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ince 1988, the nonprofit American Botanical Council Educational Literature has worked to educate the public, healthcare practition­ S ABC continues to develop and dis­ ers, media, and government agencies on the safe and effec­ tribute educational literature to tive use of medicinal plants and phytomedicines. Individu­ advance the field of phytomedicine. als, organizations and companies who share our vision As an independent research organi­ support our goals through membership. Our members zation, ABC publishes health and receive benefits including: therapeutic information on herbs in irs Our highly-acclaimed journal HerbalGram literature. A complete range of booklets, pamphlets and Access to information on our website, reports are published and distributed worldwide to stu­ www.herbalgram.org dents, educators, healthcare providers, and researchers. Your membership dollars help us provide this information. • Free and discounted research from our education department Educational and Research Initiatives • Discounts on publications from our Herbal The ABC Education Department administers an active Education Catalog internship program for students of pharmacy and dietetics. Your membership supports these important initiatives: The department initiates research projects and is available to answer questions from members, Media Education Campaign the media and industry representa- Your membership This critically important program continues to make a rives. in the American major impact on reducing the proliferation of inaccurate Botanical Council and/or negative media reports regarding herbal medicine. ABC Headquarters and contributions ABC responds to inaccuracies and misrepresentations, and In 1998, ABC acquired an historic 2.5 to our efforts make provides stories on successes in herbal medicine and acre site originally known as the Case our work possible. science-based information. Mill Homestead. The property encom­ passes a 150-year-old main building, HerbClip T M Educational Mailing Service educational facilities, materials inventory building, green­ HerbClip provides critical reviews of impor­ house, rainwater collection system, and 15 medicinal tant new articles drawn from a variety of theme gardens. Healthcare professionals and visitors professional and mainstream sources. This from all over the world attend seminars and tour these service distributes valuable information facilities that are maintained through your membership regarding the research, marketing, and contributions. Planned expansion wi ll be possible responsible use of medicinal plants. With through additional funding. more than 1500 entries, HerbClip has emerged as one of the leading Health Professional Education Projects databases in the herbal medicine movement. Selected ABC is involved in providing continuing education oppor­ research scientists, scholars, industry leaders, and ABC tunities for health professionals. Projects are produced by sponsors are sent this information bimonthly. You can also ABC in conjunction with the accrediting agencies in each receive this important information by joining at the appro­ health profession. In addition to continuing education priate membership level. modules, ABC sponsors ethnobotanical tours that offer credit for courses set in the rainforests of Africa and Peru. e need and appreciate yo ur Such tours further the understanding of the importance support as we achieve our of preserving indigenous cultures and plants throughout W mission to increase public the world. awareness and professional knowledge The latest CE book, The ABC Clinical Guide to Herbs, of the scientific research and promis­ consists of comprehensive monographs on widely used ing potential of botanical medicines. herbs, plus a clinical overview, a patient information If you value the services we provide, sheer, table of clinical studies listing brands rested for please rake a moment now to com­ AN\ERICAN each herb, and other unique features. plete the enclosed application form. BoTANICAL COJNCIL Membership Levels You can also join online. We thank you for your support. 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For Corporate and Sponsor Member dona­ country tion levels, please contact Wayne Silverman, PhD at [email protected] or 512/926-4900 ext 120. email Please allow 2-3 weeks ro recei ve your membership packer in the US. lmern ational addresses may take up ro 8 weeks. Advisory Board Each issue of Herba/Gram is peer reviewed by members of our Advisory Boa rd and other qualified experts before publi cation. dear Cind y K. Ang erhofer, Ph.D. Paul Alan Cox, Ph.D. Pharmacognosist and herbal Director, National Tropical Bota ni ca l research consul tant, Kennebunk, Garden, Kauai, Hawaii reader Maine lyle E. Craker, Ph.D. JohnTh or Arnason, Ph .D. Professor, Department of Plant and o to war wi th Iraq? T here seems to be another undeclared war, the Professor of Biology, Department of Soil Sciences, University of Biology, University of , Massachusetts, Amherst G war on herbs . Here's a summary of recenr "news from the from­ lines. " Ontario, Edward M. Croom, Jr., Ph.D. DennisV . C. Awang, Ph.D., Scientific and Regulatory Affairs St. John's wort. In April the journal of the American Medical Associ­ F.CI. C. Manager, lndena USAEa st, Inc., ation published rhe results of rhe NIH's first trial on Sr. John's won, MediPiant Natural Products Paramus, New Jersey concluding rhar neither SJW nor the prescription drug Zoloft® were Consulting Services,White Rock, B.C.. Wade Davis, Ph.D. more effe ctive than placebo in this particular trial. Media coverage fixed Canada Author, ethnobotanist, almost sol ely on SJW, wirh consumers gerring the erroneous message Manuel F. Balandri n, R.Ph., Washing ton, D.C. rhar it "does n't work." Jerry Corr, Ph.D., commenrs on the srudy in this Ph.D. Steven Dentali, Ph.D. issue of HerbaiGram. Research Scientist, NPS Vice President of Scientific and PC-SPES. In a situation that justifiably raised Pharmaceuticals, Salt Lake City, Utah Technical Affairs, American Herbal concerns across the board, Borani cLab, marketer Bru ce Barrett, M.D., Ph .D. Products Association, Silver Spring, of the controversial supplemenr PC-SPES, ceased Assistant Professor of Family Maryland operations in June, citing irs inability to obtain Medicine, University ofWisconsin­ Hardy Eshbaugh, Ph.D unconraminared product from C hinese suppliers. Madison Medical School Professor of Botany & Ass istant In February the FDA ordered the recall of SPES Marilyn Barrett, Ph.D. Curator, Willard Sherman Turrell (a n immunosrimulanr herb combination) and Pharmacognosy Consulting Service, Herbarium, Miami University, PC-SPES (made from seven Chinese herbs plus San Carlos, California Oxford, Ohio saw palmetro, shown in published clinical trials Bradley C. Bennett, Ph .D. Adriane Fugh-Berman, M.D. to treat prostate cancer). The Californi a Depart­ Associate Professor of Biology, Florida Author, Assistant Clinical Professo r, ment of Health Services' Food and Drug Branch International University, Miami George Washi ngton University found the prescription drugs alprazolam in SPES and warfarin Joseph M. Betz, Ph .D. School of Medicine, Washington, DC (Coumadin®) in PC SPES. An NIH-funded trial on PC-SPES at Johns Director of the Dietary Su pplements Joe Graedon, M.S. Methods and Reference Materials Author, syndicated col umn ist, radio Hopkins was halted due to rhe revelations of the adulteration. Tragic is Program, Office of Dietary host, Durham, North Carolina the inability of thousands of prostate cancer patients to obtain it, since Supplements, National Institutes of Mary Hardy, M.D. they, and many urologists and oncologists, believed it produced benefits Hea lth, Bethesda, Maryland Director, Ceda rs-Sinai Integrative when there were few viable alternatives (visit ) . Peggy Brevoort Medicine Medical Group, los Kava. The German governmenr surprised everyone in June, revoking Co-founder and former CEO of East Angeles, Cal ifornia li censes for kava drugs effecti ve immediately. The action followed Earth Herb; former President, Christopher Hobbs, LAc., AHG reports associating kava wi th hepatotoxicity, even though many cases American Herbal Products Herbalist, botanist, li censed include other confounding facto rs rhar make direct causal links between Association; Sea ttle,Washington acupuncturist,Willia ms, Oregon kava and liver toxicity uncertain. The vaunted German Commission E Francis Brinker, N.D. David Hoffmann, B.Sc., had recommended rh ar kava remain on the market as a prescription Lead Instructor on Botanical M.N.I.M.H drug. Other counrries followed Germany's lead, with removal in Singa­ Medicine for Associate Fellows, Medical herbalist, Santa Rosa, pore, a volunrary withdrawal in Australia, and a ban and recall in Cana­ Program for Integrative Medicine, Ca lifo rnia da. Kava was our last issue's cover story. For new information, see the University of Arizona, Tucson Maurice M.lwu, Ph.D. ABC website . Di rector, Natural ProductsResearc h Conservation Program, Senior Consultants, Seattle, Washington Institute of Medicine Safety Report. In July the National Academy Research Associ ate at the Division of of Science's Institute of Medicine released a 156-page draft report on its Thomas J.S. Carlson, M.S., M.D. Experimental Therapeutics,Walter framework to evaluate the safety of dietary supplemenrs. This may be Associate Adjunct Professor, Reed Army In stitute of Research, Department of Integrative Biology; Wash ington, D.C. adopted by FDA to help es tabli sh a (hopefully) rational system to deter­ mine safety of popular supplement ingredienrs (more at Director, Center for Health, Ecology, Timothy Johns, Ph.D. Biodiversity, & Ethn obiology; Curator Professor, School of Dietetics and ). IOM idenrified six supplemenrs for which it was of Ethnobotany, University and Human Nutrition; Centre for drafting safety reviews including two herbs: chaparral and saw palmet­ Jepson Herbaria; University of Indigenous People's Nutrition and to (S P). So me cases of hepatotoxicity were associated with chaparral in California, Berkeley th e Environment, McGill University, 1993 (see article in HerbalGram 28). Chaparral has little marker pres­ Jean Carper , Cana da ence today; a safety review of kava might have been a better investmenr Author and syndi cated columnist, ofiOM resources. SP is on rhe list because FDA has two case reports of Wash ington, D.C. cardiac incidenrs associated with SP consumption, although causality Jerry Cott, Ph.D. has nor been es tablished. IOM added SP to irs safety review process, President, PsychoFarmacology wi th the predictable outcome of a clean bill of health, as ir ass uredly Consulting Services, College Park, Maryland (continues) Continues on page 8

4 I HerbaiGram 56 2002 www.herbalgram.org Advisory Board HERBAIGRAM (continued) The Journal of the American Botanical Council Steven King, Ph.D. Eloy Rodriguez, Ph.D. Senior Vice President of Ethnobotany James Perkins Professor of Mark Blumenthal Editor I Publisher and Conservation, Shaman Environmental Studies, School of Karen Robin Managing Editor Botanicals.com, South San Francisco, Agriculture & Life Sciences, Cornell California University, Ithaca, New York Sean Barnes Art Director Thomas L. Kurt, M.D., M.P.H. Victor Sierpina, M.D. Steven Foster Associate Editor Oinical Professor, Department of Associate Professor of Family Practice Maureen Jablinske Proofreader Internal Medicine, University ofTexas Medicine, University ofTexas Medical Southwestern, Dallas Branch, Galveston Tieraona lowdog, M.D. James E. Simon, Ph .D. Contributors Herbalist, family practice physician, Professor of New Use Agriculture, Holly Bayne Jerry Cott David Kroll Assistant Clinical Professor, University Director of the Center for New Use Brian Boom Patricia Gerbarg Tim Lowery of New Mexico Medical School. Agriculture and Natural Plant Hannah Bradford David Hircock Zakir Ramazanov Albuquerque Products, Rutgers University, Don Brown Darren Huckle Christopher Robbins Tom Mabry, Ph .D. New Brunswick, New Jersey Richard Brown Timothy Johns Roy Upton Professor of Plant Biochemistry, Beryl Simpson, Ph.D. Christina Chase Chris Kilham Solomon W asser Department of Botany, University of C. L. Lundell Professor of Botany, Mary Chavez Steven King Kim West Texas at Austin Department of Botany, University of Gail B. Mahady, Ph.D. Texas at Austin American Botanical Council Staff Research Assistant Professor, Depart­ S. H. Sohmer, Ph.D. ment of Medical Chemistry & Phar­ President and Director, Kathleen Coyne Gayle Engels George Solis macognosy, College of Pharmacy, Botanical Research Institute ofTexas, Sales Education HerbClip Production University of Illinois, Chicago Fort Worth Jim Costello Lori Glenn Cecelia Thompson Robin J. Maries, Ph.D. Barbara N. Timmermann, Ph.D. Gardens HerbCiip Editorial Finance Associate Professor of Botany, Bran­ Professor of Pharmacology and Cheryl Dipper Tara Hall Kim West don University, Brandon, Manitoba, Toxicology, College of Pharmacy, Administration Special Projects Development/Membership Canada University of Arizona, Tucson Stacy Elliott Roger Sleight Margaret Wright Dennis J. McKenna, Ph.D. G. H. Neil Towers, Ph.D. Reception Web Design Accounting Executive Director, Institute for Professor Emeritus, F.R.S.C., Botany Natural Products Research; Department, University of British Wayne Silverman, Ph.D. Senior Lecturer, Center for Spirituality Columbia, , Canada Chief Administrative Officer and Healing, University of Minnesota, Arthur 0. Tucker, Ph.D. Minneapolis Research Professor of Agriculture and Subscriptions are a benefit of membership at every level. One year membersh1ps: lnd1vidual $50; AcademiC $1 00; Profess1onal $150; Organization $250. Add $20 for memberships outs1de of the Daniel E. Moerman, Ph.D. Natural Resources, Delaware State U.S. Student. Senior and Business Memberships also available, see ad 1n this 1ssue. © 2002 Ameri­ William E. Stirton Professor of University, Dover can Botanical Council. ISSN # 0899-5648. Printed in the U.S.A Anthropology, University of Nancy Turner, Ph.D. The information in Herba/Gram is Intended for educational purposes only and is not a substitution Michigan/Dearborn Professor and Ethnobotanis~ for the adv1ce of a qualified healthcare professional. Although we attempt to ensure that advertis­ William Obermeyer, Ph.D. Environmental Studies Program, ing in Herba/Gram is truthful and not mislead1ng, the publication of an ad for a product or compa­ ny 1n Herba/Gram does not constitute an endorsement by ABC of the product or the company Vice-President of Research and University ofVictoria, British being advertised. Publication of an ad that makes a health claim or structure-funct1on clam does Technology, Consumerlab.com, Columbia, Canada not necessarily constitute an approval of that claim by ABC. Annapo lis, Maryland Daniel T. Wagner, R.Ph ., MBA, Samuel W. Page, Ph.D. Pharm.D. Director, Division of Natural Products, Owner, Nutri-farmacy, Wildwood, Board ofTrustees Center for food Safety and Applied Pennsylvania Mark Blumenthal (President), Founder and Executive Nutrition, U.S. food and Drug Andrew T. Weil, M.D. Director Administration, Washington, D.C. Author, Director of the Program in Michael J. Bal ick, Ph.D. , Director and Philecology Joseph E. Piuorno, Jr., N.D. Integrative Medicine and Associate Curato~ Institute of Economic Botany, The New York Botani­ cal Garden, Bronx. New York President Emeritus, B

ABC Partners with HealthQuest, D EAR READER Continued from page 4 Offers Members New Benefit deserves. But minor damage was done; SP was reported along wi th the other ingredients as "controversial supplements, " possibly rais­ he American Botanical Council is pleased ro announce a new ing unwarranted co ncerns among wary consumers. Tpartnership with HealthQuest Travel and Education. After Ephedra. Many industry insiders have feared that ephedra may eight years of coordinating ethnobotanical rours for International become the Achilles' heel of herbs. Its potential risks draw increas­ Ex peditions, Charlotte "Chuck" de Frances partnered with Mind­ ing attention fro m health professionals, regulators, and media. bodytravel.com ro form Health Quest and expand the scope of des­ Insiders say, "If we could just get ephedra off the table, we could tinations and programs of the healrhcare travel series she inaugu­ focus on other herbs whose safety and benefits are not so contro­ rated. This, in turn, has provided a new opportunity for ABC. versial. " Having co-sponsored the healthcare travel series since its begin­ But ephedra seems to be the table with numerous professional ning, ABC is happy to co ntinue its relationship with Chuck and is groups lining up against it. In July U.S. Sen. Dick Durbin (D-IL), excited about the possibility of an expanded series of tours. who chai red a hearing on weight-loss supplements, called on HHS As part of its partnership with HealthQuest, ABC is now able ro Secretary Tommy Thompson to determine immediately whether offer a new members hip ephedra supplements pose an "imminent hazard" ro public health, benefit - a discount on the and if so, to suspend sales. In mid-August FDA and the Justice cost of the tours. Members Department initiated a criminal inves tigation of Metabolife Inter­ who join at the Individual national , a leading manufacturer of dietary supplements contain­ level ($50) receive a $50 dis­ ing ephedra, for allegedly making fals e statements to the govern­ count on any of the trips. ment. The com pany vol untarily made ava ilable more than 14,700 Academic members ($1 00) call reco rds (the majority of which are minor events). receive a $ 100 discount. Over the last fi ve years, more than 4.5 billion tablets and 50 mil­ Members at the Professional lion bottles of Metabolife 356 have been sold, according to a com­ level and above ($150 and pany letter to T hompso n. About 78 of the reports appear to be up) may deduct $150 from seri ous incidents, including hospitalizations and reportedly one The ACEER canopy walkway above the the cost of any of the health­ death. Most of the incidents are reportedly consistent with the Amazon rainforest, one of the exciting care seri es tours. All they occurrence of these conditions in the general population, accord­ educational destinat ions of ABC's ethno- ing to experts who have reviewed them. Media accounts imply that botanical tours. ©2002 Trey Bennett need to do is enter their ABC member number on all 14,700 "incident reports" were "serious" - clearly, a gross exag­ the registration form and geration. the discount will be applied. It is not clear, however, whether the new disclosures are includ­ For more information on ethnobotanical tours, v1s1t ed in previously published adverse events associated with ephedra. or call Stacy Elliott T he consensus of many experts, including the GAO and the FDA, at 800/373-7105 ext. 101. For more information about member­ howeve r, is that AERs are not a valid scientific bas is upon which to ship, visit or call develop regulatory policy on the safety of a substance. In July FDA Kim West at 800/373-7105 ext. 11 9. asked industry members whether they support mandatory report­ ing of all ephedra AERs. Metabolife said "yes," although industry Upcoming tours include: groups have not yet res ponded. Will Congress and FDA combine Belize and Tikal: Perspectives in Health care - 11 /30-12/7, the ephedra and PC-SPES iss ues to call for tighter regul ation of all 2002 herbs? These herbs generate so much "heat," others may get swept up in the furor. Amazon: Pharmacy from the Rainforest - 2/1-2/9, 2003 Ginkgo. With so many problems being reported (and misre­ (6-day ex tension to the Andes and Machu Picchu) ported), some herbs have so much accumulated research, they Southern Africa Safari (Kalahari Desert/Okavango Delta) - should be rel atively immune fro m bad press (e.g., ginkgo). But no. 8/1-8114, 2003 (3-day ex tension to Cape Town and 3-day As if things weren't bad enough, JAMA published and heavily pro­ extension to Victoria Falls) moted a study that failed to show positive effects of ginkgo on China and Yangtze River Voyage - 917-9/21 , 2003 __..- memory and concentration in healthy older adults (60 years plus). AMA distributed video news releases (via satellite) to TV stations . Coverage on the CBS Evening News with Dan Rather sugges ted that consumers should not buy ginkgo. As pointed out in ABC's press release, which is available online at , one study does not invalidate the impressive research record for the cognitive benefits for ginkgo Please provide us with your email address if extract. We emphasized that another recent study on ginkgo fol­ you want to receive periodic updates concern­ lowing a similar design for the same period of time (6 weeks) on a similar population of healthy adults produced positive effects, at a ing breaking news in the herbal community. dosage of only 50 percent more (180mg per day). This was virtu- Email to [email protected]. Continues on page 74

8 I HerbaiGram 56 2002 www.herbalgram.org Aristolochic Acid Evaluation Program: Standards of Identity for the Responsible Trade of Chinese Medicinal Herbs

he American Herbal Pharmacopoeia Clarke), thereby raking the self-regulatory steps T(AHP), in co llaboration with the Amer­ Chinese wild ginger (Asarum het­ needed to protect public health. The pro­ ican Herbal Products Association, the T her­ erotropoides F. Schmidt var. mand­ gram will also provide recommendations for apeutic Goods Agency of Australia, and the shuricum (Maxim.) Kitag, and A. the appropriate trade or restriction of these State Drug Administration of China, is sieboldii Miq., Aristolochiaceae), botanicals. establishing international standards for the akebia (Akebia quinata (Houtt.) Seed money to help offset the cost of identification of those plants known to con­ Decne., and A. trifoliata (Thunb.) obtaining authenticated botanical voucher tain aristolochic acid (AA) and those that Koidz. , Lardizabalaceae) samples was provided by the Chinese may become adulterated with AA-contain­ • Armand's clematis (Clematis armandii Herbal Products Committee of rh e Ameri­ ing plants. Franch., Ranunculaceae) can Herbal Products Association through In recent years, Chinese herbal formulas • C hinese clematis (C. chinensis Rerz., contributions from Golden Flower, Health containing AA have been associated wi th Ranunculaceae). Concerns, Chuanheng Management, KPC numerous case reports of kidney failure and Products, Inc., K'an Herb Co., and Crane kidney cancer. Many of these adulterations Herb Co. Contributors will receive a com­ are quire common and have led to import plimentary copy upon completion. alerts and trade restrictions in several coun­ Further funding is needed. To support tries. II the Aristolochic Acid Program and receive The aristolochic acid project is designed The primary goal of the Aristolochic Acid the future publication of the Aristolochic to protect and promote the responsible Evaluation Program is to develop standards Acid Eva lu ation Program: Standards of trade of Chinese medicinal herbs, specifical­ from botanically verified samples that have Identity Document, contact the AHP. ly many of those cited by the U.S. Food and already been obtained, to develop multiple For more information, contact: AHP's Drug Administration (FDA) as those that val idated methods of identification (macro­ executive director, Roy Upton at P.O. Box contain, or may be adulterated with AA­ scopic, microscopic, and thin-layer chro­ 66809, Scotts Valley, CA 95067, USA, Tel: containing plants. These herbs include: matography fingerprinting), and to com­ 831/461-6317, Fax: 831/475-6219, or • Stephania (Stephania tetrandra S. bine this with analytical work currently email: . -"' Moore, Menispermaceae), underway by FDA in val idating analytical • aristolochia (Aristolochia fongchi Y.C. methods for the analysis of AA. This will [American Herbal Pharmacopoeia. Arisrolochic Wu ex L.D. Chou & S.M. Hwang, then be formally presented to herbal prod­ Acid Evaluation Program: Standards of Id entity for the Responsible Trade of Chin ese Medicinal Aristolochiaceae), ucts manufacturers and regulatory agencies Herbs (press release). 200 I June 13.) • costus (Saussurea costus (Falc.) Lipsch, worldwide as the definitive body of infor­ Asteraceae, syn. S. lappa (Decne.) C.B. mation needed to identify these botanicals, AHPA Extends Product Label Recommendation to Class 3 Botanicals

he American Herbal Products Associa­ because of insufficient information. the safe use of the substance. In addition, Ttion (AHPA) recently expanded irs T he Botanical Safety Handbook (1997) products containing Class 3 herbal ingredi­ Trade Recommendation about safety label­ lists about 550 herbs in trade and their clas­ ents must be labeled "nor for general retail ing to include Class 3 botanicals. C lass 3 sifications. T he handbook also provides spe­ sale" and should be marketed so as to pre­ botanicals are those that pose significant cific cautionary language to be included on vent general retail sale. health risks as defined by AHPA's Botanical product labels. If the manufacturing process sets aside Safety Handbook. Formerly, only products in Class 2b or the safety concern, a product that contains AHPA previously evaluated herbs sold in 2c had labeling requirements under AHPA a C lass 3 herb need nor include the recom­ the U.S. marketplace and placed them into policy. Membership in AHPA is contin­ mended label information. four classes: gent upon meeting these standards, among Two examples of Class 3 herbs are bel­ Class 1: herbs which can be safely con- others. ladonna or deadly nightshade (Atropa bel­ sumed when used appropriately; Effective October 2003, product labels ladonna L. , Solanaceae), mayapple or Amer­ Class 2: Herbs with use restrictions: on Class 3 herb should include the follow­ ican mandrake (Podophyllum peltatum L. , 2a: external use only; ing label information: "To be used only Berberidaceae). 2b: contraindicated during pregnancy; under the supervision of an ex pert qualified The entire list of Class 3 herbs can be 2c: contraindicated during lactation; in the appropriate use of this substance." found on page 189 of The Botanical Safety 2d: Other contraindications (e.g., hyper­ Product labels on Class 3 herbal ingredi­ Handbook, which is sold by the American tension, diabetes, etc.); ents must also include: proper use informa­ Botanical Council (ABC catalog #8275) Class 3: herbs that should be used only tion, dosage, contraindicarions, potential and AHPA. --- under the supervision of a qualified expert; adverse effects and drug interactions, and [A HPA. Update New AHPA Trade Recommen­ Class 4: herbs that cannot be classified any other relevant information related to dation [press release). 2002 April 23.] www.herbalgram.org 2002 HerbaiGram 56 I 9 White House Commission on Complementary and Alternative Medicine Policy Issues Final Report by Hannah V. Bradford, M.Ac., LAc., MBA

he eagerly anticipated Final Report of Other recommendations of potential fall in the areas of Research , Education and Tthe White House Commiss ion on interest to the herbal co mmunities include: Training, Information Development and Complementary and Alternative Medicine • Increase U.S. Food and Drug Adminis­ Dissemination, Access and Delivery, and Policy (WHCCAMP) was rel eased in tration (FDA) resources to fully imple­ Coverage and Reimburse ment. Highlights March 2002, and is now avai lab le on rhe ment the Dietary Supplement H ealth in these areas are: Commiss ion's website and Educa tion Act of 1994 and in par­ Research .* ticular, finalize Good Manufacturing The Report calls for sign ifi cantly more Formall y received by Secretary of H ealth Practices, and simplifY and expand the research support for CAM, with emphasis and Human Services (HHS) Tommy G. adve rse eve nts reporting system. on th e followin g: Thompson, the Final Report is currently • Accelerate public and private efforts to • Federal research support for practi ces under review by his agency and others. Var­ develop validation and analytical meth­ and products that may be effective, bur ious groups representing practitioners , edu­ ods and reference materials . not profitable to, nor patentable by cators, and complementary and alrernar ive C reate an independent expert panel to private investors. med icine (CAM) product manufacturers develop an objective process for evalu­ • C reation of outreach programs to have distributed position statements and ating the safe ty of dietary supplements. inform manufacturers about federal have met with Administration officials and This has been starred by rhe Institute research support ava il able to pnvare journalists in attempts to shape the eventu­ of Medicine's (I OM). industry. al White House response. • Expand package inse rt information on • Creation of language by state profes­ dietary supplements, including ri sks, sional regulatory bodies to protect Key Proposed Actions interacti ons, and benefits. practitioners of CAM engaged in of the Commission • Increase financial support to the Feder­ research from sanctions. The WHCCAMP Final Report lists 29 al Trade Commiss ion to identifY • Expansion of the Agency for Health recommendations and 105 actions, organ­ deceptive adve rtising practices by Care Research and Quali ty's Evidence­ ized around the topics of research, educa­ dietary supplement manufacturers and based Practice Center review of CAM. tion and training, information development develop consumer education programs . Education and Training and disse mination, access and delivery, and • Institute vo luntary registration of The general tenor of the education and coverage and reimbursement. The most sig­ dietary supplement manufacturers training section remained rhe same as in rh e nificant recommendations are: with rh e FDA to faci litate notification Interim Report (rel eased September 18, • Create a CAM office at the highes t of se rious adverse events. 2001 ). The primary shift was rhe substitu­ level with rh e Department of Health • Require manufac turer maintenance of tion of "feasibi lity studies" for "demonstra­ and Human Services. records and reporting of serious adverse tion projects" in the areas of loan forgive­ • D evelop research infras tructure at events to the FDA. ness for students and the addition of CAM CAM institutions. As stated by Joseph Pizzorno, N.D ., a practitioners to primary care teams. This • Create demonstration projects of res i­ Commiss ion member and long-time natur­ change may lowe r the priority of the ac tion, dencies and postgraduate training for opathic educator and practitioner, the most but increases leeway to policymakers in act­ appropriately educated and trained sign ificant aspect of the Commiss ion is ing on these recommendati ons. A clear CAM practitioners. "that it actually happened." intent is to foster relationships between • Stares should, as appropriate, imple­ The release of th e Final Report calls on all CAM and conventional educati on and ment provisions for licensure, registra­ CAM groups, practi rioners, manufacturers, training programs, with a recommendation tion, and exemption co nsistent with and consumers, to "rake themselves and the to increase the core curriculum of each rh e practitioners' education, trammg, issues more se riously since now all levels of other's practi ces and concepts. Federal sup­ and scope of practi ce. the culture are paying attention to th ese port, in conjunction with professional • Develop analytical methods for pro­ issues," Pi zzo rno said. "If we build on rhe organi zations, was recommended to devel­ ducing better CAM products. groundwork laid by the Commission and op education and training guidelines. (See • Increase CAM-conventional collabora­ support implementation of the key recom­ education and training recommendations in tive research projects. mendations, we can substantially level the above "Key Proposed Actions of the Com­ • Explore expansion of loan programs to playing field of healthcare se rvices. " miss ion.") students at CAM institutions. Fo r the herbal community, the Commis­ • Support federal research on CAM cost­ sion's recommendations require develop­ effective ness and cost-benefit analys is. ment of clear statements of product quality * Within the nex t few months, the Com­ • Req uire periodic reports from federal and lend encouragement to herbal practi­ mission's printed report will be made agencies on CAM benefit policy and tioners to develop their own standards of avail able to all interested parties. their incl usion of CAM ex perts on practi ce and credenrialing. Herba/Gram wi ll publish ordering adviso ry boards. Other recommendations of importance information in Herba/Gram 57.

