW extract. No certain drug-metabolizing enzymes in the cytochrome P450 case reports of this interaction were found. Interaction with HIV system of digestive/hepatic enzymes and transport proteins, and protease inhibitors was also identified in a pharmacokinetic study; 22 I HerbaiGram 60 2003 www.herbalgram.org research reviews one case report from the UK was found. Many other medicines are specific drug reactions, implications for patient health, and metabolized by either CYPIA2, 2C9, or 3A4, and the authors suggested management of patients already taking any of these think it likely that more SJW-drug interactions wi ll be identified. drugs and SJW. HlV non-nucleoside reve rse transcriprase Herba/Gram peer reviewers emphasize that the only direct evidence inhibitors and anticonvulsa nts are included in Table 4, as their for CYPIA2 and 2C9 isozymes show no effect of SJW. pharmacology suggests that they may also interact with SJW, with In interactions involving SJW and selective serotonin re-uptake potentially se rious results. Howeve r, the authors fail to mention inhibitors (SSRls), symptoms suggest central serotonin excess, that the only clinical trial with SJW and rhe anticonvul sa nt, carba thought to be due to similar effects of SJW and conventional anti maze pine, found no interaction. Among suggesti ons for patient depressants. The authors did not mention, however, that pharma management, which include monitoring blood levels and dose cokinetic interactions (increased antidepressant blood level) result adjustments for so me medications, the recommendation to "stop ing from initial (first 2 or 3 days) inhibition of CYP3A4 by SJW SJW" is made in every instance. could also explain these effects si nce there is no direct evidence that Finally, the authors discuss efforts in the U.K. and Sweden to SJW enhances serotonin function. (SJW frequently causes an prevent harmful interactions. These include new label language initial, acute, inhibition of the isozyme for up to 2 or 3 days, and information on SJW products, changes in patient literature for followed after 7-10 days with induction, according to Herba/Gram prescription medicati ons, ci rculating information to healthcare reviewers.) The authors suggest that people taking any of these professionals, journal articles, and public education through the medications should not concurrently use SJW. In most clinical press. In Sweden, companies marketing SJW have been asked to trials of SJW products, people using conventional antidepressants conduct product-specific in vivo tests. have been excluded. In ge neral, this is not a particularly complete, clear, or balanced Some clinical trials have not excluded participants taking article, and falls in to the same trap as several other papers regard medication for hypertension, circulatory disorders, bronchial ing the interaction potential of SJW. It is a bit repetitive on the asthma, or menopausal symptoms. In these trials, there have been public misperception of herbal remedies as "natural and therefore no reported interactions between SJW and these drugs. safe" and the fact that patients often do nor mention their use of The paper includes four tables. Table I lists the main herbal products, including SJW, to their physicians, whil e physi constituents of SJW, Table 2 summarizes possible pharmacokineti c cians often neglect to inquire about such use. However, rhe persist and pharmacodynamic interactions, Table 3 provid es a breakdown ence of such behaviors makes this repetition understandable. One of unintended pregnancies attributable to the presumed interac may hope that it bears fruit in producin.$ clea rer co mmunicati ons tion of SJW on OCs (where the OCs levels were diminished between physicians and their patients.A apparently to the point of inactivity), and Table 4 summarizes -Mariann Garner-Wizard STEVEN FOSTER GROL"P. INC . eatured in HerbaiGram for over a decade, the photographs of Steven Foster are available for licensing for editorial or commercial projects. Specializing in medicinal and aromatic plants, our stock photo files include more than 70,000 images, including most major herbs sold as dietary supplements. --••o•••- Steven Foster Group, Inc. Steven Foster, President PO. Box 57, Brixey, MO 65618 4 171261-2663 fax 4 171841-4843 email: sfoster@stevenfoster. com www.stevenfoster.com CO IE TO THE SOCRCE www.herbalgram.org 2003 HerbaiGram 60 I 23 research reviews Pycnogenol® Chewing Gum Tested on Dental Plaque Formation and Gingival Bleeding eviewed: Kimbrough C, Chun M, dela Roca G, Lau B. ing. T he subjects were 40 dental students (20 men and 20 women) RPycnogenol® chewing gum minimizes gingival bleeding and aged 22-35 years. The subjects were randomly assigned to chew plaque formation. Phytomedicine 2002;9(5):41 0-3. either a sugar-free gum containing 5 mg Pycnogenol (prepared by In Europe and the United States, Pycnogenol® is available as a Fennobon Oy, Karkkila, Finland) or a control gum without proprietary dietary supplement. This patented product, which has Pycnogenol (Trident® Advantage Gum). For 14 days, each subject antioxidant activity, is made from phytochemicals extracted from chewed six pieces of gum daily for at least 15 minutes per piece. the bark of the French maritime pine (Pinus pinaster Aiton, Three pieces were chewed after meals and the remaining three were Pinaceae). The specific compounds in Pycnogenol include caffeic chewed at various acid, gallic acid, oligomeric and monomeric procyanidins, and times throughout precursors of procyanidins. the day. Previous research has shown that the whole extract in Baseline meas Pycnogenol or its component fractions produce strong antioxidant ures of gingival effects in perfused organs in vitro, in in vivo models and humans. bleeding and Studies have demonstrated that Pycnogenol protects against lipid plaque were oxidation, inflammatory disorders, and DNA damage induced by compared with hydroxyl radicals. In addition, Pycnogenol alleviates symptoms of post-treatment endometriosis and dysmenorrhea by decreasing menstrual cramps measures, which and abdominal pain. Research in mice showed that Pycnogenol were obtained after improved immune function and memory. Pharmacological studies the 14 days of have shown that Pycnogenol decreases permeability of capillary chewing the walls. Pathologies involving leaky capillaries, chronic venous insuf Pycnogenol or ficiency, and diabetic retinopathy, have been successfully counter control gums. acted in various clinical studies with Pycnogenol. Bleeding scores were determined by The extract upon which Pycnogenol is based was reportedly first French Maritime pine Pinus pinaster syn. P maritima used by Native Americans in Quebec, Canada. Some historians gently touching the Photo © 2003 Horphag Resea rch Ltd. suggest that they prepared a tea from the bark of a certain type of sulcus (crevice pine tree and offered this tea to the French explorer Jacques Cartier between the gum and his men, who and tooth surface) with a probe at four sites (facial, lingual, and were suffering from imerproximals) for 30 seconds each. If no bleeding occurred, a scurvy due to a lack score of 0 was assigned. If any bleeding occurred, a score of 1 was of fruits and vegeta assigned. The number of sites that bled was used as the sulcus bles in winter. bleeding index. Symptoms included Plaque accumulation scores were also determined. A plaque bleeding gums and disclosing solution (basic fuchsin mouthwash) was applied to the loss of teeth. The teeth and amount of visible plaque was rated on a scale of 0 to 5, explorers drank the as follows: 0, no plaque; 1, separate flecks of plaque; 2, a thin, tea, and within days continuous band of plaque (up to 1 mm); 3, a band of plaque their gums are wider than 1 mm; 4, plaque covering at least one-third of the reported to have crown; and 5, plaque covering two-thirds or more of the crown. stopped bleeding. For each subject, the bleeding and plaque scores were deter This story has mined on a set of three teeth that were not brushed during the become part of the study. Subjects wore a removable acrylic stint over the three teeth Pycnogenol story while brushing, so that these teeth would not come into contact line, although it is with the toothbrush. Compli ance with the study protocol was not historically excell ent. The authors had chosen to enroll dental students because possible to confirm they would be more inclined to follow the study protocol without its accuracy. any difficulty. In this article, a The results showed that the mean bleeding index in the control double-blind study group did not change significantly from baseline to post-treatment was used to evaluate (1.55 plus/minus 0.10 and 1.54 plus/minus 0.08, respectively) . the effect of a chew However, in the Pycnogenol group, the bleeding index dropped ing gum containing significantly from baseline to post-treatment (1.59 plus/minus Pycnogenol on 0.15 and 0.71 plus/minus 0.14, respectively; P < 0.05). The plaque plaque formation scores showed that plaque accumulation increased significantly French Maritime pine Pinus pinaster syn. P maritima and gingival bleed- from baseline to post-treatment in the control group (3 .0 1 Ph oto © 2003 Horphag Research Ltd. 24 I HerbaiGram 60 2003 www.herbalgram .org research reviews plus/minus 0.19 and 3.82 plus/minus 0.23, respectively; P< 0.05). the authors note. In the Pycnogenol group, plaque scores were unchanged from Based on these results, the authors conclude that "for individu baseline to post-treatment (2.95 plus/minus 0.23 and 2.93 als who enjoy chewing gums, the addition of Pycnogenol to the plus/minus 0.33, respectively). gum may reduce the need for frequent tooth brushing and, at the These findings indicate that chewing Pycnogenol gum can limit same time, increase the benefits in maintaining gingival health." plaque accumulation and gingival bleeding. The authors had Regarding the dose of Pycnogenol used, each piece of gum hypothesized that the potent antioxidants in Pycnogenol gum contained 5 mg and therefore the daily dose obtained from 6 might minimize gingival inflammation, and the results supported pieces was 30 mg. Plaque accumulation did not decrease in the this hypothesis. Subjects who used the Pycnogenol chewing gum Pycnogenol group, yet it increased in the control group, indicating had a greater than 50% reduction in gingival bleeding, whereas the that the Pycnogenol gum suppressed or prevented the increase that control group had no change in bleeding scores from baseline to typically occurs when the teeth are not brushed. "It would be inter post-treatment. In addition, plaque accumulation increased signif esting to know whether doubling the concentration ofPycnogenol icantly in control subjects, whereas it remained unchanged in the to 10 mg per gum may further increase its efficacy in minimizing Pycnogenol group. "The data thus suggest that Pycnogenol is gingival bleeding and plaque accumulation," the authors add. capable of minimizing the increased plaque accumulation Perhaps that might be the subject of the next study._. normally observed in individuals who do not brush [their] teeth," -Christina Chase, MS, RD Use of Valerian in Small Sample of Children Experiencing Insomnia eviewed: Francis A, Dempster R. Effect of valerian, Valeriana caused a significant increase in sleep quality (valerian: P < 0.01, Redulis, on sleep difficulties in children with intellectual deficits: placebo: P = 0.04). No adverse effects were reported. randomised trial. Phytomedicine 2002;9:273-9. Overall the findings of this small study indicate that valerian has Inadequate sleep during childhood hampers a child's learning the potential to assist intellectually impaired children with sleep potential and increases behavioral problems. The most common difficulties. Future studies should look at a longer duration of sleep problems in children are difficulties initiating and maintain treatment and a larger patient population. _. ing sleep. As normal children age, the incidence of sleep problems -HeatherS. Oliff, Ph .D. decreases. However, approximately 80% of children with intellec tual deficits have sleep difficulties no matter their age, causing stress for both the child and parents. Extracts of Mexican valerian ( Valeriana edulis Nun. ex Torr. & A. Gray ssp. procera (Kunth) F. G. a joint project of ~ • • n"' • (jl Eu """ " Co-op America Mey.,Valerianaceae) are used to treat stress and induce relaxation. The goal of this small study was to examine the efficacy of valerian for alleviating sleep difficulties in children with a variety of intel doesn't being conservative mean that you lectual and neurological deficits. Five boys (aged 7-14 years) with intellectual disabilities partici should actually conserve pated in this repeated measures, randomized, double-blind, cross over study. On a scale of 1 to 10, all parents rated their child's sleep something? difficulties as a 10 in severity. Subjects received treatment or placebo for two weeks, followed by a seven-day washout period, during which sleep was still monitored. After the washout, the subject took the alternate treatment for two weeks, followed by another monitored seven-day washout period. The valerian tablets (MediHerb, PTY., LTD., Brisbane, Australia) contained 500 mg (1 00 percent) of dried and crushed whole root. Of that, the tablet contained 5.52 mg of valtrate/isovaltrate, chemical constituents of At Green Festival, you'll see real conservatives. valerian. Placebo contained 25 mg (5 percent, not pharmacologi cally significant, according to the authors) of whole root V edulis See them conserve water, energy, time, money, extract to give the same appearance and odor. Parents gave a single open land, even the constitution. nightly dose (20 mg/kg of body weight) at least one hour before Learn how to perform these astounding feats of bedtime. An eight-week diary recorded efficacy. Sleep latency conservation yourself! 50 speakers! 300 exhibits! (time to fall asleep), time spent awake during the night, and sleep quality were assessed. Uve well, do good. The children had intellectual deficits (IQ of less than 70) along november 8 & 9 with conditions such as epilepsy, hyperactivity, and attention deficit disorder. Compared to baseline, valerian treatment signifi san francisco concourse exhibition center cantly decreased sleep latency (P = .05) and nocturnal time awake greenfestlvals.com $15 at the door (P= .02), and increased total sleep time (P< .0 1), with no signif icant changes with placebo, compared to baseline. Both treatments TOYOTA PAX WORLD www.herbalg ram.org 2003 HerbaiGram 60 I 25 research reviews Reduction of Nausea and Vomiting after Hysterectomy Using Capsicum Plaster eviewed: Kim K, Koo M, )eon J, Park H, Seung I. Capsicum treatment groups (PAS applied to the K-D2 or P6 point) Rplaster at the Korean hand acupuncture point reduces postop compared with the control group (P < 0.001 for both). The two erative nausea and vomiting after abdominal hysterectomy. Anes treatment groups were not significantly different from each other. thesia and Analgesia 2002;95: 1103-7. More specifically, in the 8 hours after surgery, the incidence of Postoperative nausea and vomiting (PONY) is very common in vomiting was significantly higher (P < 0.001) in the control group women undergoing total abdominal hys terectomy: up to 90% of (46.7%) than in the K-D2 and P6 treatment groups (18.0% and these patients experience this distressing side effect. One of the 20.0%, respectively). In the 24 hours after surgery, the incidence causes of PONY is the use of opioid analges ics. When PONY of vomiting was also significantly higher (P < 0.00 1) in the control occurs, patients are typically given anti-emetic medication. group (56.7%) than in the K-D2 and P6 treatment groups (22.0% However, alternative approaches, such as acupuncture and and 26.0%, respectively) . The percentage of patients who needed acupressure, are being investigated. rescue anti-emetics in the 24 hours after surgery was also signifi One widely used Korean method of treating PONY is capsicum cantly greater (P < 0.001) in the control group (28.3%) than in the (Capsicum spp., Solonaceae [species not noted in paper]) plaster K-D2 and P6 treatment groups (14.0% and 16.0%, respectively). (PAS ; Sinsin Pharm., Korea). A sheet containing powdered The K-D2 and P6 treatment groups did not differ significantly capsicum (345.8 mg) and capsicum tincture (34.58 mg) is applied from each other regarding any of these measures or the incidence at the Korean hand acupuncture point (K-D2). The PAS tech of nausea. During both time intervals, the incidence of nausea was nique is inexpensive (20 cents per sheet) and reportedly has been significantly higher in the control group than in both treatment found to be effective for treating motion sickness. groups (P < 0.00 I). The authors conducted a randomized, double-blind, placebo In discussing their results, the authors note that the Korean hand controlled study to evaluate the effectiveness of PAS for preventing acupuncture technique is rarely used in Western medical care, yet PONY in healthy women undergoing abdominal hysterectomy. it has been used effectively in approximately two million Korean The subjects were divided into three groups. The first group (50 patients. The theory underlying this technique is that all of the women) received PAS at K-D2, the Korean hand acupuncture internal organs are represented by points on the hands and "stim point in Koryo Hand Therapy. A second group (50 women) ulating the proper points ... in the hands can control all of the received PAS at a different location, the Chinese acupuncture functions of human organs." Application of PAS, the capsicum point pericardium 6 (P6). Numerous studies have demonstrated plaster, is simple, noninvasive, and produces no discomfort. Its the anti-emetic effect of the P6 point, the authors say. The third effects last for 8 to 12 hours, thus PAS is a useful alternative to group (control group; 60 women) received inactive placebo tape at anti-emetic drugs for treating PONY, the authors write. K-D2. According to previous studies, the timing of PAS application The PAS and placebo tapes were all the same size (5 mm2). The may be important, if the P6 point is used. PAS should be applied K-D2 point is located near the fingernail of the index finger, and to P6 before induction of anesthesia so that the trigger zone in the the P6 point is located near the wrist. In all three groups, the tapes brain is reached before standard anesthesia is given. When the K were applied to both hands before administration of anesthesia and D2 point is used, the mechanism by which PAS has its anti-emetic were left in place until 8 hours after surgery. effect is not fully understood. It appears that topically applied The authors describe the protocol for anesthesia and postopera capsicum causes a blockade of transport and synthesis of substance tive analgesia in detail. In brief, all patients received intravenous P from se nsory C fibers due to the action of capsaicin, the pungent thiopental and vecuronium to induce anesthesia. To maintain principle in capsicum. This affects the conduction of impulses anesthesia, enflurane and nitrous oxide were given, with additional through certain nerves. vecuronium as needed. The patients underwent tracheal intuba The incidence of PONY in this study, 56.7% during the first 24 tion and insertion of a nasogastric tube to empty the stomach. hours, was similar to rates of PONY found in other studies. After surgery, initial doses of analgesia were given. Patients then Nausea and vomiting are frequent side effects of opioid analgesics . used a device that delivered patient-controlled analgesia (fentanyl One study found that 50% of patients experienced nausea and and ketorolac) . vomiting during opioid patient-controlled analgesia. An independent observer who was blinded to the group assign The authors conclude that PAS, applied at either the K-D2 ments evaluated the patients for vomiting and other adverse effects point or the P6 point, significantly reduced PONY and the need at 8 and 24 hours after surgery. A 3-point scale was used to rate for rescue anti-emetics in women undergoing abdominal hysterec each patient's symptoms with regard to PONY, as follows: 0 = no tomy. It is important to note that the study was double-blind and symptoms, I = nausea only, and 2 = vomiting. Patients who expe placebo-controlled, because PAS can have substantial placebo rienced both nausea and vomiting were given a rating of 2 to effects, the authors write. "In conclusion, the PAS method allied reflect their most severe symptom. A rescue anti-emetic (metoclo with either the KD-2 or the P6 point is a simple, inexpensive, and pramide) was given promptly to any patient who requested it. effective method for preventing PONY," they add. A The results showed that all three groups of women experienced -Christina Chase, MS, RD the most PONY during the 8 hours immediately following surgery. During both time intervals (the first 8 and 24 hours after surgery), the incidence of PONY was significantly reduced in both 26 I HerbaiGram 60 2003 www.herbalgram .org research reviews Kava and Valerian Reduce Stress Reaction in Clinical Trial eviewed: Cropley M, Cave Z, Ellis J, during, and after the task. placebo effect. In addition, it is possible RMiddleton RW Effect of kava and After the first testing session (time 1, or that the other two groups knew they were valerian on human physiological and Tl), each subject was randomly assigned taking the kava and/or valerian and there psychological responses to mental stress to one of three groups (n = 18/group): fore expected to feel less stressed at T2. assessed under laboratory conditions. kava, valerian, or control. For the next 7 According to the authors, the study should Phytotherapy Research 2002; 16:23-7. days, subjects took either kava (120 mg), be performed using a placebo-control Herbal preparations thought to relieve valerian (600 mg), or nothing (non design and future research should extend the mental stress of daily life have become placebo control group) daily until they this work from controlled laboratory popular in recent years. Kava (Piper returned for the second testing session conditions to real-life stressful methysticum G. Forst., Piperaceae) and (T2). The doses of kava and valerian used situations.--' valerian ( Valeriana officina/is L., Valeri were considered standard doses. -Christina Chase, MS, RD anaceae) are two herbs that have been The results showed that for all three Editor's Note: In the past two years, there traditionally used to manage psychological groups combined, blood pressure and has been increased concern about the poten symptoms such as anxiety. However, these heart rate increased during the mental tia/liver toxicity ofkava, as its use has been treatments have very limited data to show stress task and returned to baseline levels associated with reports ofserious hepatotoxi that they are clinically effective for this following completion of the task. At T1 city, especially in individuals who have had purpose. (before the seven-day treatment), there prior history of liver disease or have used Kava is extracted from the roots of a were no significant differences between hepatotoxic drugs or have used moderate to shrub that grows in the South Pacific. At groups in resting heart rate, systolic blood large amounts of alcohol or acetaminophen low doses, kava acts as a mild sedative and pressure, or diastolic blood pressure meas simultaneously with kava. Although numer anxiolytic (anxiety reducing), whereas urements. ous countries have either banned or strongly higher doses have muscle relaxant and In response to the mental stress task, curtailed kava sales (Germany, France, anticonvulsant effects. Valerian is an increases in systolic blood pressure were United Kingdom, Canada, Switzerland, herbaceous plant. Members of the genus significantly smaller at T2 than at T1 in Ireland, Australia, and Singapore) and the grow in Europe, northern Asia, and North both the kava and valerian groups (P < US. Food and Drug Administration has America. First used by the ancient Greeks 0.001 for both) but not in the control issued a public warning about its potential and Romans, valerian is now used to treat group. This moderation of systolic blood hepatotoxicity, there has been no definitive mild insomnia and anxiety. At low doses it pressure reactivity was expected in the kava proof published to date of a mechanism to appears to promote relaxation. Its actions and valerian groups. No significant effects explain this purported hepatotoxicity. Never are relatively mild and it is generally on diastolic blood press ure were found in theless, due to concerns about the potential considered extremely safe. Known side any of the groups at any time point; it was hepatotoxicity, another clinical trial effects include excitability and headache. not clear why only systolic blood pressure controlled with placebo as suggested by the Valerian and kava may reduce psycho was affected. Heart rate reactivity was authors of this study appears unlikely until logical stress via mechanisms that moder significantly reduced at T2 compared to the issue of kava's safety is more clearly ate the physiological responses to stress, T1 in the valerian group (P < 0.001) but resolved. such as blood pressure. These physiological not in the kava or control groups. For responses can be measured in the labora heart rate, there was a significant group tory while subjects complete mental tasks by-time interaction but no significant under controlled conditions. This study main effects of group or time. evaluated whether kava and/or valerian For subjective ratings of pre-task mental HerbCiip™ would moderate the psychological and pressure, the kava and valerian groups physiological reactivity to mental stress in rated pressure lower at T2 than at T1 (P < The preceding Research Reviews are yo ung, healthy volunteers. 