10 I HerbaiGram 56 2002 www. herbalgram .org Information Development coverage and reimbursement policy would of the Commiss ion. Since May 2002, and Dissemination further support inclusion of CAM in bene­ va ri ous representatives of the Dia­ This section addresses several key con­ fir programs. Proposals to encourage federal logue's sponso ring groups have met cerns that have implications for other areas, agencies to develop appropriate clinical cri­ with Congressional staff, senators, and especially education, research, and access teria for CAM services in their programs represe ntatives to discuss specifi c ini­ and delive ry. A ce ntral recommendation is and add CAM experts to relevant adviso ry ti ati ves. for the Secretary of HHS to set up a Task co mmittees were derailed. Other recom­ • Several members of Congress have Force to identi fY and eliminate existing mendations include: launched a serious evaluati on of CAM CAM information gaps throughout the • Demonstration projects to analyze how iss ues. The Complementary and Alter­ entire Federal government. More specific CAM may contribute to addressing the native Medicine and Natural Foods acrions recommended in this section l 0 leading indicators of health. Caucus was formed by Senators Tom include: • Adding CAM practi ces questions to H arkin (D-lA) and Orrin G. H atch • Relevant federal agencies should create national surveys. (R- UT) and Representatives Dan Bur­ easy-to-understand public information • Public information campaigns on ton (R-IN) and Dennis Kucinich (D ­ materials on CAM. nutrition, exercise, and stress manage­ OH). • Expand the National Library of Medi­ ment CAM practices. • Perhaps more significantly, in anticipa­ cine and American Library Association • Incentives to schools to make healthy tion of the Commiss ion's report, the training programs for librari ans to help snacks and lunches and to eliminate Congressional Appropriations Confe r­ consumers access CAM information. advertising of products such as high-far ence Committee Report urged "the • Create a public-private partnership to snacks and soft drinks. Secretary [of HHS] to form a coordi­ develop standards for website informa­ • Evaluate the role of CAM practices and Iuting unit to review the Commiss ion's tion on CAM. products in workplace wellness and report and implement ways to better • Reques t that States require disclosure prevention activities and create incen­ coordinate the Department's many of practitioners' level of training, scope tives to develop the res ultant programs. CAM-related ac tivities." The full text of practice, licensure, certification, and • Inclusion of self-care and lifestyle deci­ of the committee report is available disciplinary actions. sion-making curriculum in profess ion­ through under Access and Delivery al CAM and co nventional trainmg "Status of 2002 Appropriations Bills. " Access and delivery policy iss ues are li ke­ programs. • During the life of the WHCCAMP, the ly to be a central focus of the proposed new IOM acted on a key Commission rec­ federal office on CAM. Recommended The CAM Office ommendati on to set research priorities actions include: A proposed office to coordinate federal by developing irs "Proposed Frame­ • Provide federal assistance to the Stares efforts was envisioned as the mechanism to work for Eva luating the Safety of in evaluating the impact of CAM legis­ implement the Commission's recommenda­ Dietary Supplements," the goal of lation and developing regulation and tions and other, emerging issues in CAM. which is the establishment of direction oversight of CAM services and prod­ The specifics include: in the study of dietary supplements. ucts. • An office at the highes t possible and The 156-page report was released in • IdentifY national healrhcare needs, and most appropriate level in the Depart­ July 2002, and is open for comments. analyze the relevance of CAM services. ment of Health and Human Services. It is ava il able online o nl y at the • Create a policy advisory committee to • An advisory committee with conven­ ational Academy Press website, address access to CAM practitioners tional and CAM experts, and represen­ . Several actions proposed in this section • The National Poli cy Dialogue Report, require funding of health se rvices research sponso red by a coalition of CAM on CAM cost-effectiveness and cost-bene­ groups, was delivered to members of firs. A national coding system for CAM and Congress. This report ex pands and periodic reports from federal agencies on clarifies the central recommendations www.herbalgram.org 2002 HerbaiGram 56 I 11 WHO Publishes Traditional Medicine Strategy for 2002-2005

he World Health Organization (WHO) The 74-page report indicates an inten­ presumably follow the outline and Thas announced the development of a tion to bring "order" to the practice and use work already being done on rhe mono­ strategy to increase the number of member of traditional medicines, which mainly graphs being published by WHO). nations having a national policy and legal refers to botanicals and other natural prod­ WHO had previously published "Guide­ framework to deal with complementary and ucts used medicinally in systems of indige­ lines for the Assessment of Herbal Medi­ alternative medicine (CAM), particularly nous and traditional medicine. cine" in 1991. (See HerbalGram 28, pp. 13- the growing use and distribution of botani­ The Traditional Medicines Strategy iden­ 20 for complete text.) In addition, WHO cal medicines. tified the following "key needs": has published a volume of herbal mono­ The report, titled WHO Traditional Med­ • National regulation and registration of graphs to establish guidelines for identity, icine Strategy 2002-2005, was presented herbal medicines. quality, safety and effective use, WHO May 16 at the World Health Assembly in • Post-marketing surveillance of herbals monographs on selected medicinal plants Vol­ Switzerland. This report is heavily focused to monitor safety. ume 1 (WHO, 1999; see "Monograph on botanicals and the need to establish reg­ • Support of clinical research on the use Update" article in HerbalGram 47, pp. 40- ulation of herbal products. Consistent with of CAM for common health problems; 45, for a cable showing the uses of medici­ irs previous positions and publications in these include rhe use of traditional nal plants supported by clinical data in this area in the past decade, WHO medicines in rhe areas of infectious dis­ WHO monographs). acknowledges the significant role that eases, as they may be appropriate, as The complete text of the WHO Tradi­ herbal preparations can offer as low-cost well as the growing problems with tional Medicine Strategy 2002-2005 is avail­ medicines when they are properly manufac­ AIDS in many developing countries. able online at

USP's Dietary Supplement Verification Program Unveils Mark

he United Stares Pharmacopeia (USP) potential contaminants • Extensive laboratory testing; Tcreated its Dietary Supplement Verifica­ • Has been manufactured properly by • Comprehensive review of quality con­ tion Program (DSVP) in November 2001 complying with USP and proposed trol and manufacturing documenta­ to help inform and safeguard the growing tion; and number of consumers who use dietary sup­ • Evaluation of manufacturer compli­ plements. USP recently unveiled the mark ance with USP and proposed FDA chat qualifying manufacturers will place on standards for GMPs. their product labels. USP is a not-for-profit organization that Nature Made® Vitamin E was the first achieves its goals through the contributions product to earn the DSVP mark. Nature of volunteers representing pharmacy, medi­ Made is a division of Pharmavire LLC, of cine, and other healthcare professions, as Northridge, CA, one of the nation's larges t well as science, academia, government, the dietary supplement manufacturers. Phar­ pharmaceutical industry, and consumer mavire was rhe first company to join DSVP. organizations. Leiner Health Products Inc. of Carson, CA; Since 1820, USP has established stan­ Inverness Medical Innovations Inc. of dards for more than 3,800 prescription and Waltham, MA; and Weider Nutrition Inter­ over-the-counter medicines. USP also has national Inc. of Salt Lake City, UT, are also FDA standards for good manufactur­ developed monograph standards for more participating in DSVP ing practices (GMPs). than 900 nutritional and dietary supple­ Under DSVP, USP evaluates and verifies Once a dietary supplement is granted rhe ment products. These standards are com­ dietary supplements according to stringent USP DSVP certification mark, USP will piled in the United States Pharmacopeia and standards for product purity, accuracy of periodically conduct random off-the-shelf National Formulary ( USP-NF;, which is ingredient labeling, and proper manufac­ tests on verified products to ensure they recognized as the nation's official compen­ turing practices. The DSVP mark helps continue to meet DSVP's strict standards. dia for pharmaceuticals and dietary supple­ assure consumers, health care professionals, USP also will continue to conduct audits of ments. For further information, visit rhe and supplement retailers that a product: manufacturer sires for GMP compliance on DSVP website, -" • Contai ns the ingredients declared on a three-year basis. During rhe intervening -Karen Robin rhe product label; years, manufacturers will be required to • Contains rh e amount or strength of conduct annual self-audits and report the [USP. Nature Made Vitamin E Is First Dietary ingredients declared on the product results to USP for review. Supplement to Gain DSVP Certifi cation (p ress label; USP evaluates dietary supplements sub­ release). 2002 June 17.] • Meets requirements for limits on mitted to the program based on:

12 I HerbaiGram 56 2002 www.herbalgram.org

Professor Sir Ghillean T. Prance Is 2002 Distinguished Economic Botanist by Brian Boom, Ph .D.

ach year, the Sociery for Economic the author of 17 books and more than 400 the banquet address after receiving the DEB EBotany (SEB), an international orga ni­ scientific and popular papers in the fields of Award. zation co ncerned wi th the rel ationships sys temati cs, co nse rvation, ecology, and eco­ The roster of D EBs over the pas t quarter between plants and people, prese ms its Dis­ nomic botany. H e holds 14 honorary cemury is a ve ritabl e "Who's Who" of eco­ tingui shed Economic Botanist (D EB) degrees and is the recipient of numerous nomic botany: Julia F. Monon (1 978), Award to an individual who has made out­ awards, such as the International CO S­ Ri chard E. Schultes (1 979), T homas W. standing co mributions to the discipline. MOS Prize (1993) and the Victoria Medal Whitaker (1980), William H . Talent T he winner of this, the SEB's highes t of Honour (1999). He was knighted in (198 1) , William L. Brown (1 982), Nor­ honor, for 2002 is Professo r Sir Ghillean T. 199 5 and was made a Commander of the man R. Farnsworth (1 983), Charles B. Prance. Order of the Southern Cross by the Pres i­ Heiser (1984), Jack R. Harlan (1985), Over the yea rs Pro­ dent of Brazil in 2000. Efraim Hernandez Xolo cotzi (1986), fesso r Prance's career Professor Prance is a mentor and an inspi­ C harles M. Ri ck (1987), Oswald Tippo has bee n divided in to rati on to numerous students ove r the yea rs, (1 988), Jack L. Beal (1 989), Herbert G. M -;. . several tracks , which he including the author of this note. He is also Baker (1990), N . W. Simmons (1 991 ), has re markably man­ a tireless speaker for the cause of biodive rsi­ Douglas Yen (1992), Mildred Matthias aged to pursue simulta­ ry conse rvation and an officer in many sci­ (1993), Walton C. Galinat (1 994), Varro neously with excel­ emific societi es, including the SEB, for E. Tyler (1 995), Jack H awkes (1996), Car­ :J-- ..,· ~ . ..~ ~J lence. He has been an which he served as President in 1996. For a los O choa (1 997), Hugh H . Iltis (1 998), A ':'C administrator at several full account of this remarkable man, I rec­ S. K. Jain (1999), James A. Duke (2000), Prance insti ru tions, and is best ommend the biography by Cli ve Lang­ and Isabell a Abbott (200 I). known perhaps for his se rvi ce as Seni or Vice mead: A Passion for Plants: from the Rain­ To learn about and to join the SEB , visir Presidem fo r Science at the New York forests ofBrazil to Kew Gardens: the Life and its website: . -"' Botanical Garden (NYBG) and subsequem­ Vision of Ghillean Prance, Director of the Brian Boom, Ph.D. , is the current Presi­ ly, as Director of the Royal Botani c Gar­ Royal Botanic Gardens, Kew, Second edition dent of the Society for Economic Botany. He dens, Kew in London. His administrative (London: Roya l Botanic Gardens, 2001 ). also is Associate Director fo r Research and talems are currently being put to good use T he SEB's Distinguished Economi c Adjunct Senior Research Scientist at the Cen­ as Scientific Director of the Eden Project, Botanist Award for this year was presented at ter for Environmental Research and Conser­ based in Cornwall, England. T he Eden Pro­ the annual mee ting, June 22-27, 2002, at vation (CERC) ofColumbia University. ject brings the sto ri es of our world to life in NYBG , where Professo r Prance delivered huge covered co nservatories, or Biomes, th at fea ture the maj es ti c rainfores ts, the Mediterranean, South Africa, and Califor­ NSF Dietary Supplements GMP Certification ni a. The Eden Project's website IS Program Certifies Contract Manufacturers . As a sys tematic botanist, Prance is bes t SF International has awarded Good Manufacturing Practices (GMP) Registrations known for his monographic resea rch on Nto three dietary supplement manufacturers. The first GMP registration was award­ vario us tropi cal tree fa milies, most notably ed to Perrigo Company's vitamin and nutritional supplement facilities in Greenville, SC; the Brazil nut fa mil y (Lecythidaceae) and followed by Arizona Nutritional Supplements, of Chandler, AZ; and Natural Alternatives the Coco plum fa mily (Chryso balanaceae) , International, of San Marcos, CA. and fo r his fl ori sti c studies of the Amazo n. GMPs are guidelines that provide a system of processes, procedures, and documenta­ T he Amazo n, particularly the Brazili an tion to assure the product produced has the identiry, strength, composition, qualiry, and Amazo n, ca ptivated most of his imellect puriry represented on the product label. The NSF GMPs are consistent with industry rec­ and energies, and he es tablished his creden­ ommended GMPs submitted to the U.S. Food and Drug Administration (FDA) in tials there as an economic botanist, having 1997. Should the FDA publish a final rule for dietary supplements GMPs, the NSF conducted ethnobotani cal inves ti gations GMP requirements will be modified, if necessary, to be consistent. Certified companies with numerous indige nous groups. W hile at undergo periodic audits to maintain the registration. NSF accepts National Nutritional the NYB G, he founded and se rved as the Foods Association GMP audits into the NSF GMP Contract Manufacturers Registration first director of the Institute of Economic Program. Botany, a deparrmem of the NYBG that NSF International, a not-for-profit, non-governmental organization, is the leading continues to thrive today under the direc­ global supplier of risk-management services in public health and safery. NSF is a World tion of Michael]. Balick, Ph.D. Health Organization Collaborating Centre for Food Safery and Drinking Water Safery In addition to his role with the Eden Pro­ and Treatment. Serving companies in more than 83 countries, NSF was founded in 1944 ject, Prance holds appoimments at Reading and is headquartered in Ann Arbor, MI. -"' Universiry in England and at the Nati onal -Karen Robin Tropical Botanical Garden in Hawa ii . He is [NSF Imernational. NSF Awards one of its first GMP registrations to Perrigo (press release). 2002 April2.]

14 I HerbaiGram 56 2002 www.herbalgram.org Libby Harvey FitzGerald Receives Tech Industry Award

ibby Harvey FitzGerald, manager and Winners were chosen based on a wide She received the pres ti gious AH PA Volun­ Lco-founder of Alpha Laborarories, has range of facrors, including the individual's teer Service Award in 1999. received the prestigious 2002 Technology leadership role in her company and busi­ Since Alpha Laborarories founding in Indusrry Award for the North Bay Business ness- related innova tions, achievemenrs, and 1982 in Petaluma, Cali fo rni a, Ms. FitzGer­ journal second annual "Women in Busi­ vision. Also considered were the nominee's ald has worn many hats, including HPLC ness: Leaders, Innovarors, Visionaries." length of service, career achievemenrs, and GC chemist, business manager, sales Awards were given accompli shments in the Norrh Bay area, and marketing direcror, pres ident, and in nine industry cate­ and communiry involvemenr. CEO ). In 1999, Eurofi ns Scientific gories. Technology Ms. FitzGerald represe nts the scientifi c acquired Alpha Laboratories to be its ce n­ industry nominations inrerests of the dietary supplemenr indusrry ter-of-excell ence for herbal products and included rop execu­ on a national level by her active se rvice on dietary supplements. Alpha speciali zes in tives in semiconducror the Analytical Laboratories Committee the analytical chemistry of natural products, and elecrronic manu­ (Chair), Standards Committee, and Educa­ development of combination sa mple ex rrac­ facturing, sofrware, tion Commirtee of the American Herbal tion/insrrumental methods, and method engineering, analyrical Products Association (A HPA). In addition, validati on for raw material and finished Harvey FitzGerald laborarory services, she has been an invited speaker at APHA, products of the dietary supplement and pharmaceutical , AOAC Inrernational, National Institutes of pharmaceutical industries._A biotechnology, medical devices, telecommu­ Health, and National Nutritional Foods -Karen Robin nications, and consulting. The orth Bay Association conferences. In 1997 she initi­ includes three major counries north of San ated a national educational se minar series [Alpha Laborarories. Technology Leader, lnnova­ Francisco: Sonoma, Napa, and Marin. entitl ed "Botanicals: Let's Talk Science." ror, Visionary ... (press release) . 2002 July 17]

Herb Society of America Honors Many, Names Blumenthal as Honorary President

he H erb Sociery of America (HSA) rec­ The Helen de Conway Little Medal of Fowler, of HSA's Arkansas Unit; and Tognized the work of several people at its Honor, for outstanding co nrributions ro Ri chard Ober (deceased) of the Potomac June annual meeting in Hershey, Pennsylva­ HSA or the world of horriculture in gener­ Unir. nia. Furrher, American Botanical Council's al, ro Caroline W. Amidon, past pres ident Certificates of Appreciation we re present­ Founder and Executive Direcror Mark Blu­ of HSA. ed to Elsie Quarterman, Ph.D., of the menrhal was named Honorary Pres ident for The Nancy Putnam Nashville Unit for her rediscovery of Echi­ a rwo-year term. Howard Award for nacea tennesseensis (Beadle) Small , Aster­ In a May 2002 let­ Excel lence in Horti­ aceae, whi ch was once thought to be ter, incoming HSA culture, ro Rebecca H . ex tinct; to Rosa Schachle of the North and presidenr Arlene Kest­ Talbo t, of HSA's Cenrral Texas Unit; and Dalmae Tucker, of ner, Ph.D., wrote that Nashville Unir. the Baron Rouge Unir. the choice of Blumen­ The Gertrude B. Based in Kirtland, Ohio, the HSA was thal for Honorary Foster Award for founded in 1933, and is dedicated to pro­ Presidenr "was based Excellence in Herbal moting the knowledge, use, and deli ghr of upon your leadership Literature, ro Deni Blumenthal herbs through educational programs, role and achievements in establishing the Bown, phorographer, lecturer and author of research, and sharin g the ex perience of its American Botanical Council as the leading more than 20 books, and past chairman of members wirh the co mmuniry. nonprofit education and research organiza­ the British Herb Sociery. To learn more about HSA and its many tion ro provide science-based information Cerrificates of Achievement we re local chapters and acti vities, visit rh e HSA on the safe and effective use of medicinal besrowed upon Mary S. Carrwright, of website, . _.­ plants and phyromedicines. " HSA's ashville U nit; Marie Garvey -Karen Robin Blumenthal, who replaces outgoing Hon­ orary President Arthur 0. Tucker, Ph.D., of Delaware State Universiry, accepted the role Don't Miss An Issue of HerbalGram "on behalf of all the employees here at ABC, both current and those who have worked Don't risk having an incomplete Herba/Gram collection. here over the last 14 years, as well as for the All members of the American Botanical Council receive a year's ABC Board ofTrustees." subscription, along with many other great benefits. Please see At the June annual meeting, HSA besrowed the following awards: page 2 for more information of becoming an ABC member.

www.herbalgram.org 2002 HerbaiGram 56 I 15 NIH Grant Funds Awarded to Bastyr University and Selected Graduates

astyr University has received a grant from the National Center Bof Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), as have two outstanding Bastyr graduates. T he grants reAects NIH interest in increasing the number of complimentary and alternative medicine (CAM) phys i­ cians trained to conduct high-quality, patient-oriented clinical research. Wendy Weber, N.D., Bastyr Uni vers ity graduate and researcher, received a career development awa rd that will fund her salary for five years and support research development. This pres ti gious grant, the first such award granted to a naturo­ pathic physician, is typically give n to a medical doctor who is sev­ eral years removed from medical school. Dr. Weber, however, received her doctorate in naturopathic medicine in June 2001. Between her 1994 graduation from Wesleyan University (psychol­ Hea ther Greenlee, N.D., practices cranio -sacra l therapy on her patient, Melea ogy/neuroscience and behavior) and her enrollment at Bastyr, Dr. Press of Seattle. Dr. Gree nlee rece ived an NIH grant to study ways to prevent Weber spent three years as a research assistant working on pediatric breast cancer in women. Photo by Clay Eals, © 2002 Fred Hutchinson Cancer psychopharmacology research at Massachusetts General Hospital Research Center. in Boston. Dr. Weber is a clinical research fellow at the Bastyr Center for NCCAM Supports CAM Research Training Natural Health, where she continues to see patients. H er main T he N IH grant to Dr. Weber comes in addition to a $1 .156 mil­ research interests are pediatrics and mental health co nditions. She lion five-year renewable grant, also from the NCCAM, to train sci­ is also working toward a master's degree in public health at the entists to do research in the field of CAM. Si milar grants have been University of Washington. awarded to four conventional medical schools; this is the first to go to a CAM school. Bastyr serves as the lead institution, in collaboration with the University of Washington, Fred Hurchinso n Cancer Research Cen­ ter, Center for Health Studies at Group Health Cooperative, and Washington State University. The program will accept four post­ doctoral fellows during years 1 and 3 of the five-year period. Each Are Head Lice aProblem? postdoctoral fellow will train for three years. Also, six predoctoral students will be accepted each year to study up to three months. Bastyr is still in the recruitment process, and interes ted candidates may obtain information from the Bastyr website, , or by calling 425/602-3416 . poo is safe to use and successful at removing resistant lice . Greenlee and the Hutchinson Center ./ Each bottle comes with a lice comb H eather Greenlee, N .D., a research fellow in Fred Hutchinson's and a fact sheet about lice. Public Health Sciences Division, received a postdoctoral N IH ./ Each bottle contains four applications. grant via the Fred Hutchinson Cancer Research Center. ./ A cli nical study in Phytomedicine reports I 00 percent success . She will research wheth er there is a safe, effective, alternative to ./ Contains essential oils of tea tree and anti-estrogen drugs to prevent breast cancer among women at high thyme plus a patented, standardized risk of the disease. LICE R EMOVER paw paw extract . Greenl ee received her doctorate in naturopathy from Bastyr. She SHAMPOO ./ Natural ingredients deplete ATP and continues to see patients at the Bastyr Center for Natural Health, \ ..~·:~ .... ~~ thwart ATP-dependent resistance. 4 Fl. OL. Ill S.S mi) where she is a clinical research fellow. Prior to her enrollment at ./ Great for pets too! Bastyr, Greenlee worked as a research assistant at both the Hutchinson Center and the University of Washington, where she •••••••••••••••• • •••••• • • •• • ••• • is pursuing a master's degree in public health as parr of her NIH­ For more information , funded training. _..- vi sit www.liceremover.com or www.naturessunshine.com , -Karen Robin or call NSP Customer Service at1-800-223-8225. [Bastyr University. First Na tional Institute of Health (NIH) Research Career Development Award for aturopathic Medicin e goes to Bastyr University Graduate [press release]. Kenmore, WA. 2002 April 22. Nawre's Sunshine Products Bastyr Universi ty Receives N IH Funding to Train Scientists in Compl e­ 75 East 1700 South Provo, UT 84 60 I mentary and Alternative Research [press release]. 2002 March 14. Fred Hutch in son Ca ncer Resea rch Ce nter. Seeking a Natural Way to Pre­ vent Breast Cance r [press release]. 2002 Feb. 5.]

16 I HerbaiGram 56 2002 www.herbalgram.org Consumers Mix Prescription Meds U.S. Food and Drug with Supplements Administration

esearchers from Boston Uni versity have mixing conventional and al ternative reme­ launches New AER Rexpressed concern with unintended dies, the authors concluded that the overlap Tracking System interactions that may occur when co n­ raises concern about "unintended interac­ sumers overl ap use of prescription medica­ tions." T he authors suggested that docu­ he U.S. Food and D rug Administration tions with use of herbal or other dietary menting usage patterns could be used to has launched a new system to report and supplements. Results fro m the Slone Sur­ improve the safety of medication use. T moni tor adverse events reports involving vey1 indicate a consistent overl ap between T he Slone Survey was a randomized tele­ foods, cosmeti cs and dietary supplements. conventional and alternati ve remedies. phone survey of the non-institutionalized T he new sys tem, under the FDA's Center Among 2,590 partici pants (at least 18 Ameri can residents in the 48 continental fo r Food Safety and Applied N utritio n years old), 8 1 percent used at least one med­ stares and the D istrict of Columbia. Data (CFSAN), is call ed CFSAN Adverse Events ication; 50 perce nt rook at leas t one pre­ was collected and analyzed from February Reporting System (CAERS). scription drug; and 7 percent rook fi ve or 1998 through December 1999. T he survey Under the new system, CFSAN will write more. H erbals and supplements were taken questions fo cused on what medi cations, by a letter of notifica tion to rhe com pany li sted by 14 percent of the populati on. In addition, type, were taken during the week preceding on rhe product label when the CAERS sys­ 16 percent of prescription drug users admit­ the survey dare.' ... tem receives an adverse event report of ill ­ red to also raki ng an herbal or supplement. I. Kaufm an OW, Kel ly J P, Rosenberg L, ness or injury al legedly associated with the Reasons fo r drug use varied widely, with Anderson TE, Mitchell AA. Recenr Par­ use of a company's product. hypertension and headache mentio ned terns of Medication Use in rhe Amb ulatory Adult Population of the Un ited Stares: The T he CAERS system will enable FDA to most often (9 percent for each). Vitamins Slone Survey. journal ofth e American Med­ identify potential public health iss ues asso­ and minerals were frequently used for gen­ ical Association 2002; 287(3) :337-44. ciated with a particular product already in eral health (35 percent), as were herbals and 2. Anon. Co nsumers Mi xing Remedies: the marketplace. FD A will use rhe in fo rm a­ supplements (16 percent). Herbals and Prescriptions. Natural Products ti on gathered fro m the system to ass ist in Owing to the rel ati vely high incidence of Industry Insider 2002 Jan 16. rh e formulatio n and dissemination of CFSAN's post-marketing poli cies and pro­ Agreement to Share Drug Revenues with cedures. FDA encourages co mpani es to share Samoan Village Sets Benefit-Sharing Precedent in fo rmation wi th the agency that is relevant and useful concerning adve rse eve nts that Twenty perce nt of any co mmercial rev- Retroviral T herapy (HAART), which is the compani es may be aware of involving rh eir 1 enues from prostratin, an ex perimental standard of care for AIDS pati ents. A study product. but promising anti-HIV compound, will be showed that prostratin inhibits HIV repli­ T he CAERS system replaces the Special returned to the people of Samoa where this cation while acti vating dorm ant, or "latent" Nurri rio nals/Adve rse Eve nt Monitoring pl ant-deri ved potential therapy was found, HIV.2 Prosrratin ca n stimulate latently System (SN/AEM S) crea ted in 1998. T he under a precedent-setting agree ment. infected cells so that the virus may poten­ SN/AEM S website, which incl uded adverse Prostratin is found in the wood of H oma­ tially be recogni zed by the immune system event reports on dietary supplements, has la nthus nutans G uill. , Euphorbi aceae, a or eradicated by currently ava il able drugs. been removed fro m the FDA website. FDA small rainfores t tree in Samoa. Paul Alan After li censing prostratin for HIV thera­ is currently evaluating how bes t to in corpo­ Cox, Ph.D ., Director of the National Trop­ PY from the NCI, Irl Barefield , Executive rate the adverse event data received from rhe ical Botani cal Garden, firs t coll ected H. D irector of ARA and Stephen Brown, M.D . CAERS system in to a website fo r publi c 1 nutans in 1984. Before beginning his ARA's Director of Clinical Research, trav­ use. research, Cox and the Samoan village chiefs eled with D r. Cox to Samoa where they mer T he CAERS system will be pilot rested agreed that a portion of any future fi nancial with healer's fa milies, village chi efs, and the this year and is expected to be operational benefit would be returned to the village. Prime Minister, Attorney General, and sev­ by May 2003. Ir may not be on the FDA Cox found rhar Samoan healers in the vil ­ eral cabinet mem bers of rhe Samoan gov­ website until 2004. In the meant ime, lage of Falealupo used the bark of the plant ernment. Under rh e terms of the agreement CFSAN's internal adverse event collection to treat hepatitis. He sent their mixtures to ARA reached with Samoa, 12.5 percent of and evaluation systems wi ll continue to the Nati onal Cancer Institute (NCI) of rh e the profits from pros rrarin will go to rhe operate . ... N ati onal Institutes of Health (NIH), which Government of Samoa, 6.7 percent to isolated prosrratin. Falealupo vill age, and 0.4 percent to rhe [America n Herbal Products Association. FDA AIDS ReSearch Alli ance of Ameri ca fa milies of each of the two (now deceased) Announces New Adverse Evenrs Reponing Sys­ (ARA), a non-profit research institution healers who showed Cox how to use H. tem for Dieta ry Supplemenrs, Food and Cos­ that has helped develop 11 of the current 17 nutans.1 metics (press release] 2002 August 29] anti-HIY d rugs, became interes ted in pros­ ews of the agreement rapidly spread, tratin a little over a year ago as the virus continued to development res istance to the current drugs used in Highly Acti ve Anti- Continues on page 55 www.herbalgram.org 2002 HerbaiGra m 56 I 17 Pawpaw Tree Extract Effective against Head Lice

new shampoo made with co mpounds fro m the rwi gs of paw­ A paw trees (Asirnina triloba (L.) Dunal, Annonaceae) has bee n shown ro kill head li ce. T he product, call ed PawPaw Lice Remove r Shampoo (Nature's Sunshine Pro ducts Inc., Spanish Fork, Utah), was introduced after laborarory and clinical studies showed that it was effec ti ve. ' O f the three rypes of li ce that in fes t humans, head li ce (Pedicu­ lus capitis deGeer, Pediculidae) are the most prevalent form. The U.S. Centers for Disease control reports that 6 ro 12 million peo­ ple worldwide are infested each yea r. ' H ead li ce are transmitted by person-ro-person co ntact and by sharing articles such as combs, clothing, and pillows. Previous control methods include applying such pes ti cides as lindane, pyrerhrins, permethrin, or malathion, and are resulting in increas ingly res istant li ce. N umerous references ro other species, also in the family Annonaceae, and including sugar apple (Annona squamosa L.) and cherimoya (Annona cherirnola Mill.), ro remove li ce are found in fo lklore. 1 T he pawpaw tree produces rh e largest edible fruit of any native N orth An1 erican tree; so me reach more than one pound. Nati ve ro eastern North Am eri ca, pawpaw trees grow wild in rh e Pawpaw As imina trifoba fruit and seeds Photo ©2002 Nature's Sunshine. hard wood forests of26 stares in the eastern U nited Stares, and they range fro m northern Florida ro so uthern Canada, and as far wes t as eas tern Nebras ka. pounds found in rhe pawpaw tree since 1976 and has identified a Jerry M cLaughlin, Ph.D., professor emeritus of pharmacognosy number of very potent compounds, ca ll ed annonaceous acero­ ar Purdue Uni ve rsity and, currently, vice pres idel) t for resea rch and genins, capable of controlling insects and pests. development ar Nature's Sunshine, has studied the bioacrive com- "T he pawpaw extract used in this shampoo has more than 50 annonaceous acerogenin compounds," he says. "It's a complicated mixture that this species has evolved ro protect itself. T he com­ pounds inhibit the mirocho ndrial production of adenosine triphosphate (ATP), which deprives the pes ts of energy. Since pes­ ti cide res istance requires ATP, res istant pes ts are es pecially suscep­ tible." n~Herbology~lridology The fo rmula also includes tea tree oil (M elaleuca alternifolia (Maiden & Berche) Cheel, Myrraceae) and thymol from rhyme • ical Herbali~t , Master Herbq~ st & (Thurn us vulgaris L. , Lamiaceae), which also deplete ATP levels. "It's been a bit of a struggle ro pursue this research in product r ~V"IOIICn·c Therppist Di}:'.~ma PI! , """ ·~ :(• development beca use there were no commerci al so urces of the ssro , Correspondenc pawpaw biomass, and ro max imize bioavailability, rwi gs can be On line Courses. co ll ected fro m rhe tree o nly during rhe mo nth of M ay," Year round registration for ...·hc: , ..,.., r~,, "" McLaughlin says. "During that rime of year, the plants pump up learning courses producti on ro protect themselves against pests." He predicts rhar co ll ecti on of pawpaw rw igs will soon become a new pursuit for wildcrafters and that pawpaw tree plantations will someday pro­ duce a commercial crop . .:.- - Karen Rob in

I. McCage CM , Wa rd SM , Paling CA, Fisher, DA, Flynn, McLaughlin JL. Developmem of a paw paw herbal shampoo fo r the removal of head li ce. Phytomedicine 2002. In press. 2. U.S. Cenrers fo r Disease Control, Division of Paras itic Diseases. Head Lice Infestation (Ped icul os is) Fact Sheer. Accessed onli ne 2002 Au gust . 3. Monon JF. Fruits of warm climates. W intervill e (NC): C reative Resource Systems, In c.; 1987. p. 65-90.

18 I HerbaiGram 56 2002 www. herbalgram.org Sloan-Kettering to Study Kampo Botanical Formula to Treat Liver Cancer

rradirional Japanese formulation comprised of seven Chinese Kampo, Japanese herbal medicine, is parr of the Easr Asian C hi­ Aherbs will be srudied by Memorial Sloan-Kerrering Cancer nese medicine rradirion. Kampo is fundamenrally a clinical sys tem Cenrer, of New York, ro determine irs effecr againsr liver ca ncer. based on the class ical medical lirerarure daring back ro rh e Han The herbal formulation being tesred is called Sho-saiko-ro or Liv­ Dynasty in ancienr C hina. In Japan roday, 75 percenr of phys icians erKampo'" (Honso Pharmaceutical Co., Lrd., Nagoya Japan). use so me traditional Kampo formulas, which are available in almosr Li ver cancer, or heparocellular carci- all pharmacies by prescription, or noma (H CC), has a poor prognosis, under rhe advice of speciall y trained Kampo combines multiple raw herbs, especially when surgical resection is pharmacists. Kampo research in Japan contraindicated. The besr rrearmenr according to specific ancient formulas, is rigorous by Wesrern standards, in for HCC is ro remove rhe rumor sur­ and then performs an extraction rhe mold of convenrional pharmaceu­ gically. If rhis oprion is nor possible, ti cal research. some parients may be eligible for abla­ on the entire mixture. Kampa is differenr fr om Wesrern rive rherapy, a rype of surgery rhar herbal medicine, which uses individ­ shrinks rhe rumor, bur does nor remove it entirely. One rype of ual herbs or their standardized exrracrion. lnsread , Kampo com­ ablarive rherapy, embolization, reduces blood Aow in rhe heparic bines mulriple raw herbs, according ro specifi c ancienr formulas, arrery, rhe vessel supplying blood ro rhe live r. and rhen performs an ex rracrion on the entire mixrure. The com­ According ro rhe srudy design on rhe Sloan-Kerrering websire bination of specific herbs and rhis extraction process creares a rem­ , Sho-saiko-ro has been used for many years ro edy considered by irs pracririoners ro be more effecri ve rh an rhe rrear chronic li ver disease. Alrhough rhere are some reasons ro benefir from each herb extracted individually. To emphasize rhis, believe rhar ir may be beneficial, Sho-saiko-ro has never been eval­ Honso product labels srare rhe raw herb amo unts before extrac­ uated in patients wirh H CC. Therefore, irs risks and benefits are tion. --- unknown. This study will be assess ing the va lue of Sho-saiko-ro in -Karen Robin parients who will be undergoing hepatic arrery emboli zation for the rrearment of HCC, bur who will nor be receiving chemotherapy. [Ho nso USA, Inc. C linical Phase I I Study on Promising Japanese Botani­ Sho-saiko-ro is comprised of roor of bupleurum (Bup!eurum cal Formula 'Sho-Saiko-ro' For Treating Liver Cancer ro Begin in New York (press release). 2002 February 25 .] fac!atum L. , Apiaceae), roor of pinellia (Pineffia ternata (Thunb.) Makino ex Breir., Araceae), rhizhome of ginger (Zingiberis o./fici­ na!e Roscoe, Zingiberaceae), root of C hinese skullcap (Scute ffaria HERBAL SCIENCES PROGRAM baica!ensis Georgi, Lamiaceae), fr uirs of jujube (Ziziphus jujuba Mill. , Rhamnaceae), Asian ginseng (Panax ginseng C.A. Mey., Araliaceae), roor of li corice ( Gfycyrrhiza g!abra L. var. g!andu!ifera (Waldsr. & Kir.) Regel & H erder, Fabaceae). Sho-Saiko-ro's in vitro, in vivo, and clinical acriviry seems pri­ marily to inhibit rumor proliferation rather than ro kill rumor cells. T he Honso USA websire includes a link ro PubMed search results of more than I I 0 studies and revi ew arricles on Sho-saiko-ro published from 1995 ro 2002 (mosr of which are conducted on rhe formula manufactured by another Japanese Kampo manufacturer, Tsumura & Co.). This clinical rrial, under an lnvesrigational New Drug Applica­ tion (IND) approved by rhe U.S. Food and Drug Administration, uses a one-stage hisrorical comparison design. Patients scheduled for ablarive therapy will be assessed for eligibility and adminis­ tered 7.5 grams of granular exrracr per day of Sho-Saiko-ro. The GET AHIGHER EDUCATION IN EVERY SENSE ourcome used ro power rhe trial is survival at 15 months, the median survival of a histori cal cohort. For secondary analyses purposes, liver fun crion, alpha-feropro­ Bastyr is proud to be the country's first accredited rein and intervenrion-free survival will be compared berween rhe institution to offer an herbal sciences program. Explore rreared cohorr and hisrorical dara. The parienrs, approximately 80 medicinal herbs. Get to the root of herbal quality in number, will be treared over a rwo-yea r period; rheir progress followed for anorher year. issues. And be prepared for a growing career in your "We are very pleased ro have had our product selected for choice of fields. srudy," said Dan Wen, M.D., presidenr of Honso USA, Inc., the American subsidiary ofHonso Pharmaceutical s Co., Lrd. based in BASTYR Tempe, AZ. "And ir's an added honor robe able ro go directly in ro U N I V- E R S I T Y a Phase II srudy due ro rhe overwhelming body of evidence thar 425/ 602 - 333 0 ::·, WWW .BASTYR .EDU already exisrs on rhe successful use of Sho-saiko-ro in rhe pasr. " CAMPUS NORTH Of SEATTLE www.herbalgram.org 2002 HerbalGram 56 I 19 Heating Garlic Can Reduce Some of Its Biological Activity

eviewed: Song K, Milner JA. The influ­ pounds. Garlic is distinguished from many adducrs by 64 percent, and garlic that had Rence of hearing on the anticancer prop­ other vegetables because of irs high sulfur been microwaved for 30 seconds provided a erties of garlic. American Society for Nutri­ content, and it is thought that the many simil ar degree of protection. However, tional Sciences. 2001 [Supplement]: 1054S- allyl sulfur compounds in garlic, including microwaving garlic for 60 seconds 1057S. S-allylcysteine (SAC), a water-soluble sul­ destroyed all of irs anticancer benefits, The potential medicinal value of ga rli c fur-containing amino acid, probably whether rhe garlic had been crushed before (Allium sativum L., Alliaceae or Liliaceae) explain many of irs medicinal properties. hearing or nor. Letting crushed garl ic sir at has been recognized for thousands of years. According ro the authors' own research, room temperature for 10 minutes before The authors cite studies that have shown microwave hearing for as little as 30 seconds microwave hearing preserved 70 percent of that garlic has a variety of pharmacologic blocked 90 percent of the activity of alli­ irs anticarcinogenic effects, compared with properties, including hypolipidemic (blood inase, the enzyme that is activated when the effects of raw garlic. C utting the top off lipid-lowering), hypoglycemic (blood glu­ garli c is crushed or cur. Alliinase rapidly of whole, intact garli c and letting it sit for cose-loweri ng), antibacterial, antifungal, converts alliin ro allicin. Allicin is responsi­ 10 minutes before oven heating also pre­ antioxidant, and anticancer effects. ble for garlic's odor, and is considered one of served some of its anticancer effects, where­ Support for the anticancer effect of garlic rhe most important biologically active com­ as oven hearing for 45 minutes without cut­ has come from epidemiologic, animal, and pounds found in crushed garli c. Microwave ting the rop of the garlic destroyed all of its laboratory studies. Preclinical research has heating of garlic for 60 seconds destroyed anticarcinogenic potential. shown rhar garlic can protect a number of all alliinase activity. When alliinase is inacti­ Thus, this research suggests that many of body tissues agai nst different kinds of car­ vated by heat, alliicin and its derivities ca n­ the medicinal effects of garli c are reduced or cinogens and can interfere with cancer not be formed. The authors eire studies destroyed by hearing. Inactivation of alli­ development at both the initiation and pro­ showing that boiling garlic at 100 degrees C inase and other hear-sensitive materials in motion stages. This article reviews research for 20 minutes inactivated its cardiovascular garli c is probably the mechanism by which about the effects of hearing garlic on irs benefits, antifungal effects, antioxidant hearing has this negative effect. "Although anticance r potential. "Although the mini­ properties, and ability ro inhibit cyclooxy­ garli c is known for its many pharmaceutical mum daily intake required ro reduce cancer ge nase (an enzyme that plays a role in the effects, these abilities ca n be depressed by risk remains ro be determined, garlic has development of some types of cancer). preparation or processing methods," the been categorized as a dietary anticarcino­ The authors also performed a study to authors conclude. A gen," the authors write. measure the effects of heating garli c (dosage Laboratory research suggests that the information was not included in the report) -Christina Chase, M.S., R.D. anticancer substances in garlic include both upon a rat anticancer assay. Raw garlic was lipid-soluble and water-soluble sulfur com- effective in reducing formation of DNA Pycnogenol® Pine Bark Extract Shows Promise in Diabetic Retinopathy

eviewed: Spadea L, Balesrrazzi E. Treat­ vessels in the eye, such as diabetic retinopa­ ages of patients taking placebo and Pyc­ Rment of vascular retinopathies with thy. Previous studies cited by the authors nogenol were 53.1 and 59.7 years, respec­ Pycnogenol. Phytotherapy Research 2001; found that antioxidants can inhibit the tively. 15: 219-23. processes of neovascularizarion (formation T he efficacy and safety results of the two This study evaluates whether Pyc­ of new blood vessels) and chronic edema phases were analyzed separately and pooled nogenol® affects the progression of vascular (fl uid retention) in the retina. Both of these where appropriate. The effects of treatment retinal disorders (conditions affecting blood processes, if left unchecked, can cause a loss with Pycnogenol or placebo were assessed vessels in the retina of the eye), including of vision. using five different parameters: visual acu­ diabetic retinopathy (disease of the retina T his trial comprised two phases. In the ity, ophthalmoscopy, visual field, fluoroan­ caused by diabetes). Pycnogenol (Horphag first phase, which was double-blinded, 20 giography, and pattern electroretinogram. Research, France) is a patented water extract patients were randomly assigned ro receive The visual acuity rest showed that, on aver­ from the bark of French maritime pine either placebo or Pycnogenol (50 mg, three age, placebo-group patients experienced (Pinus pinaster Aiton, Pinaceae, syn. P. mar­ times daily) for two months. In the second some loss of visual acui ty during the two­ itima Lam.). The primary active ingredients phase, which was open-label, 20 additional month study. This indicated that retinopa­ are flavonoid-type compounds such as cate­ patients received Pycnogenol at the same thy can cause rapid deterioration of vision chin, epicarechin, raxifolin, procyanidins, dose schedule and duration. A roral of 30 and, therefore, needs prompt treatment. In and proanthocyanidins. patients rook Pyc nogenol and l 0 rook the contrast, Pycnogenol-group patients expe­ Previous research has found that free rad­ placebo. All the patients had vascular dis­ rienced either a slowing of the deteriora­ icals play an important role in the develop­ eases of the retina due ro diabetes, athero­ tion of visual acuity or a small improve­ ment of various eye diseases, including sclerosis , hypertension, or thrombosis ment in vis ual acuity. The difference retinopathies. Evidence also suggests that (blood clot) in the central retinal vein. The between the groups was statisticall y signif­ antioxidants can be effective at both pre­ majority of the patients had ei ther diabetic icant (p < 0.05 for rh e ri ght eye and p < venting and treating diseases of rhe blood or hypertensive retinopathy. The average 0.0 I for the left eye).

20 J Herbal Gram 56 2002 www.herbalgram.org Ophthalmoscopy, performed to examine this study. They discuss the ways this the ocular fundus (deepest part of the inside extract appears to have its effects. "The reti­ of the eye), showed that Pycnogenol-treated na is very sensitive to oxygenated free radi­ patients had significant improvements from cals," they note, and therefore the ability of baseline to end of treatment. Placebo-treat­ Pycnogenol to scavenge free radicals may ed patients had no improvement. Field of ex plain its beneficial effects. As with many vision testing showed no changes in ei ther other studies on herbal medicines, the small group and no differences between the two size of this clinical trial casts its statistical groups. significance in doubt. Fluoroangiography showed that patients In addition, Pycnogenol may have other given Pycnogenol had a significant actions that contribute to its treatment improvement in rhe blood-retina barrier, effect. The authors eire a previous study with reduction of vascular permeability with rats rh at showed Pycnogenol reduced (i.e., less leakage from the blood vessels). leakage from the capillaries, strengthening Placebo patients had no changes during the their resistance, other studies that found study according to fluoroangiography. Pycnogenol decreased capillary permeabili­ The electroretinogram (a record of the ty or subcutaneous edema in venous disor­ retinal action currents produced by light ders, as well as studies that have suggested stimulus) also showed significant improve­ that diabetic retinopathy may involve ments in the Pycnogenol group but no abnormalities in localized production of changes in the placebo group. "The results nitric oxide (NO) or reactivity to nitric obtained from this objective functional test oxide (a vasodilator). Pycnogenol, like other clearly demonstrate the efficacy of Pyc­ products that contain antioxidants derived nogenol," the authors say. from plants, affects NO activity and, there­ No side effects were reported in either fore, may influence diabetic retinopathy via group, and Pycnogenol was well-tolerated. this mechanism.A French Maritime pine Pinus pinaster syn. P maritima The authors conclude that Pycnogenol led Photo© 2002 Horphag Researc h Ltd. - Christina Chase, M.S., R.D to clinical improvement of retinopathy in

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www.herbalgram.org 2002 HerbaiGram 56 I 21 Press Releases Freely Interpret Failed Study and Claims that St. John's Wort Doesn't Work by Jerry Cott, Ph .D.

he recent report in rh e Journal of the protocol, I believe there has bee n a disse rv­ research effort? Perhaps this trial could serve TAmerican Medical Association UAMA) ice to rh e medical/sciemiflc co mmunity as as a model for the inherem difficulties in on the National Institutes of Health (NT H)­ well as to the tax payers who paid more than ca rrying out antidepressa nt trials where the sponso red study of St. John's wort (Hyper­ $6 million for these data. Since both SJW average failure rate on investigati onal ami­ icum perforatum L. , C lusiaceae) in major and serrraline fail ed to show an effect on depressa nt drugs is 50 percent.'1 T he authors depression' was a disappointment in several either primary outcome measure, the only of this study acknowledged that 35 percent res pects. T he study was a bas ic three-arm logical conclusion is that the study was nor of trials res ting "known antidepressants" design: Sr. John's won (Ll- 160, Li chrwer valid. This conclusion was predetermined end in failure.' Pharm a, Berlin; 900- 1500 mg/day), se rrra­ by the Research Des ign secti on of the NIH O f primary concern is the rationale for line (Zoloft®, Pfi ze r; 50-100 mg/day), or protocol that states: " .. . hav ing an SSRI inclusion of severely depressed pati ents in placebo in 340 pati ents divided in to three arm of se rtraline will all ow an evaluation of this study. T he criterion for assess ing the equal groups. After eight weeks of treat­ the validity of the trial .. . . "' Elsewhere rhe severi ty of depression was initial ly proposed ment, neither treatment had significanrly protocol design stared, "With onl y rwo at a level of 15 or greater on rhe 17 -item di ffe rent effects from the placebo group. arms, if the findings cannot discriminate Hamilton Depression Rating Scale (HAM­ Judging by the press releases from JAMA, berween placebo and hyperi cum, the res ults D ) scale (mild to moderate depression). Duke University Medical Center (the cen­ are uncertain regarding failure of the trial or T his was later raised to the level of 20 or tral research base for this multi-center study failure of the trea tment." From a statisti cal greater (moderate to severe) . T here appears that included 12 medical centers), and viewpoint, onl y the primary outcome meas­ to be a beli ef that more severely depressed N IH, the study was a success and proved to ures determine success or failure of a thera­ patients will be less likely to res pond to a rhe waiting world that St. John's won peutic tri al. Since the study was nor va lid, placebo and thus increase the likelihood of (SJW) was ineffective in treating major from a scientific standpoint, the efficacy of showing a drug/placebo difference. '0 Actual depression (a category of depress ion that SJ W cannot be determined. As pointed our data, however, do nor support this belief." can be mild, moderate, or severe), des pite by Steve n Brarman, M .D., in the American The durati on of th e current episode was many previous studies showing that it is Botanical Council 's press release on this also rather long (more than one-third were effecti ve. '' study, resorting to analyses of secondary suffering from depress ion fo r a period T he real disappoi ntmem was rh ar, nor meas ures does nor res urrect rh e trial. '' If sec­ greater than rwo years). only did SJW fail to relieve symptoms of ondary outcome measures were valid pre­ A co mpelling case can be made that depression, there was no mea ningful discus­ dictors of effi cacy, rh e Vanderbilt University chronicall y depressed pati ents are less sion of the fa ilure of the FDA-approved study published last year in JAMA (funded res ponsive to any treatment, including with antidepressam , serrraline, to work in rhe by Pfizer) would have to be interpreted as known active pharmaceutical drugs, nor sa me trial. T here was also linle discuss ion of positi ve for SJW, since the percentage of just placebo. Inves ti gational antidepressant the major effect the failure of serrraline (a pati ents who recovered was signiflcan rl y trials conducted by pharmace utical firms selective serotonin reuprake inhibitor, or greater in the SJW group than in the con­ ro utinely use 17 on the HAM-D as an entry SSRI ) had on the interpretation of the trol group (1 4.3 perce nt vs . 4.9 percem ; level for tri als and avo id the use of chroni­ study. Nor onl y was rh e study a disa ppoi nt­ p<0.02).- T his positive outcome was so me­ cally depressed patiems. The commonali ty ment in several res pects, bur rh e surround­ how overl ooked in the JAMA editorial of of these entry criteria for other published ing publicity has bee n quire misleading. the NIH study. " depress ion studies was confirmed by the T his is refl ected in recent letters to the edi­ Give n that th e N IH study was nor suc­ article accompanying the SJW trial in tor of]AMA.'; cessful in determining the efficacy of either ]AMA discuss ing the placebo res ponse , As one who was ve ry much involved with treatment, is there anything of value that finding a mean HAM-D entry criteri a score initiation of this trial and drafting the first can be gleaned fro m this considerable of 16.7." T he ques ti on of the efficacy of SJW in major depress ion has by no means been se r­ ried by rh e rwo American clinical trials con­ Advertise in ducted to dare. Rather, they have made it even more clear that the trial that needs to be conducted should follow the des ign of the one ori ginally proposed (i.e., based on HERBAIGRAM the res ponses from subjects ex peri encing For information on display and classified mild to moderate major depression). A recent SJW placebo-controlled trial advertising in HerbalGram, call or II 512/926-4. 900, was published in the American j ournal of visit the ABC website, www.HerbalGram.org. ~ Psychiatry.' T his trial was performed in France and found a significant antidepres-

22 I HerbaiGram 56 2002 www.herbalgram .org sant effect in favor of SJW over placebo. Small Trial Shows Hawthorn Leaf and Flower The patient entry criteria was mild to mod­ erate (major) depression with HAM-D Extract Is Effective in Early-Stage Congestive scores from 18 to 25. This trial differed from the two Ameri can studies in that it Heart Failure was performed at 26 different centers in France, al l patients were self-referred (i.e., eviewed: Zapfe G . Clinical efficacy off calculated by multiplying heart rate by sys­ 2 they were nor recruited by newspapers, TV RCraraegus extract WS 1442 in conges­ toli c blood press ure by 10 • The double and radio as they are in this country), and tive heart failure NYHA class I I. Phytomed­ product was determined at rest and agai n there was a severiry range on the HAM-D icine 2001 ; 8:262-6. after exercising for 2 minutes at a workload of at least 18 bur nor more than 25. Unfor­ In congestive hearr failure (CHF), rhe of 50 W; rh e difference between these two tunatel y, the duration of the current hea rt has a reduced abili ry to pump blood values was calculated and used as the differ­ episode was not provided. __.- effectively, often due to a previous myocar­ ence of rhe double product. dial infarction (heart attack). T his usually The results showed that from the start to f erry Cott, Ph. D. , is the former Chiefof the causes symptoms such as shortness of the end of the 12-week study, average exer­ Psychopharmacology Research Program at the breath, weakness, and fluid retention in the cise tolerance improved in the treatment NIMH and has also been a reviewer ofclini­ legs and feet. "Even mild forms of C H F group (from 616.3 to 682.5 W x min), bur cal and preclinical studies of antidepressant should be treated adequately to postpone or declined in the placebo group (from 623.8 drugs at the FDA. The study under discussion to prevent progression of the disease," the to 527.6 W x min). The difference between was funded solely by the NIMH. author writes. groups was of borderline significance (p < Previous research showed that a 0.06) despite average age difference. All 20 References hawthorn extract known as WS I 442* patients in the WS 1442 group and 19 of I . Hype ricum Depress ion Trial Study Group. (Schwabe Pharmaceuticals, Karl sruhe, Ger­ 20 in the placebo group completed the Effect of Hypericum perforatum (Sr. John's many) was effective and safe for treating study; one placebo-group patient dropped won) in major depressive disorder: a ran­ C HF. Clinical studies found that WS 1442 our due to an all ergic skin reaction. domized controll ed trial. }AMA improved exercise tolerance and reduced From baseline to end of study, the differ­ 2002;287: 1807- 14. 2. Lecrubier Y, Clerc G, Didi R, Kieser M. symproms of CH F. WS 1442 is made from ence of rhe double product declined by Efficacy of Sr. John's won extract WS 5570 a dry extract of hawthorn ( Crataegus spp., 26.8 percent in the WS 1442 group bur in major depression: A double-blind, place­ Rosaceae) leaves, twigs and flowers. remained unchanged in the placebo group. bo-controlled trial. Am J Psychiatry This randomized, double-blind, placebo­ The change in theWS 1442 group was nor 2002; 159(8): 136 1-6. controlled clinical trial was performed to significant (p < 0.11), yet the author con­ 3. Whiskey E, Werneke U, Taylor D. A sys­ evaluate the efficacy and safery ofWS 1442. cludes, "rhis resulr indicates a positive tematic review and meta-analys is of Hyper­ The study included 40 male and female impact of WS 1442 on exercise tolerance." icum perforatum in depression: a co mpre­ outpatients, aged 40 to 80 years, with CHF. This reduction in the difference of the dou­ hensive clinical review. !nt Clin Psychophar­ macol. 200 I Sep; 16(5):239-52. The severi ty of their CHF was categorized ble product found in rhe WS 1442 group 4. Carr J, Wisner K. Sr. John's wort and as New York H eart Association (NYHA) may indicate that the heart was usi ng oxy­ depressive disorder (lerrer). JAMA class II , a mild chronic form of C H F. The gen more efficienrly to perform an equiva­ 2002;288(4) :448. average age of patients was 58.2 years in the lent amount of work. WS 1442 was shown 5. Carr J. IH Sr. Joh n's wort study fails ro treatment group and 66.5 years in the to be safe and well-tolerated. satisfy. The Integrative Medicine Consult placebo group. Approximately three-quar­ The cornerstO ne of management for 2002 July;4 (7) :73,77,83. ters of the patients in both groups were CHF is still conventional drug treatment 6. Am erican Botanical Council. Sr. John's women. with diuretics, ACE inhibitors, digitalis gly­ Wort stud y misinterpreted says herbal sci­ ence group [press release] . 2002 Apr. 9. Patients were randomly assigned to cosides, and beta-blockers, based on large­ 7. Shelron RC, Keller MB, Gelenberg AJ, receive either placebo or WS 1442 (240 mg scale trials focusing on such endpoints as Dunner DL, Hirschfeld R, Thase ME, er per day, divided into 3 doses of 80 mg each) mortaliry. With more research on hawthorn al. Effectiveness of Sr John's won in major for 12 weeks. WS 1442 was standardized to leaf and flower extract, it is possible that this depression: a randomized controll ed trial. contain 18.75 percent oli gomeri c procyani­ phytomedicine may become more widely }AMA 200 1;285(15):1978-86. dins. Certain drugs were discontinued, if adopted in cardiology for C HF Stage II. 8. Kupfer OJ , Fra nk E. Placebo in clinical tri­ poss ible, during the study. These included Hawthorn leaf and flower extract was als for depression: complex ity and necessi­ diuretics, calcium a ntagonists, ACE approved for this indication by the German ty. }AMA 2002;287(14): 1853-4. 9. Robinson OS, Rickels K. Concerns about inhibitors, cardiac glycosides, and other Commission E in 1994. __.- clinical drug trials. J Clin Psychopharmacol hawthorn-con raining preparations. -Christina Chase, M.S., R.D. 2000;20(6):593-6. At the beginning (basel ine) and end of 10. Schatzberg AF, Kraemer HC. Use of pl ace­ the study, patients underwent exercise toler­ • WS 1442 is marketed in Germany as bo co ntrol gro ups in eva luatin g efficacy of ance testing on a stationary bicycle. The Craraegurr' by W. Schwabe and is imported treatment of unipolar major dep ression. main outcome variable was exercise toler­ and marketed in rhe United Stares as Heart­ Care ' by arure's Way. Bioi Psychiatry 2000;47(8):736-44. ance, measured in warrs (W ) multiplied by II. Walsh BT, Se idman SN, Sysko R, Gould minutes (min). T he secondary outcome M. Placebo response in studies of major depression: variable, substantial, and grow­ variable was the double product, also ing. }AMA 2002;287(14): 1840-7. known as the pressure-rate product. T hi s is

www.herbalgra m.org 2002 HerbalGram 56 I 23 Clinical Update by Donald J. Brown, N.D. Using Raspberry Leaf During Pregnancy: A Look at Safety and Efficacy in Labor Summary: In a double-blind, ran­ wifery as an herbal tonic during pregnancy. ' Traditionally used Reviewed: Simpson M , domized, placebo-controlled clinical throughout pregnancy to treat morning sickness and reduce ri sk Parsons M, Greenwood trial, the effect of raspberry leaf of miscarriage, its primary use has been to strengthen and tone J, Wade K. Raspberry extract in tablets was studied on labor the uterus prior to birth. 2 Anecdotal reportS have suggested that leaf in pregnancy: irs and birth outcomes. The trial includ­ uterine contractions during labor may be more coordinated dur­ safety and efficacy in ed 192 low-risk nulliparous women ing labor after ingestion of raspberry leaf during the last three labor. journal of Mid­ (mean age of 28 .5 years) who were months of pregnancy.'.4 wifery & Womens Health randomized to receive either 400 mg Attempts to scientifically study raspberry leaf have led to little 2001;46:51-9. of raspberry leaf (Rubus idaeus L. , ssp. clarity as to the potential for the herb during pregnancy and some idaeus, Rosaceae) extract (3: 1, equivalent to 1,200 mg of dried safety concerns. One study found that raspberry leaf extract had leaf) or placebo rwo times per day with food. Patients took rasp­ different effects on pregnant or non-pregnant rat and human berry leaf or placebo from 32 weeks gestation until commence­ uteri.5 While the extract had no effect on non-pregnant uterine ment of labor. Commencement of the tablets at 32 weeks gesta­ strips from rats or humans in vitro, it inhibited contractions in tion was determined according to the most accurate estimate of strips from pregnant rats. However, the extract initiated contrac­ the woman's last menstrual period and/or earliest ultrasound tions in strips from pregnant humans at 10 to 16 weeks of preg­ result. The effects of raspberry leaf consumption were examined nancy - with contractions, in most cases, becoming less fre­ by comparing the raspberry leaf and placebo groups for differ- quent. An earlier study found that intravenous injection of rasp­ ences m: berry leaf extract had a relaxant effect on the uterine muscles of 1) length of gestation; cats.6 These mixed res ults have led to some texts suggesting that 2) incidence of induction of labor by syntocinon (an oxytocic raspberry leaf be avoided during pregnancy and used only under drug that stimulates uterine contractions) infusion and arti­ medical supervision during labor.' Since the above research has ficial rupture of membranes; been primarily in vitro, the relevance to humans is unclear. Prior 3) incidence of medical augmentation of slow labor with syn­ to this trial, published studies on raspberry leaf for pregnancy and toClnon; labor have been scarce. One study, published in 1941 , found that 4) incidence of artificial rupture of membranes; uterine contractions diminished in frequency and strength in 5) use of patient-requested local anesthetic drug and/or women given 20-40 g of raspberry leaf extract in the first few epidural block; days following birth.• A retrospective study, completed by the 6) length of stages of labor; and authors of this new trial in 1998, examined the safety of raspber­ 7) mode of birth. ry leaf tea in women and their babies when consumed during The safety of raspberry leaf consumption on pregnancy was pregnancy! The researchers interviewed 109 postnatal women measured by analyzing seven different variables, including mater­ (day 1-4). Fifty-eight women had consumed raspberry leaf in nal blood loss, maternal diastolic blood pressure, presence of some form (rea, tablet, tincture), at various dosages, and at vari­ meconium (the dark green fecal material that accumulates in the ous times (as early as 8 weeks gestation to as late as 39 weeks ges­ fetal intestines and is discharged at the time of birth) stained tation). A control group of 51 women who had not used rasp­ fluid, newborn APGAR scores (a system of evaluating a newborn's berry leaf were used for comparison. Interestingly, the average physical condition by assigning a value [0, 1, or 2] to each of five length of rhe first stage of labor was shorter for women consum­ criteria: heart rate, respiratory effort, muscle tone, response to ing raspberry leaf, while the second and third stages were similar stimuli , and skin color) at 5 minutes, newborn birth weight, new­ in both groups. While these results are not statistically significant, born admission to neonatal intensive care facilities after birth, there is a trend in favor of an effect, which may be important and occurrence of side effects reported. when considering pregnancy and labor. The percentage of normal Raspberry leaf was found to have no effect on any stage of labor. births was 77.2 percent in the raspberry leaf group compared to After excl usion of mothers who experienced an elective caesarean, 66.7 percent in the control group. Obviously, the results of this it was found that slightly more women in the raspberry leaf group study are difficult to quantify based on the various levels of rasp­ had normal vaginal births (62.4 percent vs. 50.6 percent) and berry leaf used and the different time of gestation women began more women in the placebo group had forceps or vacuum-assist­ raking rhe herb. Outcomes were si milar berween groups; no ed births than would be expected by chance, although not statisti­ adverse effects attributable to raspberry leaf were noted. cally significant (p = 0.19). No significant relationship was While the results of this new Australian clinical trial may ease observed berween raspberry consumption and birth outcome. concerns about the safety of raspberry leaf prior to labor (e.g. , Occurrence of adverse events was distributed equally across the facilitating preterm labor or birth), it does raise questions about rwo groups with most adverse events being pregnancy related such the degree of efficacy of the herb for improving labor. Although as nausea, vomiting, diarrhea and constipation. Raspberry leaf modest, a slight decrease was noted in the second stage of labor. appeared to have no negative effects on either mother or child. Additionally, women taking raspberry were slightly more likely to Comments/Opinions: Raspberry leaf- especially in tea form have vaginal births and less likely to require artificial rupture of - has long been promoted in traditional herbalism and mid- membranes during labor or forceps to ass ist birth.

24 I HerbalGram 56 2002 www.herbalgram.org Hopefully, future trials will follow up on this potentially benefi­ by measurement of urinary flow rate. Serum prostate-specific anti­ cial effect examing a larger population of pregnant women, as well ge n (PSA) was also measured. These measures were completed as higher doses of the herb. prior to the placebo run-in period, at baseline and at months 2, 4, Practice Implications: Raspberry leaf extract has a long history of and 6. The mean ages of the men completing the 6-month trial use for pregnant women as an herbal tonic to help ease labor. This were 64.6 (± 9.9) years for the SPBE group (n = 41) and 65.3 (± new trial suggests that this effect may be minor or non-existent, at 9.7) years for the placebo group (n = 44). least when started in the 32nd week. While certainly not a safety The mean IPSS symptom score decreased from 16.7 to 12.3 in study, the trial suggests that use of raspberry leaf extract beginning at the saw palmetto group compared with 15.8 to 13.6 in the place­ 32 weeks gestation may be safe for both mother and child. bo group (p = 0.038). The quality of life score improved to a References greater degree in the SPBE group compared to placebo (0.7 versus 1. Foster S. 101 Medicinal Herbs. Loveland (CO): Inrerweave Press; 0.3), but was not statistically significant. There was no improve­ 1998. p. 166-7. ment in the sexual function questionnaire in either group. The 2. Clifford T. Cures. New York (NY): Macmillan Publishing; 1980. p. peak urinary flow rate increased by 1.0 mL/s in the SPBE group 52. 3. Hoffmann D. The Herbal Handbook: A User's Guide to Medical compared to 1.4 mL/s in the placebo group (p = 0.73) [Note: Herbalism . Rochester (VT): Healing Arts Press; 1998. p. 151. While the increase was slightly higher in the placebo group, this 4. Mabey R. The New Age Herbalist. New York (NY): Macmillan Pub­ difference was not significant. Neither group had a notable li shing; 1988. p. 105. increase compared to baseline). There was no significant change in 5. Bamford DS, Percival RC, Tothill AU. Raspberry leaf tea: a new con­ PSA levels in either the SPBE or placebo groups. Only one adverse cept to an old problem. Br j Pharmacol 1970;40: 161-2. evenr was reported - mild gastric distress in one patienr in the 6. Burn JH, Withell ER. A principle in raspberry leaves which relaxes SPBE group. uterine muscle. Lancet 1941 ;5: 1-3. Comments/Opinions: This is the second saw palmetto study to 7. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Profossionals. London: Pharmaceutical Press; 1996. p. be completed by Glenn Gerber, M.D., and colleagues at the Uni­ 226. versity of Chicago Prirzker School of Medicine in Chicago. The first, 8. Whitehouse B. Fragarine: an inhibitor of uterine action. BMJ a 6-month, open-label, nonrandomized study using the same prepa­ 1941;13:370-1. ration and dose of SPBE, found results similar to the placebo-con­ 9. Parso ns M, Simpson M, Ponron T. Raspberry leaf and its effect on trolled trial summarized above - an improvement on the mean labour: safety and efficacy. Aust Coll Midwives j 1999; 12:20-5. IPSS (7 points) bur no improvement in peak urinary flow. 1 Interest­ Saw Palmetto Extract Effectively ingly, the earlier trial also found no change in mean serum levels of prostate specific antigen (PSA) in those men raking saw palmetto. Manages Lower Urinary Tract Gerber and colleagues have taken a novel approach to their stud­ ies of saw palmetto. While the majority of clinical trials published Symptoms in Men to dare have focused primarily on men with urinary tract symp­ Summary: In a randomized, double­ toms secondary to clinically confirmed benign prostatic hyperpla­ Reviewed: Gerber G, sia (BPH), Gerber's studies have focused primarily on men with a blind, placebo-controlled clinical trial, Kuznetsov D, Johnson B, diagnosis ofLUTS who may or may not have accompanying BPH. the efficacy of a saw palmetto (Serenoa Burstein JD. Random­ repens (W. Bartram) Small, syn. This strategy presents a bit of a paradox- while looking at men ized, double-blind, Chamaerops serrulata Michx., Corypha with LUTS may approximate the larger population choosing to placebo-controlled trial repens W Bartram [basionym], Saba/ self-medicate with saw palmetto, it creates a more diverse study of saw palmetto in men dealbata hort. ex L.H. Bailey, Saba/ population, making evaluation of the outcome more difficult. This with lower urinary tract is particularly the case when peak urinary flow is used as one of the serrulata (Michx.) Nutt. ex Schult. & symptoms. Urology primary outcome measures as many of the men included in his Schult. f., Serenoa serrulata (Michx.) 2001 ;58(6):960-65. studies had peak urinary flow of 15 mL/s or greater- essentially G. Nicholson, Arecaceae) berry extract was tested on urinary symptoms, sex ual function, and urinary flow in the normal range. in men with lower urinary tract symptoms (LUTS). Following a!­ During the 1990s, considerable debate began to arise among month placebo run-in period, 85 men, 45 years of age and older urologists as to how to categorize those men with urinary tract symptoms and clinically identified BPH (e.g., an enlarged with an International Prostate Symptom Score (IPSS)* of 8 or greater, were randomized to receive 160 mg of saw palmetto berry prostate) versus those men with urinary tract symptoms in the extract (SPBE), standardized to 85-95 percent fatty acids and sterols (Nutraceutical Corp., Ogden, Utah), or placebo rwo times A naturopathic physician, Donald Brown is one of the leading per day for 6 monrhs. Patienrs were evaluated using the IPSS, a authorities in the U.S. on evidence-based herbal medicine. An quality-of-li fe questionnaire, a sexual function questionnaire, and associate professor at the Bastyr University of Natural Health Sciences in Seattle, he is the founder and director of Natural *Note: The International Prostate Symptom Score (IPSS) is based Product Resea rch Consultants, Inc. and serves on ABC's Adviso­ on seven questions regarding urinary tract symptoms associated ry Board as well as the President's Ad visory Board of Bastyr Uni­ with benign prostatic hyperplasia. These symptoms include vers ity. He has also served as an advisor to the Office of Dietary urgency, daytime and nighttime urinary frequency, hesitancy, Supplements at the National Institutes of Health. inrermittency, sensation of incomplete voiding, and force of urine stream. www.herbalgram.org 2002 HerbaiGram 56 I 25 Clinical Update by Donald J. Brown, N .D. absence of BPH. The consensus was to use the terminology lower Treating Seasonal Allergic Rhinitis urinary tract symptoms or LUTS to describe the collection of symptoms listed on the IPSS.' While the conse nsus regarding with Butterbur Extract class ification has become largely accepted, the etiology of LUTS Summary: One hundred thirty male or BPH remains cloudy. Reviewed: Schapowal A. and female patients (aged 18 years or It's interesting to note that the class of drug that has most suc­ Randomised controlled older) with a history of seasonal aller­ cessfully treated LUTS has been the alpha-adrenergic receptor trial of butterbur and gic rhinitis (at least two consecutive blockers (e.g., Cardura®, Flomax®, and Hytrin®) and not the 5- cetirizine for treating sea­ years) were screened for a random­ alpha-reductase inhibitor finasteride (Proscar®). While studies sonal all ergic rhinitis. ized, double blind trial comparing have favo rably compared SPBE, either alone or in combination BM]2002;321:1-4. with stingi ng nettl e root (Urtica dioica L. ssp. dioica, Urticaceae), the efficacy of a butterbur ex tract and with finasteride in the treatment of urinary tract symptoms asso­ cetirizine (a non-sedating antihistamine). One hundred twenty­ ciated with BPH,JA the results of Gerber's trials suggest that the five patients were randomized to take either one butterbur (Peta­ more interesting comparison should be with alpha-adrenergic sites hybridus (L.) P. Gaertn. et al., Asteraceae) herb extract tablet receptor blockers. (standardized to 8.0 mg of total petasin per tablet, ZE 339, Zeller It's important to note that although debate co ntinues about the AG, Switze rland)* four times per day or one 10 mg tablet of cet­ quali ty of some clinical trials examining the efficacy of SPBE for irizine in the evening. Blinding was achieved by having each BPH, the conse nsus of at least two meta-analyses indicate that the patient take five tablets- four containing either placebo or but­ herbal extract does improve both peak urinary fl ow as well as uri­ terbur, and one containing either ce tirizine or placebo- depend­ nary tract symptoms in men with BPH.16 It is unclear from this ing on the treatment group. The main outcome measure was study how many men actually had BPH versus those with LUTS change of score from baseline of each item on the medical out­ in the absence of BPH. come health ques tionnaire (SF-36). The SF-36 questionnaire is a Hopefully, future cl inical trials will fo cus on the use of SPBE self-assess ment tool wi th ques tions grouped hierarchicall y in eight for LUTS over a more ex tended period and, as mentioned above, categories with a total range of 0- 100 per item. The question­ add a comparison with the more commonly used alpha-blockers. naire also includes one category with a five-point score for com­ These trials wi ll hopefully expand the clinical understanding of paring current severity of the conditi on with that of the previous where SPBE may lie in the spectrum of available treatments for year. The secondary outcome measure was the physician's clinical LUTS. global impression scale (CGI). The hypothesis was that butterbur Practice Implications: T his U.S. clinical trial suggests that a was roughly equivalent to cetirizine at the end point, defined as li posteroli c extract of saw palmetto berries may be a safe and effi­ within 10 percent of the SF-36 score or by one point in the CGI. cacious treatment option for the management of LUTS in men Improvements in both the SF-36 and CGI sco res were similar over 45 years of age. W hile successful trials with SPBE for BPH in both groups. Analys is of the main outcome measures rejected have found an improvement in peak urinary flow, this trial failed the hypothesis of butterbur's being inferior to cetirizine, with to find any effect. This may be partly explained by the fact that none of the scores in the butterbur group more than 10 percent many of the men entered in this trial had normal flow rates (> 15 worse than in the cetirizine group. T he overall incidence of mL/s) while other trials have typically studied men with abnor­ adverse events was similar for the two treatment groups. Howev­ mal flow rates (<15 mL!s) typically seen in BPH. er, two-thirds of the adverse events for the cetirizine group were References drowsiness and fatigue- symptoms not reported in rhe butter­ I. Gerber GS , Zagaja GP, Bales GT, et al. Saw palmerro (Serenoa bur group. repens) in men with lower urinary tract symptoms: Effects in uro­ Comments/Opinions: Allergic rhinitis (sometimes called hay dynamic parameters and vo idi ng sy mptoms. Urology fever) ca n be either seasonal or perennial and is characterized by 1998;5 1: I 003-7. sneezing, runny nose, nasal congestion, throat itching and irrita­ 2. Denis LJ. Editorial rev iew of "Comparison of ph ytorherapy (Per­ tion, and watery eyes. T he allergic res ponse is typically caused by mixon®) with flnasteride in the treatment of benign prostatic hyper­ the deposition of an allergen (e.g., pollen) on the nasal mem­ plasia: A randomized international study of I 098 patienrs." Prostate 1996;29:24 1- 2. branes . Typical treatment is the symptomatic use of over-the­ 3. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phyto th er­ counter antihistamines (e.g., clorpheniramine, d iphenhy­ apy (Permixon®) wirh flnasrer ide in rhe treatment of benign prosta­ dramine) or the new generation of prescription antihistamines tic hyperplasia. Prostate 1996;29:23 1-40. such as loratadine (Ciaritin®, Schering Corporation, Kenilworth, 4. Sokeland J, Albrecht J. A combination of Saba! and Urrica exr racrs NJ) or des loratadine (Clarinex®, Schering Corporation). While versus flnasreride in BPH (s tage I to II ace. to Aiken): A compari­ usually safe, antihistamines may cause drowsi ness (please note son of therapeutic efficacy in a one-year stud y. Urologe {A} that the last two products mentioned above are not associated 1997;36:327-33. with drowsi ness) and may also interact with alcohol and can 5. Wilr TJ, Ishani A, Srark G, er al. Saw palmetto extracts for rrear­ menr of benign prostatic hyperpl asia. A sys tema tic review. JAMA sometimes lead to complaints of dryness in rhe nasal passages and 1998;280: 1604-9. throat. The availability of an over-the-counter nasal spray con­ 6. Boyle P, Robertson C, Lower F, Roehrborn C. Meta-analysis of clin­ raini ng cromolyn sodium (NASALCROM™, Pharmacia, Pea­ ical trial of Permixon in rhe treatment of sympto matic benign pro­ pack, NJ) has offered all ergic rhinitis sufferers a non-sedating static hyperplas ia. Urology 2000;55:533-9. *Note: The total milli gram amount of extract per tablet is not listed in rhe publication.