0.001); this difference was not reported in drawn from the 2,000 critical reviews The subjects consisted of 54 students the control group. For ratings of pressure available online to members of ABC (30 women and 24 men) aged 18-30 years during the task, the results were similar. at the Academic level and above. The who completed a mental screening stress "Post hoc analysis showed that there was a full HerbClip Educational Mailing task on two occasions, one week apart. The significant reduction in pressure experi Service is distributed bimonthly and task, called the color/word interference enced during the task at T2 relative to T1 task, has been found to increase blood in the kava and valerian groups, but not in includes 12 critical reviews along pressure and heart rate in several previous the control (P < 0.001 ). Thus, following a with many of the original articles studies. Subjects were asked to make deci seven-day trial of kava and valerian, indi drawn from a variety of professional sions at an increasing pace as they matched viduals reduced their subjective ratings of and mainstream sources. To receive shades of color to color names on a pressure experienced before and during the the full service, contact Wayne Silver computer screen. Blood pressure, heart mental stress task," the authors conclude. man, PhD, at 512/926-4900 ext. rate, and subjective ratings of perceived One limitation of this study was that the 120, or via email at mental pressure (from "very little" to control group did not take a placebo, www.herbalgram.org 2003 HerbaiGram 60 I 27 plant patents Clover as Sources for HRT Alternatives, and Aloe Derivatives for Respiratory Conditions by Anthony L. Almada, MSc Many delivery forms are described, including oral, buccal (absorbed through the cheeks), topical!transdermal, injectable, Premenopausal Uses of and suppository. One study in the patent describes profiles of isoflavone metabolites in the blood and urine among women Clover-derived lsoflavones (menopausal status not described) administered in what the patent terms an acute (presumably single) dose of Promensil. The patent Patent: USA 6599536 states "22 mg of isoflavones," but incorrectly describes it as Date of issuance: 29 July 2003 containing "genistein 0.5 g, daidzein 0.5 mg, biochanin 26 g, and Assignee: Novogen Research Pry. Ltd. (Australia) formononetin 14 mg"). The presence of measurable amounts of Priority date (Australia): 26 March 1998 the isoflavones formononetin and biochanin in the blood and Therapy of estrogen-associated disorders ur~ne, . despite much higher concentrations of genistein and Background da1dzem, was deemed an unexpected finding (si nce formononetin and biochanin are presumed precursors of genistein and daidzein, With the hormone replacement therapy implosion following the one would expect conversion of the former two to be complete). results of the Women's Health Initiative study of 2002 showing the No tabular data are provided, nor are data regarding chronic dosing increased cardiovascular and cancer risk of hormone replacement described. therapy among postmenopausal women, the quest for effective and . Numerous single subject case reports are presented. They safe alternatives has intensified. Plant-derived agents purported to mclude a 38-year old premenopausal woman with uterine fibroids exhibit hormone-modifying effects have garnered robust attention with severe and irregular menstrual bleed and scrutiny, primarily for their claimed ing. Sustained use of a soy supplement use in peri- and postmenopausal-associ delivering about 45 mg of both genistein ated endocrine alterations. Much less and daidzein daily for six months appeared attention has been directed to their use in to provide no symptomatic relief. Within premenopausal women. In this patent, three months of starting treatment with Novogen, marketers of PromensiJ®, a red Promensil, her menstruation normalized clover extract-based dietary supplement, while an ultrasound exam confirmed that obtained claims related to the use of an her fibroids had shrunk. Other single case isoflavone-containing composltlon reports include premenopausal women with comprised of a minimum of "about 65% endometriosis, ovarian cysts, dysmenor biochanin and at least one other rhea, endometrial hyperplasia, cystic acne, isoflavone selected from formononetin, and cyclical breast pain (mastalgia). All daidzein and genistein, at a ratio from reported substantial improvement and reso about 2:1 to 5: 1." The claimed uses lution of symptoms/condition upon treat described in the patent of the composi ment with Promensil. tion are for treatment or amelioration of "pre-menopausal, benign disorders associ Notes ated with an abnormally high activity of This latest patent adds to the dozens of steroidal estrogen. These include uterine isoflavone-based patents assigned to Novo fibroids, polycystic ovarian disease, ovar- . 1 1 Red clover Trifolium pratense gen. Although the uses of the preparation Ian cysts, eye ica acne, mastalgia, Photo© stevenfoste r. com 2003 center upon "abnormally high activity" of endometriosis and endometrial hyperpla- sia. , estrogen, no data are provided indicating such an endocrine state occurred in any of the patent's clinical The patent cites specific "clovers (Trifolium spp.)" and "chick examples. It is salient to mention that Promensil, the commercial peas" ( Cicer arietinum L., Fabaceae) as sources of isoflavones: red ized invention described in the current patent, was very recently clover ( T pratense L., Fabaceae), subterranean clover ( T subter shown to be no different than placebo after 12 weeks of use in a ranean L.) , white clover (T repens L.) , "or any clover related randomized controlled trial among postmenopausal women with a species, or chick pea variety. " The patent describes the preferred high frequency of menopausal symptoms.2 This multi-center clover to be T. pratense or T subterranean. In published research study, the largest to date with red clover extracts, was sponsored by sponsored by Novogen, the biomass for its Promensil product is T. Novogen and was published in the journal ofthe American Medical pratense. 1 The methods described to produce the claimed extract Association in July 2003. In contrast, in a study not described in the employ the use of a water/water-miscible organic solvent extract of patent but publish ~d in 2002,1 18 women with menstrual cycle clover generally in the range of 1: 10 to 10: 1. Optionally, the inclu associate~ breast pam (cyclical mastalgia) received either placebo or sion of an enzyme is described, which cleaves isoflavone glycosides Promenst! at 40 or 80 mg/day, for three menstrual cycles (this to release the aglycone (carbohydrate-free and thus preferentially study was designed and funded by Novogen). T he 40 mg/day absorbable) form. group was found to show a statistically signifi cant decrease in 28 I HerbaiGram 60 2003 www.herbalgram.org plant patents breast pain. The very small sample size of this trial, in a population studies performed in dogs with radioactively labeled acemannan germane to the current patent, does require confirmation in a was used to assert that the concentrations that can be achieved in larger population. Moreover, all of the cited examples in the patent vivo, after oral dosing, are similar to those used in vitro. are testimonials (referred to as "improvements" in the patent) with The examples offered in the patent pertaining to the claimed limited objective confirmation of efficacy. The discouraging but invention were three individual case reports: 1) a professional common practice of patenting inventions that lack credible and painter (age undisclosed), with debilitating wheezing and bronchi compelling scientific data to support the claimed activity or bene tis induced by fit, even preclinical (animal) data, only undermines the value of vapors from his patents. It would appear that the true economic value of this paints and patent would manifest when more rigorous, systematic assessments solvents experi determine the clinical utility and verity of its claims. _. enced dramatic and sustained Aloe Carbohydrate Fractions symptomatic relief after taking Breathe Relief into Respiratory 800 mg/day Diseases acemannan orally for five Patent: EU 0965346: days and contin Date of issuance: 23 July 2003 ually thereafter; Assignee: Carrington Laboratories, Inc. 2) a 76-year-old Priority date (Europe): 5 November 1991 male, with a 72- Use of acetylated mannan derivatives for treating chronic respira year history of tory diseases asthma was taking 800 mg Aloe Aloe barbadensis Photo © 2003 stevenfoster.com Background acemannan daily Derivatives of aloe (Aloe barbadensis Miller, Aloaceae), arguably for an unrelated condition. He is without wheezing symptoms and are most frequently associated with skin care and topical use. The chronic bronchitis; and 3) a female coed with a 6-month history of work of Carrington Laboratories in characterizing a carbohydrate cystic fibrosis "reported an abrupt return of energy within 2 weeks fraction of the mucilaginous (gel) fraction of aloe as an acetylated of instituting oral acemannan therapy at a dose of 800 mg/day." mannan ("acemannan") has fostered a variety of immunological investigations. Acemannan is a carbohydrate polymer comprised Notes primarily of mannose, with specific regions "acetylated" (linked to As in the aforementioned patent, although it is very common an acetyl group) and other regions occasionally linked to the sugar place to encounter granted patents that lack systematic "proof of galactose. The brevity of its claims marks the present invention: " 1. concept" data, this one is , nevertheless, disappointing. The bulk of The use of an acetylated mannan in the manufacture of a medica the patent is dedicated to what this author believes to be biologi ment for reducing symptoms associated with chronic respiratory cal data of little or no relevance to the claims of the invention. An diseases" and "2. The use according to claim 1, wherein said acety animal model of asthma (an inflammatory disease) or cystic fibro lated mannan is acemannan." These rwo claims essentially describe sis (a genetic disease that predisposes individuals to respiratory a new use of an already existing patented composition, acemannan, infections) and the influence of acemannan would have been a known as Carrisyn®, a product marketed by Carrington Laborato powerful complement to the patent and its commercial value. It is nes. noteworthy to mention that the patent did not state aerosol inhala Carrisyn is a highly purified ethyl alcohol extract of the inner gel tion or intranasal applications as means of delivery of acemannan, of the leaves of aloe, comprised of no less than 73% acemannan by the closest description being "parenteral" (injected via another weight. Its production is the subject of U.S. Patent 4,735,935, route). As in the previous patent on the red clover extract, the util assigned to Carrington Laboratories. The clinical scope of the ity and merits of this patent await clinical validation._. patent focuses upon reducing the symptoms of four chronic respi ratory conditions: asthma, conjunctivitis, rhinitis, and bronchitis. References: It is unclear as to why "conjunctivitis" (a. k.a. "pink eye") is classi I. Ingram DM, Hickling C, West L, Mahe LJ , Dunbar PM. A double fied as a "chronic respiratory disease." blind randomized controlled trial of iso fl avones in the treatment of Much of the patent describes the immunostimulatory/biological cycl ical mastalgia. The Breast 2002; II : 170-4. 2. Tice JA, Ettinger B, Ensrud K, Wallace R, Blackwell T, Cummings response modifying activity of Carrisyn within in vitro experi SR. Phyroestrogen supplements for the treatment of hot fl ashes: The ments. One in vitro experiment with human white blood cells lsoflavone Clover Extract (ICE) study. JAMA 2003;290:207-1 4. incubated with acemannan showed a marked stimulation, as evidenced by substantial increases in the release of a cytokine (i nterleukin-1 ) and a prostaglandin (PGE2). The magnitude of Correction release was comparable to or exceeded that of a similar concentra In this column published in Herba!Gram 59, in the article enti tion of lipopolysaccharide, a bacterial derivative classically used to tled "BetulinicAcid Derivatives for Skin Melanoma" on page 25, provoke an immune response. Another experiment injected the Priority Date country should be USA, not Japan. We apolo acemannan into mice and then measured the capacity of their gize for any confusion that may have resulted from this error. immune cells to engulf foreign particles in vitro. A reference to www.herbalgram.org 2003 HerbaiGram 60 I 29 apturing images of the plant kingdom is now meant that the books wouldn't last as long. By 1880, easy as the click of a digital camera. In the l paper used in books was much like cheap newsprint, and and 19th centuries, however, it required time has yellowed their pages, faded the illustrations, and and pen, or perhaps watercolors. Artists made them fragile to the touch. plant enthusiasts would visit greenhouses Curiously, some of the older books are in the best trompC out into a plants native habitat and draw from condition. From the mid-l700s to the early-l800s, paper live specimen. was made from rag linen, which has less acid and lignins Now, cameras have replaced pens and pencils, than paper made from wood pulp, making it more webpages and glossy field guides have taken over durable. large, hardbound volumes. But that does not mean The Missouri Botanical Garden (MBG) library is work- the old ways are not still appreciated. ing to preserve these rare books Botanical books and illustra and make them available to tions were created for educa people worldwide. Having the tion and training purposes, as volumes in digital form they contained information on decreases the damage caused by newly discovered and rare handling the books: stresses on plants as well as common binding and oils from skin on plants. However, because the the pages and prints. cost of these books was very Some books in the MBG high when they were created, collection are being restored as libraries were rare and a status well as digitized. Loose pages symbol. Also, they had an and broken bindings are being exotic air to them, as most of repaired by a restoration labo the plants and places discussed ratory at the garden itself. If a in them were from parts of the book needs extensive work, world that were difficult, if not however, it is sent to a private impossible, to travel to. bookbinder in St. Louis. In some ways, the roles of these classic botanical texts "Repairs" done to the digital versions of the books were have not changed. Much can be learned from minimal. The MBG wanted to treat the scanned images as books, but now it is the history of botany and t"vrmonmv l artifacts themselves, so the damage to the original was not that they help impart, not new discoveries. Ownership ignored. Minor changes to colors and tone balance were the books is once again restricted, limited to collectors the only alterations made to the digital images. and institutions, those who have the resources to find , buy, and preserve books that are often damaged over Once the scanned images have been touched up, they time. are "burned" onto a CD-ROM disk. Copies of the files are uploaded onto the MBG website In the mid-19th century, book and newspaper publish Anacardiaceae (Mang ifereae ) Illustration of ANACARDIUM occidentale L. 51 (Anacardium occidentale L., cashew); From: Kohler~ Medizinal-Pflanzen in naturgetreuen Abbildungen mit kurz erlautemdem Texte : Atlas zur Pharmacopoea germanica (1887), by Franz Eugen Kohler, Volume 3 of 3. © 1995-2003 Missouri Botanical Garden http://ridgwaydb.mobot.org/mobotlrarebooks/ 32 I HerbaiGram 60 2003 www.herbalgram .org • ABOVE: Illustration of MATRICARIA Chamomilla L 64 (Matricaria chamomilla L , German chamomile); From: Kohler~ Medizinal Pflanzen in naturgetreuen Abbildungen mit kurz erlauterndem Texte : Atlas zur Phar macopoea germanica (1887), by Franz Eugen Kohler, Volume 1 of 3. © 1995-2003 Missouri Botanical Garden http://ridgwaydb.mobot.org/mobot/ rare books/ BELOW: Illustration of CERBERA Tanghin Hook fil. 57 (Cerbera venenifera (Poir.) Steud); From: Kohler~ Medizinal-Pflanzen in naturgetreuen Abbildungen mit kurz erlauterndem Texte : Atlas zur Pharma copoea germanica (1887), by Franz Eugen Kohler Volume 3 of 3. © 1995-2003 Missouri Botanical Garden http://ridgwaydb.mobot.org/mobot/ rare books/ Kilrimit Ginn Ji lt l When the digitalization program was started in 1996 as an in-house project at the MBG, digital images were created by scanning normal photographs of the pages. Later, outside funding made it possible to use better equip ment, large digital cameras and light platforms. A special cradle was also built for the project, designed to hold books open for scanning without damaging the spine. The project was funded by a $200,000 grant of the Andrew W Mellon Foundation, an organization based in New York City that creates grants for the areas of higher education, performing arts, populations, public affairs, environmental conservation, and museums and art conser vation. The Mellon grant for the project was shared with other gardens and organizations that are participating in scan ning programs, including the New York Botanical Garden in the Bronx, New York; the Royal Botanical Gardens at Kew; and the British National History Museum, both located in England. "The foundation saw this program as one that would make these resources available to people who would other wise never get a chance to see them, or even know about them," said Bill Robertson, a program officer at the Mellon foundation. C~ e ro Tagbil Boot fil. .herbalgram.org 2003 Herbai Gram 60 I 33 1 The two-year grant was awarded in 2000; however, "These books are usually kept in the rare collection area, members of the foundation were so pleased with the qual under lock and key If you wanted to look at them, you'd ity of work done at MBG that the grant was renewed in have to make an appointment and be here in person. So 2002 with the same amount as the first grant. the average person with an interest probably wouldn't be "When we first got funding from the Mellon Foundation, able to come here to look at the books. Now, however, we worked on books related to the interests of Mrs. anyone on the Internet can take a look at our books. The Mellon. She loved French illustrations and pages have been downloaded for use in books, ones that were art, history, botany and phar printed in France, and macy courses as well as by whose authors and illus people who just have an inter trators were French," said est," said Chris Freeland, web Linda Oestry, research developer for the project at librarian at MBG. MBG. "With our new round David Winston, an herbalist of funding we're actually and president of Herbalist & scanning a few books that Alchemist, Inc., based in Wash don't have illustrations. ington, New Jersey, believes that These books are the old texts are important to the frequently used by taxon understanding of the historic omists though, so we feel and artistic aspects of botany, they should be included and understanding herbal medi in the project," Oestry cines, especially information said. that has fallen out of use. The information is examined in a So far, 40 books have process called "bioprospecting" been digitized as part of the program, with more "We look though old herbals, than 12,000 pages and see what different plants were over 1,800 illustrations being used for, and then see if scanned and archived. By they are still good for that the project's end, sched purpose," Winston said. "Along uled for the fall of 2004, with Bibles, these were some of the MBG hopes to have the earliest books printed and around 20,000 pages in they are incredible storehouses its database. of knowledge. Some medicinal uses are fictitious, some are folk Work is being done to lore. But there are also things create a linked database Illustration of A. und 1-4 CERBERA lactaria Ham. that make a lot of sense." for the institutions 5-9 CERBERA Odollam Gaertn. 55 (Cerbera odol funded by Mellon, with Winston has his own private lam Gaertn.); From: Kohler's Medizinal-Pjlanzen in the intent that by work collection of herbal texts. naturgetreuen Abbildungen mit kurz erlautemdem ing together they can However, his is a working make the most efficient Texte: Atlas zur Pharmacopoea germariica (1887), by library and contains volumes use of time and resources Franz Eugen Kohler Volume 3 of 3. that he utilizes and reads. He for the digitization ©1995-2003 Missouri Botanical Garden appreciates the books as works program. http://ridgwaydb.mobot.org/mobot/rarebooks/ of art and hopes the digitization project will mean a new interest "We're working with in the old texts. other gardens because we want to have as many pieces as possible. By collaborating, we're making sure there's no "The project is just amazing," he said. "It's creating egal overlap in our work and that what we do is in the best itarian access to these works. Usually they would just be condition possible. We all want the same thing after all, to on a rich collector's bookshelf or locked up in a rare book get the information out where people can see it ," said room in a library. Most of them have been literally unob Connie Wolf, MS'G librarian. tainable for ordinary people, but now anyone can look, anyone can learn. "We want as many people as possible to have access to these images and text. The most important thing about the "They are now living things, not old dusty things in cabi project is the access it affords; people can see and repro nets or cases. They're back in society where they duce the images easily This makes them more useful to belong."--"' educators and regular people," she added. 34 I HerbaiGram 60 2003 www.herbalgram .org Palmae (Cocoi neae) [email protected] guine ens is L. 77 Illustration ofELAEIS guineensis L. 77 (E laeis guineensis]acq. , African oil palm); From: Kohler's Mediz inal-Pflanzen in naturgetreuen Abbildungen mit kurz erlautemdem Texte : Atlas zur Pharmacopoea germanica (1887), by Franz Eugen Kohler, Volume 3 of 3. © 1995-2003 Missouri Botanical Garden http://ridgwaydb .mo bot. org/mo bo tlrareboo ks/ 2003 HerbaiGram 60 I 35 • Digital Technology Preserves Texts, and Makes Them WidelY Available ready, 40 historic herbal texts have been digi ab anno 1800 ad annum 1809 per sex fascicu los edita I ized by the Missouri Botanical Garden opera et sumptibus Nicolai j osephi Jacquin. by Freiherr MBG), preserving more than I2,000 pages von Jacquin Nikolaus Joseph. Vienna; I809. Single and over I,800 illustrations. By the end of the current volume. grant project in 2004, some 20,000 pages are expected Gramineae Chilenses. by Emile Desvaux. Paris; I853. to be captured and archived in its online database. Single volume. Here is a list of some of the remarkable books that are Hesperides, sive, De malorum aureorum cultura et usu being preserved for the future by the MBG. libri quatuor. by Giovanni Battista Ferrari. Rome; A Description of the Genus Cinchona. by Aylmer I646. Single volume. Bourke Lambert. London; I797. leones pictae plantarum rariorum descriptionibus et A Supplement to Medical Botany, or, Part the Second: observationibus. Fasc. I-3. by James Edward Smith. Containing plates with descriptions ofmost ofthe princi London; 1790-93. Single volume. pal medicinal plants not leones selectae plantarum included in the materia quas in systemate univer medica of the collegiate sali: ex herbariis parisien- pharmacopoeias of sibus, praesertim ex Lesser London and Edinburgh: •• tiano I descripsit Aug. Pyr. accompanied with a de Candolle, ex archetypis circumstantial detail of speciminibus a P.]. F. their medicinal effects, Turpin delineatae et editae and of the diseases in a Benj. De Lessert . . . by which they have been Benjamin Delessert. successfully employed. by Paris; I 820-46. Five William Woodvi lle. volumes. London; I794. Volume 4 !conograp hie descrip tive of 4. des cactees. by Charles Ajbeeldingen van zeldza Antoine Lemaire. Paris; ame gewassen. by Nico I84 I-47. Single volume. laas Meerburgh. Leiden; Exceptionally rare, only I775. Si ngle volume. II copies on record. Features 50 hand-colored Kohler's Medizinai plates with an attendant Pflanzen in naturgetreuen butterfly drawn and Abbildungen mit kurz engraved by Meerburgh. erliiuterndem Tex te : Atlas Cornus: specimen botan zur Pharmacopoea icum sistens descriptiones germanica. by Fra nz et icones specierum corni Eugen Kohler. Gera minus cognitarum. by Untermhaus; I 887. Charles Louis L'Heritier Three volumes. Almost de Brurelle. Paris; I788 . . 300 chromolythographic Single volume. Illustration of Centaurea Benedicta 42 (Cnicus prints. Description des plantes benedi ctus L. , Blessed thistle) From: Medical La jlore et La pomone rares cultivees a Malmai botany : containing systematic and general descrip franraises: histoire et figure son eta Navarre. by Ai me tions, with plates, of all the medi cinal plants, indige en couleur, des jleurs et des Bonpland. I?aris; I 8I3. nous and exotic, comprehended in the catalogues of fruits de France ou natu Single volume. the materia medica, as published by the Royal ralists sur le sol franrais. by Flora Atlantica, szve Co lleges of Physicians of London and Edinburgh : Jean Henri Jaume Saint Historia plantarum quae accompanied with a circumstantial detail of their Hilaire. Paris; I 828-33. in At/ante, Agro Tunetano medicinal effects, and of the di seases in which they Six Volumes. et Algeriensi Otescunt. by have been most successfully employed (1794) by Le Jardin du Roy tres Renata L. Desfontaines. William Woodville, Volume l of 4. © 1995-2003 chrestien, Loys XII!, Roy de Paris; I798. Two Missouri Botanical Garden France et de Navare .... by volumes. http://ridgwaydb.mobot. org/mobotlrarebooks/ Pierre Vallet. Paris; I623. Fragmenta botanica, Si ngle volume. figuris coloratis illustrata : Medical botany: containing 36 I HerbaiGram 60 2003 www.herbalgram.org r ) \ systematic andgeneral descriptiom, with p!dtes, ofall the medic I ( 29 y inal p!dnts, indigenous and exotic, comprehended in the cata logues ofthe materia medica, as published by the Royal Colleges _HYPERICUM PEIU'ORATUM. . PEIU'ORATED St. JOHN'o WORT. ofP hysiciam ofL ondon and Edinburgh : accompanied with a circumstantial detail of their medicinal effects, and of the srNo NrM..t. Hnaucu .., PINtntr. L.IUL. Hn•ucu .. diseases in which they have been most successfUlly employed. by caule terete, alaro, nmof.Jlin>o; foliia -onti& pet{oruio. Bill..Slirp. R~. o. 1~3;.. Hruucva 'hllgare five pedorata, eaule rotundo, William Woodville. London; 1790-93. Volumes 1-3 of 4. foliia gliobna. Y. Bm.hia IlL 382. Hnu.Jcu>c 'hllgan, &•b· Neueste und wichtigste Medizinalpjlanzen in naturgetreuen for· •79- R4ii Spoj. 342. • Abbildungen mit Kurzem erk!drenden. by Franz Eugen C/J¥i Polyadelphi ~> Ortl. Polpndria. L. C... flat. go>. JiT. C••· Cb. CJ. s -phylluL Pdal.z S•· Ntll o. Cll/'fok .diJ • Kohler. Gera, Germany; 1898. Single volume. Hortu K~ • • .. , P!dntarum historia succulentarum = Histoire des p!dntes II= Cb. H. Florlbw trigyuiJ, caule ancipiti, foL obtuf11 peUucido grasses I par A.P deCandolle; avec leurs figures en couleurs, punaatio. dessinees par P]. Redoute. by Augustin Pyramus de THIS lj>ecieo of the Hypericum uall & foot and a half. the root is ~- nial~ li Y grow~ ~ the heigh! of Cando Li e. Paris; 1799-183 7. Three volumes. • idcd · 'lin r -- • gneou&, divided and fubdi liark 0 ·~to n":i:/ al l brunches, and covered with. ftraw-coloured P!dntarum selectarum icones pictae. by Nicolaas Meerburgh. top f~nd :If manue round, f~ of a light colour, and.towarda the but foodlalh ~ oppoliplacedte. Bo~~wthbnncbeo ; . the leaveo are with. Leiden; 1798. Single volume. 28 colored plates drawn and with a t ' ~ p&Jn ' . q are e.nnre, oval, and bcCet the llJU numbtr of IIWlute traitlparent veficleo 1 hicb ba engraved by Meerburgh. the {~ce of!:;.J I pedoratiom through the due,"'and h..;: . r-une name, ...... ,. .orarum The Bowen are nume~ ...... _1 • Recueil de p!dntes coloriees, pour servir a !'intelligence des yellow colour and ~ · '· penta,_..ous, tenrunal, of a deep ' o --n ID a corym.bw, or in cluften_ upon ihort lettres elementaires sur La botanique. by Jean-Jacques ~ I Felia aUm btaumeric bta _ Rousseau. Paris; 1789. Single volume. llill ip(a foli. (ak objeaa i n(pic~~:t' -~ . mi•utit, lll YH•tD~ ~-J.c~w: bn!a ~nd tDconcaia an ~~~t::~~iz.: ~ Revisio generum p!dntarum vascu!drium omnium atque v... Aad. &.... • 76>~ .~diu it •JIII'O'd>n """" todle,... . ~"tZ: No. •· H cellu!drium multarum secundum leges nomenc!dturae inter peduncleo ; nationales cum enumeratione p!dntarum exoticarum in itinere mundi collectarum . . . . by On o Kuntze. Lei pzig, Text From: Medical botany : co ntaining system Germany; 1891-98. Volumes 1 and 2 of 3. atic and general descriptions, with plates, of all Traite des arbres forestiers : ou histoire et description des arbre the medicinal plants, indigenous and exotic, indigenes ou naturalists .. . . by Jean-Henri Jaume Saint comprehended in the catalogues of the materia Hilai re. Paris; 1824. Single volume. medica, as published by the Royal Co lleges of Physicians of London and Edinburgh : accompa Traite des arbrisseaux et des arbustes cultives en France et en pleine. by Jean-Henri Jaume Saint-Hilaire. Paris; 1825. nied with a circumstantial detail of their medicinal Single volume. A effects, and of the diseases in which they have been most successfully employed I by William Woodville. Volume l of 4. © 1995-2003 Missouri Botanical Garden http://ridgwaydb.mobot. org/mobot/rarebooksl Classic Herbal Resources Scanered around the Internet "\V,Thile the Mellon Foundation grant has allowed wo rld, includes the accumulated li braries of al l the W the Missouri Botanical Gardens to undertake Eclectic medical schools, shipped to the Eclectic a unique effort that taps the resources . of its library Medical College as, one by one, they died, until even and its partners' collections, other institutions have that "Mother School" died in 1939. Moore writes, also posted a wealth of classic botanical information these are the writings of a discipline of medicine that online. Here is a very small sample: survived for a century, was famous (or infamous) fo r .herbalgram .org 2003 HerbaiGram 60 I 37 Studying Markets to Identify Medicinal Species for Domestication The Case of Annickia chlorantha in Cameroon by Charly Facheux, Ebenezar Asaah, Marie-Laure Ngo Mpeck, Zac Tchoundjeu, PhD I \I r- This collage, in the shape of Cameroon, includes images of the Cameroon landscape (Photos ©2003 E. Asaah) and (bottom) Adamou, one the many medicinal plant traders in Yaounde. Photo ©2003 C. Facheux n the past, African governments largely ignored to the downward trend of the economy shortly after the the importance of traditional medicine, opting creation of the institute, and activities halted until this instead for Westernized medical systems. past year when NIMP reactivated. Nevertheless, the However, diminishing revenues as a result of popularity of traditional medicine is increasing in structural adjustment programs and cuts in Cameroon thanks to several key factors. The cost of international aid have forced many governments conventional medicine is beyond the reach of many to reconsider the advantages of local health care systems. Africans and is sometimes unavailable. The ratio of In recent years, many health-oriented ministries university- trained doctors to patients in African coun throughout Africa have begun to encourage the use of tries is extremely low. Traditional medicine to treat local medicinal plants, and have established depart health problems, on the other hand, is available in ments of traditional pharmacopeia to implement this almost every village, through either traditional medical policy. In Cameroon, for example, in the mid-1980s the practitioners or knowledgeable elders. government created the National Institute of Medicinal Besides their use in traditional medicine, medicinal Plants (NIMP) to research traditional medicine and plants are precious resources for the pharmaceutical, medicinal plants. Unfortunately, little was achieved due 38 I HerbaiGram 60 2003 www.herbalgram.org food, and cosmetic industries. It is estimated that about tion program for several indigenous species. Tree 25% of medication produced and marketed in the world domestication is a complex process. Domesticating is derived from plants. 1 In 1980, the WHO estimated this agroforestry trees involves "accelerated and human world trade to be induced evolu US$500 million; this tion to bring amount is increasing Traditional medicine to treat species into wider every year. 2 The health problems is available in almost cultivation demand by most through a people in Cameroon every village, through either farmer-driven or for medicinal plants, market-led as for the rest of traditional medical practitioners or process. This is a Africa, has largely science-based been met by indis- knowledgeable elders. and iterative criminate harvesting procedure involv I of wild-growing plants, including those in the forest, 3 ing the identification, production, management, and resulting in stocks diminishing at an alarming rate. As adoption of high quality germplasm."6 In 1994, priority f demand for medicinal plants rises, harvest rates also fruit tree species were selected in the humid lowlands of increase. The situation is further aggravated through a West and Central Africa for domestication by ICRAF combination of factors including inappropriate agricul and partners through implementation of farmer prefer ~r tural systems such as slash-and-burn, commercial ence surveys and priority setting guidelines.? In logging, firewood collection, and accelerated urbaniza Cameroon, two commercially important medicinal I tion and industrialization. Documentation of medicinal use of Figure 1: Study sites African plants, propagation, system atic conservation through cultivation, Medicinal Plants Survey, Cameroon: Main Areas Visited and the development of appropriate processing technologies and market ing strategies are becoming increas ingly urgent because of the rapid loss of the natural habitat for some species. Cameroon boasts of 14,000 plant species, some of which are 6. M•lnm.dlcNipW.nt..,.rkl11 endemic to the country. An example is .-ltft!Kl • SorM Mllin IO¥>-ni Ancistrocladus korupensis D.W. fV Some Mloln road1 /V UnneroontUotlonalfrontlott Thomas & Gereau, Ancistrocladaceae; I extracts of the leaves contain signifi cant quantities of dimeric naph thylisoquinoline alkaloid, michel lamine B, isolated as the active agent.4 I Michellamine B exhibits in vitro activ t ity against both HIV-1 and HIV-2 in advanced pre-clinical tests. 5 Undoubt I edly, Cameroon's medicinal plants (Table 1) and the drugs derived from them constitute great economic and t strategic value not only for the coun ' try, but for the entire African conti I nent. However, scientific research efforts aimed at cultivat species- pygeum (Prunus africana (Hook f. ) Kalkrnan, ing and conserving this species appear to be in their Rosaceae) and yohimbe (Pausinystalia johimbe (K. infancy. In recent years, the World Agroforestry Centre, Schum.) Pierre ex Beille, Rubiaceae) -were added to formerly known as the International Centre for Research the priority list because of opportunities for farmer in Agroforestry (ICRAF), has initiated a tree domestica- income, fears about the future of the resource for indus- www.herbalgram.org 2003 HerbaiGram 60 I 39 try, and the perceived needs for conser vation of the species and their habi tats.8 A major bottleneck in the domesti cation of agroforestry species is the unavailability of good quality planting seeds/seedlings of highly valued local fruit and medicinal plants. Conserva tion through cultivation of these species will ensure: • continued existence of the species and their products in sufficient quantities for posterity; improved health care through easy access to medicinal plants prod ucts in rural and urban communi ties; and provision of valuable alternative income-generating opportunities from sales of medicinal products to collectors, herbalists, traditional practitioners, and industrialists. Marketing research on medicinal plants in Cameroon Since very little information is avail able about the complex operation of the traditional medicinal market in Central Africa (we only have some studies on pygeum9), In 2000, ICRAF initiated market research into medici nal plants used and sold for phytomed icines. This research involves under standing marketing operations, volumes sold in the markets, and further identification of potential agroforestry trees that could be both medically and financially valuable to farmers in the sub-region. The aim of this study was: • to prioritize the medicinal species used in the urban traditional healthcare system in Cameroon; determine market potential of the species; and Annickia chlorantha Photo ©2003 AB Cunningham/ Ethnoecology Services. www.herbalgram.org • develop domestication guidelines for the Table 1. Major medicinal plants commonly used "top" priority species. in Cameroon Aframomum spp., Zingiberaceae Methodology Allanblackia floribunda Oliv., Clusiaceae alt. Guttiferaceae Market research on medicinal plants in the Alstonia boonei De Wild., Apocynaceae Central African sub-region commenced in Ancistrocladus korupensis D.W. Thomas & Gereau, Ancistrocladaceae Cameroon. The study was carried out in the Annickia chlorantha (Oliv.) Setten & Maas,Annonaceae humid lowland and the humid highland savan Anonidium mannii (Oliv.) Engl. & Diels, Annonaceae nah, where the vegetation consists of tropical Baillonella toxisperma Pierre, Sapotaceae lowland rainforest and grassland (Figure 1). Bryophyllum pinnatum (Lam.) Oken, Crassulaceae Rapid reconnaissance surveys (RRS) are Canarium schweinfurthii Engl., Burseraceae generally known to give an overall view of Carica papaya L., Caricaceae market sectors.10 This tool was used to conduct a Ceiba pentandra (L.) Gaertn., Malvaceae, also in Bombacaceae I preliminary urban medicinal plant market Cola acuminata (P. Beauv.) Schott & Endl., Malvaceae, also in survey in Cameroon. The Sterculiaceae J aim of the survey was to get Costus afer Ker Gawl., Costaceae also in Zingiberaceae acquainted with the study Curcuma longa L., Zingiberaceae area, select key medicinal Elaeis guineensis Jacq., Arecaceae alt. Palmae plant products sold in the Eremomastax speciosa (Hocst.) Cufod., Acanthaceae /I market, select markets and Garcinia kola Heckel, Clusiaceae alt. Guttiferceae villages, and confer with Garcinia mannii Oliv., Guttiferaceae alt. Guttiferceae traditional medicinal heal I Guibourtia tessmanii, (Harms)}. Leonard, Caesalpiniaceae ers, medicinal plant traders --l and key informants from Kigelia africana (Lam.) Benth., Bignoniaceae various sectors (Ministry of Mangifera indica L., Anacardiaceae -f Health, pharmacists, Milicia excelsa (Welw.) C. C. Berg, Moraceae herbalists, non-government Nauclea diderrichii (De Wild.) Merr., Rubiaceae also in j organizations, etc.). Naucleaceae Newbouldia laevis (P. Beauv.) Seem. ex Bureau, Bignoniaceae Based on the results of ,I Yohimbe tree Pausinystalia johimbe (K. Schum.) Pierre ex Beille, Rubiaceae the RRS, an in-depth Pausinystaliajohimbe. Physostigma venenosum Balf., Fabaceae market survey was designed Photo ©2003 ML I Piper guineense Schumach. & Thonn., Piperaceae drawing upon some Ngo Mpeck Prunus africana (Hook. f.) Kalkman, Rosaceae I methodologies used by Mander'' to better understand quantities Pterocarpus soyauxii Tau b., Fabaceae alt. Leguminosae, also in Papilionaceae collected and/or consumed, volumes, prices, Rauvolfia vomitoria Afzel., Apocynaceae marketing channels, product forms, packaging methods, and consumer preferences. A two Ricinodendron heudelotii (Balli.) Heckel, Euphorbiaceae prong approach was adopted to select species on Senna alata (L.) Roxb., Fabaceae, alt Legurninosae, also in which research has focused: Caesalpiniaceae Spilanthes filicaulis (Schymach. & Thonn.) Adams, Compositae an ailment-led approach through the selec Strophantus gratus (Wallich & Hook.) Baillon, Apocynaceae tion of species capable of treating or reme Terminalia ivorensis A. Chev., Combretaceae dying diseases ranked "top" by the ministry Tetrapleura tetraptera (Schumach.) Taub., Fabaceae alt. Leguminosae, of public health as cause of morbidity based also in Mimosaceae on hospital records; Voacanga africana Stapf, Apocynaceae a market-driven approach that seeks to Zanthoxylum gillettii (De Wild.) Waterm., Rutaceae identify species that provide substantial Source: Laird S. Medicinal plants ofLimbe Botanic Garden. Camaroon: Limbe Botanic economic gains from their sales. Garden; 1996. Data were gathered using the following tools: Mabberley DJ. The Plant-Book. Cambridge, UK: Cambridge University Press; 1997. U.S. Department of Agricultu~e, Agricultural Researcb Service GRIN Taxonomy database. • market visits and semi-structured inter Available at: www.herbalgram.org 2003 HerbaiGram 60 I 41 identification by a botanist of species sold in those In each market, traders were selected depending upon markets; their experience in the trade of medicinal plants (at least • at least one year's bimonthly market price and five years), the number of medicinal plant species sold, quantity data collection; and their willingness to collaborate in the study. In each semi-structured interviews with other key inform of the six markets, at least 40% of the herbal medicine ants: medicinal plant pharmacists, naturalists, heal traders participated in the survey. Questionnaires were ers, traditional medicine laboratories, and decision designed to capture quantitative and qualitative infor makers in the Ministry of Health. mation from key informants about the supply of and demand for medicinal plants. Questions were targeted to Markets were selected using the following criteria: gather information on frequency of sale, quantities and • geographic localization; prices of products sold, parts sold, origin, processing, • number of medicinal plant traders; and storage methods. Medicinal plant consumers were • number of medicinal plant species sold; and also interviewed, mainly when buying medicinal prod • market accessibility. ucts, to determine the use of the products, their prefer ence, and product quality. Hence, six markets in four provinces of Cameroon were finally selected for in-depth field investigations: Keyfmdings • Mokolo and Mvog-Mbi markets in Yaounde, Centre province; The RRS method - flexible, rapid, and suitable for • New-Bell and Ndog-koti markets in Douala, quick observations - gave an overview of main plant Littoral province; species used in the traditional medicinal sector in • Bamenda market in North-West province; and Cameroon. African whitewood (Annickia chlorantha • Bafoussam central market in West province. (Oliv.) Setten & Maas, Annonaceae; syn. Enantia chlo- Table 2. Commonly used medical plants sold in urban markets in Cameroon Name Part used Uses Quantity (tons) Markets Annickia chlorantha ( Oliv.) Bark Yellow fever, malaria, Mo, MM, NB, Setten & Maas, Annonaceae Nd,Ba, Bf djave (Baillonella toxisperma Bark Iyphoid Mo,MM,NB, Pierre, Sapotaceae) Nd, Ba,Bf Zanthoxylum gillettii (De Wrld.J Palpitations, defective 2.8 • Mo, Nd, Ba, Bf Waterm., Rutaceae lactation and male sexual impotence yohimbe (Pausinystalia johimbe Aphrodisiac, anti-hypnotic 1.8 MM, Bf, Nd, NB (K. Schum.) Pierre ex Beille, Rubiaceae) pygeum (Prunus africana Bark ~ostate , malaria 1.4 NB, Ba, Bf, Nd (Hook f.) Kalkman, Rosaceae) turmeric (Curcuma longa L., Roots Constipation 1.4 Mo, Ba,Bf Zingiberaceae) Sarcocephalus kltifolius (Sm.) Bad<. Jaundice 1.2 Mo,Ba, Bf Bruce, Rubiaceae; syn. Naudea latifolia Sm. Picralima nitida Theil. & H. Fruit 0.42 MM, Mo Durand, Apocynaceae Nauclea pobeguinii (Pobeguin) Bark Post miscarriage/ 0.44 NB,Nd E.Petit, Rubiaceae abortion disorders KEY: Mo: Mokolo market, MM: Mvog-Mbi market, Nd: Ndog-koti market, New-Bell market, Ba : Bamenda market, Bf: Bafoussam market 42 I HerbaiGram 60 2003 www.herbalgram.org rantha Oliv.), djave (Baillonella toxisperma Pierre, be related to the number of diseases treated by the plant Sapotaceae), African satinwood (Zanthoxylum gillettii species and the frequency of occurrence of the disease. (De Wild.) Waterm., Rutaceae), yohimbe, and pygeum, Among the species sold, A. chlorantha is one of the most important in terms of number of diseases treated (malaria, jaundice), volume sold, and occurrence in the medicinal plant urban markets of Figure 2: Herb Prices per market Cameroon (Table 2). In the yea r 2000 alone, 14 tons of A. chlorantha bark (in the six markets) ~ 2 C'l ..:.:: , ______were sold for nearly US$28,570. This figure ~ 1.5 excludes quantities exported to pharmaceutical c. companies. ~ 1 VI :::) In general, prices did not vary within markets, ;o.s I I - I _ , I . - I I - : I I - I I · v ·1•·1- '1.- '1': '1-!:.. '1'1- '1'1 but did vary between markets for all the species ._ ·1- ~ ·;:: 0 . a. studied. For example, A. chlorantha and yohimbe ~ ~ .. . 'Oe ~o .· .· sold for the highest prices in Douala markets ,i( '0>0 .· ~e ~ ·. . (New-Bell and Ndokoti) while Baillonella toxi Markets sperma was the most expensive in Yaounde markets (Mvog-Mbi and Mokolo; Figure 2). Price A. ch/orantha B. toxisperma D Z. gilletti and benefit margin are not the same for all prod ucts. For example, A. chlorantha profit seems to be most important for street traders; the bark of this tree is generally sold in small quantities to among others, appear to be the most commonly sold in consumers, with price per kilogram varying between the markets (Table 2). US$1.60 and US$1.90. Healers buy in large quantities q Medical records from the Cameroon Ministry of and use the product progressively in the composition of Health from 1998 highlighted malaria, typhoid, jaun medicine for different ailments, making it difficult to ~~ dice, sexually transmitted diseases (STDs), tuberculosis, determine the profit margin. - and stomach problems Medicinal plants are (s uch as diarrhea, simply processed and dysentery, amoebae) as Figure 3: General medicinal plant distribution channels sold in different forms the most recurring (powder, infusion, juice, causes of morbidity. etc.). Street traders Evidence from the prepare well-known survey indicated that mixtures to be used by most of the key medic consumers for self inal plants sold in the medication. Such markets treat or mixtures are often used provide a remedy for to treat STDs, malaria, the same diseases ear and typhoid. The prod marked by the ucts are mainly packaged Ministry of Health in small plastic bags, old (Table 2). The species newspapers, or bottles, that treat the first three generally with no indica diseases as ranked by tions concerning appro the Ministry of Health Largest of flow is depending on the transaction: priate dosage and (malaria, typhoid, and .. Very high -+ Average -+ Normal .... Low ~ Very low conservation methods . jaundice) were sold in Annickia chlorantha bark almost all the markets is sold in different forms: involved in the survey. The medicinal plant species that ground fresh or dried, boiled with water or other liquids treat the "top" diseases and are sold in most of the (infusion), and juice in different mixtures or mi.iced with markets were also observed to be the most important in honey. Consumers associate good quality products of A. terms of volumes sold (Table 2). chlorantha with dryness of the powder or in the case of The volume of medicinal plant products sold seems to liquids, with the yellow color. ~.herbalgram.org 2003 HerbaiGram 60 I 43 Although the traditional medicine Perspectives for cultivation of Indigenous healers, sector is not well organized in Annickia chlorantha Cameroon, the main marketing chan collectors, and traders Annickia chlorantha is a plant from nels within the medicinal plant trade of medicinal plants the dense humid lowland forest found were identified (Figure 3). The first who participated in the from Nigeria to Angola and Democra group are collectors and street traders, study tic Republic of Congo.12 Locally named mainly men, who visit urban centers "African yellow bark" or "yellow stick," from rural areas with medicinal plant Healers the tree grows to a height of 15-25m products and sell for a couple of weeks with yellow wood and yellow bark. In Abion Therese before returning home. They Abele Rosette constitute main retailers and some Edjel Dom Magloire time suppliers for indigenous heal Mouandjo Salomom ers and medicinal plant shops in Djoam urban centers. The second group Evina Gougna are indigenous healers, mainly Kwenti Catherine older persons who generally inher Mbang Mbang Jean ited their knowledge from their I Looh Confort fathers/ancestors. These healers Akem Daniel own consulting rooms and some ' times shops where semi-processed I Tegantchouang Job products are sold. The third group Pa Mathias Tumenta i of actors consists of herbalists and Wambo naturopaths who use only herbs Yaah Bongbvemla Anna (grass) and other plant parts Abonggwa Jonas (leaves, fruit, roots, and bark) for 'l treatment. They have shops where Collectors and Traders imported and locally processed r-- Kwayep products are sold. Herbalists and Adamou naturopaths have acquired medici Ndam nal knowledge at school, and add Damdjip value to products by processing and Djip packaging local and foreign medic inal plants with understandable Moussa indications of use. The fourth Monchare group is wholesale companies, Nkongo Yaah Bongbvemla Anna, a famous healer in mostly responsible for the exporta Kumbo-Nso, a village in Northwest Ca meroon, who Bilo tion of medicinal plant products. participated in the study. Photo ©2003 C. Facheux Nkoulou They generally have their own GabaG harvesters or buy from collectors' Cameroon, stem bark extract is used to Onguene stocks in villages where medicinal treat jaundice and urinary tract infec Atangana plants occur and are exploited. tions.13 Powder formulations from bark Mballa In rural areas, women generally are reported to treat sores in Nigeria r-.... Ateba constitute the majority of first line and as scrapings on ulcers in Gabon. I4 ...,; Assiene traditional medicinal practitioners Furthermore, a novel protoberberine 1: Fru (equivalent to a General Practitioner in type alkaloid (7,8-dihydro-8-hydroxy Fumgomdji Western medicine), and are also the palmatine) has been isolated and char Alyosius primary gatherers of medicinal plants. acterized from an anti-HIV active Kenguih Men generally constitute the majority extract from A. chlorantha. 15 Root Ngom of the specialists who, as in Western formulations are reported to heal vari Penda medicine, concentrate on particular ous diseases including tuberculosis and 1 Fouda types of ailments. some forms of gastric ulcers. 6 NgoMBous According to a letter from B. Nyasse in July 2002, although the active ingre- l 44 I HerbaiGram 60 2003 www.herbalgram.org f dient can be found in all parts of the tree (bark, leaves, natural populations is required.20 An understanding of roots), the harvesting regime is not sustainable. Bark the extent and distribution of genetic variation within collectors, motivated by short-term gains, employ every and between A. chlorantha populations is essential fo r means to maximize their immediate share. In Cameroon devising strategies that will efficiently maintain genetic for example, all collections are from wild populations diversity in conservation programs. Information on the and the trees are either completely stripped or cut down genetic diversity within plant populations can be used in to remove all the bark. This hastens the death of such conservation management to determine which popula trees before they attain reproductive maturity, and could tions need protection and the effectiveness of existing significantly interfere with the natural regeneration of reserves.21 An evaluation of the genetic variability the species. If current exploitation rates continue, (morphological characteristics; molecular analysis) in extinction of the species is inevitable. Cultivation existing natural populations of A. chlorantha is neces appears to provide an alternative source of bark supply sary to formulate an appropriate conservation strategy to satisfy current and future market demand while for the species. reducing pressure on natural forests. It is, therefore, imperative that the open and collaborative pioneering Conclusion and Recommendations marketing approach used here be followed by a phase I which will consist of working directly with medicinal Maintaining medicinal plant harvesting and trade plant collectors and traditional practitioners, whose within sustainable levels presents a major challenge I livelihoods and health depend on medicinal plant today and for the foreseeable future, particularly in areas _. I where there is a heavy reliance resources, to develop strategies on traditional plant medicines, to select superior germplasm I I in terms of both health and and consecutively multiply this economic development. A material cheaply in large quan l tities for cultivation by farmers. combined effort by those -}- The approach developed by concerned with the conserva Cunningham17 for Hyphaene tion of medicinal plant species, petersiana Klotzsch ex Mart., and/or the healthcare systems dependent upon them, will be Arecaceae, and used for crucial to ensuring the long pygeum, can equally be adapted to A. chlorantha. term viability of both. The market research carried out in Methodologies for the Bamenda medicinal plants market (most of the counters the present study has identified production of planting materi display A. chlorantha tree bark, which is almost yellowish). species and estimated volumes, als of A. chlorantha will be Photo ©2003 C. Facheux forms and revenues from developed through assessment medicinal plant trade in of natural propagation potential (sexual and vegetative). Cameroon. This pilot study has appended A. chlorantha Seeds are the natural media for gene dispersal and have to the list of priority medicinal plant species (in addition advantages in ex situ gene conservation, being easily to pygeum and yohimbe) on which ICRAF is currently manipulated and immediately available for seedling conducting research in West and Central Africa. production. Although propagation by seed is the main method of plant multiplication, availability of quality It is believed that, while providing valuable alternative seed is a major constraint affecting planting. The large income-generating opportunities for rural dwellers, crowns of many species provide difficulties in attaining medicinal plants are important to the well-being and I the necessary fresh, viable seeds. 