26 I HerbaiGram 56 2002 www.herba lgram.org alternative that helps stabilize mast cells (the cells that release his­ able (Petadolex™, Weber and Weber, USA). Also a C02 extract, tamine in the mucous membranes of the nose and sinuses) and can the Petadolex product is also free of PAs. While this product has 0 act as a preventive agent. Nasal steroids are another treatment been studied for treating migraine, ' ·" it has not been studied for option for al lergic rhinitis sufferers. treatment of all ergic rhinitis. Research-s upported herbal alternatives for the management of Practice Implications: Although this trial lacks a placebo group allergic rhinitis are scarce. Small clinical trials have sugges ted that for co mparison, it suggests that butterbur ex tract may be as effec­ freeze-dried stinging nettle ( Urtica dioica L. ss p. dioica, ti ve as the antihistamine cetirizine for the management of symp­ Urticaceae) ' and the Japanese Kampo medicine sho-seiryu-to- a toms associated with seasonal allergic rhinitis. One advantage of combinati on of lico ri ce root ( Glycyrrhiza glabra L., Fabaceae), cas­ the butterbur extract appears to be the absence of sedating side sia bark (Cinnamomum aromaticum Nees, Lauraceae), schisa ndra effects associated with many antihistamines. Placebo-controlled (Schisandra sphenanthera Rehder & E. H . Wilson, Schisandraceae), trials are needed as well as more safety information on the long­ ephedra or rna huang (Ephedra sinica Stapf, Ephedraceae), ginger term use of butterbur extract.** Again, healthcare professionals root (Zingiber officinale Roscoe, Zingiberaceae), pinellia (Pinellia should use caution to ensure that any butterbur extract recom­ ternata (Thunb.) Makino ex Breit., Araceae), and asiasa rum root' mended is free of PAs. (Asiasarum is an outdated name for certain Asian species of References Asarum. T he two species used interchangeably (as Xi Xin) in Tra­ I. Mirrman P. Randomized double-blind srudy of freeze-dried Urtica ditional C hinese Medicine for colds are Asarum heterotropoides F. dioica in the treatment of allergic rhinitis. Planta Med 1990;56:44-7. 2. Baba S, Takasaka T. Double-blind clinical trial of sho-seiryu-to Schmidt var. mandshuricum (Maxim.) Kitag. and Asarum sieboldii (TJ 19) for perennial nasal all ergy. CLin Otolaryngol Mig., Aristolochiaceae.) may hold promise for the treatment of 1995;88:389-405. allergic rhinitis. H owever, there have been no follow-up studies on 3 . Wichd M. Bisset G, translator. Herbal Drugs and Phytopharmaceu­ these products. ticals. Boca Raton (F L): CRC Press; 1994. p. 366-8. Petasites hybridus is an herbaceous plant of the family Asteraceae 4. McGuffin M, Kanesz JT, Leung AY, Tucker AO, editors. Herbs of native to Europe, northern Africa, and southwestern Asia.' Commerce, 2nd edition. Silver Spring (MD): American Herbal Prod­ Although the name butterbur is used as the common name in this ucts Association; 2000. p. I 09. study, its standardized common name is purple butterbur and it is 5. Weiss RF, Fintelmann V. Herbal Medicine, 2nd edition. Sturrgan, Germany: T hi eme; 2000. p. 200-2. also commonly called sweet coltsfoot. 4 A related plant, P frigidus 6. Blumenthal M, Busse WR, Goldberg A, et al, editors. The Complete (L.) Fries, is known commonly as Arctic butterbur and less com­ Commission E Monographs: Therapeutic Guide to Herbal Medicines. monly as Arctic sweet coltsfoot or western coltsfoot - and should Integrative Medicine Communications: Boston (MA); 1998. p. 365. not be confused with coltsfoot (Tussilago farfara L., Asteraceae). 7. Blumenthal M, Busse WR, Goldberg A, et al, editors. The Complete The leaves, rhizome, and roots ofbutterbur contain a mixture of Commission E Monographs: Therapeutic Guide to Herbal Medicines. eremophilan-rype sesquiterpenes consisting primari ly of petas in Integrative Medicine Communications: Boston (MA); 1998. p. 183. and isopetasin. 3 Renowned German phytotherapy experts Rudolf 8. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for Herbal Med­ Fritz Weiss, M.D., and Volker Fintelmann, M.D., suggested that icines. Montvale ( J): Medical Economics; 2000. p. 585-8. 9. Boonen G (Zeller AG). Personal correspondence to Blumemhal M . petasin has both spasmolytic and analgesic acrions. 5 T hey wrote 2002 April 24. that this explains the historical use of the plant for whooping I 0. Lipton RB, Gobel H, Wilkes K, Mauskop A. Efficacy of Petasites (an cough and bronchial asthma. Interes tingly, the German Commis­ ex tract from Petasites rhizome) 50 and 75 mg for prophylaxis of sion E has separate monographs for butterbur leaf and rhizome. migraine: Results of a randomized, double-blind, placebo-controlled T he leaf is given a negative rating due to the assessment that other srudy. Neurology 2002;58(suppl 3):A472 [Presented at the 44th herbal drugs were more effective in relieving cough, such as thyme Annual American H eadache Society Meeting, June 22, 2002, Seattle, (Thymus vulgaris L., Lamiaceae) or sundew (Drosera rotundifolia WA] . L., Droseraceae). 6 Butterbur rhizo me, on the other hand, receives II . Grossmann M, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Inter J Clin Pharmacol Ther a positive rating for the adjunctive treatment of acute spas modic 2000;38:430-5. 7 pain in the urinary tract. I was unable to find any histori cal refer­ 12. Shuster S. Treating seasonal allergic rhinitis: Well designed experi­ ences to the herb's use for allergic rhinitis. ments should have been used (letter). BMJ 2002;324: 1277. T he dark cloud hangi ng over butterbur leaf and rhizome is the 13. Treating seasonal allergic rhinitis: Trial does not show that there is no presence of toxic pyrrolizidine alkaloids (PAs). 8 These potentially d ifference between burrerbur and cetirizine (lerrer). BMJ hepatotoxic and carcinogenic constituents have led to the demise 2002;324: 1277. of coltsfoot and comfrey root (Symphytum officinale L., Boragi­ 14. Schapowal A. Treating seasonal allergic rhinitis: Author's reply (let­ naceae) in herbal medicine as wel l. Drs. Weiss and Fintelmann sug­ ter) . BMJ 2002;324: 1277. gest that this has been the primary explanati on for the waning interest in the therapeutic use of butterbur. The ZE 339 extract used in this trial is from the aerial parts of the herb and not the rhizome of the plant. Perhaps most impor­ •• Note: Fo llowing the completion of this review, there have been many tant, the manufacturers remove PAs during the manufacturing lerrers to the editor of BMJ criticizing the design of this trial. "·" In one process.9 While the butterbur product used in this trial is current­ response, one of the authors of the trial refers to the completion of a ly unava il able in the U.S., a product made fro m the rhizo me and double-blind, placebo-controlled trial of the bunerbur extract for all er­ delivering 7.5 mg of total petasin per capsule is commercially avail- gic rhinitis which has been submitted for publication." www.herbalgram .org 2002 HerbaiGram 56 I 27

Review of Medicinal Mushroornsi\dvances Good News from Old Allies by Solomon P. Wasser, Ph.D., Dr.Sci. (Biol.)

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dible and medicinal mushrooms (macrofungi) not cal industry for the benefit of humankind. only can convert the huge lignocellulosic biomass* T he study of medici nal mushrooms through the last three Ewaste into human food, but - most remarkably - decades has proved its many beneficial outcomes and has can produce notable mycopharmaceuticals, myconutriceuti­ been followed by the rapid development of manufacturing cals and mycocosmeceuricals. businesses dealing with commercial cultivation of mush­ The most significant aspect of mushroom cultivation, if rooms. In 1999, world production of mushrooms amount­ managed properly, is to create zero emission of lignocell u­ ed to US$ 18 billion, roughly equal to the value of coffee losic waste materials. Mushroom biotechnological products sales.-'-' have multibenefi cial effects to human welfare (e.g., as Medicinal mycology has deep and firm roots in food, health tonics and medicine, feed and fertil- fungi's traditional uses in the medicine of the izers, and to protect and regenerate the envi­ Far East. For centuries, C hinese and other ronment). Pharmaceutical substances with healthcare pracnnoners employed potent and unique health-enhancing mushrooms to treat various diseases. properties were isolated recently from They valued the power of some medicinal mushrooms and distributed mushrooms as divine (e.g., a special worldwide. 1 Many of them are pharma­ goddess was associated with the ceutical products, while others repre­ reishi mushroom). Reishi is also sent a novel class of dietary supplements considered a symbol of happy or "nurraceuricals." Several antitumor augury and good fuwre, good polysaccharides, such as hetero-g-glucans health, longeviry, and even life with and their protein complexes (e.g., xyloglu­ the immortals. The use of medicinal cans, and acidic g-glucan containing uronic mushrooms has gone beyond medicine itself: acid) as well as dietary fiber, lectins, and ter­ different schools of Taoism employed reishi and penoids, have been isolated from medicinal other mushrooms as purifiers and promoters of mushrooms. In Japan, C hina, Russia, and mind and spirit.; Korea, several different polysaccharide antitu­ Only at the end of the 1960s did Eastern and mor drugs have been developed from the fruiting Western scientists start to investigate the mecha­ bodies, mycelia, and culture media of various nisms of the health effects of mushrooms. The first medicinal mushrooms, such as shiitake (Lentinus edo­ successful research discovered the antiwmor effects des (Berk.) Sing., Tricholomataceae), reishi (Ganoderma of hot water extracts from several mushroom species." fu cidum (Curt.:Fr.) P Karst., Ganodermataceae), turkey tail T he main active components proved to be polysaccharides, (Trametes versicolor (L.:Fr.) Lloyd, Polyporaceae), split gill specifically g-D-glucans. Chihara and his co-workers- isolat­ (Schizophyffum commune Fr.:Fr., Schizophyll aceae), mulber­ ed from the fruiting bodies of shiitake a water-soluble anti­ ry yellow polypore (Pheffinus finteus (Berk. et C urt.) Teng., tumor polysaccharide, which was named "lentinan" after the H ymenochaetaceae), and chaga or cinder conk (Inonotus obfiquus (Pers.:Fr.) Pilat, Hymenochaetaceae) . The potential Above: Royal sun Agaricus (Agaricus blaze!) is a culinary-medicinal of medicinal mushrooms is enormous bur mostly untapped. mushroom, and a new star in the potential treatment of cancer. It could and should evolve into a successful biotechnologi- Photo courtesy of the author.

* Biomass includes the full range of plants and plant-derived materials, such as dedicated energy crops and trees, agricultural food and feed crops, agricultural crop wastes and residues, wood wastes and residues, and municipal wastes. The majori ry of non-food biomass is composed primarily of the natural polymers cellulose, hemicellulose, and lignin and is referred to as lignocellulosic biomass. Lignocellulose is a complex of lignin and cellulose present in the cell walls of woody plants. Lignin is a complex organic polymer deposited in the cell walls of plants, making them rigid and woody. Lignocellulosic material resource, like solar energy, is sustainable. Lignocellulosic material is a kind of biomass that is estimated to amount to 1.9x I 0'' tons of dry matter on land annually.' www.herbalgram .org 2002 HerbaiGram 56 I 29 generic name of this mushroom. This was a major discovery. from rhis mushroom, under the name Kresrin (PSK), was devel­ Lentinan demonstrated powerful antitumor activity; preventing oped from the strain CM-101. It was approved for use against a chemical and vi ral tumor development in mice and experimen­ number of cancers and was covered by the Japanese healrhcare tal models."·" plan. PSK exhibits a marked effect against different types of tumors Polysaccharides displaying remarkable antitumor activity in in experimental animals when administered intraperitoneall y or vivo (i.e., through screening against sarcoma 180 in mice using orally. PSK contains 75 percent glucan and 25 percent protein. In intraperitoneal or oral methods of administration) have been 1993, Krestin comprised 25 percent of the anticancer drug market 0 14 isolated from various species of mushrooms belongi ng to the in Japan, and sales totaled US$350 million.' · An analogous prod­ orders Auriculariales, Tremellales, Polyporales, and Gasteromyc­ uct under the name Polysaccharide Peptide (PSP) was developed in etales. '·"·"·'o.u China from turkey tail strain Cov-1; rhe development process for Since rhe discovery of lentinan, several antitumor polysaccha­ this strain lasted nine years, from 1983 to 1992.'1 Mizuno" stared ride agents have been developed and commercialized, using rhe rhat, in general, a period of 10 years and a total US$75 million, or submerged cul tured mycelial biomass of turkey rail (Krestin, 10 billion yen, are required from the beginning of development of PSK; Japan), and liquid cultured broth product of split gill a new drug to the rime it is marketed. (Sonifilan, SPG, Schizophyllan; Japan). These antitumor sub­ Another IS-D-glucan developed and popular in Japan is schizo­ stances are regarded as biological response modifiers that activate phyllan from split gill. It is especially effective against cervical can­ immunological responses. This basically means rhar: cer. " A glucan from mulberry yellow polypore was developed 1)rhey cause no harm and place no addi tiona! stress on rhe recently in Korea, and an analogous polysaccharide biotechnology body; from this species has been accomplished in Japan.'" Reishi, already mentioned as a sacred mushroom in ancient C hina, has come to occupy a leading place in present-day medici­ nal mushroom development. T he market values of reishi-based natural healrhcare products in 1995 were estimated as US$215 million in Taiwan, US$350 million in China, US$600 mil­ lion in Korea, and US$350 million in Japan.1 The phys­ iologically active substances of reishi are water-soluble polysaccharides and alcohol-soluble rriterpenoids. Today, 119 differenr triterpenoids are identified in reishi," about 80 of which are biologically active. Reishi dietary supplements (DS) are valued for their immunomodulating, anti­ cancer, antiviral properties. They are used during remission of cancer and by hepatitis B patients. They also have anti-hyperlipidemic, hypotensive, and hypoglycemic actions." Some 30 years ago, epidemiologists studying the native pop­ ulation in rhe Piedade region in the suburbs of San Paulo, Brazil, noted that the rate of occurrence of adult d iseases was extremely low, and found an association with rhe Agaricus species, which was a part of the regular diet of the inhabi­ tants of rhis area. 18 This mushroom was idenrifted as A. blazei Murr., known by common names royal sun Agaricus, himematsutake, kawarihaaratake, or almond-flavored porto­ bello. Experiments conducted in Japan with mice verified that A. blazei significantly activates rhe immune system.'8 A number of immunity-enhancing, anricancer, and anrirumor fractions were isolated from A. blazei. This species was shown to be the most effective anticancer mushroom in a study comparing irs effects with shiitake, mairake (Grifola frondosa (Dicks.: Fr.) S.F. G ray, Polyporaceae), reishi, and other medicinal mushrooms. Frac­ tions identified with immune effects include polysaccharides, Shiitake Lentinus edodes ©2002 Paul Stamets (1 ~6)-(1 ~3)-~-D-glucans, (1 ~6)-(1 ~4)-~-D-glucans , polysac­ charide-protein complex (ATOM), RNA-protein complexes, and 2) they help the body to adapt to various environmenral and bio­ gl ucoman nan. u."·'-' logical stresses; T he Japan Cancer Association proved that A. blazei is effective 3) rhey have nonspecific action on rhe body, supporting some or against Ehrlich's ascites carcinoma, sigmoid colon cancer, ovarian all of rhe major systems, including nervous, hormonal, and cancer, breast cancer, lung cancer, and liver cancer, as well as immune systems, as well as regulatory functions. against solid cancers.'" It is, indeed, fai r to describe all major medicinal mushroom Higher Basidiomycetes mushrooms contain a large amount of preparations, both cellular compounds and secondary metabo­ well-balanced essenrial amino acids. Dietary fibers are abundanr in lites, as having weak antigenicity and no side effects. rhe tissue of all mushrooms; rhey absorb bile acids or hazardous A very popular and effecti ve preparation was developed from materials in the intestine, and rhus decrease the chances of car­ turkey tail in Japan as early as 1965. A polysaccharide-peptide cinogenic and other poisoning. T he overall harmonizi ng effect of

30 I HerbalGram 56 2002 www.herbalgram.org a diet balanced with mushroom, so highly praised by the ancient Below: Shiitake Lentinus edodes ©2002 Paul Stamets Chinese, is not a myth, but is continually supported by modern scientific investigations. (Treme!La spp., Tremellaceae), for instance, stimulates vascular Several other health-promoting effects of the mushrooms should endothelial cells , possesses pronounced antiradiating effects, stim­ not be overlooked. Not only polysaccharides and triterpenoids are ul ates hematogenesis, demonstrates antidiabetic, anti-inflammaro­ known as biologically active; wide ranges of substances from high­ ry, hypocholesrerolemic, anti-allergic activities, and shows hepato­ er Basidiomycetes belonging to different classes of chemical com­ prorecrive effects. It ca n be recommended to improve immunode­ pounds have been described and their medicinal properties evalu­ ficiency, including that induced by AIDS, physical srress or aging, ated. These substances represented glyco­ and it prevents senile degeneration of microvessels, lipids (schizonellin), compounds maintaining berrer blood perfusion derived from the shikimic acid conditions in viral organs:' (strobilurins and oudemansins), Most mushroom-derived aromatic phenols (drosophilin, preparations and sub­ armillasirin, omphalone), Farry stances find their use nor acid derivatives (fi liboleric as pharmaceuticals, bur as acid, podoscyphic acid), poly­ a novel class of dietary acerylenes (agrocybin, xerulin), supplements or "nurraceu- polykerides (caloporoside, ricals. " A mushroom hericenones A-H), nucleosides nurraceurical is a refined or par- (cl irocine, nebularine), different tially refined extract or dried biomass from sesquiterpenes (protoilludanes, marasman- either the mycelium or the fruiting body of es, hirsuranes, caryophyllanes, etc.), diterpenes the mushroom, which is consumed in the (cyarhin, striatal), sesrerrerpenes (aleurodscal), and form of capsules or tablets as a dietary 2 24 supplement (nor a conventional food) many other substances of different origin. · '"· Biologically active substances From higher Basid­ and which has potential rherapemic iomycetes possess antifungal, antibacterial, and antiviral appli cations. Regular intake may properties; they can be used as insecticidal and nematocidal enhance the immune responses of the agents. In medicine they are used to immunomodulare both human body, thereby increasing resistance to humoral and cellular immune Factors in the body. Polyfunctional disease, and in so me cases, causing regress ion of acidic glucuronoxylomannan isolated from jell y mushrooms a disease state. The marker va lue of mushroom OS

Turkey tail or yun zhi (Trametes versicolor). Thi s medicinal species contains antitumor polysaccharide which was used for producing an anti-digestive organ, lung, and brea st ca ncer drug (Krestin) in Japan. Photo courtesy of the au thor. www.herbalgram.org 2002 HerbaiGram 56 I 31 Reishi Ganoderma lucidum ©2002 Paul Stamets tions in a liquid culture media permits acceleration of the growth speed, resulting in biomass yield in several days. 4 The additi~nal advantage of submerged culturing is the fact that most med1cmal mushrooms do nor produce fruiting bodies under commercial cul­ tivation. Reliable industrial cultivation techniques are known for only 37 mushroom species,3 but medicinal mushrooms include many mycorrhizal or parasitic species that need several years for development of normal fruiting bodies on trees. Such species cannot be grown commercially, but their mycelia can be grown easily and economically with the help of submerged culturing. High stability and standardization of mycel ium grown in submerged cultures is impor­ tant nor only for producing DS, bur also might be beneficial for producing mushroom-based medicines. T he use of medicinal mushrooms goes hand in products worldwide is estimat- hand with development ed at US$6 billion per year. The market val ue of reishi mushroom­ of their artificial culti­ based DS alone in 1995 was es timated at more than US$1.628 bil­ vation. The most sig­ lion.' nificant aspect of The safety of mushroom-based dietary supplements is further mushroom cultiva- enhanced through the following controls: tion, if managed prop- 1. The overwhelming majority of mushrooms used for pro­ erly, is to create zero emis- duction of DS are cultivated commercially (and not gath­ sions (no waste). Since more than 70 percent of agricultural and ered in the wild). This guarantees proper identification, and forest materials are non-productive and are wasted in processing, pure, unadulterated products. In many cases it also means rhis is a very real advantage." Many of these waste materials can be generic uniformity. This may also benefit conservation of used as substrates to grow mushrooms. This fact gives a basis to the biodiversity. opinion of many researchers in the field (including this author) 2. Mushrooms are easily propagated vegetatively, and rhus keep that sustainable development of mushrooms and their products in ro one clone. The mycelium can be stored for a the 21st century can become a "non-green revolution."-' long rime, and the genetic and biochemical Prof Solomon P Wasser is the Head ofthe International Center consistency may be checked after a consider­ for Cryptogamic Plants and Fungi, at the Institute of Evolution, able period of rime. University ofHaifa (Israel); and the Head ofthe Department of 3. Many edible and medicinal mushrooms are Cryptogamic Plants, at the N. G. Kholodny Institute ofBotany, capable of growing in the form of mycelial National Academy ofSciences of Ukraine. biomass in submerged culrures. 4 Born and educated in Ukraine, Prof ~sser earned his This last aspect, in our experience, advanced degrees at the N. G. Kholodny Institute of Botany, offers a promising future for standard­ National Academy of Sciences of Ukraine in Kiev. He was ized production of safe mushroom­ elected a member of the National Academy of Sciences of based DS. Submerged culture and semi­ Ukraine in 1988, and became Professor of Botany and solid state fermentation has more con­ Mycology in 1991. He founded the International Center sistent and predictable composition for Cryptogamic Plants and Fungi at the Institute of Evo­ than that of fruit bodies. For most sub­ lution in Haifa University in I 994 and has directed its stances, this mycelium biomass obtained work since then. Since 2000, he has been a fo.ll Professor of by submerged cultivation also has higher Haifa University (Israel). nutritional value. The culture media in In addition to his scientific studies, Prof ~sser performs a which mycelium grows are made of number ofpublic and social activities. He is a founder and chemically pure and ecologically clean editor-in-chief of three international journals, Algologia substances. The cultivation of mush­ (Ukraine), International Journal of Medicinal Mush­ rooms for fruit body production is a rooms (USA) and International Journal on Algae long-term process, taking one to several (USA). He is an author and co-author of 400 scientific months for the first fruiting bodies to publications, including 35 books and 12 patents. appear, depending on species and sub­ strate. By contrast, the growth of pure References: mushroom cultures in submerged condi- I . Idaho National Engineering and Environmental Laboratory. IN EEL Bioenergy Initiative. 200 I Jul y. Avai lable online: Yellow brain mushroom (Tremella mesenrerica). . . antidiabetic, antiinfiammatory, hypocholes­ 2. Wasser SP, Weis AL. Medicinal properties of substances occun ng In terolemic, antiallergic activities. Photo courtesy of hi gher Basidiomycetes mushrooms: Current perspectives [Review] . the author. International journal ofM edicinal Mushrooms 1999; I :31-62.

32 I HerbaiGram 56 2002 www.herbalgram.org 3. Chang ST. Global impact of edible and medicinal mushrooms on human welfare in rhe 21 sr cenrury: nongreen revolution. Interna­ tionaL Journ aL ofM edicinaL Mushrooms 1999; 1: 1-8. 4. Wasser SP, Nevo E, Sokolov D , Reshernikov S, Timor-Tismenersky M. Dietary supplemenrs from medicinal mushrooms: diversiry of rypes and variery of regulations. InternationaL journaL of MedicinaL Mushrooms 2000;2:1-19. 5. Chang ST, Buswell JA. Ganoderma Lucidum (Curr.:Fr.) P.Karsr. (Aphyllophoromycerideae) -a mushrooming medicinal mushroom. InternationaL j ournaL ofMed icinaL Mushrooms 1999; 1: 139-48. 6. lkekawa T, Uehara N, Maeda Y, Nakanishi M , Fukuoka F. Anriru­ mor acriviry of aqueous exrracrs of edible mushrooms. Cancer Res 1969;29: 734-5. 7. C hihara G , Maeda Y, Hamuro J, Sasaki T, Fukuoka F. Inhibition of mouse sarcoma 180 by polysaccharides from Lentinus edodes (Berk.) Sing. Nature 1969;222:687 -8. 8. Zakany J, Chihara G, Facher J. Effect of Lenrinan on rumor growth in murine allogeneic and syngeneic hosr. lnt J Cancer This novel hat is constructed from the medicinal mushroom known as the 1980a;25:37 1-6. Ice Man fungus (Fames fomentarius).ln Hungary and the Ukranian part of 9. Zakany J, C hihara G, Facher J. Effect ofLenrinan on rh e production the Transcarpathian Mountains, la rge specimens of this fungus grow on of migration inhibirory fa cror induced by syngeneic rumor in mice. Eu ropean beech trees (Fagus sylvatica). and are used to ma ke ha ts, purses lnt J Cancer 1980b;26:783-8. and napkins for decorative purposes. Photo© 2001 Solomon Wasser. 10. Mizuno T. The extraction and developmenr of anrirumor-acrive polysaccharides from medicinal mushrooms in Japan [Review]. InternationaL j ournaL ofMedicinaL Mushrooms 1999; I :9-30. basidiomycere, Agaricus blazei Murrill, mediated via narural killer 11. Mizuno T. A developmenr of ami rumor polysaccharides from mush­ cell ac tivation and apoprosis. Cancer Immunof lmmunother room fungi. Food & Food lngred j (Japan). 1996;167:69-85. 1998;46: 147-59. 12. Kim HW, Kim BK. Biomedicinai rrirerpenoids of Ganoderma 22. Fujimiya Y, Yamamoro H , Niji M , Suzuki I. Peroral effect on Lucidum (Curr.:Fr.) P.Karsr. (Aphyllophoromycerideae). Internation­ tumor progression of soluble beta (1 ,6)-glucans prepared by acid aL Jou rnaL ofMedicinaL Mushrooms 1999; 1:121-38. treatmenr from Agaricus bfazei Murr. (Aga ricaceae, Higher Basid­ 13. Sramers P. Growing Gourmet and MedicinaL Mushrooms. iomycetes). InternationaL journaL of MedicinaL Mushrooms Berkeley/: Ten Speed Press; 2000. 2000;2:43-50. 14. Chang ST. Mushroom biology: rh e impact on mushroom produc­ 23. C ho SM, Lee Jh, Han SB, Kim BK. Chemical fearures and purifi­ tion and mushroom products. In: Chang ST, Buswell JA, Chiu SW, cation of immunosrimulari ng polysaccharides from the fruit bod­ et aL, edirors. Mushroo m BioLogy and Mushroom Products. : ies of Agaricus bfazei. Korean} Myco/ 1999;27: 170-4. Chinese Universiry Press; 1993. p. 3-20. 24. Lorenzen K, Anke T. Basidiomycetes as a source for new bioacrive 15. Hiroshi S, Takeda M. Diverse biological acriviry of PSK (Kresrin), a natural products. Curr Org Chern 1998;2:329-64. protein-bound polysaccharide from Coriofus versicoLor (Fr. ) Quel. In: 25. Poppe J. Use of agricultural waste materials in the cultivation of Chang ST, Buswell JA, Chiu SW, et aL, editors. Mushroom BioLogy mushrooms. In: Van G riensven DLJL, ediror. Science and cuLtiva­ and Mushroom Products. Hong Kong: Chinese Univers iry Press; tion ofedibLe fungi. Rorrerdam/Brookfield: A. Balkema; 2000. p. 3- 1993. p. 237-245. 24. 16. Mizuno T. The developmenr of an anrirumor BRM from song gen, or meshimakobu, PheLLinus Linteus (Berk. er C urr.) Teng mushroom [Review]. InternationaL Jo urnaL of MedicinaL Mushrooms 2000;2:2 1- 34. 17. Wasser SP, Weis AL. MedicinaL mushrooms. In: Nevo E, ediror. Reishi Mushroom (Ganoderma Lucidum (Curr.:Fr.) P.Karsr. ) Haifa, Israel: Peledfus; 1997. p. 1-37. 18. Mizuno T. 2002. Medicinal properries and clinical effects of Agaricus bfazei Murr. Internation- aL journaL of MedicinaL Mushrooms 2002;4 (forrhcoming). 19. Mizuno T, Hagiwara T, Nakamura T, Iro H , Shimura K, Sumiya T, Asaku­ ra A. Anrirumor acriviry and some properries of water-soluble polysaccha­ rides from "Himemarsurake," rhe fruiting body of Agaricus bfazei Murrill. Agricuft Bioi Chern 1990;54:2889-96. 20. lro H , Shimura K, Iroh H , Kawade M. Anti­ rumor effects of a new polysaccharide-protein complex (ATOM) prepared from Agaricus blazei (!wade srrain 101 ) "Himemarsurake" and irs mecha­ nisms in rumor-bearing mice. Anticancer Res 1997; 17:277- 84. 21. Fujimiya Y, Suzuki Y, O shiman K, Kobori K, Morigushi akashima H , Marumoro Y, Takahara S, Ebina T, Karakura R. Selec­ tive rumoricidal effect of soluble proreoglucan extracted from rhe

Chaga or cinder conk lnonorus obliquus ©2002 Pau l Stamets

www.herbalgram.org 2002 HerbaiGram 56 I 33 Under such an "eco-labeling" program, companies would commit voluntarily to buy, manufacture, or sell herbs obtained from sources that have been independently certified by a third­ party to meet certain environmental standards, including sus­ tainable harvest levels and practices. 1 In exchange, those compa­ nies could use a special label, logo, or seal that allows them to make claims of sustainability and distinguishes their herbal products from market competitors. The Market Speaks The results from the survey of American consumers show that most would buy herbal supplements that contain sustainably sourced ingredients, if presented with that choice. The survey was conducted by Edge Research for TRAFFIC North America in August 2001. Survey respondents were select­ ed from an initial sample of herbal supplement users via the Internet who were subsequently screened and included in the online survey only if they considered themselves the primary shopper within the household. A total of 508 individuals com­ pleted the survey. The margin of error was +1- 4.2 percentage points at the 95 percent confidence level. Using ginseng as a trial case, 78 percent said they would buy ginseng products with labels that verify the sustainability of production instead of those without such a label. Almost 70 per­ cent would still buy "certified sustainable" ginseng even if it meant paying a 5 percent premium. Verifying whether con­ sumers would actually pay more for an eco-labeled product remains to be tested.

ssues of quality and sustainable harvest of source plants are increasingly important to the herbal market I as consumers evolve in sophistication. Both private and governmental agencies of various interests are work­ ing to promote or protect different facets of the environ­ ment, production method, or materials. Drawing from standards may lead to a cohesive program to certifY the quality of products in commerce, and clearly identify them for market advantage. Several efforts are underway to achieve that end, including a project by TRAFFIC, the wildlife trade monitoring program of the World Wildlife Fund and the World Conservation Union (IUCN). In August 2001, TRAFFIC surveyed separately two small groups: American consumers and Hong Kong gin­ seng importers. Both groups expressed their preference for purchasing wi ldcrafted botanicals that promise higher quality and that are harvested in a matter that promotes environmental quality and protects the future of the spectes. The surveys are part of efforts by TRAFFIC North America to improve sustainable production of medicinal plants harvested from the wild. The basis for this work is the belief that market-based strategies for the conserva­ tion of medicinal plants may provide the private sector with an economic incentive to contribute to the conserva­ tion of these resources, reinforcing or even replacing reg­ ulatory intervention. Giving consumers the option to pur­ chase herbal products marketed under a label that reflects sound environmental stewardship is another guiding phi­ losophy.