18 Vegetative propaga health of rural and urban populations. For that reason, tion offers the opportunity to overcome rapidly these they need to be managed and produced on a sustained I limitations by circumventing the need for sexual repro basis. Research has to contribute significantly in this I duction and facilitating the capture of individual geno respect by: types.19 For the present case, both propagation methods providing sustainable rate of harvest in order to I (sexual, and vegetative through rooting of cuttings or preserve A. chlorantha as a case study for conserva grafting) should be investigated to find the most suitable tion of many medicinal plant trees; l for this species. designing guidelines for sustainable harvesting I The effective management of genetic resources, in practices that guarantee the survival of A. chloran terms of exploitation and conservation of biodiversity, tha, thereby reducing future pressure on the natural I entails that knowledge of the genetic diversity present in resource; I ' 2003 HerbaiGram 60 I 45 domesticating and promoting cultivation of A. chlo Hague: International Service for National Agricultural rantha by farmers, collectors, and healers through Research; 1996. Research Report No 8. Available at training in appropriate technologies. __.- < http://www. isnar.cgiar.org/pu blica tions/ pdf/RR- 08.pdf>. Accessed September 3, 2003. 8. Leakey RRB, Simons A). The domestication and commer Acknowledgements cialisation of indigenous trees in agroforestry for the alle The assistance of indigenous healers, collectors, and viation of poverty. Agroforestry Systems 1998;38: 165-76. traders of medicinal plants is gratefully acknowledged in 9. Cunningham AB, Mbenkum FT. Sustainability of harvest the conduct of this study (see list on page 44). The paper ing Prunus africana bark in Cameroon: a medicinal plant international trade. Paris, France: United Nations Educa benefited considerably from discussions, practical and tional, Scientific and Cultural Organization (UNESCO); analytical inputs from Ann Degrande, Peter Mbile, and Liz 1993. People and Plants Working Paper 2. Betser. This work was jointly funded by the International 10. Holtzman JS. Rapid Reconnaissance Guidelines for Agricul Centre for Research in Agroforestry (!CRAP), and the tural Marketing and Food System Research in Developing International Fund for Agricultural Development (!FAD). Countries. Lansing, Michigan: Michigan State University: 1986. Working Paper No. 30. The authors are employees ofWorld Agroforestry Centre, II. Mander M. Marketing of Indigenous Medicinal Plants in which is formally known as International Centre for South Africa: A Case Study in Kwazulu - Natal. Rome: Research in Agroforestry!African Humid Tropic Program Food and Agricultural Organization; 1998. Regional Office, based in Yaounde, Ca meroon. Charly 12. Vivien J, Faure JJ. Arbres des forets denses d'Afrique Pacheux is Marketing Specialist at !CRAP African Humid Centrale. Paris, France: Agence de Cooperation Culturelle Tropics Region. Ebenezer Asaah is a tree propagation and et Technique; 1985. improvement specialist at !CRAP African Humid Tropics 13. Adjanohoun JE, Aboubakar N, Dramane K, et al. Tradi Region. Marie Laure Ngo Mpeck is a tree propagation tional Medicine and Pharmacopoeia: Contribution to specialist at IRAD!ICRAF. Zac Tchoundjeu, PhD, is a Ethnobotanical and Floristic Studies in Cameroon. Porto senior tree domestication specialist and the !CRAP African Novo, Benin: Organization of African Unity Scientific, Humid Tropics Program regional coordinator. Pacheux is Technical and Research Commission, Centre National de Production de Manuels Scolaires; 1996. the corresponding author: World Agroforestry Centre, 14. Burkil HM. The Useful Plants of West Tropical Africa. Vol1 African Humid Tropics Region. P 0 . Box 2067 Yaounde, (Families A-D). 2nd ed. Kew, UK: Royal Botanic Gardens; Cameroon; Tel: +237 223 75 60, Fax: +237 223 74 40; 1985. Email: 46 I HerbalGram 60 2003 www.herbalgram.org ECONOMIC BOTANY Economic The foremost publication of its kind in the field, this Botany \ol. ~ 7 '\u. I journal is interdisciplinary in scope, bridging the gap , ,,,,,,,r-:~~;-,::~..,-::~~ between pure and applied botany by focusing on the use of plants by people. It encompasses the past, present, and potential use of plants and documents the rich relationship that has always existed between plants and people around the world. Features include original research articles, book reviews, annotated bibliotheca, notes on the economic plants, and instructions to contributors. Established in 1947 by Dr. Edmund J. Fulling, Economic Botany has been the official I•Wk .. publication of the Society for Economic Botany since ...... , ,_. , ...... ·~ ...... , .... _...... ,.,..,,.,,,,,Lft.o""'•4ll"'t.•l'••,.. 1959. 2004 RATES 2004 Volume No: 58 Subscription U.S.A. Non U.S.A. Issues per year: 4 Institutional $122.00 $134.00 Frequency: Quarterly Individual $106.00 $118.00 ISSN: 0013-0001 ••••••• Subscriptions entered for the calendar year. Advance payment in U.S. Dollars required. Back issues are available at $14.00 each. Write or e-mail the address below for more information. THIS .JOURNAL IS PEER REVIEWED. ADVERTISING IS ACCEPTED. THE MAILING LIST MAY BE RENTED. INTENDED READERSHIP National and international to include professionals, graduate students, laypersons, and libraries THIS .JOURNAL IS ABSTRACTED AND/ OR INDEXED IN: Agroforest Abstr., Art & Archaeol. Tech Abstr., Biodet. Abstr., Biol Abstr., Biol. & Curr. Adv. Ecol. Sci., Curr Cont., Energy Info Abstr., Environ Abstr., Environ. Per. Bibl. (1980-), Excerp. Med., Field Crop Abstr., Forest Abstr., Forest Prod. Abstr., Herb. Abstr., Hart. Abstr., Ind. Sci. Rev. , Ind. Vet., Rice Abstr., Rural Recreat. Tour. Abstr., Ornam. Hart., Plant Breed. Abstr., Rev. Plant Path., Sci. Cit. Ind., Seed Abstr., Sel. Water Res. Abstr., Soils & Fert., Sugar Ind. Abstr., Vet. Bull., VITIS, Weed Abstr., World Agri. Econ. & Rural Social. Abstr. E coNOMIC B oTANY THE NEW YORK B OTANICAL GARDEN PRESS 200th Street & Kazimiroff Boulevard Bronx, New York 10458-5126 USA (718) 8 17-8721 • FAX (7 18 ) 8 17-8842 [email protected] • www.nybg.org A Rational Perspective on Adverse Events Reports on Herbs: Misinterpretation of Adverse Reactions Tabulated in the TESS Annual Report of the American Association of Poison Control Centers as They Relate to Ephedra Dietary Supplements BY RICHARD KINGSTON, PHARMD, AND MARK BLUMENTHAL ne of the persistent challenges facing professionals and regulators alike is that of obtaining information regarding adverse events potentially asso ciated with herbs and then, sharing this information in a meaningful way 0 with the public. Despite the fact that many of these substances have been used for centuries and a substantial body of historical data exists to support their relative safety, there is still a need to ensure that current usage in terms of types of preparations, strength and concentration, doses, indications and use patterns do not change a given safety profile. For these reasons there is still a need to monitor the clinical experience related to the use of these substances, especially as it pertains to adverse effects. There is a variety of venues whereby adverse events received by individual health professionals, regulators or involving herbs might be discussed. Health profession other governmental officials, the media, organized als often rely on information contained in scientific medical information services such as poison centers, reports that appear in the medical literature. In these and manufacturers or distributors of dietary supple instances, adverse effect information may be included in ments. These reports are often tabulated into a database the results of a clinical trial or represent the experience and further subjected to analysis and interpretation. of a random sampling of patients taking a given herb. The nature of these reports is often quite different from Another more common scientific reporting method other scientifically documented incidents. Although involves that of anecdotal or case reports. In these cases, this type of information is vital in monitoring the safety independent practitioners evaluate and summarize landscape, it must be recognized that the reports are information regarding a given adverse effect or experi typically not the same as those contained in prospective ence involving a specific patient and the clinical obser clinical trials or even isolated anecdotal reports from vations that may suggest a temporal relationship independent practitioners where readers may examine between that patient's condition and other events or all (o r at least most) of the available facts regarding a external factors which might include the taking of an given case and draw their own conclusions. Sponta herbal product. neous reports have both strengths and weaknesses, both of which must be acknowledged and considered when In addition to these types of scientific reports, there attempting to evaluate the significance of individually are also situations whereby incidents involving adverse reported incidents or aggregated incidents. effects or injury involving herbs may be "spontaneously reported" to a variety of entities. These reports might be 48 I HerbaiGram 60 2003 www.herbalgram .org Ephedra Under Scrutiny usually the practi ce of poison specialis ts to consider a worst-case scenari o regarding the incident in ques ti on. This may res ult in Recently, the herb ephedra (Ephedra sinica Stapf, Ephedraceae) referral of individuals without the presence of any adverse effects has received substantial scrutiny regarding its adverse effe ct profil e. in ques ti onably toxic situati ons so that healthca re providers can While some of the concern has been generated by legitimate clin provide a mo re in- ical trials where certain types of adverse effects have bee n docu depth hands-on mented, much of the informati on comes from data contained in pati ent assessment. here does not spontaneously reported incident data coll ecti on systems. In these have to be an instances, aggregated spontaneously reported incident data has It is important to bee n interpreted to sugges t that a safety concern exists. As an realize that not all calls actual case of example, in March of 2003 a paper was published in the Annals of represent ex posures "poisoning" for Internal Medicine' that reviewed the relative incidence of adverse and not all ex posures effects "rel ated" to ephedra that were repon ed in the Ameri can represent poisoning. an individual to Association of Poiso n Control Centers (AAPCC) incident database In more than 72% of contact a poison known as the Tox ic Ex pos ure Surveillance System (T ESS) . T he ex pos ure related article received rel atively widespread media attention and was cited inqumes, no adverse center. as a bas is for the need for increased warnings or a ban on ephed ra effects res ulting from dietary supplements. Before looking more closely at this article, a the exposure are brief review of T ESS as well as the nature of spontaneously reported. When incl uding those cases in whi ch no more than reported incident data should be considered. minor effects are reported, the total represents more than 87% of the cases. 19 It is also important to recognize that not all reported The TESS Database incidents are created equal, especially those call s classified as "adve rse effects" secondary to drugs, chemicals, or other agents. Since 1984, the ex perience of poiso n centers has been reported Some reported effects might be as minor as self-limiting brief irri through the publicati on of an annual report ofTESS. 2· 19 Currently, tati on from a simple irritant in the eye whereas other incidents these reports appear annuall y in the September iss ue of the Amer may represent se rious li fe-threatening effects such as arrhythmias ican j ournal of Emergency Medicine. These data have been quoted or respiratory arres t. in numerous publications addressing iss ues of toxicology and the epidemi ology of poiso ning in the United States. Each case is documented and typicall y includes: The focus of certified regional poison ce nter operations is tele • General demographics regarding the ca ll er and the exposed phone-based poison informati on. There is no pre-registrati on, individual; payment or any other requirement of the call ers who use the se rv • Reason fo r exposure; ice and calls may be made anonymously although phone numbers may be identified by the "Caller ID" service provided by local • Substance(s) involved in the incident; phone companies. Calls or reports to the center are voluntary, as there are no local or nati onal requirements that any given incident • Reported effects and subjective assess ment of relatedness of must be reported. T he center's pho ne lines are considered each effect to the substance invo lved; "hodines" and so me centers ali gn themselves or co-locate se rvice • Treatments recommended (by the poiso n center or others) with nurse "advice line" programs, drug information centers, and/or rendered; industry product surveillance services, or community 911 emer gency phone operati ons. • Pati ent dis positi on; "Information" calls are separated from "exposure" calls and have • Subjecti ve assessment of the relatedness of the incident sever not bee n tabulated in TESS annual reports. That is, there does not ity with the substance(s) involved. have to be an actual case of "poisoning" for an individual to Each case is assessed as to its overall outcome. T he options are contact a poison center. An individual need only perceive that an "no effect"; "minor effect"; "moderate effect"; "major effect"; adverse effect or poisoning rel ated threat may exist or has occurred. "death"; "no fo ll ow-up, nontoxic"; "no foll ow-up, minimal toxic The poison center speciali st assesses the incident and determines ity", "no foll ow-up, potentially toxic"; and "unrelated". Unless the most specifically coded as "unrelated", the severi ty rating implies that a ppropria te the overall outco me is the result of the ex posure to the substance(s) method to identified in the incident. Al though a "causal link" is suggested mitt ga t e with this type of classifica ti on sys tem, many epidemiologists do InJury, if not bel ieve that these reported incidents are amenabl e to determi InJUry IS nati on of "cause-effect" relati onships and at best, may onl y suggest likely. T his an assoctanon between a give n substance and a certain effect or may incl ude outcome. advisin g the call er o n Another as pect of TESS data is that in the vas t majori ty of appro prta te reported incidents, informati on is simply taken at face value from treatm e nt individuals who may not be knowledgeable of all the exposure options or circumstances, clinical effects and treatments that have been referring a re ndered. Often, pati ents may relay what was explained to them by pati ent to a local healthcare fac ility for further medical evaluati on. medical practitioners regarding diagnosis and treatments rendered. Recognizing the limitations of telephone patient assessment, it is The specialist must then translate this information into correspon- www.herbalgram .org 2003 HerbaiGram 60 I 49 ding TESS data fields in order to document the incident. There is Another significant limitatio n in reviewing these data, is that no attempt o r ability to "authenticate" these incidents in terms of calls classified as adverse reaction are infrequently reported to their validity o r the integri ty of the informatio n that is collected . poison centers as compared to incidents involving single, acute Furthermo re, in those few cases where there is som e attempt to do exposures to potentially toxic substances. C alls classified as repre so, it is impossible to segregate those incidents from aggregately senting "adverse reactio n" represent o nly 2.2% of the 1,931,84 1 reported data contained in the overall database. It is important to calls received by poison centers nationwide. 19 [And, with respect to acknowled ge the strengths and limitatio ns of this and other data aiL botanical calls, cases classified as "adverse reaction" represent bases representing spontaneously reported information. This is only 2, 11 5 incidents o r 0.1% of all cases reported in the 2001 es pecially true when drawing safety conclusions from aggregated T ESS annual report.] This suggests that calling poison centers is data represented in the database. either an infrequent option fo r consumers and healthcare providers for the repo rting of adverse reactions involving botanicals, or that Problems with the Recent Report on Ephedra the relative frequency of these incidents is extremely small. This Adverse Event Reports may further sugges t that the "sensitivity" of this database m ay not be sufficient to identifY any significant trends one way or the other. In the Bent et a!. article 1 which compared the number of repo rted incidents involving ephedra-containing products to other An additional and substantial fl aw in the methodology used by herbs, a number of concerns have been raised over the scientific Bent et a!. pertains to the assumption of outcome and adverse clin m ethod ology used and unsupported conclusions regarding safety ical effects regarding all incidents listed in the "adverse reaction" being drawn.20 column for ephedra-containing substances. It was assumed that all of the 1, 178 incidents represented cases in which adverse effects The article was written by Stephen Bent, MD (University of were either reported or believed to be associated with these botan Califo rnia San Francisco), Thom as N . Tiedt, PhD (Med-Tox ical substances. T he autho rs were apparently unaware that of all G roup, Longboat Key, FL), and Michael D. Shlipak, MD, MPH incidents involving ephedra-containing products, approximately 58% (San Francisco M edical Affairs M edical Center, San Francisco, were coded in a number of outcome categories that either suggested CA). First, the authors in this report imply that the reported inci there were no do cumented adverse efficts or that the effects were dents coded as "adverse reaction" and contained in TESS are adju believed to be unrelated to the substance in question. These outcome dicated as attributable to a given substance. As mentioned earlier, categori es are not li sted in the table that was relied upon by the spontaneously reported incidents contained in the T ESS database authors and no t readily apparent from the tables contained in the are not investigated or validated in such a way so as to allow a cause TESS annual report.* Furthermo re, it is assumed that for those and effect determination . M any of these repo rrs are m ade ano ny cases w here adverse clinical effects are repo rted , all of these effects mously, and all are taken at face value without the benefit of inde are d eem ed to be of equal concern and severity. Again, there is no pendent confirmation by a li censed healthcare practitioner. way of determining how the individual cases were coded according to the nine avail able optio ns. Thank You! It is not poss ible ro determine the actual statistical significa nce of ephedra-conraining botanical supplemenrs in the TESS database fro m the in for mation used by Benr et al. from the tabl es in the ABC wishes to thank all its annual report. Al though there is a breakdown for how all calls are distributed by the fi ve outcomes listed in the table, there is not a members and supporters of the breakdown for each type of call classification. Thus, it is unknown how calls class ified as involving an "adverse reaction" question are past year. Together we are ultimately coded in terms of their medical outcome. There are likely making a difference in health "adverse reaction" cal ls coded with outcomes indicating that either "no effects" or "unrelated effects" occurred but the number of cases on the planet. coded in this manner is simply unknown. Unless a researcher purchases that data from AAPCC and individually separates them Please consider giving an ABC out, one cannot draw any meaningful and statistically documentable co nclusions. T he primary author of this paper (RK) checked the Membership as a gift to friends, numbers that were reported in the Ben t et al. paper and they match relatives, or health professionals. those fro m the annual TESS report tables; the authors stated in their methodology that th ey si mply rel ied on the annual report, not a purchased subset containing the relevanr details. T he signi fica nce of Tax-deductible year-end gifts beyond this limited research and its erroneous conclusions can be seen in the membership dues will be gratefully fo llowing analys is of the data: If one were to view the table in the 200 I TESS report (page 439) which reports 7, 11 5 exposures ro accepted and thoughtfully used "Mul ti-botanicals with rna huang" (i.e., ephedra), only 42% of the to further ABC's nonprofit 7,115 expos ures were coded with outcomes representing clinical effects (minor, moderate, major, and death) and these 7, 11 5 expo miSSIOn. sures include al l reasons such as intentional overdose, intentional abuse/misuse, unintentional misuse, and adverse reaction. O ne must Please call (512) 926-4900 ask how the other 58% of the cases were coded for outcome. T here or apply online: ~~RICAN are no data presented in the published annual report ro answer this. www.herbalgram.org BoTiWICAL Fo r "Ma huang/ephedra (single ingredient)" again, only 43% had Ca.JNCIL outcomes reportedly associated with clinical effects. Again, it is not readily apparent how the other 57% were coded for outcome. 50 I Herba!Gram 60 2003 www.herbalgram.org It is also curious as to why Bent et al. chose to compare the W ith respect to a letter from Annette Dickinson, PhD, president effects of ephedra-containing substances to the wide variety of of rhe Council for Responsible Nutrition, that questions the market other botanicals, the effects of which are not only diverse, but statistics used by the authors to conclude that ephedra supplements often times subtle and noted over an extensive period of time. constitute only I% of the roral herbal supplement market but in 2 Ephedra, on the other hand, demonstrates clinical effects that may actuality constitute approximately 33% of the market in 200 I , " be readily detected and quire noticeable to the user within a rela Bent et al. , respond, "We are perplexed at Dr. Dickinson's statistic tively short period of time. These expected effects, even when of ephedra sales from the Nutrition Business journal. We did nor rely minor in nature, may be interpreted as unpleasant to one user as on this journal's data because the journal uses an unspecified opposed to another. If the authors were attempting to compare the combination of sales data relative incidence of reported adverse effects of these substances, a and information from more meaningful comparison might have been to compare against surveys of herbal manu n the vast majority other agents that possess either similar pharmacology or indica facturers and also uses tions. dollar sales rather than of reported inci unit sales (the relatively Lastly, the authors used inaccurate sales data to suggest that dents, there is no expensive cost of ephedra ephedra-containing dietary supplements are disproportionately products biases the dollar attempt or ability to responsible for many botanical adverse event reports (AERs): they sales esrimares)."23 erroneously stated that ephedra sales constitute less than 1% of "authenticate" Despite this response, it is total supplement product sales in the botanical m arket. More accu the optnton of the these incidents in rate sales data suggests that ephedra-containing dietary supple authors of this article rhar terms of their valid ments comprise an estimated 20-30% of the botanical supplement the data suggesting that sales.** Considering its shortcomings, for the Bent et al. paper to ity or the integrity ephedra supplements are have received such considerable attention with so little knowledge only I % of the tOtal of the information able peer review and scrutiny, objective scientists might reasonably herbal marker upon question whether or not ephedra and other dietary supplement that is collected. which Bent er al. relied is botanicals may be the subject of a double standard (or perhaps misleading in relation ro inexact scientific scrutiny) as compared to the evaluation of the the actual volume that safety of pharmaceutical drugs. As an example of the importance ephedra previously enjoyed in the U.S. market. given to this paper, the erroneous conclusions from the Bent et al. article were cited by the U.S. Food and Drug Administration in Monitoring of adverse effects potentially associated with herbs the Federal Register in February when the Agency made reference and other natural medicinals will continue to be a challenge. W hile to it as part of its rationale for proposing strong warnings for the the use of multiple methods to track and report incidents is impor- labels of ephedra supplements.21 [Note: T he authors of the present article are not attempting to diminish the safety concerns concern ing ephedra by making these comments. However, as demon From public comments made by the American Botanical Council to strated in this article, there appears to be a problem of potentially FDA in response to FDA's proposed label warning on ephedra: "Bent significant proportions in attempting to rationally interpret and et al. conclude that there is a high (78-fold) ratio of ephedra-related draw meaningful conclusions surrounding AER data on herbal AERs (a reported 64% of all herbal AERs) in relation to ephedra products from the existing reporting mechanisms.] market share of 0.82%. The calculation of a relative risk factor of 78 times for ephedra compared to other herbs listed in the report is erro In defense of their article, upon publication of letters ratsmg neous, based on inaccurate market statistics. That is, the denomina questions about their methodology by the senior author of this tor of 0.82 is not a reasonable statistic and has no realistic basis in article and his colleague Stephen W. Borron MD, MS (Interna market reporting. ABC recognizes that it is difficult to adequately tional Toxicology Consultants, Washington, D.C.),20 Bent et al. and accurately measure the total retail sales levels of herb products sold as dietary supplements because solid econometric data are not respond that, "The data from the national system of Poison available for all market channels (i.e., health and natural food stores, Control Centers provide a critical safety valve for consumers. multi-level marketing companies, mail order and internet sales, sales H ealth researchers, government agencies, and product manufac via healthcare professionals, ere.). Accordingly, only the mainstream turers rely on these data to warn the public about product dangers market (grocery stores, drugstores, mass market retailers) produces and to design safer products."23 There is no question that such reliable data on herb sales. Current estimates of herb supplement groups do utilize the TESS database. As noted in the present arti sales in 2001 range from $ 1.3 to 1.7 billion, according to Nutrition cle, misinterpretations can, and do, occur even when well-inten Business journaL and ABC. Compared to a relatively conservative esti tioned or authoritative entities analyze information contained in mate of about $4 billion in total retail sales, depending on how the herb market is defined and measured, the current percentage of the TESS annual report. Bent et al. also responded with another ephedra supplements should be in the range of 32.5 to 42.5%. If the calculation without grounds. They respond to the point that an total herb market is more liberally estimated at $5 billion, then the average of 15 .4% of all AERs in the database (herb and non-herb) ephedra percentages drop to a range of 26 to 34%. Thus, given a are later determined to be unrelated ro the substance in question more accurate and comprehensive view of the total market, and by using this figure ro once again compare ephedra ro other based on the method of calculation employed by Bent er al. of the "herbs." The salient point that was brought to their attention was TESS data, the range of the ratios of ephedra AERs to other herbs that it is impossible to calculate this relative incidence, because the may more likely be in the range of 2.5-fold (64% divided by 26%) numbers are not present in the data that Bent et al. had available to 1.5-fold (64% divided by 42.5%) of relative risk, assuming, for rhe for evaluation. The percentage of AERs implicating ephedra, and present purposes, the accuracy of the 64% numerator (which as noted above, is probably nor reliable). Consequently, we believe that then subsequently determined ro be unrelated, could theoretically rhe study in question does nor appear to provide valid or reliable range from 0- 100%, rendering their calculation meaningless. conclusions upon which the agency can contemplate current or future regulatory policy on ephedra."23 www.herbalgram.org 2003 HerbaiGram 60 I 51 rant, the strengths and limitations of all available reporting options a vital part of product stewardship and safety assurance. Defining must be considered. A significant strength of monitoring sponta and monitoring the safety of dietary supplements is a dynamic neously reponed data is that it is well-suited to generate hypothe process, and cooperation among multiple stakeholders using reli ses on safety or toxicity. It is also extremely useful in defining a able methods of surveillance and analyzing collected data in proper particular product's safety profile, especially when a given method context will aid in this process. A of adverse event reporting is well positioned to be utilized by those Richard (Rick) Kingston, PharmD, is Co-Founder, Vice President who may experience an adverse effect and report it to a given and Senior Clinical Toxicologist with the PROSAR International reporting system. Poison Center and an Associate Profossor in the Department ofExp er imental and Clinical Pharmacology, University ofM innesota, College The authors were apparently of Pharmacy. He has over 26 years experience in poison control and clinical toxicology, previously serving as co-founder and former Direc unaware that of all incidents tor of the Minnesota Poison Control System. At the University of involving ephedra-containing Minnesota, Dr. Kingston serves as Course Director for "Therapeutics products, approximately 58% of Herbal and other Natural Medicinals," a course dedicated to the clinical application of science related to dietary supplement use. The were coded in a number of outcome PROSAR International Poison Center Referen ces: As the future of herbs and other dietary supplements unfolds, l. Benr S, Tiedt TN, Odden MC, Shlipak MG. The relative safety of there must also be a concerted effort on the part of healrhcare ephedra compared with other herbal products. Ann Intern Med2003 Mar 18;138(6):468-71. providers and other professionals, regulators, manufacturers, and 2. Lirovitz T, Veltri J. 1984 Annual Report of the American Association the public at large to participate in the process of dietary supple of Poison Conrrol Cenrers National Data Collection System. Am j ment post-market surveillance. Coll ection of spontaneously Emerg Med 1985;3:423-50. reported botanical AERs in a systematic and consistent manner is 3. Litovitz T, Normann S, Veltri J. 1985 Annual Report of the Ameri- Unparall Our addipharma reference substances are like diamonds- of the very finest quality, precisely cut to the needs of our customers and certified with complete documentation of all of their qua lity features. In a word, beyond compare -and yet well suited for comparisons. Whether as part of a highly reliable analysis or of a pharmacological test of natural products. Secure the best possible references fo r yourself now because true quality isn't always apparent at first glance. ~} the nature network www.phytolab.com 52 I HerbaiGram 60 2003 www.herbalgram.org can Association of Poison Control Centers National Data Coll ection System. Am ] Emerg Med 1997; 15:447-500. System. Am J Emerg Med 1986;4:427-58. 15. Lirovitz T, Klein-Schwartz W, er al. 1997 Annual Report of the 4. Litovirz T, Martin T, Schmitz B. 1986 Annual Report of rhe Ameri American Association of Poison Control Centers Toxic Exposure can Association of Poison Control Centers National Data Collection Surveillance Sys tem. Am ] Emerg Med 1998;16:443-97. System. Am] Emerg Med 1987;5:405-45. 16. Lirovitz T, Klein-Schwartz W, er a!. 1998 Annual Report of rhe 5. Litovitz T, Schmitz B, Matyunas N, eta!. 1987 Annual Report of rhe American Association of Poison Control Centers Toxic Expos ure American Association of Poison Control Centers National Data Surveillance System. Am ] Emerg Med 1999; 17:435-87. Collection System. Am] Emerg M ed 1988;6:479-515. 17. Lirovitz T, Klein-Schwartz W, er a!. 1999 Annual Report of rhe 6. Litovitz T, Schmitz B, Holm K. 1988 Annual Report of the Ameri American Association of Poison Control Centers Tox ic Exposure can Association of Poison Control Centers National Data Collection Surveillance System. Am ] Emerg Med 2000;18: 517-74. System. Am M Emerg Med 1989;7:495-545. 18. Lirovitz T, Klein-Schwartz W, er al. 2000 Annual Report of the 7. Lirovitz T, Schmitz B, Bailey K. 1989 Annual Report of the Ameri American Association of Poison Control Centers Toxic Exposure can Association of Poison Control Centers National Data Collection Surveillance System. Am] Emerg M ed 200i ;i 9:337-95. System. Am j Emerg Med 1990;8:394-442. 19. Lirovitz T, Klein-Schwarrz W, er al. 200 I Annual Report of the 8. Lirovitz T, Bailey K, Schmitz B, era!. 1990 Annual Report of the American Association of Poison Control Centers Toxic Exposure American Association of Poison Control Centers National Data Surveillance System. Am ] Emerg Med 2002;20: 391-452. Collection System. Am] Emerg Med 1991 ;9:461-509. 20. Kingston RL, Barron SW The relative safe ty of ephedra compared 9. Lirovitz T, Holm K, Bailey K, et a!. 1991 Annual Report of rhe with other herbal products (lerrer). Ann Intern M ed 2003 Sept American Association of Poison Control Centers National Data 3; 139(5)part 1: 385 . Collection System. Am J Emerg Med 1992; I 0:452-505. 21. U.S. Food and Drug Administration. Dietary supplements contain 10. Lirovirz T, Holm K, Clancy C, et a!. 1992 Annual Report of the ing ephedrine alkaloids; Reopening of the comment period. Federal American Association of Poison Control Centers National Data Register2003 March 5;68(4 3):1004 17-20. Collection System. 1993 September; II (5):494-555. 22. Blumenthal M. Lerrer to Food and Drug Administration in response II. Lirovirz T, Clark L, Soloway R. 1993 Annual Report of rhe Ameri ro Docker No. 95N-0304: Proposed Rule: Dietary Supplements can Association of Poison Control Centers National Data Collection Containing Ephedrine Alkaloids; Reopening of Comment Period; System. Am J Emerg Med 1994; 12:546-84. 68 Fed. Reg. 104 17 (March 5, 2003). Apr 7, 2003. 12. Litovitz T, Felberg L, Soloway R, er a!. 1994 Annual Report of the 23. Bent S, Tiedt TN, Shlipak N G. The relative safety of ephedra American Association of Poison Control Centers National Data compared with other herbal products (lerrer). Ann Intern Med 2003 Collection System. Am] Emerg Med 1995;13:551-97. Sept 3; 139(5)part 1:386. 13. Litovitz T, Felberg MA, er a!. 1995 Annual Report of the American 24. Dickinson A. The rel ative safety of ephedra compared with other Association of Poison Control Centers Toxic Exposure Surveillance herbal products (lerrer). Ann Intern Med 2003 Sept 3; 139(5) part System. Am ] Emerg Med 1996;14:487-537. 1: 385-6. 14. Lirovirz T, Smilksrein M, er a!. 1996 Annual Report of rhe American Association of Poison Control Centers Toxic Exposure Surveillance t )- Scripps Center for Integrative Medicine You are corJially invifeJ to FOLLOW YOUR HEART Natural Supplements in WHEN: Evidence-Based Practice: Now. A Clinical and Research Update WHERE : Ba<~tyr Univer.~ity~ Seattle. Friday, ]anuary 16, through Sunday, january 18, 2004 WH Y : Hilton La j olla Torrey Pines • La jolla, California Don~t Jettle. Be true. Live green~ work green. World-renowned faculty, including Mark Blumenthal, Make your pa.~Jion your life'.! work. Mary Hardy, MD; Mitch Gaynor, MD; Sheldon Hendler, With a degree in Herbal Scienced. MD , PhD, FAIC ; and jeffrey Bland, PhD, FACN, CNS, will present the latest clinical and research evidence on the safety, efficacy and regulation of dietary supplements. * &\STYR UNIVERSITY Register early! Call Scripps Conference Services at 858/882.8456 or visit www.scrippsintegrativemedicine.com *Scripps Clinic designates this CME activi ty [or 16.5 credit hours in Category 1 o[ the Physician's Recognition Award o[ the Ameri can Medical education in the -world, please visit Herbs.Bastyr.edu. 425-602-3330. Association. This activity has been reviewed and is acceptable [or up to 16.5 Call elective credit hours by the Ame rican Academy o[ Family Physicians. Or email [email protected]. www. herbalgram .org 2003 HerbaiGram 60 I 53 Roots of cryptolepis Crypro/epis sanguinofenta Photo ©2003 Dia ne Robertson Winn An African Traditional Medicine that Cryptolepis Provides Hope for Malaria Victims by Mar ian Addy, PhD he root of the plant cryptolepis ( Cryptofepis sanguinolenta (Lind!.) Schl eeter, Asclepiadaceae or Periplocaceae) is used in traditional Afri can medicine to treat a va ri ety of diseases, including malari a. 1·6 Scientific investi ga ti ons have indicated a number of biological/pharmacological effects of compounds isolated from the plant materi al, including anti-bacterial , anti-hyperglycemic, anti-inflammatory, anti-plas modial/anti-malari al, and Tanti-viral effects.?- 19 Some of these effects have bee n demonstrated in the crude extract as well as its fractions, including a dose-dependent inhibitory effect on the classical pathway of complement fi xation.*11 During the past few years, cryptolepis has received additional attention by the phytomedicin e division of a pharmaceutical company in G hana, which developed an herbal tea based on this traditional medicinal herb and recently demonstrated the clinical effi cacy of a tea-bag fo rmulation in the treatment of malari a. 20 A preliminary clinical study in 1989 conducted with an aqueous ex tract of cryptolepis, prepared by boiling powdered cryptolepis roots in water, also suggested the effi cacy of the plant materi al against malari a. 21 *Complement is a group of proteins in the blood that, when fixed (i. e., combined with antibodies bound to the surfaces of fo reign cells, including bacteri a) , triggers a precisely regulated cascade of reactions leading to destructi on of these fo reign cells or the antigen. 54 I HerbaiGram 60 2003 www.herbalgram.org Unlike most other plant-derived malaria medications on the and other plant parts of cryptolepis. market (i.e., the drug quinine, a pure compound extracted from Dried cryptolepis has a sweet fragrance. The root, the plant part the bark of Cinchona spp. of the family Rubiaceae, and the recently used for the treatment of malaria, varies from 0.4-6.6. em long developed pure compound artemisi nin and semi-synthetic deriva and 0.31 - 1.4 em wide and has a bitter taste. The root surface is tives from the Chinese herb quin hao or li ght to medium brown in color. The sweet wormwood, Artemisia annua L. , tex ture is hard and brittle, longitudi Asteraceae), the herbal tea based on cryp- nally ri gid with occasional cracks and tolepis is a true herbal remedy containing striati ons. Rootlets are not present. the naturally occurring complex mixture Due to high levels of C ut roots show a bright yellow surface , as seen in the photo on this of phyrochemicals in a traditional dosage resisbmce, typical form, with a long-established history of dru{~ page. use, just like the old remedies from which pharn1aceuticals are losing the two aforementioned malaria drugs Range and Habitat were derived. their ability to trc Clinical Trials Safety In a preliminary study aimed at comparing effi cacy of an aque Safety is one of the most important considerations for the assess ous ex tract of cryptolepis with that of chloroquine, G .L. Boye, of ment of any agent administered for treatment of a disease. Assess the Unive rsity of Ghana, used the WHO extended seven-day in ment of toxicity is therefore critical in research and development of vivo tes t43 to measure P folciparum response in a number of phytomedicines. C ryptolepine is believed to interact with DNA13 patients attending the outpatient clinic of the Centre for Scientific and this could result in toxicity. 56 I HerbaiGram 60 2003 www.herbalgram .org Evidence of DNA being rhe direct and clinical chemistry tests. This tea bag target of cryprolepine has been formulation, which represents an aque provided by Bonjean and his co-work M2l2ri8 kills more th~m ous preparation, was shown to be safe. 4S ers. 42 Their work has shown that cryp The LD (lethal dose in which 50 1 50 tolepine binds rightly to DNA. As is million people every yt~ar. percent of tes t animals died) obtained well known, DNA in rhe nucleus of mostly young children was above 2,000mg/kg, more than two living organisms exists as a double helix, orders of magnitude higher than the two intertwined coils or helices. Some under 5 ye2rs of 2ge. effective dose. It is noteworthy that Luo chemical compounds can insert them et al. report the use of cryptolepis selves, or intercalate, between the two extrac t as a tonic, often taken daily for helices, thereby interfering with the functions of the DNA that years without evidence of side effects or toxicity. 2S depend on this unique double helical structure. One such function is cell division, preceded by replication of the nuclear material and Concluding Remarks separation of the two sets of nuclear material res ulting from the In new drug discovery from medicinal botanical preparations, replication. DNA replication occurs through nucleic acid synthe most pharmaceutical companies would use an approach that relies sis, using one uncoiled strand of DNA as a template. The reactions on random, mostly in vitro, mechanism-based, high throughput responsible for replicating the nuclear material, must therefore screening, es pecially in the initial phases. This approach leads to involve uncoiling and recoiling of DNA, and are catalyzed by a set the formulation of a drug based on a pure chemical compound of enzymes including those responsible for the unwinding and isolated from a medicinal plant or a deri vative of such a relaxation of the DNA to remove the tightly coil ed helices. One of compound. An alternative pathway is based on ethnomedical these enzymes is known as topoisomerase, responsible for the inter informati on obtained mainly from traditional medical practition conversion between the relaxed and coiled forms of DNA. For this ers (TMPs) and unequivocal biological/pharmacological research interconversion to take place, the DNA must be cut and then results of a number of scientists and clinicians working on the rejoined. Topoisomerase I cuts only one strand of the double products used by these TMPs. The latter approach is the one used stranded DNA and topoisomerase II cuts both strands. When by the Phyromedicine Divis ion of Phyto-Riker, coupled with toxi topoisomerases are inhibited, DNA replication ceases to occur. city as wel l as clinical confirmatory tests. The scientific research Cryptolepine has been shown to be a potent inhibitor of topoiso that ought to be an important part of this alternative pathway is merase II. Its effect is to stop the cell from dividing and is proba bly the basis for its effect on microorganisms, including the malaria paras ite. It is also the basis for it being regarded as a promisi ng anti-tumor agent. 42 There have been reports of toxicity of the aqueous extracts of cryptolepis and compounds isolated from the plant material when cell lines usually used to assess anti-tumor activity or in vitro meth ods of risk assessment were used.43 Cytotoxicity in anti-viral test systems has also been reported. 44 In one study, cytotoxicity, meas ured as anti-tumor activity (against B 16 melanoma cells) did not correlate with toxicity in the in vivo mouse model for malaria used in the same studyY Phyto-laria, the cryptolepis product formu lated as a tea, was evaluated in vivo by administering it orally to mice, rats, and rabbits and using the conventional acute toxicity A field of cryptolepis Photo ©2003 Diana Robertson Winn not merely to inject science into the art of healing that is practiced by indigenous people using medicinal plants, but also to make this art better serve the indigenous and other people. As demonstrated in some of the research work on the biol ogy/pharmacology of cryptolepis, the alcoholic extract is more effective compared to the aq ueous extract that the people normally use. It would be worthwhile to carry out appropriate toxicity tests to ensure that the more effective ethanolic extract is just as safe as the aqueous extract, and that it does not extract from the plant compounds that are toxic to humans in addition to extracting more of the effective and safe compounds. When this has been done and the safety of the ethanolic ex tract ass ured, a better prod Aerial part of cryptolepis showing inflorescense. Photo ©2003 Diana Robert son Winn uct could be formulated. As shown in the accompanying Pharmacology article, cryp- www.herbalgram.org 2003 HerbaiGram 60 I 57 tolepis, or compounds extracted from it, has antimicrobial proper References: ties, affecting a number of different microorganisms. In West l. Silva 0, Duarte A., Cabrita J, Pimentel M, Oiniz A, Gomes E. Africa, where the plant originates, infections from microorga nisms An timicrobial activity of Guinea-Bissau traditional remedies. J are rampant. Malaria is endemic in the sub-region as well . A Ethnopharmacol 1996;50:55-59. 2. Sofowora A. Medicinal Plants and Traditional Medicine in Aftica. phytomedicine that is capable of treating malarial and other infec John W iley and So ns. Chichester; 1982. p 22 1-3. tions could provide an excell ent remedy for a whole host of diseases 3. Boye GL, Ampofo 0. Medici nal Plants in Ghana. In: Wagner and which affli ct the majority of the people. It is for this reason that Farnsworth N R, editors. Economic and Medicinal Plants Research. many local health professio nals are keen on promoting scientific Vol. 4. Plants and Traditional Medicine. London: Academic Press; research effo rts required for the development of such a remedy. 1990. p 32-3. Q uali ty, safety, and effi cacy are obviously key iss ues. Evaluation of 4. O live r-Bever BEP. Medicinal Plants in Tropica l West Aftica. these parameters should be conducted on the plant extract so that Cambridge: Cambridge University Press; 1986. p. 18, 4 1, 13 1, 205. standardized remedies of plant materials can be produced without 5. TonaL, Kam bu K, Ngimbi N, Cimanga K, Vlietinck AJ. Antiamoe bic and phytochemical screening of so me Congolese medicinal requiring processes that would make the remedy extremely expen plants. f. Ethnopharmacol 1998;61 :57-65. sive and unaffordable to a large number of people. ---- 6. Irvine FR. Woody Plants ofGhana. London: Oxford University Press; 1961. Marian Addy, PhD, is a Professor ofB iochemistry at the University 7. Bierer DE, Fort OM, Mendez CD , et al. Ethnobotanical-directed of Ghana and a Research Consultant for the Phytomedicine Division discovery of the antihyperglycaemic properties of cryprolepine: its ofPhyto- Riker. isolation fro m Cryptolepis sanguinolenta, synthesis, and in vitro and in vivo activities. j Med Chem 1998;41: 894-901 . 8. Bamgbose SOA, Noamesi, BK. Studies on cryptolepine II: Inhibi tion of carrageenan-induced oedema by cryptolepine. Planta Med Pharmacology of Cryptolepis n vitro anti-plasmodial activities, which are indicative of IC50 value, determined from linear regression analysis of dose anti-malarial activity, have been carried out using inhibition response curves, was 0.114 micromolar for cryptolepine, I of the incorporation of the malaria parasite into red blood compared to a mean value of 0.2 micromolar for chloroquine cells.l2,13,15.19,35,37 In one study in which both the chloroquine diphosphate. sensitive D6 strain and the chloroquine-resistant K-1 and W-2 strains of the malaria parasite were used, the anti-plasmodial activity was measured using the incorporation of 3H-hypoxan thine into red blood cells infected with P. Jalciparum, the stan dard anti-plasmodial assay. Aqueous, alcoholic, and total alka loidal extracts, and compounds isolated from the plant material were found to be effective against all three strains of parasite to varying degrees. Of the extracts, the total alkaloid was the most active with mean IC50 values of 47, 42, and 54 micromolar for the three strains, respectively, compared to values of 2.3, 72, and 68 micromolar, for chloroquine. The aqueous extract was the least active. Of the isolated compounds, cryptolepine was the most effective, with mean IC50 values of27, 33 and 41 micro molar for the D6 chloroquine-sensitive and K-1 and W-2 chloroquine-resistant strains, respectively. Hydroxy-cryptolepine was the next best compound with IC50 values of31, 45, and 59 micromolar, respectively, followed by neocryptolepine. Quindo line, or nor-cryptolepine, without the methyl group, was the least active anti-plasmodial of the isolated compounds.35 This is an indication that the methyl group contributes to anti-malarial Cryptolepis Cryptolepis sanguinolenta Photo ©2003 Diane Robertson Winn activity, at least in part. The result of this study with respect to the K-1 strain is in agreement with the work of Noamesi and coworkers, 15 as well as Kirby and coworkers, 13 who reported the Inhibition of beta-hematin formation in a cell-free system is anti-plasmodial activity of cryptolepine against the multi-drug another in vitro test for anti-plasmodial activity. Reduction or resistant K-1 strain of E folciparum. elimination of the characteristic peaks of beta-hematin at 1663 In another study, Wright et al., using multi-drug resistant K1 and 1210 cm·1 in an infrared spectrum indicates efficacy. Cryp strain of E :folciparum and a method of assessing inhibition of tolepine has been shown to be effective in this model, the peaks parasite growth based on measurement of lactate dehydrogenase disappearing when the reaction mixture was pre-incubated with activity, showed that among a number of anhydronium bases, the alkaloid,37 suggesting that cryptolepine's anti-plasmodial only cryptolepine, the major alkaloid in cryptolepis, had anti effect depended, at least in part, on a quinine-like mode of plasmodial activity similar to that of chloroquine. 19 The mean action. A relatively simple method of measuring beta-hematin, 58 I HerbaiGram 60 2003 www. herbalgram.o rg 198 1;4 1:392-6. 15 . Noamesi BK, Paine A, Kirby GC, Warhurst DC, Phillipso n ]D. In 9. Boakye-Yiadom K, Herman Ackah SM. C ryptolepine hydrochlo vitro antimalari al activity of cryptolepine, an indoquinoline. Trans ride: Effect on Staphylococcus aureus. J Pharmaceut Sci 1979;68: 1510- Roy Soc Trop Med Hyg 1991;85:315. 4. 16. Oyekan AO, Botting JH, Noamesi BK. Cryptolepine inhibits 10. Boye GL, Ampofo 0 . Clinical uses of Cryptolepis sanguinolenta platelets aggregation in vitro and in vivo and stimulates fibrinolysis (Asclepiadaceae). In: Boakye-Yiadom K, Bamgbose SOA, editors. ex vivo . Gen Pharmacol1988 ;1 9:233-7. Proceedings ofthe First International Symposium on Cryptolepine; 1983 17. Paulo A, Pimentel M, Viegas S, Pires I, Duarte A, Cabrita J, Gomes University of Science and Technology. Kumas i, Ghana. ET Cryptolepis sanguinolenta activity against diarrhoeal bacteria. j II. C imanga K, DeBruyne T, Lasure A, Van Poe! B, Pieters L, C laeys M , Ethnopharmacol 1994;44: 73-77. VandenBerghe D , Kambu K, TonaL, Vlietinck AJ. In vitro biolog 18. Sawer IK, Berry MI, Brown MW, Ford JL. (1995). T he effect of ical activities of alkaloids from Cryptolepis sanguinolenta. Planta Med cryptolepine on the morphology and survival of Escherichia coli, 1996;62: 22-7. Candida albicans and Saccharomyces cerevisiae. J Appl Bact 12. Grellier P, Ramiaramanana L, Milleriox V, Deharo E, Shreve! J, 1995;79:314-321. Frappier F. Antimalarial activity of cryptolepine and isocryptolepine, 19. Wright CW, Phillipso n JD, Awe SO, Kirby GC, Wa rhurst DC, alkaloids isolated from Cryptolepis sanguinolenta. Phytother Res Querrin-Leclerq J, Angenot L. Antimalarial activiry of cryptolepine 1996; I 0:31 7-32 1. and some other anhydronium bases. Phytother Res 1996; I 0:361-3. 13. Kirby GC, Paine A, Warhurst DC, Noames i BK, Phillipson JD. In 20. Boye GL. Clinical efficacy of Phyto-Laria®: a formulation of Cryp vitro and in vivo antimalarial activity of cryptolepine, a plant-derived tolepis sanguinolenta- in uncomplicated malari a in Ghana (2002). An indoquinoline. Phytother Res 1995;9:359-363. unpublished report of a study carried our to obtain clinical evidence 14. Noamesi BK, Bamgbose SOA. Studies on cryptolepine: Effect of of anti-malarial efficacy of the rea bag formulation of cryptolepis for cryptolepine on smooth muscle contraction and cholinergic nerve registration with Ghana's drug regulatory body, The Food and Drugs transmission of isolated guinea pig ileum. Planta Med 1983;48: 48- 51. Continues on page 67 using absorbance in a simple spectrophotometer, is currently being bacterial agent, and it is more active against Gram-positive bacte used in the Department of Biochemistry of the University of ria rhan the Gram-negative ones.28,38 Some of the minor alkaloids Ghana, and could be adopted for assessing the efficacy of extracts are also effective as anti-bacterial agents, including the hydrochlo of cryptolepis and compounds isolated from them in a research ride,9 cryptoheptine, neocryptolepine, and biscryptolepine; cryp and development effort to develop this particular phytomedicine. toquindoline was not active. 