34 I HerbaiGram 56 tat. Diggers ea rn an es timated US$ 18 million annually from research reveals that more than I 00 compani es sell botani cals the sale of wild Ameri can ginse ng roots in states where the rh ar rh ey claim have been harvested in a res ponsible manner, bu r plant is legall y coll ected.' Ginse ng (Panax spp.) is consistently no ne of these claims is independently substantiated or certi fie d. among the top selling herbs in the Ameri can marker, with sales Clea rl y, these claims demonstrate that herbal supplemenr in 200 I at nearl y US$3 1 million.3 This assess ment work is part manufacturers perceive they are catering ro a base of consumers of a broader initiative in which the Yellow C reek Botanical who ca re about the environment and purchase products that Institute, the H erb Research Foundation, and T RAFFIC seek conform ro their environmental beli efs. Indeed, manufacturers to fo ster a sustainable economy in Appalachia by developing, of herbal supplemenrs already procuring raw materi als from marketing, and managing the region's ri ch di ve rsity of botani­ natural plant populati ons in a se nsitive, sustain able manner may cal resources, while striving to pro tect irs natural heritage and be eli gible fo r third-parry certi fica ti on when or if such a program environment for future generati ons. becomes available. In 1973, concerns stemming from the harves t of wild Ameri­ can ginse ng in the United States and Canada for export to Asian Work in Progress medi cinal markets led to irs listing in Appendix II of CITES Efforts ro protect plant resources are not new, neither are they (Conve ntion on International Trade in Endangered Species of in the hands of just a few organi za ti ons. For instance, the Fores t Wild Fauna and Flora).4 Today, rhe United Stares is the only Stewardship Council is primarily concerned with rh e ecological exporter of wild American ginseng and implements the CITES and social criteri a of fores t products harvest whereas good man­ li sting by authorizing exports on a stare-by-state, annual basis ufacturing practices (GMPs) place standardization - instead of depending on the population status of the species and efficacy of sustainable sourcing- of ingredients at the rop of their priori­ management measures in these states. ty li st. Des pite the current emphas is on product standardiza ti on, Ginse ng's wides pread use affords rhe species a level of visibili­ GMPs may be written ro rake sustai nable sourcing into account. ty unmatched by any other medicinal plant. T hus, the intro­ O rganic certificati on, as developed by the U.S. Departmenr of duction of an eco-labeled ginse ng product in to the marketplace Ag ri culture's ati onal Organi c Program, is another mechani sm may be more recognizable and marketab le to consumers th an rhat supportS the sustainable production of "wild crops" and less popular herbs. rhar wi ll all ow producers ro label wild­ In addition, historicall y steady harvested plant material as organic.- demand for th e valuable wild roots of Still other non-governmental and gov­ Ameri can ginseng in Asia and poten­ ernmental certificati on systems for agri ­ ti al markers in No rth America and cultural or fo res t pro ducts are already --NORTH AMER ICA-- Europe fo r susrainably sourced, ava il able to the private secror or are in woods-grown products are likely to development.' T he first phase of T RAF­ provide powerful economic incentives for developing eco-label­ FIC's assessmenr of eco-labeling fo r Ameri can ginse ng is evalua­ ing for the species in its natural habitat. T he interes ts of conser­ tion and compari son of existing ce rtificati on mechanisms, such vationists and As ian traders may merge under eco-labeling, as as those mentioned above, to determine their strengths, weak­ only the older, more valuable plants would be harvested. nesses, and economic prac ticality. Younger plants would be allowed to reach seed-producing age C ritical to the success of eco-labeling are the opinions and co n­ and produce substantive quantities of seed prior ro harvest. On ce rns of stakeholders whose input will continue robe sought and the Asian market, the value of a wild American ginseng root is integrated into the prioritization and planning process. Pending determined primarily by size, with older, larger roots (believed to funding, the next phase of work will fo cus on the design and harbor the highes t concentration of active in gredients) fetching implementation of a pilot project, including sire selection in the highest prices. 5 One of the most tangible benefits of eco­ wes tern North Carolina and recruitment of landowners, har­ labeling for traders may be an increase in ava ilability of larger, ves ters, traders, and manufacturers to participate in the pilot more des irable roots harves ted by wildcrafrers or growers who, proJect. under the terms of voluntary, third-parry ce rtificati on, would T he res ults and recommendations fro m the ginseng case study only supply plants meeting minimum age requirements. will be adapted ro explore voluntary certification for other Similarl y, harves ters and traders are ex pected to benefit from medicinal species of co mmercial value in eco-regions of hi gh eco-labeling as As ian buyers begin ro associate a "certified sus­ conservati on importance, such as black cohosh (Actaea racemosa tainable" label with older, larger, and superi or wild or woods­ L., Ranunculaceae, syn. Cimicifoga racemosa (L.) Nurr.) in the grown roots for which they are likely to pay a premium price. Blue Ridge Mounrains, Oregon grape (Mahonia aquifolium Indigenous and local stakeholders, including harvesters and (Pursh) N urr., Berberidaceae) in the Pacific Northwes t, and dealers, should and will have a critical rol e ro play in developing As ian gin se ng (Panax ginseng C.A. Mey., Arali aceae) and an eco-labeling program rhar reAecrs their kn owl edge, use, and eleuthero (Eleutherococcus senticosus (Rupr. & Max im .) M ax im ., management of the resource base.6 Arali aceae) in the Russian Fa r Eas t. A

Claims Aimed At Consumers Christopher S. Robbins prepared this article as Senior Program American companies are increasingly eager ro sell products Officer at TRAFFIC North America, a program oJWWF- US based that claim to contain herbal ingredients that were ethically, sus­ in Washington, D. C. He now works out of Portland, Oregon, as a tainably, or ecologically wildcrafred, as evidenced by the number of such claims documented in the marketplace. TRAFFIC's Continues on page 39

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MEMBER ~~ American Herbal Products Association The Road

by Tim Lowery

the highway onto a sandy road leading down until it disappears into the sand. The mighry mesquite we I urn 0 II to our destination. Almost wide enough (Prosopis glandulosa (L. Bens.) M.C. Johnst., Leguminosae) for rwo cars, the road to El Desem­ waves ge ntly as we pass. Teddy bear choll a ( Opuntia bigelovii boque snakes its way through the Sonoran Desert. From end Engelm., Cactaceae) flaunts irs yellow fuzzy nubs, electric to end the camino offers stretches of parallel side roads that against the oli ve, silver, and taupe of Sonora. I see other small­ promise less jarring, dipping, and bouncing than the wash er brush lining the road that I don't ye t recognize, but which beds and truck ruts of the main road. T he truck rattles and I'm certain have medicinal uses . squeaks as we traverse a wash. What am I doing here? I as k Medicine. That's why I'm here. I want to see how one small mysel( Well, you are here to set up a community pharmacy, sli ce of the 80 percent of the world's population who li ves study medicinal plants, and encourage traditional foods. But without Western pharmaceuticals heals with plants. ' I want to why are you here? I brace myself against the das hboard as we supplement my pharmacy school education with an experi­ blast over a section of rutted roadway. Looking around, I ence that may help me understand where medicine came notice the giant saguaros ( Carnegiea gigantea (Engel m.) Brit. from , where it needs to go, and what I can do to help it get & Rose, Cactaceae) passing by the left and ri ght of the truck. there. With as many as rwo dozen arms We round a long curve revealing the stretching toward the sky, these cement houses belonging to the Seri residents ancient beings rise out of the desert I actually prefer these times of El Desemboque. The permanence of these structures reminds me of the importance of and blanket the hillside. T heir pro­ when everyone is speaking cession is halted only by the sierras, the work here. T he Seri, or Comcaac as they the horizon, and as we draw closer Seri. They remind me of the call themselves, lived as hunter/gatherers well to El Desemboque, the Sea of connection between into the rwentieth ce ntury. ' Settled in the Cortez. I look towards other plants language diversity and permanent fishing villages of El Desemboque and try to name those that I've only species diversity, and the and Puenta Chueca in the middle of that cen­ seen in books. The palo verde ( Cer­ tury, the adult popul ation knows a tremen­ cidium microphyllu m (Torr.) Rose & knowledge embedded in a dous amount about their desert surroundings. Johnst., Leguminosae) is green lang uage itse lf. This includes the medicinal plant knowledge from its pointed rips all the way their parents depended on. As we pass by rhe www.herbalgram .org 2002 HerbaiGram 56 I 37 rows of houses and ap proach the center of exe rcise. Satisfied with the degree of over­ town, these thoughts feed my imagi nation on lap, I respond in my best Spanish, "Si, es the possible impact a community pharmacy I would find it difficult to bueno." could have to help prese rve this knowledge. Pechita, the pod of the mesquite tree, is recommend a better To morrow is July 1, the Seri New Year that the first traditional food we collect. Driving celebrates the fruiting season, and the center of medicine than one that into the desert, I fo llow the directions of town is full of fo lks preparing for the fi es ta. For simultaneously promotes one of the cooperative members to a place the next three weeks , I'll live and work with the health and natural with mucho pechita. Under the shade of a Seri in El Desemboque, and attempt to set up a stand of mesquite trees, we gather the community stewardship. community pharmacy using traditional desert ripened pechita that cover the ground. medicines for the pharmacopeia. The specifics After a little coaching, I begin to distin­ of how this goal will be accomplished are vague guish the quality of the pods by taste and and mysterious, but for today and tomorrow, I thickness. The pods we collect will later be am co ntent to enjoy the dancing and feasting during this annual ground into traditional flour and the seeds discarded. For now community celebration. though, I focus on the task of gathering pechita, tasting their hulls I am here with Laurie Monti, a nurse practitioner, ethnoecolo­ for sweetness, and listening to Seri women trade stori es in their gist, and Northern Arizo na University professor, who worked with native tongue. the Seri for fi ve years. The community pharmacy is part of a broad­ I actuall y prefer these times when everyone is speaki ng Seri. er project to promote sustainable desert land use. Laurie will be in They remind me of the connection between language diversity and El Desemboque for a week, during which time she'll make the nec­ species diversity, and the essary arrangements for me to continue working after she leaves . knowledge embedded in a language itself. The Seri give me hope that these people, their way of life, and their sur­ rounding diversity wi ll survive. To collect pitahaya, the fruits of the saguaro, or organpipe, cactus (Stenocereus thurberi (Engelm .) Buxb., Cac­ taceae), we go further into the desert on side roads and paths I could never navigate on my own. Here we don't have the luxury of mesquite shade and must settle for the small sunl ess area The author kneels to gather pechita near a farm outside of El Desemboque. beneath a saguaro. After Photo © 2002 Christina Monroy. placing our lunch and water jugs in this little After the New Year's celebration, we meet the women with shaded spot and hanging whom I'll be working. T hese women are members of Cooperativa a colorful scarf to guide Comcaac, a natural products cooperative that promotes tradition­ us back, we head in dif­ al foods and medicines. I am most impressed by the age diversity ferent di recrions carry­ Ripe pirahaya on an organpipe cactus and of this group. Ranging from 20 to 60 years old, I view th is si de- by­ ing pitahaya sticks and the tip of the palo, the digging stick used to side involvement of different ge nerations as a positive sign for the buckers. The sticks are retrieve them. Photo© 2002 Tim Lowery. continued transmission of traditional knowledge. Through the made from a long course of our co nve rsation, I learn that we won't collect any medic­ saguaro rib with a nail or sharpened stick lashed to one end. Below inal plants, as the cooperative already has a good supply. T he group the point is a v-shaped notch that helps steady the stick against the wants me to help prepare the co llecti ons they already have, includ­ cactus and provides some leverage for removing stubborn pitahaya. ing showing them how to make creams and salves. Since now is Walking through the dusty wi lderness searching for fruiting cac­ the prime fruiting season for many species, the women also wa nt tus gives me so me sense of how important these traditional food to focus on traditional food collections. I run this new information collections are. Not only do they provide the Seri an alternative to through the objectives li st in my head, and find it to march. The a wes tern diet linked to diabetes and obesity, they also strengthen role of the pharmacist, my memory tells me, is to provide educa­ the connection between the Se ri and their desert. And this con­ tion about medicines and diseases, ensure proper medication selec­ nection has helped the desert remain as it is for as long as it has . I tion, dosage, and dosage form, and encourage the first two com­ would find it difficult to recommend a better medicine than one ponents of any chronic disease management plan, proper diet and that simultaneously promotes health and natural community stew-

38 [ Herbal Gram 56 2002 www.herbalgram.org ardship. human health I must also promote rhe As we return to E l Desemboque short­ By now, when I am actually working health of the environment. T he connec­ ly after noon, the townspeople emerge tion to h erbal m edicine also comes to from the shade of their homes a nd con­ with the Seri, I am content with labels mind as healing plants m ay provide the gregate by rhe tailgate of rhe truck and that give the traditional dose and only sustainable form of medicine.3 I rhe buckers of pitahaya we are unload­ preparation methods, confident that realize rhar regardless of the direct impli­ ing. The sweet, red juice from rhe fi g­ this information would not have cations to the community pharmacy in like pitahaya soon drips from the faces of £ 1 D esemboque or elsewhere, I need to been passed down through oral children a nd w ithin an hour, rhe lor is learn more about herbal m edicine and consumed . In rh e excitem ent created by history had it not been safe. environmental health. As I lay back on this desert rrear, sodas a nd candy are my cor a nd look o ur into rh e stars, rhe momentarily forgorren. possibilities for service projects rhar pro­ After siesta, I meet w irh rhe coopera- more health in rhe broadest sense seem tive to label medicinal plants and to reach some simple cream and limitless. And perhaps they are. --" salve formulas I learned from herbalist D enise Tracy, founder of T he Super Salve Compa ny, prior to m y arrival in Mexico. The Tim Lowery is a third-year PharmD. student at the University of labels a nd directions for use have been wrirren in both Seri and North Carolina at Chapel Hi!!. The funding for his experience was Spanish , so the cooperative might sell rheir herbs to nearby M exi­ provided by the j oseph Hoffingsworth Memorial Scholarship. To con­ can communities as well as utilize rhem for rhe needs of their own tact Tim, please email him at . tribe. I am concerned primaril y with rhe safety of these herbs and possib le contraindications to their use. I had spent some rime References: researching these topics in the U.S. several weeks ago. This proved I. Farnsworth N R, Akerele 0, Audrey S, Soejarto DO, Guo Z. Medic­ inal plants in therapy. 1985;63(6):965- to be a frustrating endeavor because many of the species in rhe Seri Bull World Health Organ 11 70. pharmacopeia had few or no published studies. By now, as I acru­ 2. Felger RS, Moser MB. People of the Desert and Sea. Tucso n: Univer­ ally work with the Seri, I am content with labels that give rhe tra­ sity of Arizona Press; 1985. ditional dose and preparation m ethods, confident rhat this infor­ 3. McCaleb RS. Medicinal plants for healing rhe pl aner: biodiversity mation would not have been passed down through oral history had and environmental health care. In: Grifo F, Rosenthal J, editors. Bio- rhey nor been safe. Contraindicarions and inreracrions with other diversity and human health. Washington DC: Island Press; 1997. p. herbs a nd drugs, however, still trouble m e. How to establish these 221-42. without knowing rhe m echanism by which rhe herbs heal, is a question I'll be thinking about when I return to m y formal uni­ Eco-LABELS versity pha rmacy classrooms. Continued from page 35

consultant to TRAFFIC North America. For additional information on TRAFFIC North Americas eco-labeling project, contact the author by email . To learn more about the TRAFFIC Networks global medicinal plant prog.ram and priorities, visit TRAFFICs website . References: I. Bass S, Thorber K, Markopoulos M , Roberrs S, Greig-Gran M. Cer­ tification's impacts on forests, stakeholders and supply chains. Fin al report. London: Internati onal lnsr irure for Environment and Devel­ opment; 200 I. 2. Robbin s, C.S. G inse ng dealers surveyed , conservation measures addressed. TRAFFIC Bulletin 1999; 18( I ):3-5. 3. Blumenthal M. Herb sales down in mainstream marker, up in natu­ ral food stores. HerbalGram 2002;55:60. 4. Robbins CS. Comparative Analysis of Management Regimes and Medicin al Plant Monitoring Mechanisms for American Ginseng and Gold enseal. Conservation Biology 2000 October; 14(5): 1422-34. 5. Perso ns SW. American Ginseng: Green Gold. Revised edition. As hevi ll e (NC): Brighr Mountain Books, Inc.; 1986. 6. Turner NJ. "Doing it Right": Issues and Practices of Sustainable Har­ A sack of pee hi to collected under a stand of mesquite trees nea r a wash south­ vesting. (Earlier version presented to Non-Timber Forest Products east of El Desemboque. Photo© 2002 Tim Lowery. Workshop, Krunaxa Kinbasker Treaty Council , Yaqa n Nukiy, Cre­ ston, B.C.) B. C. journal of Ecosystems and Management 200 I; I (I). Online journal . T he women of Cooperativa Comcaac thank m e for the help a nd 7. U.S. Department of Agriculrure Agricultural Marketing Service. wave m e into the evening. I walk towards the edge of town and Standards for rh e Natio nal Organic Program in rhe United Srares. down to m y camp by the sea. T he sky fades over the village, a nd I 2001 , Washington, D .C. [ci red 200 1 Dec 19]. Avai lable online . rhink about what I want to do after I leave El D esemboque. H ere, 8. Ozinga S. Behind the logo, an environmental and social assessment in rhis quiet, distant place, the connection between human health of forest certification schemes. Gerard N, Wenban-Smirh J, editors. and enviro nmental health is clear. I understand rhat to promote Fern. United Kingdom; 200 I. www.herbalgram.org 2002 HerbaiGram 56 I 39 by Richard P. Brown, M.D., Patricia L. Gerbarg, M.D., and Zakir Ramazanov, Ph.D., D.S.

hodiola rosea L., also known as "golden root" or "roseroor" belongs to the plant family Crassulaceae. ' R. rosea grows pri­ marily in dry sandy ground at high alti­ tudes in the arctic areas of Europ~ and Asia.' T he plant reaches a height of 12 to 30 inches (70cm) and produces yel­ low blossoms. It is a perennial with a thick rhizo me, fragrant when cur. The Greek phys ician, Dioscorides, first recorded medicinal applications of rodia riza in 77 C.E. in De Materia Medica.3 Lin­ naeus renamed it Rhodiola rosea, referring to the rose-like attar (fragrance) of the fresh cur roorstock. 4 For centuries, R. rosea has been used in the traditional medicine of Russia, Scandi­ navia, and other countries. Between 1725 and 1960, va rious medicinal applications of R. rosea appeared in rhe scientific literature of Sweden, Norway, France, Germany, the Soviet Union, and IcelandY ·" Since 1960, more than 180 pharmacological, phyto­ chemical, and clinical studies have been published. Although R. rosea has been ex ten­ sively studied as an adaptogen with various health-promoting effects, irs properties remain largely unknown in the West. In part this may be due to the fact that the bulk of research has been published in Slavic and Scandinavian languages. T his review pro-

40 I HerbaiGram 56 2002 www.herbalgram.org vi des an introduction to some of the traditional uses of R. rosea, its Alps, the Carpathian Mountains and other mountainous Balkan phytochemistry, scientific studies exploring its diverse physiologi­ regions. Several varieties of Rhodiofa species have also been identi­ cal effects , and its current and future medical applications. fi ed ac ross Alaska, Canada, and the northern mountains of rh e continental United Srares. 20 In fact, the world database of botani­ Rhodiola rosea in Traditional Medicine cal literature shows many citations identifying a broad range of Traditional folk medicine used R. rosea to increase phys ical species of the genus Rhodiola, in so me cases including R. rosea, in endurance, work productivity, longevity, resistance to high altitude many diverse locations in northern latitudes (see Table I). sickness, and to treat fatigue, depression, anemia, impotence, gas­ The current taxonomical status of the genus Rhodiofa has trointestinal ailments, infections, and nervous system disorders. In become quite complex. Before mountain villages of Siberia, a bouquet of roots is still given to World War II , some taxono­ couples prior to marriage to enhance fertility and assure the birth mists se parated different of healthy children.' In Middle Asia, R. rosea tea was the most species of Rhodiola into effective treatment for cold and flu during severe Asian winters. an independent genus, Mongolian doctors prescribed it for tuberculosis and cancer. 13 For belonging to the sub­ centuries, only family members knew where to harves t the wild family Sedoidae. 20 "golden roots" and the methods of extraction.' Siberians secretly Then Rhodio!a was transported the herb down ancient trails to the Caucasian Moun­ reclassifi ed as a sub­ tains where it was traded for Georgian wines, fruits, garlic, and genus of the larger genus honey. Chinese emperors se nt expeditions to Siberia to bring back Sedum, whi ch contain ed the "golden root" for medicinal preparations. about 10 species . In 1963 Hegi Linnaeus wrote of R. rosea as an astringent and for the treatment identified more than 50 species of of hernia, leucorrhoea (vaginal discharge), hysteria, and Rhodiofa and re-established them as a 4 7 headache. • In 1755 R. rosea was included in the first Swedish separate genus.'" Due to their morphological Pharmacopoeia. Vikings used the herb to enhance their phys­ similarities, they form a distinct Rhodiola ical strength and endurance." German researchers described group." There are still differing opinions among the benefits of R. rosea for pain, headache, scurvy, hemor­ specialists about which new species should or 6 rhoids, as a stimulant, and as an anti-inflammatory. '1·' should not be included in the genus Rhodiofa. The In 1961, G.V. Krylov, a Russ ian botanist and taxonomist in rationale and defining criteria for the boundaries of the Department of Botany at the Novosibirsk Branch of the Russ­ the genus remai n somewhat controversial. This is ian Academy of Sciences, led an expedition to the cedar taiga in not, in itself, necessa rily counterproductive, since the Altai Mountains of southern Siberia where he located and the acquisition of botanical knowledge inevitably identified the "golden root" as Rhodiofa rosea. 17 Extracts of the stimulates new understanding and insight, creat­ R. rosea root were found to contain powerful adaptogens. ing the need for revised systems of classification. Research revealed that it protected animals and humans from In the case of R. rosea, however, this taxo nomic mental and physical stress, toxins, and cold.w The quest for new ambiguity may have unex pected and potentially medicines to treat diseases such as cancer and radiation sickness, negative consequences. and to enhance physical and mental performance, led to the dis­ Popularizing a phytomedicinal plant like R. covery of a group of phenylpropanoids that are specific to R. rosea can create confusion when the public is rosea. (See Phytochemistry section below.) offered a vari ety of "Rhodiola" products using the general plant family name instead Geographical Distribution and of the full botanical name of the particular Taxonomy of Rhodiola rosea species. For example, products cal led "Rhodiola While Rhodiofa as a genus may have originated in the moun­ spp., Tibetan Rhodiola or Indian Rhodiola" may tainous regions of Southwest China and the Himalayas, 18 botanists incorrectly imply equivalence with R. rosea have established that various species of the genus Rhodiola natural­ extract. Because of significant species-dependent ly display a circumpolar distribution in mountainous regions in variation in phytochemistry and pharmacology, the higher latitudes and eleva- the use of "Rhodia fa " as a general term is inaccurate tions of the Northern and misleading. The correct identification of all Rhodiofa Hemisphere. In Central species according to precise and generally accepted botani­ and Northern Asia, the cal, phytochemical, and genetic taxonomic criteri a is nor genus is distributed merely an abstract intellectual exercise. It is critical for both from the Altai Moun­ scientific and phytopharmacological accuracy, as well as for tains across Mongolia product labeling for the public. Consumers may need pro- into many parts of fessional guidance to avoid purchasi ng ineffective brands, partic­ Siberia. '9 According to ularly those that do not provide full information, including the Hegi, irs distribution complete botanical name of the plant species. Companies may in Europe extends from change their suppliers over time. Therefore, consumers should Iceland and the British periodically check independent sources of product evaluation, as Isles across well as requesting information about quality control and content Scandinavia as Rhodiola rosea Baxter, William. British Phoenogomous from manufacturers. far south as the Botany. Oxford, published by the author, sold by J. H. The pharmacological Pa rker [etc.], 1834·1843, vol. 5, plate 391. Courtesy ofThe Rlzodiola rosea Pyrenees, the Hunt Institute for Botanical Documentation. and medicinal properties A Plwtomed ici na I Overview www.herbalgram.org 2002 HerbaiGram 56 I 41 Rlzodiola rosea of Rhodiola are species­ Us ing newly developed methods of analys is, Dubichev and col­ A l'lwtnnwd ici n,1l Overview dependent phenome­ leagues demonstrated that R. rosea root contains three cinnamyl na. 22 Of all the Rhodiola alcohol-vicianosides - rosavin, rosin , and rosarin - that are spe­ 8 9 species, R. rosea has been cifi c to this species.' ·' T he term rosavins can be used to include the predominant subject of phytochemical, animal, and human rosavin , rosin, and rosarin (see chemical fi gures) . 2 18 23 24 srudies. · · · Table 2 compares the research record of R. rosea with It became evident that salidroside is present in all chemicall y al l other species of the ge nus Rhodiola. Approximatel y 51 percent analyzed plants in the genus Rhodiola, and in a wide va ri ety of 5 34 of all animal studies and 94 percent of all human studies conduct­ species outside the ge nus. '·' - The term salidroside is derived from ed on plants in the ge nus Rhodiola are on the species R. rosea. Only Salix, the genus name for the willows. Salidroside was first isolated R. rosea has passed extensive toxicological studies and has bee n cer­ in 1926 from Salix triandra L. (Salicaceae)Y Since then it has been tified safe for both animals and humansY detected in Vaccinium vitis-idaea L. (E ricaceae) and in Rhododen­ dron35·36 (plants not belonging to the ge nus Rhodiola) in concentra­ ti ons that can be hi gher than levels found in Rhodiola species, Table 1. Distribution of plants in the genus Rhodiola including R. rosea. T herefore, salidroside alone is nor a useful Asia: China (Ga nsu, Hebei, Jili n, Shanxi, Sichuan, Xinjia ng); Kaza­ marker compound for differentiating trueR. rosea from other Rho­ khstan and Uzbekistan; Mongoli a; Ru ss ian Federation (Altai, Eastern diola species; nor should it be used as the only marker compound Siberia, Ka mchatka, Khaba rovsk, Magadan) for the standardization of R. rosea root extracts. According to the revised 1989 Soviet Pharm acopeia/7 the Europe: Austri a; Bulgaria; Czechoslovakia; Fin land; France; Green­ extracts of R. rosea- primarily in the form of water/alcohol tinc­ land; Iceland; Ireland; Ita ly; Norway; Poland; Roman ia; Russia n Feder­ tures or dried root extract - are now standardized for both ation (Eu ropean part); Spain; Sweden; United Kingdom; Yugoslavia rosavins and salidrosid e. Although rosavins are now the accepted North America: Canada (British Columbia, Northwest Territory, marker for generi cally pure R. rosea (and irs extracts), they are not Yukon Territory); United States (Alaska, California, Colorado, Idaho, necessarily the only pharmacologically active ingredients res ponsi­ Minnesota, Montana, Nevada, New Mexico, New York, Oregon, Ten­ ble for the effi cacy observed in clinical studies. In fact, precise nessee, Utah, Virginia, Wash ington, Wyoming) identifica ti on of rh e compounds responsible for the numerous health benefits of R. rosea remains to be confirmed. R. rosea extracts used in most human clinical studies were stan­ Phytochemistry of Rhodiola rosea dardized to minimum 3 percent rosavins and 0. 8-1 percent T he in ves ti gati on of the phytochemistry of R. rosea root has salidroside because the naturally occurring ratio of these com­ revealed the presence of six distinct groups of chemical com­ pounds in R. rosea root is approximately 3: I. pounds: • Phenylpro panoids: rosavin, rosin, rosarin (specific toR. rosea); • Phenylethanol deri vatives: salidroside (rhodioloside), tyrosol; Table 2. Comparison of human and animal studies of • Flavanoids: rodiolin , rodionin, rodiosin, acetylrodalgin, tricin; • Monoterpern es: rosiridol, rosaridin; plants in the genus Rhodiola * • Triterpenes: daucosterol , beta-sitosterol; Species name Animal Studies Human Studies • Phenoli c acids: chlorogenic and hydroxycinnamic, gallic acids. R.rosea 32 17 The standardizati on of R. rosea root ex tracts has gone thro ugh R.altern a 0 0 two distinct phases. Initially, in the 1970s, the compound respon­ sible fo r its unique pharmacological properties was believed to be R. brevipetiolata 0 0 4 6 27 salidros ide (rhodioloside). '·23.' ·' • Therefore, the first generati on of R.coccinea 0 R. rosea tincture/extracts approved by the Russian Pharmacopoeia R. crenulata 4 Committee was standardized to a minimum of0.8 percent salidro­ R. e/lipticum 0 0 side content. 25 In th e late 1980s, demand for R. rosea- based phytomedicines R. fas tigita 2 0 dramatically increased. The wild-crafted raw materi al was over­ R.gelida 0 0 harvested, res ulting in a steady decline in the quality and effective­ R.henryi 0 0 ness of "Rhodiola" prepara tions. Scientific investigation revealed R. heterodon ta 1 0 that other species of ge nus Rhodiola (which also co ntained salidro­ side) were being substituted for R. rosea. While some of these R. kirilowii 6 0 mixed batches were hi ghly va ri able in quali ty, others had no phar­ R. pinnatifida 0 macological effect. Logically, the suspicion arose that the salidro­ R. quadrifidia 1 0 side standard was inadequate. Based on comparative analys is, the R. sachalinensis 6 0 obvious hypothesis was that the original high potency product co ntained other acti ve compounds specific to R. rosea that had not R.sacra 5 0 yet been identified. R. wolongensis 1 0 R. yunnanensis 0 0 Specific compounds set Rhodiola rosea apart from other Rhodiola species *NOTE: Numbers in this table indicate the number of animal and human After more than a decade of research, Kurkin and colleagues pre­ studies on each plant species of the genus Rhodiofa, according to a Copernic sented evidence in 1986 that the chemical composition of R. rosea online database search, 2001. This article reviews many additional studies not root is, in fac t, different from the other species of genus Rhodiola.' 3 listed in on line databases.