38 The anti-bacterial actions of Studies have been carried out to evaluate rhe anti-microbial neocryptolepine appear to mirror those of the major alkaloid, properties of cryptolepis extracts and compounds isolated from cryptolepine.39 Cryptolepine also has some anti-fungal activity 18 them. In a program of biological evaluation to justify traditional against Saccharomyces cerevisiae but not the Candida species. Its uses of herbal remedies, cryptolepis was studied because of its anti-fungal activity seems to be limited compared to its anti-bacte successful use in treating diarrhea caused by intestinal amoebiasis, rial activities. and found to be effective in vitro against Entamoeba histolytica.s Some pharmacological effects of cryptolepis, quite unrelated to Diarrheal diseases are very common in West Africa and therefore, rhe use of rhe plant in folkloric medicine, are its anti-inflammatory any anti-diarrheal reme~y is of great interest. Ove~ 100 strains of and anti-hyperglycemic properties. It hall been .rh.ore than two Campylobacter species, which are causative agents for gastroenteri decades since the anti-inflammatory properties were established, as tis, have been used to study the effect of cryptolepis and indicated by inhibition of carageenan-induced edema and that of compounds isolated from it on diarrheal bacteria.17 The finding platelet aggregation.s,t6 (Carageenan-induced edema is a typical that cryptolepine was more effective than co-trimoxazole and pharmacological test for antiinflammatory drugs; carageenan, a sulfamethoxazole, just as effective as ampicillin and less effective gelatinous preparation made from seaweed, is injected into parts, than erythromycin and streptomycin, the antibiotics usually used often the paw, of test animals to produce a localized inflammation against diarrheal diseases, indicates rhat cryptolepis may be a - usually, the type characterized by accumulated fluids, i.e., potential remedy for diarrhea. The ethanolic extract, not rhe aque edema. The tested agent is then measured for its ability to inhibit ous one, had activity but not as good as that of the isolated alka the resulting inflammation.) The anti-hyperglycemic property has loid. The effect of the plant material was not so dramatic when been shown as enhanced insulin-mediated glucose disposal in a Vibrio cholerae, the causative agent for enteric infections, was used mouse model of diabetes and in an in vitro system using the 3T3- as the test organism. Obviously, cryptolepis could be used as rher Ll glucose transport assay, indicating an effect on Type 2 apy for gastroenteritis although it is not known as such in the diabetes.7·25 Hypotensive properties have also been reported, region where it is used to manage a number of infections. including effects on cholinergic nerve transmission, alpha-adreno Out of 12 plants used in Guinea-Bissau traditional remedies to ceptors, and muscarinic receptors.40,4t Malaria and other infectious treat infectious diseases, only cryptolepis was found effective diseases are more prevalent in the West African sub-region and against Escherichia coli and nine out of 10 microbial test organisms therefore the anti-plasmodial and anti-bacterial properties of cryp used; only Pseudomonas aeruginosa was not susceptible.1 Ineffec tolepis are more exciting. However, one should not underestimate tiveness against P aeruginosa was also reported in another anti rhe potential of cryptolepis in treating some of these orher microbial screening study in vitro, using extracts as well as five diseases. A alkaloids isolated from cryptolepis.26 Of all the isolated alkaloids, cryptolepine is rhe most active anti- www.herbalgram.org 2003 HerbaiGram 60 I 59 Memorial Herbal Garden Thrives in the Heart of Chicago n herb garden with more than 80 different will remain constant though the years. "With an herb medicinal plants has been created at the garden, yo u want the plants solidly established. We may Medical Center of the University of Illinois bring in new plants if old ones aren't doing well, but ulti at Chicago (UIC). The purpose of the mately we want the garden well-stocked and stable," he garden is to aid in education and research by said. Afeaturing plant s popular in herbal supplements as well as Several of the garden's plants, like Chinese hibiscus plants used as sources for conventional pharmaceuticals. (H ibiscus rosa-sinensis L. , Malvaceae), grapefruit (Citrus The Dorothy Bradley Atkins Medicinal Plant Garden paradisi Macfad., Rutaceae), and mango (Mangifera was created with a $1 million gift in memory of the first indica, L. , Anacardiaceae) are permanently planted in large wife of retired surgeon Robert Atkins, MD, of Cham pots in the garden. To protect them from the cold of paign, Illinois. (Dr. Atkins is not related to the late diet Chicago winters, they are transported to a greenhouse book author of the same name.) facility in Downer's Grove, a suburb west of Chicago. The first planting was in the summer of 2002, from late T he greenhouses, part of the pharmacognosy depart April to June. More than 100 people attended the dedica ment field station, are also the so urce for plant material tion ceremony in July. used in research at the university. During the academic year, the garden is used for instruction only, a living lecture A few of the species hall while all plant in the garden include material for lab work is foxglove (Digitalis obtained from the purpurea L., Scrophu greenhouses. lariaceae), source of the cardiac glycoside "Dr. Atkins' dona digoxin used in heart tion was placed in an medication; St. John's endowment, so it will won (Hypericum perfo produce funds for ratum L., Clusiaceae), maintenance," said used to treat mild to Larson when asked moderate depression; about the future of the ginkgo (Ginkgo biloba garden. L., Ginkgoaceae) used "We're only midway to treat memory though the second year. impairment and age Nothing's fully stabi related cognntve lized so we can't make dysfunction; and tea Pharmacognosy professo r Harry Fang, left, director of the garden and fiel d station, exact projections for (Camellia sinensis (L.) and Steve Totu ra, supervisor of the field station, kneel to exa mine one of the plants cost. However, it looks Kuntze, Theaceae), in the garden. Photo courtesy of Grant Therkildsen/UIC Photo Services like the endowment which is becoming will produce enough to increasingly popular for its recognized benefits as an keep things going for a while, even allowing for unex- antioxidant, cancer preventative, and for its beneficial peered expenses." cardiovascular effects. Common food plants with medici nal value such as garlic (Allium sativum L., Liliaceae) and The memorial garden honors Dorothy Bradley Atkins, a onion (A. cepa L.) are also in the garden. graduate of the UIC Coll ege of Pharmacy and daughter of a pharmacist. She and Robert Atkins met at the UIC "The garden is about 100 by 80 feet, in a courtyard of campus while he attended medical school and she phar the UIC Medical Center. It was designed to be a mix of macy school. They married in 1946. She worked as a phar functional and ornamental plant life," said Jeff Larson, macist during his service in the U.S. Army and his surgi UIC director of advancement. "People like to come here to cal residency. They and their three children moved to relax, look at the plants and the fountain, and we put some Champaign, Illinois in 1956. They had been married for benches in this past summer." 49 years when she succumbed to cancer in 1995. --- According to Larson, the types of plants in the garden -LeAnne Hunt and Sarah Jackson 60 I HerbaiGram 60 2003 www.herbalgram .org , ~'#_ #. #. , • • • • f Grant Therktli:Jsen/UIC Photo , Photo courtesy of Grant T herktldsen/UI ~ P.hoto Serv1ces Evening primrose Oenothera blenms f Grant Ttierkildsen/UIG Pnoto • t. I • I I II ... •• legal & regulatory Canada Issues Final Natural Health Product Regulations by Joel B. Taller, BSc, MBA Health Canada as the Therapeutic Products Directorate (TPD), which regul ates medical devices and drugs, and the Food Direc n June 18, 2003, the Canadian government established a new torate, which regulates food. This new regul atory authori ty, the O class of drug products, Natural Health Products (NHPs), Natural Health Products Directorate (NHPD), is to be perma when it published the Natural Health Product Regulations (NHP nently staffed by individuals with expertise and experience in the Regulations) in the Canada Gazette Part !1. 1 This is the final regu field of NHPs, agreeable to both government and NHP stake latory step that, beginning January 2004, will control all aspects of holders (e.g., members of the natural health products industry). the commercializati on of N HPs, including manufacturing, impor T he new initiative was affirmed on March 26, 1999, by the tati on, labeling, and packaging. N HPs include herbal and botani Government of Canada and the Minister of Health (Minister), and cal supplements in dosage form (e.g., pills, tinctures, and even teas, was greeted by the majori ty of the NHP stakeholders as a breath of depending on the tea's ingredients and claims). A more detailed fresh air. A new regul atory authori ty on par with food, drugs, and definition is included below. devices, staffed with individuals familiar with and accepting of the new category promised a regulatory framework that could increase Background the number of regulated NHPs authorized to make approved, Canada's review of the regulatory framework for NHPs began meaningful health claims. Further, this new system promised to several years ago. The most significant as pect of this review began increase acceptance ofNHPs by Canadian consumers. In 1998 the as a res ult of the proposed introducti on of Establishment Licens pro posed new Canadian system caught the attention of the U.S. ing (EL) for drug products, which included many NHPs. EL was herb industry and its leaders, particularly because the NHPD was tied to the requirement fo r Good Manufacturing Practices (GMPs) given the same regulatory authority as the directorates that regul ate for drugs, which manufac turers of many NHPs (which were and conventional foods and drugs . will be regul ated as drugs in Canada until January 1, 2004) were required to co mply with. Previously, and even today, many NHPs General Overview have bee n and are manufac tured to meet food GMPs, des pite the T he N HP Regulations prov ide for the following regulatory over ongoing requirement in Canada to meet drug GMPs. Stakehold sight: (I ) a pre-market review and approval process with res pect to ers, realizing the impact that compliance with drug GMPs would all aspects of the NHP, including safety, efficacy, claims, and prod have on the NHP industry, began a coordinated political action uct specificati ons; (2) a requirement to manufacture, package, and campaign. T his campaign ultimately led to the government's label NHPs in accordance with GMPs that will apply to both review of N HPs, completed in November 1998. domestic and imported NHPs; (3) the requirement to hold a Site T his review was conducted by the Standing Committee on Li cense where any regul ated activity is carried out with respect to Health (the "Committee") of the Federal Parliament. Noting the an N HP, including importati on; (4) the regulatory oversight of the complexi ti es of the regul ation of NHPs the Committee stated, clinical trial process involving NHPs; and (5) a post-market "Although we feel the government has a responsibility to protect surveillance program to track potential adverse reactions. public health and safety, this should not be applied in a way that unreasonably denies co nsumers access to products that they Adverse Reaction Reporting perceive to be necessary for their well being. Thus, a balance must As part of the post-market surveillance program,3 an NHP be struck between safety and access."2 Furthermore, the Commit product license holder must take certain actions with respect to tee noted, " . .. the framework must allow for more products to be adverse reactions.4 The Licensee must: marketed to provide people with that choice."2 • provide a case report for each serious adverse reactions to the T he Committee made 53 recommendations in its 1998 report, NHP that occurs in Canada within 15 days of becoming including creati on of a separate regulatory authority responsible aware of the serious adverse reaction; for regul ati on of NHPs. After considering four options, the • provide a case report for each se rious unexpected adverse reac Committee recommended a new NHP regulatory authority that ti on6 to the N HP that occurs inside or outside Canada within would report directly to the Assistant Deputy Minister of what is 15 days of becoming aware of the serious unexpected adve rse now known as the Health Products and Food Branch (HPFB). reacti on; T his new directorate would be created at the same level within • annuall y prepare and maintain a summary report that contains a concise and critical analysis of: Abbreviations Used in this Article 0 all adverse reacti ons to the NHP that have occurred inside Canada; and DIN Drug Identification Number 0 all reactions for which a case report is required to be EL Establishment License provided within 15 days, that have occurred: GMP Good Manufacturing Practices during the previous 12 months; and HPFB Health Products and Food Branch - at a dose used or tes ted for the diagnosis, treatment, or NHP Natural Health Product prevention of a disease, or for modifying organic fun c NHPD Natural Health Products Directorate ti ons in humans. NPN Natural Product Number In addition, if the Minister (through the NHPD) has reaso nable SOE Standards of Evidence gro unds to believe the NHP is no longer safe to be used under TPD Therapeutic Products Directorate recommended conditions, after reviewing either the case reports or 62 I HerbaiGra m 60 2003 www.herbalgram .org legal & regulatory any other safety data, the Minister may request that the NHP single homeo pathic preparations), the manufacturer wo uld only li cense holder provide within 30 days : include the indications for which it wanted to submit evidence. • a copy of the summary report; or There is no requirement to claim all potential uses or benefi ts , even • an interim summary report containing a concise and critical if they are ge nerally known. analysis of: 0 all adverse reactions to the NHP that have occurred inside Product License Canada; and In order to sell an NHP, an applicant (i. e., a manufacturer, 0 all reacti ons for which a case report is required to be importer, or distributor) must submit a product li cense application provided within 15 days, that have occurred; to the NHPD and receive a product license before the NHP may since the date of the most recent summary report; and be sold in Canada. The application for a product license must - at a dose used or tes ted for the diagnosis, treatment, or include sufficient information to support its safety and efficacy. prevention of a disease, or for modifYing organic func T he type of evidence submitted will determine the types of tions in humans. claims that can be made in association with that NHP (i. e., a struc The foregoing adverse reaction reporting requirements come ture/function claim, along the lines of those claims being made for into effect as soon as the product license applicant (e.g., the manu dietary supplements in the U.S. under the Dietary Supplement facturer, importer, distributor, or marketer) receives a product Health and Education Act of 1994), risk-reduction (i.e., the reduc license for the NHP. tion of risk of developing a disease, disorder, or abnormal phys ical This report, together with additional information reques ted by state or its sy mptoms), or therapeutic claims associated with drugs the Minister (through the NHPD), may be used as justification to (i.e., diagnosis, treatment, mitigation, or prevention of a disease, stop7 or suspend8 the sale of an NHP. T he Minister may direct a disorder, abnormal physical state or its symptoms). The NHPD is licensee, manufacturer, importer, and/or distributor to stop the in the process of finali zing the criteria that must be met in order to sale of the NHP. A stop sale directive wi ll only be lifted when the make a claim, which will be contained in a policy entitled, "Stan Minister receives information to support the sa fe use of the NHP. dards of Evidence. " T he Minister may direct any of these parties in the distribution chain to stop sale, whether they are the actual li censee or not. Standards of Evidence The Minister may also suspend the NHP, but must first give to The Standards of Evidence (SOE) will outline the types, the Licensee 90 days notice to provide information to support the strength, quality, and quantity of evidence that will be required by continued sale of the NHP, unless immediate suspension is neces the Minister (through the NHPD) to support the safety and effi sary to prevent injury to the health of a purchaser or consumer. If cacy of an NHP. Based on current documents with regards to the a product license is suspended, the Minister must provide the development of the SOE,13 NHPs wi ll be divided into two cate licensee an additional 90 days to respond with more information gories based on ingredients: traditional and non-traditional. before the li cense can be cancelled. Traditional NHP ingredients are those that are widely used within a cultural context and have been used for 50 years (at least NHP Definition two generations). Previously, non-traditional NHP ingredients An NHP has a twofold defi nition,9 based on (1) ingredients; and were proposed by the NHPD to be divided into three subcate (2) claims. For a product to be an NHP it must first contain the go ri es: (1) generally accepted use (macronurrients), (2) those with specific substances set out in Schedule 1 of the NHP Regulations previous experi ence in humans, and (3) limited or no experience in (i.e., plant or plant material, bacteria, fungi [ex tracts and isolates humans (new NHPs). T his categorization provided for varying of same provided there is no change in the molecular structure degrees of information that was to be submitted as part of the from that found in nature], certain vitamins, minerals, amino premarket review process. acids, essential fatty ac ids, probiotics). Synthetic duplicate versions It is beli eved that the NHPD wishes to move away from this of the foregoing are also included. categorization to one that divides NHPs into only two categories: In addition to the required ingredients, the NHP must be sold traditional and non-traditional (the latter without the subcate or represented for use in: (a) the diagnosis, treatment, mitigation, gories outlined above). In the event that the NHPD adopts this or prevention of a disease, disorder, or abnormal phys ical state or abbreviated approach, additional qualifications will be required in symptoms in humans; (b) restoring or correcting organic functions the SOE. These qualifications wi ll be necessary to differentiate in humans; or (c) modifYing organic functions in humans in a between the level of evidence that must be submitted to establish manner that maintains or promotes health. Excluded from the safety and efficacy based on the NHPD's level of fami li arity with definition of an NHP or from the appli cation of the NHP Regula the non-traditional NHP. The evidential data outlined in the draft tions are products containing prescription and injectable drugs SOE ranges from traditional monographs to human clinical trials (i ncluding homeopathic injectables), those drugs set out in Sched for new NHPs. ule C of the Food and Drugs Act (radiopharmaceuticals), 10 The draft SOE also indicates that the NHPD may use the substances regulated under the Tobacco Act, 11 and substances set co ncept of self-care, sel f-medication, and responsible self-medica out in any of Schedules I to V of the ControlLed Drugs and tion to determine allowable claims for over-the-counter use. This Substances Act. 12 To clarify, some type of health benefit claim is a may inean that only the over-the-counter NHPs used in the mandatory requirement for aiL NHPs. A manufacturer who previ context of self-treatment may be approvable for sale as an NHP. ously represented that its product consisted of 500 mg of St. John's wort without any claim, must say something about the effect of the Product License Application product. For products with potentially multiple uses (e.g., so me As part of the approval process, a product license appli cant must www.herbalgram.org 2003 HerbaiGram 60 I 63 legal & regulatory provide the proper and common name for each medicinal ingredi Of the approximately 50,000 NHPs currently on the Canadian ent, 14 its quantity per dosage unit, its potency15 if a representation market, only a small number hold a DIN and, thus, could be rel ating to its potency is to be shown on any labels of an NHP, a reviewed quickly since they have already passed the TPD's pre description of its so urce material, and a statement indicating market review process . It is estimated that more than 10,000 appli whether it is synthetically manufactured. The product license cations will be submitted to the NHPD during 2004 (perhaps application must also include a qualitative list of the non-medici during the first several months). In light of this workload and the nal ingredients that are proposed for the NHP and a statement relative inexperience of the NHPD in reviewing applications, it that indicates the purpose of that ingredient (i.e., an excipient, might take more than a year to obtain approval and a Natural filler, flowing agent, binder, or coating added for technical and Product Number (NPN). manufacturing purposes). The NHPD proposes to indicate what non-medicinal ingredients may be used without the necessity to Labeling provide safety and efficacy data to support thei r use. The NHP Regulations outline specific labeling req uirements for NHPs and include, by reference, certain labeling requirements for GMPs/Site License drugs from the Food and Drug Regulations. Some of the labeling NHPs must be manufactured, packaged, and labeled in accor requirements include reco mmended conditions of use, the dance with the GMPs outlined within the NHP Regulations, inter common and proper name of each medicinal ingredient, a listing preted by a policy to be finalized in November 2003 by the of the non-medicinal ingredients, storage conditions, a description NHPD. In addition, a manufacturer, packager, labeler, or importer of the so urce materi al of a medicinal ingredient, a lot number, and must obtai n a Site License (SL), which is evidence of GMP expiry (expiration) date. co mpliance (i. e., an SL will not be iss ued until information is submitted to the NHPD for review to ensure GMP requirements Transition Period are met). While the NHP Regulations will become effective January 2004, The product license application must also include the SL a transition period will permit staged compliance over six years for numbers for each parry co nducting any regulated activity with products bearing a DIN and offered for sale prior to January 1, respect to the NHP (i. e. , the product applicant is required to 2004. There is a two-year transitional period for GMP compliance provide the SL number for all manufacturers, packagers, and label and to obtain a Site License; four years to obtain a product license ers of the NHP). If not available, the information must be and comply with labelling requirements; and, fin ally, six years to provided by the product license holder before sales activity convert existing drug products that already have a DIN. commences. Further, if the NHP is imported, the product license These transition provisions have been revised from the first draft application must include similar information with respect to all of the NHP Regulations and appear to only permit the sale of an foreign si tes performing any regulated activities. NHP that is not yet in compliance with NHP Regulations during the rel evant transition period, provided the NHP has been iss ued Product License Application Review Streams a DIN. T his is not the case for many products presently in the The product li cense application review process will be broken Canadian market. down into several streams, based on the type of product li cense It is believed that the NHPD intends to prioritize enforcement application: of the NHP Regulations according to the potential level of risk to • Drug Identification N umber (DIN)16 applications originally consumers of non-compliant NHPs. The NHPD intends to submitted to the TPD with res pect to a drug that will on review all non-compliant NHPs to bring them into compliance January 1, 2004, be classed as an NHP and for which the according to this risk-management approach over the four-year TPD review has not been completed; transition period for product li censing. • abbreviated applications for the co nve rsion of an NHP bear To date, this approach has been referred to by the NHPD in oral ing a DIN; discussions in response to inquiries as to the content of a ye t-to-be • a product license application submitted in compliance with an released Compliance and Enforcement Policy. Without the inclu NHPD Monograph (for which no evidence needs to be sion of very clear language as to the fundamentals of this approach, submitted to support safety and efficacy; rather, the applicant as well as the criteria upon which NHPs will be reviewed to bring attests to co mpliance with the NHPD Monograph); and them into compliance, those involved with the sale of non-compli • a product license application where there is no NHPD Mono ant NHPs will have little defense to the enforcement of the NHP graph and evidence must be supplied to support the safety and Regulations by the HPFB Inspectorate, a separate, and equal, entity efficacy of the NHP. within Health Canada. Hopefull y, this issue will be answered early this fall with the rel ease, in draft form at least, of a Compliance and Review Time Enforcement Policy. The NHP Regulations require the Minister to co mplete the Public Education and Research review of a product license application within 60 days I? if it is with respect to an NHP where the applicant confirms the NHP The NHPD has indicated that by November 2003 it intends to complies with an NHPD Monograph. This provision will go into launch a public awareness campaign to inform both stakeholders effect July 2004.18 The NHPD has indicated it hopes to rel ease at and consumers about the NHP Regulations and their impact. The least 100 monographs prior to January 1, 2004, with another 200 Regulatory Impact Analys is Statement notes that the NHPD will thereafter. The NHPD is developing its own monographs, rather work with the industry to educate and inform the industry on the than refer to other established monographs. T here is no regulated new requirements. timeframe for the review of any other product license application. As a res ult of the 1998 Committee recommendations, several 64 I Herbal Gram 60 2003 www.herbalgram.org legal & regulatory federal governmental research bodies were asked to encourage 6. "Serious unexpected adverse reaction" means a se ri ous adverse reac research immediately with respect to NHPs. In response, the tion that is not identified in nature, severity, or frequency in the risk NHPD has been developing research priorities and strategies to information set our on the label of the natural health product. S.O. R./2003-196, S.1(1). ensure effective use of research dollars. In addition, Health Canada 7. S.O. R./2003-196, S.16 and 17. has committed Can$5 million over five years to create the NHP 8. S.O.R./2003-196, S.18 to S.2 1. Research Program. The complete NHP Regulations can be viewed 9. S.O.R./2003-1 96,S. l. at American Botanical Council Clarifies Safety Issue on Star Anise Tea n September 10, the U.S. Food and Drug Administration market. Several authoritative reference books and European phar O (FDA) issued a Consumer Advisory regarding the agency's macopeias have published analytical methods to help make the concerns about some cases of poisoning related to rhe substitution proper distinctions. of the toxic Japanese star anise (Illicium anisatum L. , Illiciaceae) for "Herbal teas sold by reputable companies in the United States the safe C hinese star anise (I. verum Hook. f. ). are quire safe," said Mark Blumenthal, founder and executive The following day, many news outlets reported the story. Unfor director of the American Botanical Council. "The herb industry tunately, many consumers, reporters , and even natural foods and has known about the problem with the two kinds of star anise for grocery industry members have become confused over FDA's many years and has developed quality ass urance programs to actions and the ensuing publicity, incorrectly suspecting problems ensure that commercial herb teas use the safe C hinese star anise." with all commercially manufactured herbal teas containing star The cases of poisoning with Japanese star anise that rhe FDA cited amse. were not related ro herbal teas produced by reputable rea companies, C hinese star anise is a safe and flavorful component of some Blumenthal added. Most of the poisoning cases probably involved popular herbal rea blends, and iris also a flavor component of spice cases where consumers purchased the roxie Japanese star anise in mixes used in food products. It has the same star-shape as Japanese bulk and made their own teas. Japanese star anise has been sold for star anise, but the Japanese species contains som e toxic many years for its use as an ingredient in potpourris because of its compounds. The herbal tea industry has long used the safe shape and fragrance. Ir is not intended for internal use. Chinese star anise, not the Japanese material. C hinese star anise is ABC also pointed out rhar rhe public should not confuse star recognized as safe for food use by FDA, as acknowledged in FDA's anise with an ise, sometimes called aniseseed (Pimpinella anisum L., advisory. Apiaceae), a member of rhe carrot family. Anise is a safe, Because the two species' star-shaped seedpods look so much commonly used food fl avoring that is also generally recognized as alike, the herbal tea industry many years ago developed laboratory safe by rhe FDA. Because of irs licorice-like taste, anise oil is the techniques to distinguish between them. In-house quali ty control main ing[edient used in making "licorice" candies in the United laboratories at herb tea companies in the United States employ States. A microscopic analytical techniques as well as chemical tests to [Source: Herbal Science Group Clarifies Safety Issue on Star Anise Tea ensure that the herbal material they receive is the proper, safe herb (press rel ease) . Austin, TX: American Botanical Council ; September 12, before it is processed into herbal teas released to the commercial 2003.] www.herbalgram .org 2003 HerbaiGram 60 I 65 legal & regulatory FDA Publishes Rule to Incorporate AHPA's Herbs of Commerce in Herb Labeling n August 28, 2003, the U.S. Food and Drug Administrati on AHPA published Herbs of Commerce in 1992 as self-governing O (F DA) published a direct final rule in the Federal Register1 to guidance for irs members to reduce confusion in labeling botanical amend its regulati ons on labeling of botanical ingredients in ingredients. FDA incorporated the document by reference in 1997 dietary supplements by incorporating the current editio n of as the age ncy initiated rulemaking to implement the Dietary AHPA's Herbs of Commerce. 2 T he new rule becomes effec tive on Supplement Health and Educati on Act of 1994 (OSH EA). January I, 2006, co nsistent with FDA's published poli cy on Over the past few yea rs, AHPA has often requested that FDA uniform effective dates for food labeling regul ations. revise the regulations to incorporate the second edition of Herbs of FDA also updated its reference so urces to include the current Commerce. T he agency has now initiated the rulemaking process edition of the International Code of Botanical Nomenclature (St. by iss uing this direct fin al rul e. In the Federal Register, FDA Louis Code) 2000 (IC BN). T he ICBN is accepted by the world explained that it initiated rulemaking in this manner instead of the wide taxonomic community as "the rules usual notice-and-comment process as it does not expect to receive that govern scientific naming in botany" as significant adverse comments on the pro posal. The agency, never determined and "revised at Nomenclature .~~tw.t · theless, simultaneously published a virtually identical proposed Secti on meetings at successive Interna rule in the event that significant adve rse co mments are tional Botanical Congresses. T he prese nt received.""' edition of the International code of botani -Mark Blumenthal cal nomenclature embodies the decisions of References: the XVI International Botanical Congress I. 68 FederaL Register 51693-704. Also avail abl e online at held in St Louis in 1999 and supersedes 66 I HerbaiGram 60 2003 www.herbalgram.org CRYPTOLEPIS 42. Bonjean K, DePauw-Gillet MC, Defresne MP, et al. The ON, calating alkaloid cryptolepine interacts with topoiso merase Continued from page 59 inhibits primarily DNA synthes is in B 16 melanoma cells. 1 Board (FOB). FOB requires clinical studies on a product before regis 1988;37:5 136-46. tration. 43. World Health Organiza tion. Advances in malaria chemot 21. Boye GL. Studies on antimalarial action of Cryptolepis sanguinolenta Report of WHO Scientific Group. Technical Report Se ri1 extract. Proceedings of che International Symposium on East-West 1984. Medicine; 1989 October 10-11; Seoul, Korea. p. 243-51. 44. Ansah C, Nigel JG. Extracts of Cryptolepis sanguinolenta, 22. Dwuma-Badu D, Ayim JSK, Fiagbe NY!, Knapp PhE, Schiff Jr. PL, African herbal medicine, is cytotoxic (200 I ). This was a 1-pa Slatkin OJ. Constituents ofWest African medicinal plants XX: Quin de prepared for publication and communicated to Phyto-Rikt doline from Cryptolepis sanguinolenta. j Pharm Sci 1978;67:4339- toxicity of cryptolepis was being investiga ted. The work was 434. out at the Molecular Toxicology Unit, Division of Bi o1 23. Paulo A, Gomes ET, Houghton PJ. New alkaloids from Cryptolepis Sciences of the Imperial College School of Medicine in Soud sanguinolenta. J Nat Prod 1995;58: 1485-9 1. ington, London. 24. Wan JM, Breyer-Brandwijk MG. The Medicinal and Poisonous Plants 45 . Cimanga K, Pi eters L, C laeys M, Vanden Berghe D, Vlieti J ofSouthern and Eastern Africa. 2nd Edition. Edinburgh and London. Biological activities of cryptolepine, an alkaloid from CIJ Livingstone; 1962. p. 128-129. sanguinolenta. Planta Med 1996;57 Supplement Issue 2: A98-A 25. Luo J, Fort DM, Carlson TJ, et al. Cryptolepis sanguinolenta: an 46. Noguchi Memorial Institute for Medical Research (N Mill ethnobotanical approach to drug discovery and the isolation of a report from the Chemical Pathology Unit of NMIMR on potentially useful new antihyperglycaemic agent. Diab Med studies carried out on Phyto-l aria® when the product wa: 1998; 15:367-74. submitted to the co untry's drug regulatory agency for regi: 26. Paulo A, Duarte A, Gomes ET. In vitro antibacterial screening of (2002). Cryptolepis sanguinolenta alkaloids. j Ethnopharmacol 1994;44: 127- 30. 27. Kerharo J, Adam JG. La pharmacopee Senegalaise traditionnelle. FEATURED ITEMS FROM ABC'S CATAL Plantes medicinal et toxiques. Paris: Vigor et Freres; 1974. pp 632-3. 28. Boakye-Yiadom K. Antimicrobial properties of some West African medicinal plants. II. Antimicrobial activity of aqueous ex tracts of Ginkgo Leaf & Ginkgo Cryptolepis sanguinolenta (Lindl.) Schlechter. Quart j Crude Drug Res Leaf Extract: Ginkgo 1979; 17:78-80. 29. Gel lert E, Raymond-Hamer, Schlitder E. Die Konstitution des Alka biloba L. Standards of loids Cryptolepin. (The structure of the alkaloid ctyptolepine) Helv Analysis, Quality Control Chim Acta 195 1;34:642-51. 30. Ablordeppey SY, Hufford CD, Borne RF, Dwuma- Badu D. 1H-NMR and Therapeutics. and 13 C-NMR assignments of ctyptolepine, a 3:4 benzo-d-carboline derivative iso lated from Cryptolepis sanguinolenta. Planta Med 2003. Editor: Roy Upton. The 1990;56: 4 16-7. latest monograph from the Arne 31. Tackie AN, Boye GL, Sharaf MHM, et al. C ryptospirolepine, an can H erbal Pharmacopoeia. unique spiro-nonacyclic alkaloid isolated from Cryptolepis sanguino - Comprehensive review of thera lenta. j Nat Prod 1993;56:653-70. peutic uses; complete safety and toxicology data, and 32. Pousset JL, Martin MT, Jossang A, Bodo B. Isocryptolepine from more. Fully referenced and peer reviewed. 14 pages. Cryptolepis sanguinolenta. Phytochem 1995;39:735-6. $24.95. Item 446. 33. SharafMHM, SchiffJr. PL, TackieAN, Phoebe Jr. CH, Martin GE. Two new indoloquinoline alkaloids from Cryptolepis sanguinolenta: Steven Foster Photography cryptosanguinolentine and cryptotackieine. J H eterocyclic Chern 1996;33:239-43. Medicinal Plants -Volume 1 CD-ROM 34. Sharaf MHM, Schiff Jr. PL, Tackie AN, Phoebe Jr. CH, Johnson RL, Minick D. The isolation and structure determination of cryptomis This royalty-free CD ROM contai1 rine, a novel indolo[3,2-b] dimeric alkaloid from Cryptolepis 102 photos of some of the most pof sanguinolenta. J Heterocyclic Chern 1996;33:789-97. lar medicinal plants in use today. 35. C imanga K, De Bruyne T, Pieters L, Vlietinck AJ. In vitro and in vivo Medicinal Plants - Volume I is antiplas modial activity of cryptolepine and related alkaloids from designed for both Macintosh TM anc Cryptolepis sanguinolenta. j Nat Prod 1997 ;60:688-91 . Windows TM operating systems. 36. Paulo A, Pimentel M, Viegas S, et al . Cryptolepis sanguinolenta activ ity against diarrhoeal bacteria. j Ethnopharmaco/1994;44:73-7. The images are high resolution: 8x 37. Wright CW, Addae-Kyereme J, Breen AG, et al. Synthesis and evalu inches at 300 dpi (20.3x30.5 em at 118 dpcm) and ha\ ation of cryptolepine analogues for their potential as new antimalar excellent highlight and shadow detail. ial age nts. j Med Chern 2001;44:3187-94. 38. Sawer IK, Berry MI, Brown MW, Ford JL. Antimicrobial activity of ° For products produced in quantities ofless than 100,000 units. F< cryptolepine. j Pharm Pharmacol 1993;45: 1108- 11 . complete listing of the plants in this collection, visit: 39. Cimanga K, De Bruyne T, Pieters L, et al. Antibacterial and antifun http://www.herbalgram.org/default.asp?c=sfg_images gal activities of neocryptolepine, biscryptolepine and cryptoquindo To order, please line, alkaloids isolated from Cryptolepis sanguinolenta. Phytomed 1998;5:209-1 4. call800-373-7105, ext.ll8 40. Noamesi BK, Bamgbose SOA. The a-adrenoceptor blocking proper or for secure online ordering, ties of cryptolepine on the rat isolated vas deferens: studies on cryp IMERIC tolepine. Part I. Planta Med 1980;39:51-6. please visit the Herbal Education BoTI"NIC 41. Rauwald HW, Kober M, Mutschler E, Lambrecht G . Cryptolepis Catalog section of our website: COUN sanguinolenta: antimusca rinic properties of cryptolepine and the = alkaloid fraction at M I , M2 and M3 receptors. Planta Med 1992;58:486-8 . WWW.HERBALGRAM.OR www.herbalgram.org 2003 HerbaiGrarr ~nference report inPharma Expo 2003, lima Peru: :ural Products Roundtable, Trade Show, Buyers/Sellers Meeting A. Brinckmann research centers, and public institutions. products companies in the United States, Lectures were co nducted in Spanish and Japan, and European Union - that are second annual LatinPharma Expo Portuguese, with English translati ons based on already existing traditional Jk place July 8- 11 , 2003, at the provided. Highlights included a presenta knowledge from Latin Ameri can so urces. .1 arters of the Andean Community ti on, entitled "T he ro le of natural products In this presentation, and in others ions (CAN) in Lima, Peru. T he first in research and industrializati on," by Prof. described during the conference, patents 'harma took place in San Salvador, Dr. Armando Caceres, of the Universidad that have been awarded to American tlvador, in April 2002. Topics de San Carlos and coordinator of the corporations for maca inventions were ;ed at the Lima co nference included Ibero-Ameri can Network of Phytophar discussed as highly controve rsial. ;ional and world markers for Andean mace utical Products (Riprofito) , Program For example, Pure World Botanicals, cal products, intell ectual property for the D evelopment of Science and Tech Inc. of South Hackensack, New Jersey, and patents granted to Ameri can, nology in Latin America (CYTED), now has three U.S. Patents on maca ean, and Japanese co rporati ons for Guatemala. Dr. C iceres focused on fair inventions (U.S. Patent nos. 6,552,206; I product inve ntions based on tradi trade issues and the need for Andean 6,428,824; and 6,267,995), and Biotics knowledge. botani cal raw materi al producers to move Research Corporati on of Rosenberg, : of the primary obj ectives of Latin up in the va lue chain, away from produc Texas, has one maca patent (U .S. Patent ta was to promote intra-regional ing only raw materials and towards the no. 6,093,42 1), while in its country of in medicati ons, natural and producti on and ex portati on of value origin, no Peruvian institutions have ye t ti c, particularly among the partici added intermediate (e.g. , extracts and oils) obtained a maca patent. One main point : countries of CAN (specifically and finished co nsumer products (e.g., of Dr. Delgado's presentation was that 1, Colombia, Ecuador, Peru, and medicinal herbal extracts in dosage form), producers in developing countries need to uel a) . T he co nference included particularl y to the European and North become acutely aware of the increasing :s and roundtabl e discuss ions on Ameri can markets. He emphasized that number of patents that are being iss ued to I products with a concurrent trade while Peru exportS US$5-6 million annu corporations in developed countries that in the adjacent hall, plus a well ally in medicinal plants, ve ry little va lue may threaten the future ability to produce zed two-day natural products and added processing occurs inside Peru . He and market certai n value-added forms of 1ments buye rs/sellers mee ting. went on to state that the mere exporting of native plants, even when they are eve nt was orga ni zed by the lnterna crude botanical raw materials cannot be pro moted for traditional uses . In these Trade Centre (ITC) baiGram 60 2003 www.herbalgram.org conference report Medicinal Herbal Products at the • camu-camu fruit (Myrciaria dubia ex tract of turmeric and eat's claw), and Trade Show (Kunth) McVaugh, Myrtaceae); Laboratorios H ersil S.A., also of Lima, a The trade show itself was surprisingly • eat's claw stem bark ( Uncaria tomen 490-employee manufacturer and distribu small with room only for 22 booths, some tosa (Willd.) DC, Rubiaceae); tor of several laboratory and cl inically of which were shared by more than one • chuchuhuasi bark (Maytenus krukovii tested herbal medici nal products including company. For example, the BANCOEX A.C. Sm., Celastraceae); La Molina® Maca (gelatinized maca booth represented I 0 different Venezuelan • dragon's blood croton latex (Croton tablets), the subject of a Phase I study at companies. Other interesting exhibitors lechleri Mull. Arg., Euphorbiaceae); the Universidad Peruana Cayetano Here included the Instituto Peruano de Produc • hercampuri whole plant ( Gentianel!a dia, Lima, Peru, investigating its effects on 1 tos Naturales www.herba lgram.org 2003 HerbaiGram 60 I 69 conference report were also on hand fo r private consultation. copy of the Market News Service for Medi marion o n LatinPharma 2003, v1s1t: Participants also received a CD-ROM cinal Plants & Extracts (see excerpt in with distinguished international fac ulty the worlds of nature and health a prosperous and fulfilling career Contact us for information, to arrange a visit, or to attend our next open house. Be part of the nation's first graduate degree in Western herbs. This rigorous academic program, taught by prestigious intern ational faculty, offers students abundant experiences in nature and the opportunity for cl inical experience. Delivered in a full-time, flexib le format. 70 I HerbaiGram 60 2003 www. herbalgram.org conference report Students of Pharmacy and Herbal ism Meet, and learn, in Belize by Dan Wagner, RPh, MBA PharmD n an unprecedented display of coopera District ofWestern Belize, nea r the town of and snorkeling around Snake Island, Ition in the interest of expanding educa San Ignacio. The principal student instruc located in a 500-square-mile ocean reserve tion of medicinal plants and herbs, students tor was world-renowned herbalist and natu within H onduras Bay, 40 minutes by from American schools of pharmacy and ral-medicine doctor Rosita Arvigo, MD. motorboat from Punta Gorda. naturopathy met in Belize, Central America Dr. Arvigo is the author of Sastun, The I 00 The coll aboration of the students from from May 19-28, 2003. The students trav- Healing Plants of Belize, and Rainforest these two distinct disciplines of health care Remedies. She taught the group courses undoubtedly helped to es tablish a bond of in Maya medicine, the healing plants of cooperation and understanding of natural Belize, and ethnobotany. Dr. Arvigo and holi sti c medicine. They not onl y was joined by three local healers who become friendly toward each other, but are members of the Belizian Healers become friendlier with the natural world Association. These well-known Belizian and the healing plants that thrive there. The healers included Beatrice Waight, a midwife and Maya medicine practi tioner; Leopolda Romero, a bushmaster and expert plant coll ector; and Juana Shish, a midwife and plant medicine expert. They assisted the group in an The SRF group of thirty. May, 2003. Photo ©2003 Dan ethnobotanical fi eld exercise that Wagner included collection, accurate descrip tion, location name (Spanish or eled with the Student Rainforest Fund Mayan) , use and posology of each speci (SRF), a nonprofit, educational organiza men. AJI plant samples were numbered and tion established in 1995. The SRF provides documented for poss ible research at the the means and substantial funding for National Cancer Institute in the United American coll ege students studying the States. Bushmaster and traditional healer Polo Romero health profess ion, to learn more about the While in the Cayo District, the students instructs a group of students before going into the forest. Photo ©2003 Dan Wagner "roots" of their profession in the rainforests also visited Xuantunich, the highes t Mayan of Central and South America, truly the ruin in Belize that overlooks the Guatemala opportunity for these yo ung and impres world's greatest pharmacy. 2003 is the border, and went caving and swimming at sionable students to work hand-in-hand eighth consecutive year that the SRF has Rio Frio Falls, located on the Pine Ridge of with indigenous traditional healers has sponsored 20 or more students on an eight Western Belize. immeasurabl e value, for it is information day expedition of Belize. The weekend that cannot be This year's team included eight pharmacy was a time for attained in a university students from Duquesne University's touring the beau classroom. There is School of Pharmacy, located in Pittsburgh, tiful mountains, little doubt that this Pennsylvania, and six students from the plains, and shores life, spiritual, and University of Montana School of Pharmacy, of Belize. The educational ex peri ence located in Missoula, Montana. For the first group headed will be of grea t value time, nine students studying herbal medi so uth to the to them as they further cines and naturopathy from Bastyr Univer Toledo District their health field sity in the state of Washington attended. and stayed at the related caree rs. The American faculty included the author; Sea Front Lodge The SRF has future Norbert Pilewski , PhD, RPh, vice president in Punta Gorda. student expeditions of SRF, and associate professor of pharma After a lecture by planned for Beli ze, cognosy at Duquesne University in Pirrs Dr. Pilewski enti- SRF President Dr. Dan Wagner (R) and VP Dr. Norbet Costa Rica, and possi burgh; Steven Morris, ND, from Mukilteo, tied "Plants that Pil ewsski (L) with Mayan healer and midwife Beatrice bly Suriname. Contact Waight. Photo ©2003 Dan Wagner Was hington, who is also an adjunct profes Change d t h e SRF at P.O. Box 238, sor of ethnobotany at Bastyr University; World," the team Wildwood, PA 1509 1. and Bruce Sigman, RPh, MBA, PharmD, a visited an ancient Mayan ruin call ed Nim Li Website: he 5-Minute Herb and Dietary members of the parsley family, Apiaceae) TSupplement Consult, by Adriane hemlock smells rank; fennel smell s like New Book Profiles Fugh-Berman, MD. Lippi ncott Williams licorice." and Wilkins: Philadelphia, PA. 2003. 474 The final section of the book co ntains ue to economic considerations pp., hardcover, includes references and many reference tables designed to ass ist the Dand the natural evolution of book index. $59.95 ISBN 0-683-30273-6. practitioner. This book is recommended marketing and sales, the American With the wealth of information on herbs for every healthcare provider, from the Botanical Council is adding to its cata and supplements floating around the library novi ce regarding the clinical use of herbs log very few of the good new books shelves, through cyberspace, and over the and supplements to the most experienced. that are being published. However, we kitchen table, it is extremely difficult to Consumers also will find Dr. Fugh do intend to keep our readers informed know how best to use it. Both patients and Berman's up-to-date and to-the-point of books of particular interest that have providers must devote an immense amount discussions of the herbs and other supple arrived in our offices. In this ongoing of time to analyzing the available data to ments highly valuable. I recently heard an feature, we only describe these new learn when and how to use herbs and after dinner speaker offering the following books; we have not yet had them supplements, and when not to use them. formula for success - "stand up and be reviewed. This latest book, written by a physician recognized, speak to be heard, and sit If you are interested in purchasing who is well-versed in the field of herbal down to be appreciated." This book any of these books or those that have medicine, 1s targeted to healthcare follows this dictum in a most pleasant and been reviewed fully, and you want to providers, and useful way. --" help ABC at the same time, please go offers a most -Michael J. Balick, PhD to the online version of this article on valuable 5- Vice President and Chair, our website 72 I HerbaiGram 60 2003 www.herbalgram.org book reviews abuse and misuse is the m ain reason why hours I sat with indigeno us healers and bacteria resistance is a global iss ue. But we shamans in the rainforests of Afri ca, and of each explained. The essential oils' role in aromatherapy as well as in the perfume, have to recognize that antibiotics have saved Central and South America. These remark cosmetic and food industries is also included. millions of lives and helped immensely with able men and women believe that the plants Emphasis is placed on the need to conserve the longevity of the human species. The speak to them in a language that they can the rainforests from which these valuable oils golden age of antibiotics may indeed be o nly hear when in a trance or dream-like are obtained. coming to an end, but most people would state. W hen they encounter an illness or a The Cherokee Herbal: Native Plant Medi not want to abandon their use in the face of disease in the vi ll age with which they are cine from the Four Directions, by J.T. Garrett. Bear & Co.: Rochester, VT; 2003. em erging disease from "the ho t zon e. " not fam iliar, th ey often wait until the 274pp., softcover, illustrations, bibliography Buhner may or may not agree. specific herb, tree o r vine that ho lds the cure and medicine formul as. $15.00 ISBN 1- Buhner stands o n much firmer ground "speaks" to them in a dream . Buhner says it 8791-8196-7. when attacking the pharmaceutical giants in well w hen he writes that plants are our This book is a practical guide based on the area of syntheti c hormones. These teachers and healers and have a language Cherokee herbal medicine. Discussing the use female "xeno-estrogens," (mostly derived that we have long known. of more than 450 North American plants and their use in the treatment of more than 120 from forty years of birth control pills and Filled with hundreds of exotic and fasci conditions. Also included are traditional hormone replacement therapy use) are nating quotes from masters such as Goethe teaching stories used by the Cherokee for negatively affecting the enviro nment m a to a litany of contemporary environmental generations to explain the origin of illnesses, myriad of ways. He sites a Cana a nd natural-healing animal myths connected to medicine, and dian study where white perch in the authors, the book reads how plants were named. Great Lakes are becoming unisex quickly like a suspense Shamanism and Tantra in the Himalayas, by Surendra Bahadur Shahi, Christian Ratsch, after three weeks of direct exposure novel. It is not difficult Claudia Miiller-Ebeling. Inner Traditions Incl. to estrogen. Estrogens such as to recognize that the Ltd.: Rochester, VT; 2002. 