42 I HerbaiGram 56 2002 www.herbalgram.org Rhodio/a rosea in Modern Medicine Pharmacological and Clinical Studies Since 1969, R. rosea has been included in official Russian medi­ The traditional use of R. rosea as a tonic in Siberian and Russian cine. The Pharmacological and Pharmacopoeia Commirree of rhe medicine stimulated extensive research leading to identification of Soviet Minisuy of H eal th recommended medicinal use and indus­ R. rosea as an adaptogen - a substance that nonspecifically erial production of liquid R. rosea exrracr. In 1975, rh e Soviet Min­ increases the resistance of an organism and does not disturb nor­ isrry of Health approved and registered preparation No. 75/933/ 14 mal biological parameters. Studies in cell cultures, animals, and as a medicine and tonic, allowing large-scale production under rhe humans have revealed antifatigue, anri-srress, anrihypoxic (protec­ name Rhodiola Exrracr Liquid, an alcohol-based exrracr (40 per­ tion against damaging effects of oxygen deprivation), anri cancer, cenr ethyl alcohol). Medical and pharmacological texts describe irs antioxidanr, immune enhancing and sexual stimulating 4 38 0 use as a srimulanr for asthenia (fatigue), for somatic and infectious effecrs. '·'"·' · -' Since the Russian and Bulgarian lirerarure is so illnesses, in psychiatric and neurological conditions, and in healthy extensive, this discussion will highlight seminal studies and major individuals to relieve fatigue and to increase arrenrion span, mem­ reviews. The authors were forrunare to gain access to origi nal ory, and work producriviry. The common dose is 5-10 drops 2-3 reviews, articles, and doctoral theses. T his overview relies heavily rimes a day, 15-30 minutes before eating for a period of I 0-20 on monographs and peer-reviewed publications. The research data days . In psychiarric disorders wirh fatigue, a starring dose of I 0 conrained in these documenrs are helpful for understanding recent drops 2-3 rimes a day is gradually increased up to 30-40 drops for human studies in normal and pathological conditions. 1-2 monrhs. In Sweden, R. rosea was recognized as an H erbal Medicinal Prod­ Effects upon the Central Nervous System uct in 1985 and has been described as an anrifarigue agent in rhe The systemati c study of rhe pharmacological effects of R. rosea, Textbook ofPhytomedicine for Pharmacists! In the textbook of phar­ begun in 1965, found that small and medium doses had a simu­ macology for dispenser training in Sweden, R. rosea is menrioned lating effect, such as lengthening rhe time mice swim and remain as a planr with a stimulant action. Also, the Pharmaceutical Book on vertical perches to the limit of their abilities. In conrrasr, larger (Ldkemedelsboken 97 /98) menrions R. rosea as one of rhe most doses were found to have more sedative effects. Small doses commonly used psychosrimulanrs in the group of officially regis­ increased the bioelectrical activiry of the brain, presumably by tered herbal medicinal products.'' In Denmark, R. rosea is regis­ direct effects on the brainstem ascendi ng and descending reticular 23 39 4 tered as a medical product in the category of botanical drugs. Reg­ formarion. ·'".. '"· · ' Furrher studies showed that medium range istered preparations are extensively used in Sweden and other Scan­ doses, unlike tranquilize rs , enhanced the developmenr of condi­ dinavian countries to increase mental work capaciry during stress, tioned avoidance reAexes in rats and facilitated learning based on as a psychostimulanr, and as a general suengthener. emotionally positive reinforcement."-''·''' Overall, in small and medium doses, R. rosea stimulated nor­ epinephrine (NE), dopamine (DA), serotonin (5-HT), and nicotinic cholin­ ergic effects in the cenrral nervous sys­ tem (C S). Ir also enhanced the effects of these neurorransmirrers on the brain by increasing the permeabiliry of rhe Brain Stem blood brain barrier to precursors of DA Reticular Activating System and 5- HT.'·'' .. '-'"·''' In comparing studies of R. rosea, Asian / '\.., ginseng (Panax ginseng C.A. Mey., Arali­ + NE + 5-HT + NE + 5-HT + DA + Ach aceae), meclofenoxate (cenrrophenox­ ~ T ~ ~ ~ ~ ine), piraceram, citicholine, and other Cerebral Cortex Limbic System Pathways nootropics (s ubstances that enhance cog­ + Cognitive Functions Regulate Emotional Tone & Mood nition, protect the brain, and have low toxiciry and few side effects), Petkov and Prefrontal & ~ ~ ~ colleagues noted that all of these agenrs Frontal Cortex Hippocampus Amygdala Hypothalamus enhance learning and memory in animal +Attention Emotion models and increase 5-HT levels in the +Memory Emo~ion - CRF Memory Memory frontal cerebral cortex."'''0 Diagram I +Learning Vigilance Pituitary illustrates rhe possible effects of R. rosea J / /"J - mct;mtcoph;o on neurotransmirrers in multiple neu­ V ~drenal Gland ronal pathways. " Starting in the brain Forebrain Reward Sys/1em - Release of Cortisol stem, R. rosea promotes release of E, 5- Pleasure, Sat1ety - NE H T, and DA in ascending pathways that Energy, Dnve Epinephrine activate the cerebral cortex and the lim­ bic system.'·'"-'° Consequenrly, the cogni- Brain & Heart tive (thinking, analyzing, evaluating, cal­ cul ating, and planning) functions of the Cognitive Stimulation Emotional Calming

NE = norepinephri DA =dopamine, Ach =acetylcholine, CRF = corticotr + = 1 ves or increases , - = decreases Rlzodiola rosca i\ Phvlonwdicin,11 0\'l'n' il'\\' www.herbalgram .org 2002 HerbaiGram 56 I 43 Rlzodiola rosea cerebral cortex and the bance; inability to relax; and irritability; A Ph\·tonwdicinal On' n ·iL'\\" attention, memory, and • inability to recover through rest, relaxation, or enjoyment; learning functions of the • does not occur in the presence of organic mental disorders, affec­ prefrontal and frontal tive disorders or panic, or generalized anxiety disorder. cortex are enhanced. Other neuronal sys tems also contribute to the In an open study 27 healthy students, physicians, and scientists many aspects of memory: encoding, so rting, storage, and retrieval. aged 19-46 years were given 10 drops of R. rosea tincture (equiva­ For example, the cholinergic system uses the neurotransmitter lent to 100-150 mg R. rosea ex tract) once or twice a day for 2-3 acetylcholine (Ach) and contributes to memory function via path­ weeks, beginning several days before intense intellectual work, ways ascending from the memory storage systems of the limbic sys­ such as final exams.5 8 The extract improved the amount and qual­ tem to various areas of the cerebral cortex (memory retrieval). ity of work and in all cases prevented asthenic decompensation Agents that block Ach suppress the activity of these ascending (loss of work capacity due to fatigue). A series of studies using a pathways and interfere with memory. R. rosea reverses this block­ proofreading test showed that a one-time dose of R. rosea did not ade.4950 The deterioration of these systems with age results in age­ significantly increase the number of symbols corrected, but very associated memory loss. 52 R. rosea may prevent or ameliorate some significantly decreased the percent of errors made, particularly over age-related dysfunction in these neuronal systems. an 8-hour period.65·66 Positive results found in the studies of proof­ As an antioxidant,H· 55 R. rosea may help protect the nervous sys­ reading tests were based on 300 mg/day or more. In medical treat­ tem from oxidative damage by free radicals. Stress interferes with ments, the usual doses are 200-600 mg/day. R. rosea increased memory functions and, over time, causes deterioration in memory intellectual capacity (particul arly by improving perception and systems. In addition to enhancing cognitive functions, learning, processing of information) to a greater degree than an extract of and memory by stimulating NE, DA, 5-HT, and Ach neuronal eleuthero, formerl y called Siberian ginseng (Eleutherococcus sentico­ systems, R. rosea may exert positive effects on memory and cogni­ sus Rupr. et Max. , Araliaceae). 18 tion by improving resistance to phys ical and emotional stress. The decrease in physical and mental performance of physicians Thus, the dual action of cognitive stimulation and emotional on prolonged night call is well known. Low dose (170 mg/day) R. calming creates benefits for both immediate cognitive and memo­ rosea extract was given to 56 young, healthy phys icians on night ry performance and for the long-term preservation of brain func­ call. 18 The effect was measured as total mental performance calcu­ tions. lated as "Fatigue Index." The tests reflected an overall level of men­ The psychostimulant effects of R. rosea were studied in 53 tal fatigue involving complex cognitive functions, such as associa­ healthy subjects and 412 patients with neuroses and as thenic syn­ tive thinking, short-term memory, calculation, concentration, and dromes (of both functional and organic origin). 56.58 Symptoms of speed of audio-visual perception. These parameters were tested as thenia (fatigue, decline in work capacity, before and after night duty during three periods of two weeks each trouble falling asleep, poor appetite, in a double-blind crossover trial. A statistically significant improve- irritability, and headaches) responded ment in mental performance tests was observed in the treat­ favorably to R. rosea 50 mg three ment group (R. rosea) during the first two-week peri­ times a day. Treatment dura­ od. However, at 6 weeks the effect appeared to be lost. tions ranged from 10 days to 4 No side effects were reported. These results suggest that months. The asthenic states R. rosea extract can reduce fatigue under certain stressful included both psychiatric and conditions for some period of time. Poss ible reasons for phys ical causes, for example, fol­ the loss of efficacy over time may be the low dose used, lowing influenza or other illness. In an the crossover design, or the overall length open study of 128 patients aged 17-5 5 of night duty with increased fatigue by years, R. rosea alleviated fatigue, irritability, dis­ weeks 5 and 6. tractibility, headache, weakness and other vegeta­ Spasov and colleagues compared 100 tive symptoms in 64 percent of cases. 57 Improvement mg/day R. rosea extract (S HR-5, Swedish was assessed by psychological testing and work Herbal Institute, Goteborg, Sweden; standard­ productivity. ized to 3 percent rosavin and 0.8 percent salidro­ In 1869 Beard coined the term "neurasthenia" side) with placebo in a double-blind 20-day study to include various forms of nervous asthenia. Con­ of 60 Indian medical students studying in Russia troversy over this term has centered on the overlap of symp­ during their final exam period. 38 Despite the low tomatology and co-morbidity with other conditions (e.g., depres­ dosage, investigators found significant improve­ sion , neuroses, somatoform diso rders, and chronic fatigue syn­ ments in general well-being, physical fitness, mental fatigue, final drome). Although this diagnosis has fallen out offavor in the Unit­ exam grades, and coordination, but not in some aspects of cogni­ ed States and no longer appears in The D iagnostic and Statistical tive functioning in students taking R. rosea extract compared to Manual of the American Psychiatric Association (DSM-IV) ,59 it is placebo. 60 sti ll widely used throughout the world. -63 Neurasthenia is defined In a double-blind placebo-controlled study of 60 foreign stu­ by the World Health Organization in the International Classifica­ dents at a Russian high school, administration of a R. rosea extract tion ofD iseases (ICD-1 0)64 as: (660 mg/day of a preparation named Rodaxon) resulted in an • either persistent and distressing feelings of exhaustion after increase in physical (velergometric) work capacity, coordination, minor mental effort, or persistent and distressing feelings of fatigue kinesthetic sensitivity, and general well-being along with a decrease after minor physical effort; in psychic fatigue and situational anxiety.39 Unfortunately, this • accompanied by one or more of the following symptoms: mus­ study provides no information on the amount of R. rosea in the cular aches or pains; dizziness; tension headaches; sleep distur- Rodaxon preparation.

44 I Herbal Gram 56 2002 www.herbalgram.org R. rosea was beneficial in posttraumatic and vascular lesions of ex rract is approximately equivalent to 150 mg of dry encapsulated the brain. It was especially effective in combination with piracetam root extract standardized to 3 percent rosavin and 1 percent for patients with marked cognitive dysfunction. 56 However, it did salidroside. After 30 minutes, they pedaled an electric bicycle not reduce manic symptoms and could wo rsen paranoid states . In ergometer ro produce a precise amount of work-induced baseline one study of more clearly depressed patients, R. rosea in co mbina­ fatigue. After a 5-minure rest, rhey performed further work ro tion with tricyclic antidepressants (TCAs) produced significant determine rhe maximal duration of work they could accomplish at improve ment in rhe majority of cases and decreased side effects of a specific intensity. During rhe second period of work, R. rosea the TCAs.67 Ultimately, some of these patients were able to respond drops, eleuthero extract, and piridrol increased work capacity by 9 to R. rosea alone. percent, 6 percent, and 6 percent respectively (p<0.04) compared Antipsychotic medications used in large doses over many years to placebo controls. Recovery was defined by the rime of normal- ro treat schizophrenic patients sometimes affect rhe ization of heart rare and arterial pressure. During the dopaminergic nerves in the basal ganglia, the same recovery period, at I 0 minutes, the pulse slowed by nerves that are damaged in patients with Parkinson's a factor of 2.5 (67 beats per minute) in the R. rosea Disease. When these nerves are compromised, group versus 1.9 (87 beats per minute) in the con­ patients develop a constellation of "Parkinsonian" trol group. During the 3-day total recovery peri­ symptoms, including stiffness, tremors, bradykine- od, subjects given piridrol complained of sia (slowed movements), and others. Anticholiner- insomnia, excitability, and irritability; whereas gic medications have been used to relieve these symp­ those given R. rosea had no adverse side toms when they are caused by antipsychotic medica­ effects and no complaints. tion; however, they so metimes fail ro help. In schizo­ Endurance is the capacity ro maintain phrenic patients whose anticholinergic medica­ work despite fatigue. Forty-rwo master tions had failed ro relieve Parkinsonian symptoms, level competitive skiers (20-25 years of 56 68 R. rosea was found to be of benefit. · age) rook either R. rosea extract or placebo R. rosea may affect emotional tone by influencing 30-60 minutes before training races (30 neurotransm itter monoamine levels (NE, DA, 5- km ) and a biathlon (20 km race on skis HT) in nerve rracrs involved in the regulation of carrying a rifle and shooting targets at mood, anxiety, and emotion in the amygdala, hip­ stops) . Athletes given R. rosea had sta- pocampus, hypothalamus, and midbrain. The stimu­ tistically significant increased shooting lation of nicotinic cholinergic activi ty in the emo­ accuracy, less arm tremor and better tional circuits of the limbic system (in the temporal coordination. Thirty minutes after work lobe) may also contribute ro these effects. Alter­ performance, the heart rare in the R. ations in monoamine levels underlie this com­ rosea group was 104-106 percent of plex spectrum of psychotropic activity: stimu­ baseline, versus 128.7 percent in the place­ lating, tranquilizing, anti-stress, and antidepres­ bo group (p<0.02). R. rosea improved sant. recovery time, strength, endurance, car­ The authors have found that R. rosea can help diovascular measures, and coordinarion.69 patients with depressive syndromes, mental and Adaprogens differ from other stimulants physical fa tigue (secondary ro psychiatric and during forced, exhaustive muscular work. medical conditions), memory loss and cognitive With classical stimulants the initial dysfunction from a variety of causes, sexual dys­ increase in work-capacity is followed by function, and menopausal-related disorders. Dr. a period of substantially decreased Brown and Dr. Gerbarg have successfully treated (markedly below average) work-capacity. more rhan 150 individuals with R. rosea extract Repeated use of CNS stimulants depletes (3 percent rosavin and 1 percent salidroside) brain carecholamines and decreases condi­ and have supervised the treatment of more tioned reflexes. In contrast, with extracts of than 100 additional cases (See Case Studies). R. rosea, the initial increase in work-capacity is followed by a lesser diminution, such rhar rhe work-capacity Effects on Physical Work Capacity continues robe above ave rage.'0 A number of studies have shown that R. Animal studies suggest mechanisms that may be involved in rosea increased physical work capacity and dra­ these effects. R. rosea increased essential energy metabolites, matically shortened the recovery rime berween bouts adenosine triphosphate (ATP), and creatine phosphate in the of high-intensity exercise. These studies included muscle and brain mitochondria in mice made to swim to their normal individuals exposed ro maximal work on a limit." It may also enhance the ammonia reassimilation and ener­ bicycle ergometer and Olympic-level cross co untry gy metabolism of the cell by increasing ATP, ribonucleic aci d skiers and biathletes. 69 In one study, 52 men (18-24 years of age) (RNA), protein, and amino acid synthesis." In animal studies, R. were given one dose of either 15 drops of R. rosea extract, 2 ml rosea increased metabolism of fats rwice as much as eleuthero -3 and eleuthero, or 1 ml of a 1 percent solution piridrol (a stimulating improved energy metabolism in the brain during intensive muscu­ psychotropic simil ar to methylphenidate). Fifteen drops of R. rosea lar workloads.' 4

Above and left: Rhodiola rosea Oeder, G. C. [Flora Danica.] leones plantarum sponte nacentium in regnis Daniae et Norvegiae ... Hafniae, C. [&A.] Philibert, 1766 [i.e., 1761]-1883, val. 2, plate 183. Courtesy ofThe Hunt Institute for Botani­ Rlzodiola rosen cal Documentation. r\ Ph\'lonwdicinal OYerYiL'\\'

www.herbalgram.org 2002 HerbaiGram 56 I 45 Rhodiola ro sea (superoxide radicals induced by menadione 600 microM for 2 A Phytomedicinal Overview hours); and heavy metal-induced stress (copper 50 microM for 1 hour or cadmium 20 microM for I hour). Both eleuthero and R. rosea strongly protected snail embryos from lethal heat shock, from Adaptogenic, Anti-Stress, and the adverse effects of menadione-induced superoxide radicals, and Neuroendocrine Effects from toxic exposure to heavy metals (copper and cadmium). In rheir classic 1968 paper, Soviet pharmacologists Brekhman Although the degree to which resistance was enhanced depended and Dardymov surveyed rh e literature on 189 medicinal plants on the type of stressor applied, these results confirm the defi nition and identified five (including R. rosea) that met the three defining of phyto-adaptogens as being universal enhancers of non-s peci fi c criteria for an adaptogen:71 resistance against different kinds of stress conditions. T he mecha­ • An adaptogen should be innocuous and cause minimal distur­ nisms of nonspecifi c resistance are not entirely clear, but probably bance of the normal physiological functions of an organism; involve improvements in cellular energy metabolism, based in part • T he action of an adaptogen should be nonspecific (i.e., it should on ATP (as discussed above). increase res istance to adverse influences of a wide ra nge of harmful In higher animals and humans, nonspecific res istance may also factors of physical, chemical, and biological nature); be enhanced by improvements in the neurological mechanisms of • An adaptogen may possess normalizing action irrespective of the dealing with stress (carecholamines, serotonin, and endorphins). direction of the preceding pathological changes (i.e., if a body T he serotonin system is necessary for rh e stress response reaction, parameter is high, the adaptogen brings ir down towards normal; adaptation to new environmental conditions, and tolerance of if a parameter is low, the adaprogen brings it up towards normal). hypoxia. N umerous stressors decrease serotonin in the hypothala­ mus. Theoretically, the abi li ty of R. rosea to increase the nonspe­ cifi c res istance of animals may be rel ated to its capacity to increase serotonin in the hypothalamus and midbrain. Additional research showed that an intact hypothalamic pituitary adrenal axis and par­ ticipation of the gonads and thymus were necessary for this anti­ stress effect.' Furthermore, R. rosea reduces the activation of sever­ al components of the stress response sys tem. For example, it mod­ es tl y increased serum beta-endorphins that protected rats against subsequent stress-induced excess endorphin elevation.80 In addi­ tion, R. rosea moderates the release of opioid peptides that occurs H as part of the pituitary adrenal axis response to stress. This reduced rel ease protects against sudden excess opioid and catecholamine T he forced swimming test, used by Russ ian scientists to measure (NE and DA) levels (which interfere with normal brain functions nonspecifi c resistance to stress, was later named after Porsolt who and can lead to heart damage), while allowing a more moderate ass igned specific parameters such as water temperature and the rel ease that increases stress tolerance without damaging the ce ntral dimensions of the glass cylinder in which a mouse or rat was forced nervous system or the cardiovascul ar system (see Diagram 2). R. to swi m to exhaustion (about 15 minutes). After an initial period rosea extracts also protect the brain and heart by reducing the secre­ 081 of vigorous acti vity, the rodent adopts a characteristic immobile tion of corticotrophin releasing factor (CRF) under stress.' · posture, making only the minimal movements necessary to stay afl oar.7r' T he val idi ty of the Porsolt swim test and its relationship to 77 depression have been discussed ex tensively ·7' and it subsequently became a screening rest for antidepressa nt agents by pharmaceuti­ HO cal companies. Although different laboratories have made minor technical modifications, rhe fundamentals of rhe test remain the same. Adaptogens and antidepressants in crease the amount of time 0 the animal is able to keep swimming actively." Panoss ian and col­ leagues propose to update the definition of adaptogen by high­ lighting more specific biochemical actions as metabolic regula­ torS. 70T he wide range of medical bene firs and physiological actions may be based on the effects of adaptogens on regulatory systems H found in many organs and tissues (e.g. , immune, hormonal, CNS, cardi ovascul ar, muscular, etc.). T hey hypothes ize that adaptogens Endocrine and Reproductive Effects reduce damage from stressors by altering the reacti vity of the organism's defense sys tem, including the hypothalamic pituitary Neuroendocrine animal studies showed that R. rosea, like other axis (HPA) and the efferent sympatho-adrenal sys tem (SAS) .70 adaptogens, enhanced thyroid function without ca usi ng hyperthy­ A recent study showed that R. rosea and eleuthero protected the ro idism." In addition, the thymus gland functioned better and was embryos of freshwater snails (Lymnaea stagnalis) from a variety of protected from the in vol ution that occurs with aging. The adrenal environmental stressors. 79 Enhancement in res istance was studied glands functioned with better reserve and without the kind of by applying phyto-adaptogen extracts for a period of 20 hours to hypertrophy caused by other psychostimulants. 3-day old L. stagnalis larvae. Subsequently the larvae were exposed Egg maturation was enhanced in rats and an anabolic effect in to the following highly toxic environmental stressors: a physical males (increased muscle building and gonad strengthening similar stress (heat shock: 43 degrees C for 4 minutes); an oxidative stress to effects of low-dose testosterone) was observed in a number of

46 I HerbaiGram 56 2002 www.herbalgram.org species. Administration of rhodosin (extract of R. rosea for intra­ to R. rosea (150-200 mg/ day for 3 months) with substantially venous, intramuscular, or peritoneal injection) to sexually mature improved sexual function , normalization of prostatic fluid, and an 56 69 female mice over a period of 4 weeks prolonged menstruation from increase in 17 -ketosteroids in urine. · 1.3 days (control) to 2.8 days (rhodosin treated), reduced the rest­ ing period from 3.8 days (control) to 2.2 days (rhodosi n treated), Cardioprotective Effects and increased the relative number of estrus days from 29 percent Cardioprotective effects of R. rosea include: prevention of stress­ 80 8 84 to 56 percent. In the majoriry of rhodosin treated animals, the induced cardiac damage, · " decreased myocardial catecholamines number of growing follicles, the oocyte volumes, the accumulation and cyclic adenosine monophosphate (cAMP) levels; and reduced 0 of RNA in oocyte cytoplasm, the proliferation of the lining and adrenal catecholamine release' ·" (see Figure 2). Furthermore, R. glandular cells of the uterine horns, and the preparation of uterine rosea activation of mu-opiate receptors in heart muscle prevented mucosa for fertilization all increased. In sexually mature mice, rho­ reperfusion arrhythmias in animal hearts. This effect could be dosin increased the mean weight of the uterine horns from blocked by naloxone injection (known to inhibit mu-opiare recep­ 39.6±4.11 mg to 59.5±1.59 mg and the mean weight of the ovaries tors), thus confirming rhat rhe anti-arrhythmic effect of R. rosea is from 6.4±0.65 mg to 9.1±0.45 mg. However, the administration associated with the mu-opiate receptors in myocardial (heart) mus­ of rhodosin to sexually immature female white mice for 3 weeks cle. 84 did not affect sex ual maturation, the onset of estrus, the weight of In a series of joint Swedish and Russian double-blind, random­ ovaries or uterine horns, or the maturation of follicles. Thus, it is ized placebo-controll ed studies," 10 healthy bur sedentary men probable that the estrogenic effects of R. rosea preparations depend (ages 20-31 years) were evaluated. Twenry percent of rhe subj ec ts upon a specific hormonal milieu.8283 had average physical work capaciry as measured by Power Work T hese pre-clinical investigations led to a study of R. rosea extract Capaciry (PWC-170) and 80 percent had below-average PWC- in women suffering from amenorrhea (loss of menstrual cycles). 170, indicating a low level of physical training (PWC-1 70 is a cal­ Forry women with amenorrhea were given R. rosea (either 100 mg culation based on rhe amount of work performed by a man if his heart rate reaches 170 beats per minute, bpm). A sequence of complex 1- to 7- day trials compared the effects of an adaptogen formula, a mixture of mono­ and polyphenolic adaptogens (MMPA). Each tablet contained the following ingredients: 3 mg rhodioloside from R. • Stress Response System rosea root extract, 50 mg; 3 mg total sum Adrenal Gland Heart- - Risk of Tachycardia and Arrhythmia of isofraxidine-, syringine-, and release of NE syringaresinoie-glycosides from release of Epinephrine eleuthero root extract, 100 mg; and 4 • Sympathetic/Parasympathetic System mg schizandrine and gamma-schizan­ Balances 5/ P Input -- Heart - Improves: drine from schisandra (Schisandra chi­ + Parasympathetic Heart Rate Variability nensis (Turcz.) Bail!. , Lamiaceae) fruit - Sympathetic Energy Efficiency and Reserves extract, 150 mg. During the 7 -day adaptogen trial, sub- • Direct Effects of Rhodiola Rosea on the Heart jects were given 3 capsules (containing a Neurotransmitters: - NE, - DA total of 150 mg R. rosea) twice a day on + Cellular Energy Production : + ATP, + Creatine Phosphate , - cAMP days 1-3; 4 capsules (200 mg R. rosea) twice a day on days 4-6, and 4 capsules NE = norepinephrine, DA = dopamine , ATP = adenosine triphos phate, cAMP= cyclic adenosine monophosphate, + = improves or increases , - = decreases once on day 7. The mean increase in physical work capaciry was 28 percent with dosed physical loads in subjects R. rosea extract orally twice a day for 2 weeks, or 1 ml rhodosin treated with the adaptogen formula. Thus, sedentary subjects given intramuscularly for 10 days). In so me subjects the treatment cycle the adaptogen were able to perform in the lower level of trained was repeated 2-4 rimes. Normal menses were restored in 25 athletes without any exercise training. Their heart rate variabiliry women, 11 of whom became pregnant. In those with normal and inotropic (s trength of heart muscle contractiliry) functions menses, the mean length of the uterine caviry increased from 5.5 improved. em to 7.0 em (normal) after R. rosea treatment."2·83 One of the Both the sympathetic and parasympathetic inputs to the heart authors (Dr. Brown) has treated in his practice several women who were enhanced such that the heart showed increased reserves under had failed to conceive with standard fertiliry drugs, and who stress of greater intensiry. The autonomic nervous system controls become pregnant within several months of beginning R. rosea automatic or involuntary functions of the body. It has two com­ extract. These preliminary clinical observations warrant controlled ponents: the sympathetic and the parasympathetic nerves (see Dia­ follow-up clinical trials. Using the in vitro estrogen receptor com­ gram 2). The sympathetic nervous system is the "fight-or-flight" petition assay, Patricia Eagon, Ph.D. (personal communication, system that helps the organism respond to stress (e.g., by increas­ December 2001) recently found that R. rosea extract showed ing heart rate, respiratory rate, and muscle tone). The parasympa­ strong estrogen binding properties that require further characteri­ thetic nervous system conserves and restores energy (e.g., by slow­ zation. ing the heart rate, respi­ In an open study, 26 out of 35 men with erectile dysfunction ratory rate, and metabo­ and/or premature ejacul ation (of 1-20 years duration) responded lism). By enhancing the Rhodiola rosea A Phvtomedicinal Overvie\\' www.herbalgram.org 2002 HerbaiGram 56 I 47 Rhodiola rosea functions of the sympa­ into mice) and normal bone marrow cells in two mouse cancer A Phytomedicinal Overview thetic and parasympa­ models.90 One group of mice with Ehrlich ascites tumor (EAT) and thetic systems, R. rosea another group with Lewis lung carcinoma (3LL) were first treated enables the organism to with 100 mg/kg cyclophosphamide (a chemotherapy agent) that put out more energy during stress while at the same time main­ suppressed tumor growth to 31-39 percent and limited 3LL taining higher energy reserves. One of the challenges presented by research on a multi-ingredient formula is that it is not usually pos­ sible to attribute the results to the activity of any one single herbal component. However, the results of this study are consistent with results of other research conducted solely on R. rosea monoprepa­ ranons.

Antioxidant and Anti-carcinogenic Effects R. rosea is rich in phenolic compounds, known to have strong 5 6 antioxidant properties. ·'·' Animal studies have shown that R. rosea metastases to 18 percent, while also reducing the number of nor­ decreases toxicity from cyclophosphamide, rubomycin, and adri­ mal bone marrow cells, leucocytes, and myelokariocytes, to 40-50 amycin (anti-cancer drugs), while it enhances their anticarcino­ percent and 20- 25 percent of normal, res pectively. In comparison, 87 9 ge ni c effects . ·• Udintsev and Schakhov studied the effect of R. RRRE, 0.5 mg/kg/day given orally 2- 8 days after tumors had been rosea root extract (RRRE), a tincture manufactured according to transplanted, suppressed growth of both tumors by 19- 27 percent the Russian Pharmacopoeia standards (minimum 0.8 percent and 3LL metastases 16 percent. However, in contras t to cyclophos­ salidroside and 3 percent rosavin), on tumor cells (transplanted phamide, RRRE caused no reduction in normal bone marrow

Clinical Case Studies he following cases are representative examples of the many ication. She had a partial response to the antidepressant sertraline Tclinical situations in which R. rosea may be beneficial. (Zoloft®, a selective serotonin reuptake inhibitor, SSRI), but this Although the presentation of individual cases does not carry the was not adequate for her to do more than carry out her daily job. weight of double-blind placebo-controlled trials, the authors The addition of 600 mg/day R. rosea extract (Rosavin"') enabled hope that these samples from their larger case series may help to her to return to normal enjoyment and full productivity in life. It generate interest and funding for future controlled clinical trials took about 2 months to see these effects. After 6 months, the to explore the medical applications of this multipotent medicinal patient began to doubt that she needed the R. rosea and discon­ herb. Note that in some cases the patients served as their own tinued it on her own, only to relapse over the next 3 weeks. Upon controls by discontinuing R. rosea, relapsing, and then improving reinstitution of the R. rosea, she returned to full remission and upon resumption of treatment. remains well 2 years later on sertraline and R. rosea. Ms. W., a 45-year-old writer, never quite finished her doctoral Mr. S., a 74-year-old man, had suffered from Parkinson's dis­ thesis. A "block" prevented her from completing any manuscripts ease for 10 years. Despite conventional treatment with pramipex­ for publication. Seven years of psychotherapy did not alleviate the ole (Mirapex®), levodopalcarbidopa (Sinemet®), donepezil (Ari­ problem. After "drifting" for years and being terrified of taking cept®), and rivastigmine (Exelon®) for motoric and cognitive any more prescription antidepressants, she tried 100 mg extract deficits, he was functioning poorly. He spent most of the day sit­ of R. rosea (Rosavin"', a preparation standardized to 1 percent ting in a chair, rarely speaking or initiating any activities. His salidroside and 3 percent rosavin, Ameriden International, Fall­ wife, a practicing neurologist, carefully observed his clinical sta­ brook, CA) twice a day. Although she had not considered herself tus and reported that within one week of starting 300 mg R. rosea to be depressed (and did not meet criteria for dysthymic disor­ extract (Rosavin "') twice daily he began to recover with marked der), within 6 weeks she experienced a new sense of enthusiasm progressive improvements in his abilities to think, speak, read, and increased productivity. She became able to complete writing and initiate independent activities. Because of some residual cog­ projects and to feel happy with hersel£ She was well for over two nitive impairment, galanthus ( Galanthus spp., Amaryllidaceae) an years on R. rosea. However, feeling recovered and happily mar­ herbal extract (customized formula by Ameriden International ried, she decided on her own to stop the herbal medicine and containing 100 mg R. rosea, 200 mg galanthus, and 50 mg plant gradually relapsed over 6 months. Upon resuming the R. rosea, cell-derived vitamin C) was added with consequent additional she again improved with full recovery. improvement. Ms. P., a 50-year-old computer analyst, complained of con­ Ms. A., an athletic 62-year-old Oriental woman, was diag­ stant fatigue, dragging herself out of bed every morning, and nosed with infiltrating ductal carcinoma of one breast. She began dreading encounters at work. Because she was highly sensitive to chemotherapy but suffered extreme fatigue and suppression of side effects of any psychotropic medication, she began with one her white and red blood cell counts to the point where, despite pinch (equivalent to about 50 mg) of R. rosea extract (Rosavin"') conventional treatment adjuvants, the chemotherapy regimen in her morning tea. Within a few days her fatigue was gone. She had to be repeatedly interrupted. A trial of 150 mg R. rosea had the energy and confidence to deal more effectively with the extract (Rosavin"') twice daily restored her energy and complete­ inevitable conflicts at work. ly normalized her white and red blood cell counts, allowing com­ Ms. B., a 45-year-old mental health professional, had refracto­ pletion of chemotherapy. Four months after mastectomy and ry depression and fibromyalgia for 5 years. Her symptoms were chemotherapy, Ms. A. resumed her usual rigorous martial arts completely unresponsive to multiple trials of psychotropic med- practice.

48 I HerbaiGram 56 2002 www.herbalgram.org cells. In animals given both RRRE and cyclophosphamide, the RRRE increased the antimetastatic effect of cyclophosphamide by 36 percent (p<0.05). RRRE also increased the number of leuko­ cytes by 30 percent and myelokariocytes by 16-18 percent. In another mouse tumor model, Udintsev and colleagues showed that RRRE (minimum 0.8 percent sal idroside and 3 per­ cent rosavin) increased the antitumor effect of the drug adriamycin while substantially reducing its liver toxicity. 89 Many chemothera­ py agents are hematotoxic (reduce the number of normal blood cell precursors in bone marrow) or hepatotoxic (ca use damage to the liver). These serious side effects were significantly ameliorated by RRRE. Thus, the research suggests that RRRE can both enhance tumor inhibition by chemotherapeutic drugs while allevi­ ating dangerous side effects.

Rhodiola rosea One-year-old seedlings. Photo © 2002 Bertalan Galambosi

studied, the authors advise caution in patients with bipolar spec­ OH trum diso rders. The herb does not appear to interact with other medications, though it may have additive effects with other stim­ ulants. It is bes t absorbed when taken on an empty stomach 30 Substances that reduce the incidence of chromosomal aberra­ minutes before breakfast and lunch. As with any herbal prepara­ tions are termed antimutagenic. Salikhova and colleagues found tion, patients should inform their primary heal thcare practi tioner that in mice injected with cyclophosphamide, RRRE (minimum when raking R. rosea. 0.8 percent sal idroside and 3 percent rosavin) had antimutagenic effects!' Compared to placebo controls, RRRE reduced the devel­ opment of chromosomal aberrations by 50 percent and reduced the incidence of cells with micronuclei by more than 50 percent. RRRE also increased indices of DNA repair in bone marrow cells after exposure to the mutagen N-nirroso-N-methylurea (NMU)."' In a small pilot study of 12 patients with superficial bladder car­ cinoma (TIG 1-2) , treatment with RRRE (minimum 0.8 percent salidroside and 3 percent rosavin) improved parameters of leuko­ 0 cyte integrines and T-cell immunity. 92 The average frequency of H relapse was reduced, but did not reach statistical significance. Larg­ er placebo-controlled studies of R. rosea extracts to augment tumor Rhodiola in the Future inhibition and reduce toxic effects of chemotherapy agents are needed. More scientific research is needed ro confirm the preventive and curative benefits of R. rosea. Controll ed studies are warranted to Toxicity, Side Effects, and Contraindications explore irs use in antidepressant augmentation, disorders of mem­ R. rosea has a very low level of toxicity. In rat toxici ty studies, the ory and cognition, attention deficit disorder, traumatic brain LD (lethal dose at which 50 percent of animals die) was calculat­ injury, Parkinson's disease, protection against arrhythmias, sportS 50 performance, aviation and space medicine (enhancing phys ical and ed to be 28.6 ml/kg, approximately 3,360 mg/kg. 25 The equivalent dosage in a 70 kg man would be about 235 gm or 235,000 mg. mental performance while reducing stress reactions), endocrine Since the usual clinical doses are 200-600 mg/day, there is a huge disorders (infertility, premenstrual disorder, menopause), sexual margin of safety. 87 dysfunction, disorders of the stress response system (fibromyalgia, Overall, R. rosea has very few side effects. Most users find that it chronic fatigue syndrome, and post traumatic stress disorder), and improves their mood, energy level, and mental clarity. Some indi­ enhancement of chemotherapy/radiation with amelioration of tox­ vi duals, particularly those who tend to be anxious, may feel overly ICity. activated, jittery, or agitated. If this occurs, then a smaller dose In the co urse of evolution, R. rosea has adapted to the harsh con­ with very gradual increases may be needed. R. rosea should be ditions of high al titude (extreme cold, low oxygen, little rainfall, taken early in the day because it can interfere with sleep or cause and intense irradiation from the sun) by producing a group of vivid dreams (not nightmares) during the first few weeks. It is con­ powerful protective compounds that have diverse beneficial effects traindicated in excited states. Because R. rosea has an activating in animals and humans. One is struck by the versatility of R. rosea, antidepressant effect, it should not be used in individuals with from irs description in bipolar disorder who are vulnerable to becoming manic when Greek medicine, 2000 given antidepressants or stimulants. Until this has been further years ago to its use by Rhodiola ro sea A Phytomedici nal OverviL'W www.herbalgram.org 2002 HerbaiGram 56 I 49 Rlzodiola rosea 20th century cosmo­ Biotechnology Development. In 1991 he accepted a research fellowship J\ l'hytonwd ici n,ll O vL·rvil'w nauts. It is time for at Louisiana State University. The recipient of numerous research modern research, using grants, Dr. Ramazanov is known for his work in space biology, the controlled clinical trials, cultivation of photosynthetic organisms in space stations, and the to develop the potential medical applications of this unique phyto­ develop ment of marine natural products from sea vegetables. He has adaprogen. ""' published more than 140 scientific studies and co-authored two books: Arctic Root (Rhodiola rosea) -The powerful new Ginseng Alter­ Richard P Brown, M.D., is Associate Clinical Professor ofPsychia­ native (1 998) and Effective Natural Stress and Weight Manage­ try at Columbia University College of Physicians and Surgeons in ment Using Rhodiola Rosea and Rhododendron Caucasicum New York City. He received his M.D. in 1977 from Columbia Uni­ (I 999). Dr. Ramazanov is President and CEO of National Rio­ versity College of Physicians and Surgeons in New York. D r. Brown sciences Corporation, Chester, NY. completed his Residency in Psychiatry and a Fellowship in Psychobiol­ Acknowledgement: The authors are gratefol to D r. Bertalan Galam­ ogy and Psychopharmacology at New York Hospital. Dr. Brown is the bosi from Agrifood Research Finland, Ecological Production, of recipient of numerous awards, including a Mead-Johnson Neuropsy­ Mikkeli, Finland, for providing the photographs ofRhodiola rosea. chopharmacology Travel Fellowship, a Mallinckrodt Scholar award, and a Fellowship in Neurosciences and Brain Imaging from the Dana References Foundation. H e has had a longstanding interest in herbal and com­ 1. Engler A. Syllabus der Pjlanzenfamilien. Vol. 2. Berlin, Germany: plementary medicine, especially as relevant to psychiatry. In 2000, he Bornrraeger; 1964. p. 199-200. 2. Saratikov AS , Krasnov EA. Rhodiola rosea is a valuable medicinal co-authored the book, Stop Depression Now, which presents a holis­ plant (Golden Root). Tomsk, Russ ia: Tomsk State Unive rsity Press; tic approach to the treatment of depression, including SAM-e. Since 1987. 1999, Dr. Brown has taught a foil day course on Herbs and Nutrients 3. Mell CD. Dyes, tannins, perfumes, and medicines from Rhodiola in Psychiatry at the annual meetings ofthe American Psychiatric Asso­ rosea. Textile Colorist 1938;60(715):483-4. ciation. Dr. Brown has no financial interest in Rhodiola rosea. 4. Linnaeus C. Materia Medica. Liber I. De Plantis. Stockholm, Swe­ Patricia L. Gerbarg, M.D., is Assistant Clinical Professor in Psy­ den: Lars Salvius; 1749. p. 168. chiatry at New York Medical Center. She graduated from Harvard 5. Linnaeus C. Ortabok. Stockholm, Sweden: Almquist and Wiksell; Medical School in 1915 and completed her Psychiatry Residency at 1725. p. 127. 6. Linnaeus C. Plants ofLapland. Uppsala, Sweden: T he Royal Science Beth Israel Hospital in Boston in 1979. She finished psychoanalytic Academy's documents; 1754. p. 182-7. training at the Boston Psychoanalytic Society and Institute in 1992 7. Linnaeus C. Flora Oeconomica eller Hush!dls-Nyttan af de i Swerige, and has maintained a private psychiatric practice for 23 years. Dr. Wildt wiixande Orter. Stockholm, Sweden: Lars Salvii; 1748. p. 399. Gerbarg has taught and lectured on a range oftopi cs in psychiatry and 8. Linnaeus C, Tonning H. Norwegian Rarities. Uppsala, Sweden: Johan psychoanalysis. Over the past eight years she has been increasingly Edman;l768. p. 3-19. involved in research and writing about alternative and complementa­ 9. Sandberg F, Bohlin L. Fytoterapi: viixbaserade Liikemedel [Remedies ry medicine in psychiatry and has co-authored numerous articles and based on herbs]. Stockholm, Sweden: Halsokostdidets forlag AB; book chapters with Dr. Brown. Dr. Gerbarg has no financial interest 1993. p. 13 1. 10. Commission Nationale de Ia Phatmacopee Fran<;:aise. Pharmacopee in Rhodiola rosea. Franfaise. IX ed. Table alphabetique revisee des drogues vegetales. Paris, France: French Agence du Medicament-Direction des French Laboratoires et des Comr6les, Unite Pharmacopee; 1974. p. II A2l4- JOJ. 11 . Sandberg F. Herbal Remedies and Herb Magic. Stockholm, Sweden: Det Basta; 1998. p. 223. 12. Mashkovskij MD. Doctor's manual: medical drugs. 12th ed. Vol. 1. Moscow, Russ ia: Medirzina; 1976. p. 161-5. 13. Khaidaev Z, Menshikova TA. Medicinal Plants in Mongolian Medi­ cine. Ulan-Bator, Mongolia; 1978. 14. Magnusso n B. Fiigringar: Viixter som beriir oss (Beauty: herbs that touch us) . Ostersund, Sweden: Berndtssons; 1992. p. 66-7. 15. Hoppe H . Drogen kunde. Band 1, Angiosperm 8.Berlin, Germany: Walter de Gruyter; 1975. p. 986-7. 16. Norr H . Phytochemical and pharmacological investigation of the adaptogens: Eleutherococcus senticocus, Ocimum sanctum, Codonopsis pilosula, Rhodiola crenulata [dissertation] . Munich, Germany: Facul­ ty of Chemistry and Pharmacy, Ludwig-Maximilians-Universitat MUnchen; 1993. Roots of 5 year old cultivated Rhodiola rosea. L. Mikkeli, Finland, 2002 17. Krylov GV: Herbs for Life. Novosibi rsk, Russ ia: Academic Press; Photo © 2002 Bertalan Galambosi 1969. p. 264. 18. Darbinyan V, Kteyan A, Panossian A, Gabrielian E, Wikman G, Wagner H . Rhodiola rosea in mess induced fatigue: a double blind Zakir Ramazanov, Ph.D., D.S., is Professor ofBiochemistry at Las cross-over study of a standardized extract SHR-5 with a repeated Palmas Technological Institute, Spain. In 1978 he received a bache­ low-dose regimen on the mental performance of healthy physicians lor's degree with a double major in biochemistry and plant physiology during night duty. Phytomedicine 2000;7(5):365-7 1. 19. Komarov VL, editor. Flora ofthe USSR. Volume IX, Rosales and Sar­ from North Caucasian State University and in 1981 a Ph.D. in Plant raceniales. Genus 698: Rhodiola L. Leningrad, Russia: The USS R Physiology and Biochemistry from the Soviet Academy ofSciences . H e Academy of Sciences: 1939. Translation: Jerusalem, Israel: Israel Pro­ has served as Senior Scientist and Chiefof the Department ofBiotech­ gram for Scientific Translation; 1971. p. 20-36. nology at the Soviet Academy of Science and as Chairman ofAlgal 20. Hegi G, editor. lllustrierte Flora von Mitteleuropa. Vol.IV/2, Liefering

SO I HerbaiGram 56 2002 www.herbalgram.org 2/3. Hamburg/Berlin, Germany; P. Posey: 1963. p. 99-102. valuable medicinal plant (Golden Root) . Tomsk, Russia: Tomsk State 21 . Ohba H. A revision of the eastern Himalayan species of the subgenus Un ive rsity Press; 1987. p. 194-215. Rhodiola of the ge nus Sedum. In: Ohashi H , editor. Flora of Eastern 42. Petkov VD, Stancheva SL, Tocuschieva L, Petkov VV. Changes in Himalaya, 3rd report. Tokyo, Japan: University ofTokyo Press; 1975. brain bioge ni c monoamines induced by the nootropic drugs p. 283-362. adafenoxate and meclofenoxate and by citicholine (ex periments on 22. Sarati kov AS, Krasnov EA. Chapter I: C hemical composition of rats). Gen Pharmacol1990;2 1(1 ):7 1-5. Rhodiola rosea. In: Saratikov AS , Kras nov EA. Rhodiola rosea is a 43. Baranov VB. Experimental trials of herbal adaprogen effect on the valuable medicinal plant (Golden Root) . 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Sverdlovsk, Russia. 1970 Sept 15-16. Siberian Branch of 61. Merikangas K, Angst J. Neurasthenia in longitudinal cohort study of the Russian Academy of Sciences. p. 46-8. 83.Sararikov AS, Kras­ young adults. Psychological Medicine 1994;24(4): 1013-24. nov EA. Chapter Vl: T he influence of Rhodiola on endocrine glands 62. Lin TY. Neurasthenia revisited: irs place in modern psychiatry. Psy­ and the liver. In: Sararikov AS, Krasnov EA, editors. Rhodiola rosea is chiatric Annals 1992;22(4): 173-87. a valuable medicinal plant (Golden Root) . Tomsk, Russia: Tomsk Stare 63. Zheng YP, Lin KM, Takeuchi D , Kurasaki KS , Wang Y, Cheung F. University; 1987. p. 180-93. An epidemiological study of neurasthenia in C hinese-Americans in 84. M aimeskulova LA, Maslov LN, Lishmanov luB, Krasnov EA. The Los Angeles. Comprehensive Psychiatry 1997;38(5):249-59. participation of the mu-, delta- and kappa-opioid receptors in the 64. U.S. Department of H ealth and Human Services. The international realiza tion of the ami-arrhythmia effect of Rhodiola rosea. Eksp Klin Classification ofD iseases. lOth Revision (IC D-10). Washington, DC: Farmako/ 1997;60(1 ):38-9. U.S. D epartment of H ealth and Human Services; 1992. 85. Baranov VB. The respo nse of cardiovascul ar system to dosed physi­ 65. Zarova MI, Krilov GV, Sararikov AS. Golden root: new stimulative cal load under the effect of herbal adaprogen. Contract 93-11-615 and adaptogenic drug. Proceedings of Siberian Academy of Sciences. Phase I and Phase II. Moscow: Russ ian Federation Ministry of Biological and Medical Sciences. 1965;2: 111 -9. Health Institute of Medical and Biological Problems; 1994. 66. Saratikov AS. Screening for natural central nervous system stimu­ 86. Bolshakova IV, Lozovskaia EL, Sapezhinskii II. Antioxidant proper­ lants. In: Sararikov AS, ediror. Stimulants of the Central Nervous Sys­ ti es of a series of extracts from medicinal planrs. Biofizika tem. Vol. I. Tomsk, Russia: Tomsk State University Press; 1966 p. 3- 1997;42(2):480-3. 23. 87. Udinrsev SN, Schakhov VP. Decrease of cyclophosphamide haema­ 67. Brichenko VS, Kupriyanova IE, Skorokhova TF. The use of herbal roroxicity by Rhodiola rosea root extract in mice with Ehrlich and adaprogens with tricyclic antidepressants in patients with psy­ Lewis transplantable rumors. Eur J Cancer 1991;27(9): 1182. chogenic depression. In: Sararikov AS, editor. Modern Problems of 88. Borovskaya TG, Fomina TI, laremenko KY. A decrease in rhe roxie Pharmacology and Search for New Medicines. Tomsk, Russia: Tomsk action of rubomycin on the small intestine of mice with a trans­ State University Press; 1986. p. 58-60. plantable rumor through the use of a Rhodiola exrracr. Antiobiot 68. Manson MP, Pedersen WA, Duan W, Culmsee C, Camandola S. Khimioter 1988;33(8):615-7. Cellular and molecular mechanisms underlying perturbed energy 89. Udinrsev SN, Krylova SG, Fomina TI. The enhancement of the effi­ metabolism and neuronal degeneration in Alzheimer's and Parkin­ cacy of adriamycin by using heparoprotecrors of plant origin in son's diseases. Ann NY Acad Sci 1999;893:154-75. metastases of Ehrlich's adenocarcinoma to the liver in mice. Vopr 69. Sararikov AS, Krasnov EA. C hapter III: Stimulative properties of Onkol 1992;38(10):1217-22. Rhodiola rosea. In: Sararikov AS, Krasnov EA, editors. Rhodiola rosea 90. Udinrsev SN, Shakhov VP. The role of humoral factors of regenerat­ is a valuable medicinal plant (Golden Root). Tomsk, Russia: Tomsk ing li ver in the development of experimental rumors and the effect of Stare University; 1987. p. 69-90. Rhodiola rosea ex tract on this process. Neopfasma 1991;38(3):323-31. 70. Panoss ian A, Wikman G, Wagner H. Plant adaprogens. III. Earlier 91. Salikhova RA, Al eksa ndrova IV, Mazurik VK, Mikhailov VF, and more recent aspects and concepts on their mode of action. Phy­ Ushenkova LN, Poroshenko GG. Effect of Rhodiola rosea on the tomedicine 1999;6(4) :287-300. yield of mutation alterations and DNA repair in bone marrow cells. 7 1. Salnik BU. Effect of several srimularors on central nervous system Patol Fiziol Eksp Ter 1997;(4):22-4. energy metabolism during muscular workload [dissertation]. Tomsk, 92. Bocharova OA, Marveev BP, Baryshnikov Alu, Figurin KM, Serebri­ Russia: Tomsk State M edical Institute; 1970. akova RV, Bodrova NB. The effect of a Rhodiola rosea extract on the 72. Adamchuk LB. Effects of Rhodiola on the process of energetic recov­ incidence of recurrences of a superficial bladder cancer (experimen­ ery of rat under intense muscular workload [dissertation] . Tomsk, tal clinical research). Urol Nefrol (Mosk) 1995;(2):46-7.

52 I HerbaiGram 56 2002 www.herbalgram .org Small Minority Accounts for Majority of Botanical Product Sales

ccording to a report in Nutrition Busi­ dietary supplements and organic, natural percent of Americans don't take vitamins, 70 Aness j ournal, Consumer Research in the and functional foods remain positive, the perce nt don't take herbal supplements, 75 Nutrition Industry II, consumers are industry reli es upon a ve ry "pliable" con­ percent don't take minerals, 85 percent don't expressing a strong and growing desire for sumer. Consumers lack educati on in herbal take specialty supplements, and 95 percent better health through their beliefs, and, to a science, brands, and regul ations- without don't take sports supplements. T he numbers lesse r extent, through purchases of food, it they remain vulnerable to misco nceptions of rare and occasional users are also high, supplements, and other healthy lifestyle and misin fo rmati on. leaving a vas t majori ty of sales in a smal l products. Unfo rrunately, many co nsumers T he information in the table below is minority of the population for every catego­ are also, at bes t, vague and, at worst, con­ compiled by N BJ from more than 30 credi­ ry with the exception of multivitamins. fused or ignorant about eve rything except ble consumer surveys and reconciled agai nst T he full report, with data on all product basic nutritional messages. manufacturer and retailer sales fi gures. categories, may be ordered by calling Reviewing the results of N Bfs annual Perhaps most interesting, and most reveal­ 6 19/295-7685 ext. 12, or online at consumer iss ue, it is clear that while ing, is not who is taking supplemenrs, bur . -"" resea rchers believe long-term tre nds for who is not. N BJ concludes that about 45 -Karen Robin

Consumer Usage: Herbs & Botanicals 2000-2001

U.S Consumer Herbs/Botanicals Use 2000 Consumer Type Population %of # of purchases $spent/ Annual Total %ofmkt. (mil.) pop. /month month ($mil.)

Heavy Consumers 3.3 1.5% 2.5 $29.62 $1 '178 29%

Regular Consumers 10.5 4.8% 1.0 $11.85 $1,492 36%

Occasional Consumers 17.7 8.0% 0.3 $3.47 $735 18%

Rare Users 33.7 15.3% 0.2 $1.78 $718 17%

Non-Users 155.7 70.5% 0.0 $0.00 0%

Totals 221 Total Herbs/Botanicals $4,123 100%

U.S Consumer Herbs/Botanicals Use 2001 Consumer Type Population %of # of purchases $spent/ Annual Total %of (mil.) pop. /month month ($mil.) mkt.

Heavy Consumers 3.3 1.5% 2.5 $29.47 $1 ,1 83 28%

Regular Consumers 10.6 4.8% 1.0 $1 1.79 $1,501 36%

Occasional Consumers 18.2 8.2% 0.3 $3.45 $752 18%

Rare Users 34.6 15.5% 0.2 $1.77 $733 18%

Non-Users 156.3 70.1% 0.0 $0.00 0%

Totals 223 Total Herbs/Botanicals $4,170 100%

Source: Nutrition Business Journal (San Diego), derived from a variety of sources. Totals may not add up due to rounding. Copyright ©2002 Penton Media, Inc. Reprinted w ith permission. Some figures are approximations that have been compiled from more than 20 consumer survey sources. These sources include The Hartman Group, Multi-Sponsor, Harris Interactive, The Natural Marketing Institute, Health Focus, Sloan Trends & Solutions, the U.S. Census Bureau, Food Marketing Institute, Q2 Brand Intelligence, Key Note, Prevention Magazine, Rodale, Roper ASW, Mintellnternational and SRI Business Intelligence. Usage figures vary greatly. The Nutrition Business Journal (NBJ ) has made every effort to present accurate usage and buying patterns by reviewing all relevant sources of consumer data and reconciling this research against consumer expenditures estimated and publi shed by NBJ. Although NBJ has made every effort to be accurate, all figures are not the result of direct surveys and therefore are not guaranteed to be accurate. Errors are unintentional. Population figures assume 2000 pop= 281 m, 2000 adults=221 m, 2001 pop=284m, 2001 adults=223m (m = million). www.herbalgram.org 2002 HerbaiGram 56 I 53 Farm Bill Bans Use of Name 11Ginseng" on Non-Panax Species: 11Siberian Ginseng" no longer allowed as commercial term by Mark Blumenthal

he new Farm Security and Rural Invest­ given as preferred over Siberian ginseng (B) only labeling or advertising for Tment Act of 2002 ("Farm Bill") has a ("Other Common Name"). In 1997 the herbs or herbal ingredients classified provision that effectively bans the use of the U.S. Food and Drug Administration (FDA) within that genus may include the name "Siberian Ginseng" and any other use adopted Herbs ofCommerce as an official list term 'ginseng'. of the term "ginseng" in a commercial for common names of herb products sold in (2) AMENDMENT - Section 403 of herbal product unless it is used for an herb the United States. Subsequent federal regu­ the Federal Food, Drug, and Cosmetic in the genus Panax. The new law, signed by lations require that common names used on Act (21 U.S.C. 343) (as amended by President George W. Bush on May 13, products be consistent with the names stan­ subsection (a)(2)) is amended by 2002, makes the term "S iberian ginseng" dardized in that edition of Herbs of Com­ adding at the end the following): for Eleutherococcus senticosus illegal in com­ merce.5 Thus, eleuthero has been the pre­ '(u) If it purportS to be or is represented merce on herb product labels, as well as in ferred commercial name since 1997. as ginseng, unless it is an herb or herbal promotion literature and adverrising. 1 The second edition of Herbs ofCommerce, ingredient derived from a plant classi­ The term "Siberian Ginseng" has been published in 2000, also lists eleuthero as the fied within the genus Panax'. used in the United States since Eleutherococ­ "Standard Common Name;" Siberian gin­ The ginseng provision was introduced cus senticosus (Rupr. & Maxim.) Maxim., seng is listed as an "Other Common Name" into the Farm Bill by U.S. Sen. Russell Araliaceae was introduced as a commercial along with "Ussurian thorny pepperbush," Feingold (D-WI), presumably representing herbal product in the 1970s and since the a name proposed by Russian researchers the interests of the fairly influential Wis­ publication of Richard Lucas' booklet that never received appreciable acceptance consin American ginseng growers lobby, Eleuthero (Siberian Ginseng). 2 In the late in commerce." including the Ginseng Board ofWisconsin, 1970s there was considerable debate within The introduction to Herbs of Commerce Inc. (GBW). According to a release from the herb industry about the name. Ginseng states, "In no case is the listing of a common AHPA, the organization worked closely purists did not want to see it sold with the name in this ("Other Common Names"] with Feingold's office "in developing this common name ginseng as they did not con­ field meant to imply that such a name is an law in a manner that is consistent with cur­ sider it a true ginseng (i.e., in the genus acceptable option in identifying plants in rem FDA regulations and AHPA's Herbs of Panax, which includes Asian ginseng, P. gin­ labeling, and, in fact, only the Standardized Commerce. We were able to successfully seng, and American ginseng, P. quinque­ Common Name is acceptable for this pur­ show that their original approach, based on filius). Others with commercial interest in pose."" The book's editors and AHPA offi­ the chemistry of ginsenosides, was problem­ the importation of eleuthero argued, suc­ cials anticipate that FDA will eventually atic. We were also persuasive in requesting cessfully at the time, that both genera are adopt this second edition as its listing of that this legislation not attempt to amend members of the family Araliaceae, both are standardized common names for herbs sold DSHEA [the Dietary Supplement Health used as adaptogens or tonics, and they are in the United States, but the FDA has not and Education Act of 1994]. Ultimately, somewhat interchangeable in their use. The announced its acceptance. however, it has been a principle cause of the new Farm Bill now settles that old argu­ The American Botanical Council rein­ Ginseng Board of Wisconsin to reserve the ment in favor of the purists, particularly forces this nomenclature in its publications. name 'ginseng' for plants of the genus those with an economic interest in the term Eleuthero is the common name used in Panax, and this legislation is the Ginseng "ginseng" here in the United States: ginseng HerbalGram and the li stings for E. senticosus Board's coup de grace on this issue."7 farmers in Wisconsin. in ABC's three books* have used this term. AHPA's reference to ginsenoside chem­ A press release from the Ginseng Board of istry refers to the position taken by the Gin­ Wisconsin called for the immediate removal Specific language seng Board ofWisconsin, Inc. (GBW) that of "false products" from the U.S. market, The Farm Bill provision contains the fol­ the chemistry of both P. ginseng and P. quin­ stating, erroneously, that American and lowing language under Subtitle I- Gener­ quefolius is characteristically different from Asian ginseng are the "only two kinds of al Provisions: the chemical structures in eleuthero. A ginseng in the world."3 Other species in Section 10806. Market Names for Cat­ GBW press release states that eleuthero commerce that qualifY as ginseng include fish and Ginseng: "does not contain any ginsenosides (the Japanese ginseng (P. japonicus C.A. Mey.) (b) Ginseng Labeling - [primary] active ingredients in ginseng) but and Vietnamese ginseng (P. vietnamensis Ha (1) IN GENERAL - Notwithstanding contains Eleutherosides E and B. Some of & Grushv.). any other provision of law, for purpos­ The trend toward using the common es of the Federal Food, Drug, and Cos­ * ABC's three books are The Complete name eleuthero for E. senticosus began as a metic Act (21 U.S.C. 301 et seq.) German Commission E Monographs: movement within the herb industry itself, (A) the term "ginseng" may only be Therapeutic Guide to Herbal Medicines and was codified in the first edition of Herbs considered to be a common or usual (1998), Herbal Medicine: Expanded of Commerce.' In that 1992 publication, name (or part thereof) for any herb or Commission E Monographs (2000), and which lists approximately 550 herbs sold in herbal ingredient derived from a plant The ABC Clinical Guide to Herbs (in the U.S. market, the name eleuthero was classified within the genus Panax; and press).

54 I HerbaiGram 56 2002 www.herbalgram.org the eleutherosides are glycosides, but they rion that FDA will "rake al l appropriate Health Herb of Russia. R&M Books: don't include the 'saponin glycosides that action to expeditiously enforce" the new Spokane (WA); 1973. characterize Panax ginseng."'3 limits to the use of "ginseng" on product 3. Ginseng Board of Wisconsin. Farm bill bans use of name "ginseng" on non-Panax On June 18, 2002, AHPA's President labeling or in advertising. Obey is the rank­ species: Siberian ginseng, Indian ginseng, Michael McGuffin wrote to the FDA and ing minority member of the House Appro­ Brazilian ginseng, and others no longer the Federal Trade Commission (FTC), not­ priations Committee, which includes the allowed as commercial term (press release). ing that AHPA nomenclatural policy was Subcommittee on Agriculture, Rural Devel­ Wausau , WI. 2002. already codified as an industry standard by opment, Food and Drug Administration 4. FosterS. Herbs of Commerce. Austin (TX): both editions of Herbs ofCommerce, that the and Related Agencies. American Herbal Products Association; term ginseng was reserved for species in the AHPA reports rhat it has received a 1992. genus Pana.x, and that eleurhero was already response to its requests from FTC, in which 5. 21 Code of Federal Regulations. Sec. 10 1.4(h)( 1) -(2). the standardized common name for E. sen­ they stated, "While the FTC will coordinate 6. McGuffin M, Karresz JT, Leung AY, Tuck­ with FDA and provide whatever assistance ticosus.7 er AO. Herbs ofCommerce . 2nd edition. Sil­ ''AHPA fully understands and accepts the they may require in their enforcement of ver Spring (MD): American Herbal Prod­ purpose and rationale of the Farm Bill's gin­ this new measure, we anticipate that FDA ucts Association; 2000. seng section and AHPA does not oppose will take the primary role in implementing 7. McGuffin M. Letter to JA Levin, C Taylor, this law," he wrote. However, McGuffin rhis amendment to their statute." The FDA MK Engle, M Rusk. 2002, Jun 18. noted that many of AHPA's members need had not yet responded. 8 8. Gellman R. Eleuthero/Ginseng. AHPA ample time to sell already manufactured AHPA said they learned from Obey's Report. 2002 September. products labeled Siberian ginseng, that office that the word "expeditiously" is nor some members still use the name Siberian meant to instruct FDA to make this their ginseng, and he requested a moratorium to most immediate priority, it is also clear that SAMOAN VILLAGE allow members to re-label future eleuthero he will not support a full year of non­ Continued from page 17 products. enforcement. with a major article appearing in London's The AHPA letter requested the follow­ The U.S. Senate Agriculture Appropria­ Financial Times. It is believe that the ARA­ ing:7 tions Subcommittee, chaired by Sen. Herb Samoa agreement is the first rime that a • Products labeled Siberian ginseng: a Kohl (0-WI), also has j urisdicrion over the pharmaceutical developer has agreed to period of one year from May 13, 2002, FDA budget, among other agencies. Like return royalty shares on a drug to indige­ within which to run out inventories of Obey, Kohl reportedly would like to see the nous peoples and village healers. products containing eleuthero that are law on this issue enforced expeditiously. "Ethnobotanical research in Samoa presently labeled as "Siberian ginseng." Nthough a relatively popular herb, helped us to learn about this important nat­ • Products labeled eleuthero: a period of eleurhero usually lags behind Asian ginseng ural resource and irs potential for treating two years from May 13, 2002, within in retail sales in most channels of trade and HIV," Barefield said. "It is only right that which to manufacture and ship prod­ ahead of American gi nseng. Market surveys the people of Samoa share in any potential ucts containing eleuthero that are are often unspecific about the type of gin­ reward, and we hope that this agreement labeled as eleuthero with parenthetical seng being measured, so ir is probable that will set a standard on ethical dealings with information that references the former such survey statistics can include sales for medicines derived from indigenous cul­ name of "Siberian ginseng" (e.g., "for­ both American and Asian ginsengs as well as tures." merly known as Siberian ginseng," or eleurhero. The AHPA letter cites a survey Cox, who originally discovered the plant, "formerly, Siberian ginseng"). from Nutrition Business journal staring that said that rhe signing of the agreement was • Advertising eleurhero: a period of two sales of "ginseng" were reponed in 2000 to one of the "happiest days" of his life. "As an years from May 13, 2002, for manu­ be $173 million, or 7.5 percent of all "sin­ ethnobotanist, my dream has always been to facturers, distributors, and retailers to gle herbal category" sales. return some benefit to the indigenous peo­ advise consumers in advertising that The new legal provision also impacts the ple who have been so kind and caring to me eleuthero was formerly known as use of the word "ginseng" in relation to over the years. I hope that the ARA-Samoa "Siberian ginseng." other species not in rhe genus Pana.x includ­ agreement will prove to be a useful model McGuffin stated that AHPA was in con­ ing so-called "Indian" or "Ayurvedic gin­ for benefit sharing in the future."--- tact with Feingold's staff and the Wisconsin seng" for ashwagandha ( Withania somnifera -Kim West G inseng Board ofTrade on this matter and (L.) Ounal, Solanaceae), "Brazilian ginseng" requested from FDA and FTC their agree­ for suma (Hebanthe eriantha (Poir.) Peder­ Reference: ment and assent to the AHPA proposal and son, Amaranthaceae, syn. Pfaffia paniculata I. Benefit sharing and prostratin [interview]. a compliance timetable. As of rhe rime of (Mart.) Kuntze, Amaranthaceae), and other Plant Talk. 2002;27:38-9. this writing Quly 23), there was no word terms that have exploited the term ginseng 2. Kulkosky J, Culnan OM, Roman J, Dor­ from either agency of their agreement to the in commerce. --- nadula G, Schnell M, Boyd MR, Pomer­ proposal. References antz RJ . Prostrarin: activation of latent HIV-1 expression suggests a potential A report from rhe U.S. House Commit­ I. 107rh Congress. Farm Security and Rural inductive adjuvant therapy for HAART. tee on Appropriations dated July 26, 2002, Investment Act of 2002. Public Law I 07- 171 . David Obey (O-Wl) that states an expecta- 2. Lucas R. Eleuthero (Siberian Ginseng): www.herbalgram.org 2002 HerbaiGram 56 I 55 FDA Issues Final Rule Banning Use of Aloe and Cascara Sagrada in OTC Drug Products by Holly J. Bayne, Esq. n May 9, 2002, the U.S. Food and subject to FDA premarket approval require­ labeled in accordance with the TFM, which O Drug Administration (FDA) issued a ments applicable to "new drugs."4 General­ mandates certain warning statements. final rule banning the use of aloe (Aloe spp., ly, only active ingredients used in OTC The 1985 TFM also classified "senna­ Aloaceae) and cascara sagrada (Frangula drug products in the United States prior to sides A and B" derived from certain senna purshiana (DC.) ].G. Cooper, Rhamnaceae; December 1975 were included in the (Senna alexandrina Mill., Fabaceae; syn. syn. Rhamnus purshiana DC.) as laxative Review. To facilitate the process, FDA Cassia senna L.) sources (fruits and leaves) as ingredients in over-the-counter (OTC) divided OTC drugs into therapeutic classes CRASE for stimulant laxative OTC drug drug products. 1 Under the new regulation, and set up advisory panels to consider safe­ use. the botanical ingredients "aloe," "aloe ty, effectiveness, and labeling (i.e., indica­ In 1998, FDA proposed amending the extract," and "aloe flower extract," as well as tions, warnings, and directions for use). In TFM to reclassify aloe, cascara sagrada, and "cascara sagrada'' (including "casanthrol," general, each panel prepared a report that senna ingredients from CRASE ("Category "cascara fluid extract aromatic," "cascara was published by FDA in the Federal Regis­ I") to "Category III" (i.e., more data need­ sagrada bark," "cascara sagrada extract," and ter for public comment as an advance notice ed).7 FDA issued the proposed rulemaking "cascara sagrada fluid extract") are deemed of proposed rulemaking. The reports set apparently after considering data and infor­ not "generally recognized as safe and effec­ forth the conditions (i.e., active ingredients, mation on the safety of bisacodyl, senna, tive" (CRASE) for use as stimulant laxative therapeutic claims, and labeling) under and "rwo related" anthraquinone laxative ingredients in OTC drug products. The which the panels believed the products are ingredients, danthron and phenolphthalein. regulation is scheduled to become effective CRASE and not misbranded. This classifi­ Formerly, phenolphthalein was the active on November 5, 2002. After that date, any cation is known as "Category I." The panels ingredient in leading over-the-counter laxa­ OTC drug product containing aloe or cas­ also identified the conditions under which tives marketed by the pharmaceutical cara sagrada and labeled for laxative use that they believed OTC drugs are not CRASE industry.• is introduced into interstate commerce will (that is, "Category II") , or not classifiable The proposed reclassification was based be considered a "new drug" in violation of because there were insufficient data at the on FDA's conclusion that aloe, cascara federal law. No recall of products already on time of the review to make a decision sagrada, and senna contain anthraquinone the market or in distribution has been sug­ regarding safety or efficacy ("Category III"). ingredients which require mutagenicity, gested. Under the OTC Drug Review proce­ genotoxicity and carcinogenicity tests to In response, on June 10, the American dures, after consideration of comments to a confirm safety. In a notice of proposed rule­ Herbal Products Association (AHPA) and panel report, FDA publishes a "tentative making published in the Federal Register on the International Aloe Science Council final monograph" (TFM), which has the June 19, 1998, FDA indicated that the (IASC) filed a joint petition with FDA legal status of a "proposed rule." After con­ Center for Drug Evaluation and Research (''AHPNIASC Petition") requesting that sidering comments to the TFM, FDA issues (CDER) Carcinogenicity Assessment Com­ FDA stay (i.e., set aside) the effective date a final monograph (final rule) , which is mittee (CAC) "has recommended that the of the regulation and reconsider the status eventually codified in the Code of Federal anthraquinone laxatives (aloe, cascara sagra­ of the aloe and cascara sagrada ingredients.' Regulations (CFR). OTC drugs that com­ da, and senna) and bisacodyl be tested in The AHPNIASC Petition challenges FDA's ply with the specifications of a final mono­ the standard battery of genotoxicity rests final rule on both legal and scientific graph are not "new drugs" and may be mar­ and under the test conditions by which grounds, arguing that aloe and cascara keted without FDA approval of a new drug phenolphthalein was found to be positive. "9 sagrada ingredients cannot be deemed to be application. At that time, FDA advised interested per­ "new drugs" because they are CRASE based sons to consult with the agency concerning on readily available information. Although FDA's review of laxative drug carcinogenicity testing requirements and FDA regulations require the FDA Commis­ products protocols before initiating such resting. sioner to "promptly review" such petitions, In 1975, FDA's Advisory Review Panel FDA also indicated that, if data were nor there is no time frame imposed upon the on OTC Laxative, Antidiarrheal, Emetic, provided or were deemed to be inadequate Commissioner to act. 3 and Antiemetic Drug Products recom­ for aloe, cascara sagrada, and senna (and mended that aloe and cascara sagrada ingre­ bisacodyl), the ingredients would be Overview of FDA's OTC Drug dients be classified CRASE for laxative drug deemed not CRASE and placed in "Cate­ Review use. 5 In January 1985, FDA published a gory II." 10 In response, FDA received safety The ban is part of FDA's OTC Drug proposed rule (TFM) setting forth the con­ data only on senna (and bisacodyl) and has Review, an ongoing administrative review ditions under which OTC laxative drug indicated that these ingredients will be process begun in 1972 to determine which products are CRASE and nor misbranded.6 addressed in a future issue of the Federal active ingredients are CRASE for use in In that TFM, the stimulant laxative ingredi­ Register. OTC drug products. Drugs that are gener­ ents "aloe" and "cascara sagrada ingredients" In issuing the May 2002 ban on the use ally recognized by qualified experts as safe are classified as CRASE, that is, "Category of aloe and cascara sagrada in OTC laxative and effective for their labeled uses are not I," for use in OTC drug products when drugs, FDA concluded that, because inter-