320pp., hardcover, Premarin, Prempro, and synthetic ancient knowledge and index, bibliographical index, photos and illus horm ones from birth control pills w isdom of the few trations. $49.95 ISBN 0-8928-1913-8. are some of the most commonly rematntng indigenous Filled with beautiful photographs of tradi prescribed drugs in the industrial healers w ith the ability to tional Himalayan artwork and shamanistic ritual, this book gives a rich and detailed look world. The deluge of problems they "speak" to the plants is at at the shamans and tantricas of Nepal. Draw are spawning include low sperm a d angero us precipice. ing from 18 years of field research by the count in m en living in industrial One can only hope that authors, and the help of five shamans, this ized nations, increased cancer risk our modern society can book explores the psychological, cultural, and among women due to estrogen someh ow garner this historical facets of herbal medicine and heal ing in this remote part of the world. dominance, an earlier onset of language skill, which is puberty in young girls, and environmental likely within each of us, and discover the Treating Cancer with Herbs: An Integrative Approach, by Michael Tierra LAc, ND, havoc regarding the sex organs of fish, plant medicines aki n to healing diseases of AHG. Lotus Press: Twin Lakes, WI; 2003. reptiles, and amphibians. It is truly a disas humankind, and hopefully save the ecosys 528pp., softcover. $27.95 ISBN 0-9149- ter in the making. I wish Buhner would tem in time. Stephen H arrod Buhner is an 5593-4. have written an entire chapter on environ experienced writer who exempli fies impec This book examines the benefits of herbal m ental "xeno-estrogens," but he did an cable research and knows how to keep the medicine in cancer treatment when used with admirable job exposing the enviro nmental reader in suspense. His writing style is other techniques to attend to the whole patient, not just the cancer. Minor diagnosis toxicity caused by a cocktail of other drugs elegant and you som etimes get the feel ing steps, plant description and use suggestions, such as anti-depressants, chem o-agents, and that you are reading poetry. Buhner best and additional methods of treatment are even personal care products (no n-prescrip sums up the importance of his book for the included. tio n drugs). generation of the new millennium by evok Healing Plants of Peninsular India, by John In addition to being an enviro nmental ing a simple logic: "herbalism is based on a A. Parrotta. CABI Publishing, CAB Interna medicine book and a pharmaceutical relationship between rlants and humans, tional: New York; 2001. 994pp., hardcover, index, glossary, photos. $140.00 ISBN 0- humans and planet." _. beware book, The Lost Language of Plants 8519-9501-2. does a good job explaining the chemistry of -Daniel T. Wagner, PharmD, RPh, MBA Descriptions and medicinal uses of more than plants and herbalism . Buhner states, "using Nutri-farmacy 500 plants found in Central and Southern herbs in the healing process m eans taking Wildwood, PA India. In addition to the scientific name of part in the ecological cycle." H e proves this plants, common names are provided in more point w ith both compassion and scientific [Note: T h e Lost Language of Plants than 14 different languages. expertise. Drawing on traditional Native received a 2003 Nautilus Award in the Ecol Plants of the Gods: Their Sacred, Healing Am erican wisdom and believable modern ogy/Environment category .from NAPRA, the and Hallucinogenic Powers, by Richard Evans Schultes, Albert Hofmann, Christian day research, Buhner wants to reconnect the Network of Alternatives for Publishers, Ratsch. Healing Arts Press: Rochester, VA; reader with the natural environment, even Retailers & Artists, which honors books that 2002. 208pp., illustrated, photos. $29.95 making a plea for children to feel the earthly contribute significantly to conscious living ISBN 0-8928-1979-0. impulse w hich he calls "biophilia." and positive social change. The NAPRA This revised and expanded edition of the As I finished reading this energized and website 74 I HerbaiGram 60 2003 www.herbalgram .org book reviews used culinary herbs in the European and potentially anti-aging properties . Due to an U.S. markets. in creas ing number of chemical studies, tive Medicine, edited by Chun-Su Yuan, MD, PhD, Eric J. Bieber, MD. CRC Press: The present volume is a self-published ge neti c improvement in the plant, and New York; 2003. 404 pp., hardcover, index, manuscript containing what is probably the widening of the areas of its applications, references, illustrations, charts, glossary fo r most comprehensive treatment of the rhyme has bee n growing in intern ati onal each chapter. $99.95 ISBN 1-84214-134-1. botany, chemistry, pharmacology, and agro trade as a co mmodity of increased commer Designed as a CAM overview for non-CAM nomics of this pl ant anywhere in the cial importance. practitioners, this textbook covers informa English literature. The author is an expert T his book summarizes the chemistry, tion about a variery of CAM methods, a few of which are herbs, homeopathy, meditation, on the commercial cultivati on of medicinal pharmacology, tox icolo gy, ethnobotany, biofeedback, prayer, acupuncture, traditional plants, having extensive experience in the cultivati on, analys is, methods of ex traction Chinese medicine. Attention is paid to how cultivati on of chamomile, echinacea, thyme and processing, internatio nal standards, methods are used in a clinical setting and and many relatively exotic medicinal plants. commercial aspects, and ecological and interactions with conventional medicine. Dr. Letchamo has conducted research for aesthetic values of different thyme species. Potter's Herbal Cyclopedia, by Elizabeth M. more than a decade on the chemica l, phys i It discusses in derai l the therapeutic appli Williamson, BSc, PhD, MRPharmS, FLS. T he C.W Daniel Co. Ltd.: Essex, United ological, and ge netic studies of thyme, and cati ons of thyme together with its mode of Kingdom; 2003. 503pp., softcover, index, has developed high-quali ty thyme cultivars acti on on different biological sys tems. It illustrations. $39.95 ISBN 0-85207-361-5. for commercial field and greenhouse culti also suggests va ri ous product fo rmulations Fi rst published in 1907, as Potter's Nnu Cyclo va tion under North Ameri can growing based on thyme ex tracts and essential oils. pedia, this book has been a source of valuable conditions. With the recent fi ndings about its thera herbal information for scientists, medical and The ge nus Thymus, in the family Lami peutic properties, libido-enhancin g, anti herbal practitioners and laypersons. This new aceae, co nsists of more than 3 15 species. fa ti gue, and memory-enhancing acti vities, printing has been expanded with the latest informacion fo r 700 plants, with details on a Thyme is perennial, with wide natural thyme has earned much medicinal impor plant's habitat, medicinal uses, and prepara distribution extending from the Mediter tance, especially as a potential addition to tion and dosage. ranean to the coasts of Greenl and, Canary herbal supplements and nutraceutical prod Green Pharmacy: The History and Evolu Islands, North Afri ca, highlands of ucts. tion of Western Herbal Medicine, by Ethiopia, the southwes tern Arabian high T his book contains 10 chapters, with Barbara Griggs. Healing Arts Press: Rochester, lands, Sinai Peninsula, arid regions ofWest illustrati ons, tables, chromatograms, and Vermont; 1997. 432 pp., softcover, index, notes. $19.95 IS BN 0-89281 -727-6. and East As ia, Himalayas, and Northern graphs. All aspects of thyme, including This book examines the people, ideas, and Europe extending to Siberia. T hyme species recent research findings fro m many foreign discoveries that have molded Western herbal - such as T. serpyllum, T vulgaris, T pule language so urces, are included. medicine, discussing the use of herbs stretch gioides, T cotroidora, and T zygis - are It includes updated information on ing back to prehistoric times. Attention is known to thrive well upon introduction to botany, ethnobotany, pharmacology, tox i paid to fo rces in sociery and industry that new growing areas, such as South and cology, chemistry, biosynthetic pathways of have harmed and helped herbal medicine, with emphasis on appreciating herbal medi North America (including Canada), South the vo latile oil s, harvesting, post-harvest cine in this era of manufactured medicines. and West Africa, Australia, and New handling, industrial processing, formula Clinical Botanical Medicine, by Eric Zealand. ti ons for dietary supplement, nutraceurical Yarnell, ND, RH, Kathy Abascal, BS, JD, Thyme has an integral place in Western and personal ca re products, color and Carol G. 'Hooper, MD, MPH. Mary Ann culture and folklore, and has bee n used chemical differences in esse ntial oil, chemi Liebert Publishers: Larchmont, New York; since ancient rimes not onl y as a traditional cal differences between females, male or 2003. 418pp., hardcover, index, charts, photos. $99.00 IS BN 0-913113-95-6. medicine, but also, the author notes, as a hermaphrodite rhyme, and the agricultural tonic and libido enhancer. The esse ntial oil and ecophys iological aspects of the genus Designed for medical practitioners, this book contains both historic and scientific background or the alcohol extract from its leaves are Thymus. In all , this is a highl y useful refer to support the use of certain herbs. Organized by used as natural preservatives in conven ence for researchers , formulators, growers, illness or condition, the chapters have a listing of tional food, beverage, cosmeti c, and and others with an interes t in determining suggested herb and a description of studies done perso nal care products. Thyme oil and commerciall y useful applicati ons of this to support this suggestion. extracts are among the top 10 natural prod somewhat im_portant med icinal and culi Complementary and Alternative Medicine: ucts that have demonstrated antibacteri al, nary plant. An Evidence-Based Approach, by John W A Spencer, PhD, Joseph J. Jacobs, MD, MBA. antimycotic, antioxidarive, and even so me -Mark Blumenthal Mosby, Inc.: St. Louis, Missouri; 2003. 632pp., softcover, index, references, charts. $49.95 ISBN 0-323-02028-3. Lloyd Herbert Shinners: By Himself By Ruth Ginsburg This comprehensive, evidence-based resource Sida. Bot. Misc. No. 22, 2002 examines current clinical research on comple issn 0883-1 475, pbk isbn 1-889878-10-3, pbk mentary and alternative medicine. It includes 5 'h" , 9" xti + 223 pp, 63 b/w figures updated material and new chapters on legal $28 + p&h (USA $3; international $5) and ethical issues; integration of clinical prac Texas residents add $2.3 I sales tax. tice; and medical training with complemen Ava ilable from tary, alternative and evidence-based medicine. Botanica l Research In stitute ofTexas Press A useful reference for ph~icians , healthcare 509 Pecan Street I Fo rt Worth, TX I 761 02-4060 USA providers and scientists. ~ E-mail: [email protected] ·Fax 1-81 7-332-411 2 tBRIT www.brit.orglsid alsbmlsbm23toc.htm PRESS www.herbalgram.org 2003 HerbaiGram 60 I 75 tn• memortam• the rest of his life. He represented Ghana turned to the plant medicines, Dr. Boye at numerous meetings on traditional medi became a clinical consultant to the cine and participated in international company, des igning and carrying out clin symposia and workshops on traditional ical trials on the plant medicines which we medicine. He helped to es tablish the developed based on recommendations Centre as a WHO Coll aborating Center of from Dr. Arnpofo. Traditional Medicine and became an av id Being a physician, Dr. Boye knew what spokesman for the importance of tradi the plant medicines could do to help tional medicines at many international patients. His clinical research with patients co nferences. He co nducted numerous co nvinced him of the value of these pl ant clinical trials evaluating plant medicines medici nes, his understanding of the plant for diabetes, hypertension and malaria and medicines was vast and his co ntributions published results of all of these trials. He were enormous. Of particular importance, Gilbert Boye was also the editor of the first Ghana I believe, were his contributions to the Herbal Pharmacopoeia. study of the efficacy of Crypto lepis 1934-2003 I first met Gilbert Boye in the late eight sanguinolenta in the treatment of malari a. he field of plant medicine in Africa ies. I went to Ghana in the early sixties to He had published a paper in 1983 entitled T recently lost an excellent researcher. se t up a medical research laboratory and "Clinical uses of Cryptolepis sanguinolenta Prof. Gilbert Boye was a physician and a started working with the late Dr. Oku (Asclepiadaceae)," which was published in pharmacologist with the University of Arnpofo and his plant medicines. I came the Proceedings of the First Intern ational Ghana Medical School, Department of back in the earl y seventies to wo rk with Seminar on Cryptolepine. Pharmacology. He had been Director of D r. Ampofo in Mampong, which In 1990, he published another paper the Centre for Scientific Research into happened to be the time when the Centre entitled "Studies on antimalarial action of Plant Medicines, founded by the late Dr. for Scientific Research into Plant Medicine Cryptolepis sanguinolenta extract," in the Oku Ampofo, and he speciali zed in was born. On another visit in the late Proceedings of the International Sympo conducting clinical trials on the Centre's eighties, Dr. Arnpofo ve ry much wanted sium on East-West Medicine whi ch was plant medicines. me to mee t with the doctor who had taken held in Seo ul , Korea. Prof. Gilbert Boye received his medical over the directorship of the Centre. I heard In late 200 1, he confirmed the eli ni cal degree from the Queen's Unive rsity of much about Dr. Boye eve n before I met effi cacy of Phyto-Laria®, a tea bag formu Belfast in Northern Ireland and did his him, as he represe nted the continuation of lation of this same plant, which Phyto post-graduate Diploma in Clinical Phar Dr. Arnpofo's dream to conduct further Riker was going to put on the market as its macology at the University of Manchester, research into and ex pand the use of first standardized medicinal plant prepara Manchester, England. He then spent three Ghana's plant medici nes throughout the tion against malari a. This he did usi ng years at Michigan State University in Eas t country. facilities at the University of G hana Lansing, Michigan, as a WHO Fellow in Over the next few yea rs, I developed an Medical School and those of two Polyclin Clinical Pharmacology and subsequently excellent working relationship with Dr. ics. Of the thirty one patients with acute obtained his M.Sc. in Pharmacology at the Boye. A company called HealthSearch, uncomplicated malaria who completed the same institution. He held several posts as which I founded at the reques t of Dr. 28-day observation period, all had cleared H ouse Officer at Belfast City Hospital, Ampofo, entered into a joint ve nture their paras itaemia by Day 5. The cure rate Research Fellow at Manchester Royal Infir agreement with the Centre to study into at Day 7 was therefore 100% and the fever mary, Senior House Phys ician at Queen's and commercialize certain of their medici clearance time was as early as 12 hours. University of Belfast and Medical Registrar nal plants. Dr. Boye was patient, persist We are expecting the results of that trial at Lagan Vall ey Hospital in Northern ent, of good humour, and always eager to to be published soon. That publication Ireland. He returned to Ghana to Lecture help. I don't believe that the word "no" was should win Cryptolepis international in Pharmacology at the Universi ty of a part of his vocabulary. His laughter was respect as an anti-malarial, and the results Ghana Medical School, and later spent a unique, as we all can recall; I've never of that study will become one of Dr. Boye's yea r as Research Fellow in the Department heard anyone else laugh like that. Heaven greatest legacies. Also, please refer to the of Clinical Pharmacology at the Royal must be resounding with a new sound, article about Cryptolepis in this iss ue of Infirmary of Edinburgh. He returned to with everyone looking to see the new soul HerbalGram, written by Prof. Marian Ghana and became Associate Professo r in who has just joined them Addy of the University of Ghana, in which Pharmacology, and subsequently, H ead of In the mid-nineti es, Dr. Arnpofo chal she cited Dr. Boye's two defining studies the Department of Pharmacology at the lenged me to acquire GIHOC Pharmaceu on patients with malaria. University of Ghana Medical School. ticals through the Ghana Government's T he world of medicinal science has lost Most significantly, he was the Director Divestiture Implementation Programme. I a researcher, a great mind, and a mentor. and Physician in C harge of C linical founded Phyto-Riker Pharmaceuticals, But, it is the loss of his knowledge that we Research at the Centre for Scientific and the Company obtai ned financing and mourn. When a person with such knowl Research into Plant Medicine (the Centre) was successful in winning the bid to take edge dies, they say it is as if "a library has from 1986 to 1994 and carried his belief in over GIHOC and started selling generic burned down." His knowledge and expe and love for plant medicines with him for drug products across West Africa. As we ri ence were unique and can never be 76 I HerbaiGram 60 2003 www.herbalgram .org . . zn memorzam replaced. He has gone to join Dr. Ampofo time, flirtatious to the end, known and with his three best buddies, "That was me, and others who also took a great deal of loved by many. Will Griffith, Pio and Belisle in the knowledge with them. We who are left and He played an important role in the daily 1930s." The older people would get who believe in what these plant medicines lives of us riverside dwellers. As the King of together and talk about plants and discuss can do are left with the responsibility to the River, he ran a dory tax i every Saturday their uses and herbal preparations. He amass new knowledge and build new morning for decades, it was he who care wrote the old timers' healing recipes in a libraries. --" fully and lovingly ferried our children to book which he hid in the thatch roof of his - Diane Robertson Winn and from school, motoring between DuffY house in DuffY Bank. He started practic Executive Vice President Bank, where he lived, and the banks of San ing healing when he was only in his 20s Phyto-Riker Pharmaceuticals Ignacio. His dories we re filled with black along with his three buddies. He was the Wash ington, D.C. mangoes in July and August when he was a only one of them who followed the healer's fa miliar figure in San Ignacio, pushing his path for the res t of his life, starting first to wheelbarrow in front of him, shuffiing treat his family members, friends, and then behind at a slow pace, painstakingly selling some of his fame spread until others heard his mangoes at six for a dollar year after of him and came for help. He believed that year. How we marveled at his stamina and one of the greatest healing secrets was especially his eagle sharp eyesight and prayer and those who knew him well were intellect way up until he reached 90 yea rs often regaled with deep spiritual conversa old. He never wore glasses and could spot tions in which Mr. Tom could have held a tree branch sticking up in the river long court with the finest theologians. Spiritual before anyone else. He spent days remov matters were close to his heart and he ing rocks and impediments from the river followed a path of spiritual awakening his passage so that he and others could sail entire life and always held the Almighty through in the dry season with no harm . close to him. He had his international moments of He was a master of a well-turned phrase fam e as well when he was invited to attend and could give just the ri ght words to the World's Fair in New Orleans in 1984 match any situation. Once we discussed where he carved a dory out of a tree trunk the subject of fear- I will never forget his Thomas Green over a period of several months, managi ng sage words of advice, "Rosita, if you don't to maneuver his way through an American face the lion in the cave you must face the 1906-2001 city on his own, undaunted and totally snake at the entrance." Another time, I was t is with great sadness that we announce thrilled by the ex perience. He served in a rushing to get some much-overdue chore I the passing of Traditional Healer Belizean regiment during the World War done, when he came by to visit and I Thomas Green, on January 29, 2001. He II in Scotland, where he learned to speak expressed my frustration at the lack of time was 95 at the time of his passing. Mr. and read Gaelic. He was happy to get back, to accomplish my tas k. He shrugged, Thomas is buried in the cemetery of St. he said, because it was too cold up there. smiled and said, "The advantage here is Ignacio, above his wife, T heresa, and next Among his prized possessions were a letter press ure! " When he met Rosalind Roe, to his son, Francisco (Chico). We will all from the former U.S. Secretary of State in who had quadruplets in the 90s, he looked miss his unique brand of humor, innate Washington, Dean Rusk, complimenting on her right in the eye and said, "Hmph! Lady wisdom, and the sound of his canoe on the the grand work accomplished at the World's have pickney like pig. " Macal River. Here follows the eulogy Fair; his certificate as one of the National So we bid farewell and safe passage to presented at his funeral. Treasures of Belize awarded by his colleagues our beloved T homas Green - may he be We gather today to remember and say in the Traditional Healer's Foundation, and forever "verde" and may he be welcomed farewell to one of our more colorful his Gaelic Bible which he read from every into the lovi ng arms of the Almighty God members of the Cayo community and a day at bedtime by lamplight without he loved so much. --" member of the Traditional Healer's Foun eyeglasses well past the age of 90. -Rosita Arvigo, ND dation. Mr. Thomas Green. T-bone, Mr. Tom was born in the Orange Walk Director, lx Chel Tropical Research Foundation Tomasito Verde, Don Tomas, O ld Man District on January 7, 1907, and outlived Cayo, Belize River, Evergreen but Never Ripe, Siempre his two brothers, two sisters, a so n C hi co, Reprinted with permission from the viva, were only some of the names given to and his wife Dofia Theresa, a famous February 2003 issue of Tree of Life, the Don Thomas during the time that I knew midwife who plied her trade along the newsLetter of the TraditionaL HeaLers Foun him. It struck me that people who go by a Macal River paddling from home to home dation in BeLize. This semi-annuaL pubLica number of different names must have an by herself for many decades. After the pass tion for donors and members features the Life interesting personality, difficult or impos ing of Dofia Theresa, he was once asked stories of traditionaL heaLers, their favorite sible to put under one name like the rest of what he would li ke for the rest of the yea rs pLants, and newsworthy stories about activi us. That was certainly Don Thomas, a man he had to live, he answered, "I would like ties in BeLize and abroad. The cost is US$30 who was fascinating, wisened, funny, a partner, but it's a hell of a time to get per year, as a donation to the THF For more sometimes tricky, a master craftsman and one., information, write TraditonaL HeaLers Foun dory maker, a traditional healer, father, He learned about medicinal plants and dation, San Ignacio, Cayo, BeLize, CentraL husband, ever reliable and astoundingly on healing as a child during the time he spent America. There is no website. www.herbalgram .org 2003 HerbaiGram 60 I 77 calendar Education Credits are ava ilable for most educa (GFP), a novel marker for gene express ion, as 2003 tional seminars, including first time certification in source material. Learn modern methods in protein the Clinical Use of Lase r Acupuncture. Products purifica ti on and characteriza tion in a problem November 2--6: IFEAT International Conference and services offered by more than 40 exhibitors. Ph: ori ented course, a stimulating ex peri ence for 2003. The Ana Hotel, Sydney, Australia . T his 301 /94 1- 1064. E- mail : 78 I Herba!Gram 60 2003 www.herbalgram.org calendar tradeshows.com>. Website: In this department of H~rbaLGram , we list resources such as publications, organizations, seminars, and networking for our readers. A listing in this section does not constitute any endorsement or approval by HerbalGram, ABC, or irs Advisory Board. Economic Botany Available Online. 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Contains Condition, Herb, and Supplement Monographs with extensive information geared toward medical practitioners. Thirteen Quick References all ow easy and targeted access to the information. 472 pp. H ardcover. $49.95. #B523. Special offer $40.00! Quick Access Professional Reference to Conditions, Herbs & Supplements CD-ROM by Integrative Medicine Communications, 2000. Monographs address numerous medical conditions, provide information on a range of treatment options, outline uses, dosages and interac tions for over 115 herbs and supplements and present nutrition depletions associated with the most popular drugs. PC compatible. $49.95. #COO l. Special offer $40.00! Herba/Gram BackPacks Don't leave any gaps in yo ur library. HerbalGram back issues provide a comprehensive store of information on herbs, book reviews, research, conference reports, and regulatory developments. BackPacks are a set of HerbalGrams from 1989, except the most current iss ue, and include a Cumulative Index. Order a complete set of BackPacks (Volumes II, III and IV) for $95 and receive 2 slipcases to protect and store those back issues at no extra charge ($19 value). To order, call toll free 800/373-7105, fax 512/926-2345, email: [email protected] or order online at www.herbalgram.org to see the complete Herbal Education Catalog and to see special offers, visit us online at: www.herbalgram.org/bookcatalog Now in print! ---...__ ---~-.-. . . Th< American Bi!w>ilai Coundl Get the Facts with H J! A B 'C CL NJCAL ~ GUIDE To... 1 The ABC Clinical Guide to Herbs HERBS- . • ... or healthcare professionals, researchers, consumers and retailers, it Fclarifies the evidence concerning the safe and effective use of herbs for prevention and treatment of conditions and diseases. This reference work delivers information about 29 commonly used herbs and 13 proprietary products: l~ Answer Complex Patient Questions l~ Review the Latest Clinical Research ~ Access Information in a Clinical Setting "This volume deserves l~ Give Patients Accurate Information to Take Home to stand alongside ~ Utilize a Reference Reviewed by Health Professionals Gray's Anatomy as one of the defining texts ~ Identify Brand-name Products Backed by Clinical Research of medicine." ~ Obtain Continuing Education Credits - Larry Dossey, MD ~ Understand safety and regulatory issues Executive editor, Alternativ~ Th"api~s In ~ ABC Members receive 10% discount H~alth And Medicine Author, Rdnvmting Medicine, Healing Beyond The Body, and H~aling WOrd Order now for $69.95 (plus shipping and handling) Exclusive Worldwide Trade Distributor To order, please call 800-373-7105, ext.l18 or Thieme Medical Publishers 800-782-3488, 212-760-0888 visit www.herbalgram.org I Fax 212-947-1112 Thieme or visit www.thieme.com F=~===~r.o. 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