56 I Herba iGram 56 2002 www.herba lgram.org ested persons (e.g., members of the pharmaceutical and dietary sup­ agency did nor consider the effects of the final rul e on companies plement industries) failed to submit new data from carcinogenicity that manufacture and market dietary supplements containing aloe studies for these ingredients, they are not C RAS E. Thus aloe and and cascara sagrada as laxa ti ve ingredients, as well as rhe effects on cascara sagrada ingredients will not be included in the forthcoming companies selling aloe as a food or dietary supplement product fo r final monograph for OTC laxa tive drugs. T he FDA has determined non-laxative use. Previously, FDA has recognized rhar most of the that these ingredients should be eliminated from laxative drug manufacturers and distributors of dietary supplements meet the products within 180 days of publication of the final rule (i.e., definition of a "small business." " November 5, 2002), regardless of whether toxicology tes ting is undertaken in the future." While compani es are encouraged to Future actions comply with the regulation immediately, products containing aloe C urrently, it is uncertain whether FDA wil l act on the and cascara sagrada may be marketed and distributed through AHPA/lASC Petition in a timely manner. However, FDA is not November 4. Beginning November 5, existing inventory on mar­ likely to rev ise rhe regulation to permit rhe use of aloe an d cascara ket shelves may continue to be sold until it is gone, but no further sagrada in OTC laxa ti ve drugs unless industry submits new data. distribution wi ll be permitted. Industry could submit to FDA new toxicological resting data or data concerning general recognition of safety as parr of a citizen The AHPA/IASCS petition petition to amend rhe monograph. Under FDA procedures, the The AHPNlASC Petition seeks a stay in the effective date of rhe agency must act on such petition within 180 days. regulation until FDA and a rel evant Advisory Committee have Alrernarivel y, new data concerning aloe or cascara sagrada could reco nsidered the action. Principally, rhe Petition argues that: be submitted to FDA as parr of a new drug application (NDA) to • rhe failure of interested perso ns to submit resting data reques t­ obtain prescription or OTC marketing status. This route appea rs ed by FDA does nor invalidate the general recognition of safe­ highly unlikely due to the huge investment in rime and money that ty and effectiveness of aloe and cascara sagrada confirmed by such undertaking would require, particularly since these ingredients the Advisory Committee that initially reviewed rhe data; are not patentab le. Moreover, although an "innovator" company • FDA does nor have the statutory authority to unilaterally can ge nerally ex pect five yea rs of marketing excl usivity for a drug decide the requirements of general recognition of safety and approved by FDA under a NDA (regardless of any parent prorec- efficacy; and • aloe and cascara sagrada meet rh e legal standard for "ge neral Continues on page 58 recognition of safety" established by FDA's own regulations which state: "a low incidence of adverse reactions or significant side effects under adequate directions for use and warnings against unsafe use .. . proof [of safety] shall include results of significant human experi ence during marketing .... "" AHPA and lASC also assert rhar FDA fai led to consider relevant data and readily avai lable information and conclusions of qualified experts, including information contained in AHPA's Botanical Safe­ NORTH ty Handbook, published in 1997. 13 In addition, FDA apparently AMERICA'S PREMIER fai led to consider relevant work by other notable ex pert bodies. T he MAGAZJNE German Commission E lists both aloe and cascara sagrada as DEVOTED TO THE SlUDY.CONSERVATION, approved botanical drug ingredients for use in rh e treatment of RESTORATION AND constipation, according to certain use restrictions." Consumers are CULTIVATION OF advised to obtain laxative effects through rhe use of bulk forming OUR CONTINENrS WILD FLORA. laxatives prior to use of aloe or cascara sagrada. The World Health •Wildflower ha5 Organization (WHO) also recognizes clinical data on aloe for the been publishing for short-term treatment of occasional constipation, 11 as do the mono­ 18 continual years and i5 the OLDEST & ONLY graphs published by the European Scientific Cooperative on Phy­ native plant magazine torherapy (ESCOP)."' of North America. The Petition also cites an American Botanical Council publica­ •Wildflower explores the art and sc1ence of our ootan1cal heritage from the tropical rain forests of Panama to the mosses tion, Herbal Medicine: Expanded Commission E Monographs, noting and lichens of the Arctic tundra. • Each 52-page quartery issue its review of evidence regarding cascara sagrada, the first Western of Wildflower features news on wildflower gardening. ecosystem use of which was reported by an Eclectic phys ician in 1877.17 restoration, rare and common native plant profiles. boo( rev1ews. new book listings. artwork. photography. botanizing tr-a1 el The AHPNlASC Petition al so chal lenges FDA's rule under rhe accounts. •Wildflower is a "orum and catalyst for gardeners. Regulatory Flexibility Act, which requires an agency to consider field-botanists. naturalists. teachers and al who srare the vision to comprehend and preserve our nat;ve. wild flor·a . regulatory opti ons to minimize the economic impact of rul emaking on small businesses, if a rule will significantly impact a substantial • USA & OVE

Then You N eed Rosavin™. Holly j. Bayne is an attorney based in Washington, D. C. at the Law Office ofHol ly Bayne, P.C., who specializes in advising companies on Start feeling better with our regulatory and business issues concerning food, dietary supplement, and SPECIAL OFFER botanical products. CALL NOW TOLL FREE Reference: 1. 67 Federal Register 31125 (May 9, 2002). 1-888-405-3336 2. Docket No. 78-N-036L, American Herbal Products Association and the Intern ational Aloe Science Council, Petition for Reconsideration AMERIDEN INTERNATIONAL and Petition for Stay of Action, Status of Aloe Ingredients and Cas­ PO BOX 1870 cara Sagrada Ingredients as Over-the-Counter Drug Active Ingredi­ Fal lbrook, CA 92088 ents ("AHPNIASC Petition"). 2002 June 10. 3. 21 Code of Federal Regulations. Sections I 0.33, I 0.35. www.ameriden .com 4. 21 Code of Federal Regulations. Sections 32 1(p), 355. * Summari zed from the book Arctic Root, written by Carl Germano 5. 40 Ferkral Register 12902 (March 21, 1975). 6. 50 Ferkral Register 2124 Oanuary 15 , 1985). & Dr. Zakir Ramazanov, Kensington Press and Effective Na tural Stress 7. 63 Federal Register 33592 Oune 19, 1998). & Weight Management, Safe Goods Publishin g. The above informa­ 8. FDA reopened the adm inistrative record on danthron and phenolph­ tion is fo r educational purposes only. These statements have not been thalein in th e Federal Register of September 2, 1997 (62 Federal Regis­ eva luated by the Food and Drug Administration. This product is not ter 46223), and discussed ca rcinogenic risk of these ingredients. When intended to diagnose, treat, cure, or prevent any disease. Continues on page 59

58 I HerbaiGram 56 2002 www.herbalgram.org FTC Commissioner Wants More Rigorous Self-Regulation in Dietary Supplement Industry by Mark Blumenthal and marketers, their ad agencies, and expert o r celebrity endorsers of products in ads. "M any egregious claims - particularly fo r ederal Trade Commissio ner Sheila F. Anthony has called on weight loss products - often appear in the mainstream media. Fmembers of the dietary supplement industry to implement Majo r national newspapers, magazines, television, cable, and radio additio nal and improved self-regulation and said that the media statio ns seem ready to accept the substantial advertising dollars of sho uld refuse ro run supplement ads that contain claims that are this industry without q uestion, often airing patently fraudulent ads obvio usly fal se. with claims of extreme, instant and effortless weight loss . .. . W h ile Adding that she was speaking fo r herself (her term is ro expire many publi cations screen ads for taste and appropriateness, they September 2002) and not fo r other commissioners or the Commis­ appear reluctant to take a few extra steps to weed out obvio us sion as a whole, M s. Anthony told an audience at the Food and fraud," she said. Drug Law Institute's 4 5th Annual Educational Conference in She said that more measures should be taken ro protect the Washington, D.C. in April that, since passage of the D ietary Sup­ American public against false, deceptive or misleading ads. "The plement H ealth and Education Act (O SHEA), there has been a Commissio n uses a variety of means to combat deceptive claims fo r "dramatic increase in the marketing of supplements and, with that dietary supplements. But more needs ro be done. I believe that increase, we have seen more examples of questio nable claims ...." there needs ro be more and better self-regulatio n in rhe dietary sup­ Antho ny named two factors that have had a significant influence plement industry. T he industry m ust step up to the plate and take over this growth. T he first is the Internet, which has made it easier a more active role in policing those in their industry who are for unscrupulous marketers to sell their products globally. The sec­ engaged in fraud and deception , and are giving the entire industry ond is the erro neous belief among some supplement marketers that a black eye," she noted, suggesting that there are responsible and OSHEA provides a green light to make implied health and disease ethical companies whose image is tarnished by those who would claims and thus avoid FDA review o r approval, which is clearly not mislead the consumer. the case. Consequently, the FTC has brought over 60 enforcement "I also bel ieve that the media has an exceptionally important role actions in the past five years challenging false or unsubstantiated ro play thro ugh media screening of problematic ads," Anthony said. claims about the efficacy and safety of a wide variety of d ietary sup­ "I hope that the media also steps up ro the plate and chooses ro plements, "and we have m any more in the pipeline," she said. forgo placing ads that result in a fraud on the public, who, after all, "We are also looking broadly at the question of who has liability are their cusromers too." __.- for deceptive advertising claims," she said. G uidelines published by the FTC in 1998 stared, " ... all parties who participate directly o r [Anthony SF. Combating Deception in Dietary Supplement Advertising indirectly in the marketing of dietary supplements have an obliga­ [Remarks before the Food and Drug Law Institute 45th Annual Educa­ tional Conference, Washington, DC]. 2002 April 16. Available online tio n to make sure that claims are presented truthfully and to check ] the adequacy of the support behind these claims." Antho ny noted that the FTC has acted against manufacturers

FDA defoulted to "Category II" status according graphs on selected medicinal plants. Vol. 1 to FDA procedures. Both Chinese rhubarb Geneva, Switzerland: World Health Orga­ Continued from page 58 and frangula are popular stimulant laxatives nization; 1999. p. 33-48. Note: WHO dif­ FDA announced that it planned to ban in Europe, approved by the German Com­ ferentiates aloe ("the dried juice of the phenolphthalei ns, ovanis reformulated mission E. leaves of Aloe vera . .. or A. ferox ... and its Ex-Lax'" to include sennosides as the active 11 . 67 Federal Register 31 126 (May 9, 2002) hybrids ...." used for treatment of consti­ ingredient in its regular and maximum 12. AHPA/IASC Petition at 3-5. See also 21 pation) from aloe vera gel ("the colourless strength fo rmulas. In a similar fash ion, Code of Federal Regulations. Section mucilaginous gel obtained from the Schering-Piough reformulated Correctol'". 330.1O(a)(4 )(i). parenchymatous cells in the fresh leaves of Bayer dropped Phillips' Gelcaps'". 13. AHPAIIASC Petition at 5-7. See also Aloe vera" traditionally used for external 9. 63 Federal Register 33592 Oune 19, 1998). McGuffin M, Hobbs C, Upton R, Gold­ treatment of mi nor wounds and skin irrita­ 10. Common herbal ingredients such as, berg A, editors. American Herbal Products tions). "prune powder," "prune concentrate dehy­ Association's Botanical Safety Handbook. 16. European Scientific Cooperative on Phy­ drate," Chinese rhubarb (Rheum palmatum Boca Raton (FL): C RC Press LLC; 1997. p. totherapy. Monographs on the medicinal uses L., and R. officinale Bail!. , Polygonaceae) 7-8,96, 177-9, 183. of plant drugs. Fascicule 5. Exeter, United and frangula or buckthorn (Frangula alnus 14. Bl umenthal M, Busse WR, Goldberg A, Kingdom: ESCOP; 1997. Mill., Rhamnaceae; syn. Rhamnus Jrangula Gruenwald J, Hall T, Riggins CW, Rister 17. AHPA/IASC Petition at 6. See also Blu­ L.) are included among the list of "Catego­ RS, editors. Klein S, Rister RS, translators. menthal M, Goldberg A, Brinckmann J, ry II" stimulant laxative ingredients. FDA The Complete German Commission E editors. Herbal Medicine: Expanded Com­ did not determine these laxative ingredients Monographs: Therapeutic Guide to Herbal mission E Monographs. ewton (MA): Inte­ are unsafe and/or ineffective, nor has it Medicines. Austin (TX): American Botani­ grative Medicine Communications; 2000. done so with respect to aloe and cascara cal Council; Boston (MA): Integrative 18. AH PA/IASC Petition at 9-14. See also 60 sagrada. Rather, there were insufficient data Medicine Communication; 1998. p. 80-1, Federal Register 672 11 (Dec. 28, 1995). in the administrative record to confirm 104-5. 19. 65 Federal Register 1000, 1015 Oan. 6, safety and/or efficacy. T hese ingredients 15. World Health Organization. WHO mono- 2000). www.herbalgram.org 2002 HerbaiGram 56 I 59 Industry Takes the Lead in the Conservation of U.S. Botanicals by David Hircock, B.Pharm., MRPS, MNIMH keynote speaker, summed up the importance of the two days, say­ ing, "Overcoming diffe rences that distanced us from one another in he medicinal and aromatic plant industries have a tradition of the past, representatives from many cultures, professions and Tsharing new research, exploring product development, and clar­ regions found common ground on how to conserve and use native ifYing consumer safety issues. However, the perspective of First Peo­ medicinal plants." ples usually was not included, nor were conservation data. Adding To honor the source of our earliest native plant knowledge and to both to the agenda made the IndustriaL Leadership for the Preserva­ emphasize that respectful plant use also requires respectful relation­ tion ofMedicina Land Aromatic PLants a unique experience for par­ ships with native peoples, the symposium began with a traditional ticipants. T he symposium brought all stakeholders into the discus­ blessing, led by Canoncito Navajo Spiritual Elder Leon Secatero, sion and provided a forum for the exchange of multidisciplinary who was assisted by other PCA-MPWG Elders' C ircle members information. from six tribes based in the United States. T he Elders' Circle is a A two-day symposium held February 26 and 27, 2002, Industri­ committee of representatives from the Navajo, Mohawk, Yurok, aL Leadership for the Preservation ofMedicina Lan d Aromatic PLants, Catabwa, Cherokee, Kumeyaay, and Accohanock tribes, invited by brought together Native American elders, conservationis ts, members of the M PWG to rake a strong leadership role in native botanists, scientists, industry members, and government officials to medicinal plant conservation. address their shared growing concerns fo r the future conservation of The blessing established the tone and direction fo r the two days domestic North American wild botanical resources, as well as the of presentations and discussions. It also signalled rhe critical role status of foreign botanicals used in the United States. Facilitated by these elders played, both in endorsing the symposium and in guid­ the Plant Conservation Alliance-Medicinal Plant Working Group ing program development. "The elders say you must take care of (PCA-MPWG), a consortium of federal agencies and non-federal the land and your surroundings to fulfill your sacred path and cooperators working collectively for native medicinal plant conser- become part of Mother Earth's beautiful gift," Secatero said in vation, the symposium was explaining the commitment of native peoples to exploring cooper­ sponsored by industry leaders ative efforts with industry and other organizations to help reverse such as Aveda, American the loss of biodiversity. Herbal Products Association, As a symposium sponsor, Dominique Conseil, President of the Steven Foster Group, Aveda, also expressed why rhe symposium was important to him as Inc., GlaxoSmithKline, and a businessman, ''Ar Ave da, we think there is no responsible alterna­ the American Botanical tive to doing business in an environmentally sustainable way. We Council. T he symposium was see the challenge of environmental sustainability as one of protect­ held in Philadelphia's Shera­ ing biodiversity. Caring for endangered species starts in our own ton Rittenhouse Hotel, a backyard, with the aromatic and medicinal plants we use as an leading "green" hotel in the industry." United States that combines quality lodging with environ­ A Sampling of Presentations mentally responsible busi ness Speakers came from as far away as India and as close as Pennsyl­ principles such as energy con­ vania to share a message of joint cooperation for the benefi t of servation and the use of recy­ medicinal and aromatic plants. cled materials. Akash Chopra, Ph.D., CEO of Biosys Group, Rothamsted, U K, W ith the setting of the Rit­ shared examples of successful projects that demonstrate the benefits U.S Fish and Wildlife Service Assistant tenhouse as a daily reminder of traceability (tracking a product back to where irs raw materials Director Kenneth Stansell (left) presents of the enviro nmental differ­ originated), including eliminating adverse effects on the environ­ the agency's 2002 Corporate Wildlife ence committed leadership ment and communities at the same time that they establish a fair Stewardship Award to Dominique Con­ can make, symposium speak­ price structure and eliminate the causes of product adulteration. seil, president of Aveda, at the Industrial ers described some of the Transparency, according to Chopra, allows all stakeholders in the Leadership symposium.© 2002 Aveda. steps taken to ensure the sus- supply chain to engage from a position of mutual understanding, tainability of va rious plant makes all stakeholders responsible fo r the overall issues, and builds species: for example, Aveda's work on sandalwood (SantaLum aLbum trust as well as the ability to incorporate values into the system that L., Santalaceae), Strategic Sourcing's work with goldenseal benefi t all partners. Chopra ended his presentation with a simple (Hydrastis canadensis L., Ranunculaceae), and Glaxo SmithKlein on statement: "O n behalf of Mother Earth and those who cannot be black cohosh (Actaea racemosa L., Ranunculaceae, syn. Cimicifoga here to speak for themselves, we have shown that we have a collec­ racemosa (L.) N utt.). Distinguished researchers, industry leaders, tive responsibili ty, as stakeholders, in the use and preservation of and First Peoples shared new ways to hel p balance conservation, natural resources, and there should be a fair distribution of the business, and cultural concerns associated with medicinal and aro­ commercial proceeds." matic plant use. Bruce Stein, Vice President of NatureServe, Rosslyn, Virginia, Gary Paul Nabhan, Ph.D., Director of the Center for Sustainable provided an environmental context with which to begin to evaluate Environments at Northern Arizona University, and the symposium the sustainable use of native U.S. plants. According to Stein, the

60 I HerbaiGram 56 2002 www.herbalgram.org United Stares has ap proximately 16,000 native vasc ular plants - thing." about 7 percent of the world's total - 4,000 of which are found Ann Koontz, Director of EnterpriseWorks, of Washington D.C., nowhere else. The United States does share many plants at the level discussed balancing environmental, social, and business issues in of family and genus with Asia, including American gi nseng (Panax the aro matic plants and essential oils arena. She stressed the need to quinquefolius L., Araliaceae) and mayapple (Podophyllum peltatum balance a variety of factors: 1) the growing demand for aromatic L., Berberidaceae). NarureServe assesses the status of many plants, products worldwide; 2) the fact that the peo ple closest to the based on selected criteria: number of populations, abundance of resource are often poor, with few resources to manage sustainable range, trends, threats, intrinsic fragility. T he NatureServe database harvesting; 3) absence of knowledge concerning sustainable yields provides a so urce of authoritative and harvesting practices for many species; and 4) the continued loss conservation information on more than of many aromatic plants found in biodi­ 50,000 plants, animals and ecosystems in versity-rich areas due to over-harvesting the United States and Canada. Stein con­ and other threats. Koontz provided exam­ cluded by offering several recommenda­ ples from Nepal of successfully balancing tions: 1) improve monitoring of both these factors by: 1) looking at all the play­ trade volumes and field population condi­ ers , their functions, and technologies and tions; 2) monitor data that are compara­ their role in a sector's markets, pai red with ble across sires and species; 3) look at threat analysis to understand the range of broader impacts on ecosystems; and 4) reso urce degradation; 2) using economic engage the professional botanical commu­ benefits as the entry point to working nity and mobilize volunteers. with producers while balancing environ­ Michael McGuffin, president of the mental and social equity iss ues; and 3) American Herbal Products Association promoting linkages with multiple players (AHPA), defined iss ues of susrainability to increase producer benefits. for the global marketplace, with particular Native American elders Tis mal Crow (left) and Leon Uwe Koetter, Ph.D., Director of New emphasis on U.S. nati ve species. Based on Secatero blessed the symposium with a traditional Products Research for GlaxoSmirhKline knowledge of the trade in these species, he invocation. © 2002 Aveda. Consumer Healthcare in Parsippany, New offered tools that could be considered to Jersey, introduced his company's work help ensure sustainabiliry: proper harvesting practices; industry wi th G . Harnischfeger, Schaper & Brummer, in the cultivation of consumption data; cultivation; substitutes; national and interna­ black cohosh. GlaxoSmithKline contracts for cultivation to achieve tional regulations; and botanical data. He ended on a hopeful note, improved quality and consistency of plants. Its goals also include citing a remark made in 1903 by Henry Kraemer, editor of the susrainability, purity, and reliability. American j ournal ofPharmacy and the preeminent pharmacognosist David Hircock, herbalist co nsultant to Aveda based in New York, of his day: "We believe that Americans will be as successful in the New York, used sandalwood as an example of Aveda's commitment conservation of their forests and wild plants and animals as they to sustainabili ty. Hircock posed the question: "How do we investi­ have been original, fearless and fortunate in the discovery of her gate sustainabiliry, and what happens when we find a potential treas ures and the development of her resources." problem?" In the case of sandalwood, Aveda sourced its raw mate­ Trish Flaster, President and CEO of Botanical Liaisons of Boul­ rials from India, until it began to suspect sa ndalwood was being der, Colorado, addressed quality control in a co ntext different from poached. Knowing how old a sandalwood tree must be to produce how it is usually presented. In her words, quality co ntrol spans the oil, the company began to require suppliers to submit documents entire process - from soil to soul, from seed to consumer. Docu­ proving that Indian sandalwood oil was supplied from legal Indian mentation of the process at each stage is critical because the chain government sources. W hen suppliers failed to demonstrate of custody of plant material is huge given the size of the marker. progress, Aveda took steps to ensure a sustainable and traceable sup­ Also, if quality control does not include native knowledge, even ply of the oil. Research suggested that poachers who illegal ly cur support for native languages, which are being lost at alarming rates, down sandalwood trees also poached As ian elephants as another then knowledge of the plants is diminished as is biodiversity. Flaster emphasized the importance of talking to the people in the field , "They have a knowledge base of how to co llect, when to collect, Fostering the sustainable use where to collect. Do not separate the people and rhe plants. With offlora and fauna the respect for the people you then have the res pect for the Earth, biota for nature and humanity and when we can keep respect for the Earth and its many gifts, then we are able to pass them forward to the generations to come. " Leon Secarero, Spiritual Leader of the Canoncito Navajo of New Mexico and Tis Mal Crow, Hirichiri Cherokee elder from Ten­ Providing reliable research and accurate nessee, spoke ex tensively on the Native American perspective con­ reporting on the sustainable management, cerning the state of American wild herbs. "In my language," said Tis Mal Crow, "we have 45 words for snow, 65 words for rain, but no utilization and marketing of biological resources. words for extinct. It is a foreign word. Bur now this word has an impact on me. When I was yo ung I thought there would be no end visit www.biotaconsulting.com or call (503) 335-7002 to the plants I worked with, but now I know that this word is a real www.herbalgram.org 2002 HerbaiGram 56 I 61 source of income and were involved in various human rights viola­ 2. We acknowledge that we are all stakeholders in rhe preserva­ tions. Rather than continuing to source materials from the wi ld , ti on of plants. Aveda so ught alternatives. As an interim measure, it used sandal­ 3. We recognize that we need guidance from our indige nous eld­ wood from Australia, because that co untry has strict laws of sus­ ers. rainabiliry controlled by the Sandalwood Act and Wildlife Conse r­ 4. We intend to develop a more formal structure for industry par­ vation Act, among other legislation. However, Aveda also seeks to ticipation in PCA and PCA-MPWG. continue ro support sandalwood in India by purchasing from plan­ 5. We will hold another Industrial Leadership meeting in about tations and forest collectors with reliable traceability and sustain­ one year to assess our progress toward formalizing a structure. abili ty programs. In addition, the group agreed to move forward with an Industry Other speakers included: Steve n Foster, noted American native Committee, chaired by AHPA's Michael McGuffin. The committee plant expert; Peggy Olwell, PCA chai r; Julie Lyke, form er PCA­ seeks participants to help carry our irs agenda. Further, the follow­ MPWG chair; Ed Fletcher, cultivation manager for Strategic Sourc­ ing action were identified: ing, Inc.; Danna J. Leaman, Ph.D ., IUCN Medicinal Plant Spe­ 1. Native American spokespeople continuing to send the message cialist Group chair; Charlotte Gyll enhaal, University of Chicago; that the plants are sacred. Tensie Whelan, Rainforest Alliance Executive Director; Monique 2. video distribution of this event to interested herb schools and Simmonds, Royal Botanical Gardens, Kew, England; Barry Dim­ other organizations. son, President and CEO of Sheraton Rittenhouse Square; Michelle 3. existing standards for sustainable harvest promided to the Penna, Director for Business Development for EcoEnterprises MPWG (Partners: Rainfores t Alliance and Center for Sustain­ Fund; Bruce Mannheim, attorney with Bennett, Turner & Cole­ able Environments). man; Kelly McConnell, NarureServe; Diane Don Carlos, United 4. survey of tonnage of wild medicinal plants produced/harves t­ Plant Savers; Jennifer Morris, Manager of Enterprise Development ed in 2001 (Partners: AHPA, USFWS). and Support at Conservation International; Pierre Franchomme, 5. CITES (the Convention on International Trade in Endangered Aromatic Sourcing; and Freddie Ann Hoffman, Pfizer, Inc. Species of Wild Fauna and Flora) implementation for native medicinal plants (Partners: AHPA, USFWS). Results T he goal now is to follow up on the intention to meet again next Industrial Leadership in the Preservation ofMedicinal and Aromat­ year. By 2003, the second meeting of Industrial Leadership in the ic Plants was a remarkable event in which people who seldom have Preservation ofM edicinal and Aromatic Plants will report on progress the occasion to interact found that they share the same goals. At rhe to advance knowledge of the sustainabiliry of these important end of the symposium, approximately 125 people representi ng plants. -"' more than 60 organizations reached consensus on the following: 1. We endorse the Plant Conservation Alliance (PCA), and the David Hircock is an environmental and herbalist for the Plant Conservation Alliance-Medicinal Plants Working Group Aveda cosmetics company. British born, he holds degrees in pharmacy (PCA-MPWG) and irs Mission. and herbal medicine.

Expo Asia in Hong Kong, May 15-17, 2002 by Alicia Goldberg

xpo As ia, sponsored by New Hope Natural Media during May ry without competition. Several American companies se nt repre­ E2002, was the first natural products trade show in Asia. It was sentatives without setting up booths. Elephant Pharmacy, a start-up surprisingly active, with 200 exhibitors representing 25 countries, retail chain integrating a conventional pharmacy with natural and 4,000 buyers from 50 co untries. T he mix of buyers included 35 remedies, so ught innovative products backed by quality control and percent retail ers, 18 perce nt suppliers, and 11 percent manufacturers. clinical research. Other American companies, such as the Ayurvedic Hong Kong is the place to do business, serving as the English­ product line Ayurceurics, chose to use the U.S. Commerce booth speaking gateway to China and the rest of Asia. The trades how Aoor to distribute information. buzzed with genuine excitement and eagerness to do business. Big The co mpanies that exhibited from China were typically large deals happened easily, wi th rime for in-depth conversatio ns . The manufacturers with university affili ations, with facilities based on New Hope ream was friendly and well-organized, utilizing a staff of Good Manufacturing Practices and clinical studies. However, most local experts rhar successfully secured media coverage in both Eng­ labeling was not U.S.-compliant, and they were nor yet selling to lish and Chinese papers. the U.S. marketplace. Other countries represented included Aus­ Fi ll ed with light and perched on the bay, the Hong Kong co n­ tralia, New Zealand, and the Philippines, with a booth focused on vention center may be the most beautiful in the world. So me atten­ new cosmetic soaps, bea uty masks, and bath powders . dees took a moment to watch small traditional boars sa il past large New Hope regarded the show as the most successful first show it cruise ships, while sipping oolong tea. T he conference layout was had ever produced. Executive producer Andrew Work enthusias ti ­ difficult to navigate, despi te the small size, however, New Hope cally res tated New Hope's co mmitment to Expo As ia as key to the provided areas with tables and chairs that were useful to co nduct future expansion of the natural products industry. _. meenngs. The mai n American companies with booths were NOW Foods, Alicia Goldberg is director of Phytomed International, based in ]arrow, and Capsugel, taking advantage of a window of opportuni- Austin, Texas. Her email address is .

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Originally isolat­ covery of the mode of action by which it ed and characterized in 1971 , the ami­ prevents cancer growth would have been cancer mechanism of action of paclitaxel significantly delayed." was not evident until 1979 when a young It was nor until 1985 that the laboratory New York scientist, Susan Band Horwitz, of Leroy F. Liu, Ph.D., who was then at Ph.D., asked for a sample of the new drug. Johns Hopkins University, demonstrated Now president of a leading cancer research conclusively that camptothecin acted to cre­ society, the American Association for Can­ ate an unusual type of DNA damage in can­ cer Research, the then-junior Dr. Horwitz cer cells by trapping the enzyme ropoiso­ Monroe E. Wall demonstrated that pacliraxel uniquely pro­ merase I during its normal action in regu­ 1916-2002 moted the overpolymerizarion of micro­ lating DNA structure. tubules within cancer cells, effectively Monroe Wall was born on July 25, 1916 onroe E. Wall, Ph.D., a renowned inhibiting cell division. Paclitaxel is now and grew up in Newark, New Jersey, earn­ M natural products chemist whose dis­ known as Taxol®, the original generic name ing his bachelor's, master's, and doctoral coveries defined rhe utility of botanical coined by Wall and Wani, which was select­ degrees from Rutgers University. His early sources for cancer therapeutics, died of ed by Bristol-Myers Squibb as the trade work focused on the nutritional require­ heart and kidney fai lure on July 6, 2002 in name of this anticancer drug. ments of the tomato plant, the crop most Chapel Hill, North Carolina. Dr. Wall was ]. Paul Eder, M .D ., clinical director of responsible for New Jersey's designation as just three weeks shy of his 86th birthday at th e experimental therapeutics program at The Garden State. In 1941 , Dr. Wall mar­ the rime of his death. A dedicated and pas­ the Dana-Farber Cancer Institute, calls the ried his wife, Marian, and joined the U.S. sionate investigator - who for more than discovery of paclitaxel, "One of the most Department of Agriculture (USDA) in 40 years was a commanding presence in the significant clinical advances in cancer thera­ Philadelphia where he researched agricul­ Research Triangle Park, NC, scientific com­ PY in the last decade. Paclitaxel has tural sources for products essential ro the munity - Dr. Wall had worked continu­ increased the cure rate of metastatic ovarian war effort, such as alternatives to rubber. ously with his laboratory group at Research cancer, breast cancer, and has important During the 1950s most of his research Triangle Institute (RTI) until just two activity in lung cancer. It is essential ro note focused on the search for phytosteroids that weeks before his death. that it rook nearl y 25 years from the time of could serve as precursors for cortisone. In Dr. Wall and Mansukh C. Wani, Ph.D., Dr. Wal l's initial discovery unril the first doing so, he collected thousands of plane his colleague for more than 35 years, are clinical trials of paclitaxel began, underscor­ extracts. A serendipitous 1957 visit ro credited as co-discoverers of the anticancer ing the difficulties in bringing new agents ro USDA by NCI pioneer, Jonathan Hartwell, drugs pacliraxel, from the Pacific yew tree the clinic." M .D., changed Wall's focus in a way that (Taxus brevifolia Nun., Taxaceae), and In contrast, camptothecin was initially would chan the next 40 years of his efforts. camptothecin, from xi shu or "happy tree" unsuccessful as an anticancer drug due to Hartwell had been a student of folk med­ (Camp to theca acuminata Decne., Cor­ severe toxic reactions during human trials icine and recognized that nature might also naceae), a native Chinese tree that had been sponsored by the National Cancer Institute provide treatments for cancer. Dr. Hartwell introduced ro the United States. These dis­ (NCI) in the early 1970s. However, camp­ seized upon the late 19th century folk use of coveries were among hundreds of natural tothecin has led to two semisynthetic deriv­ the mayapple (PodophyLLum peftatum L., compounds identified by Dr. Wall and Dr. atives, topotecan (Hycamtin®, manufac­ Berberidaceae) by the Penobscot Indians of Wani. tured by GlaxoSmithKline, Philadelphia) Maine for cancer. The same plant was also Paclitaxel and camprorhecin particularly and irinorecan (CPT-11; Camprosar®, by used by physicians in Louisiana and Missis­ stand out because each agent reveals previ­ Pharmacia & Upjohn Company, Peapack, sippi for venereal warts. One of its compo­ ously unknown ways of killing cancer cells, New Jersey) as well as a number of other nents, podophyllotoxin, was later demon­ and emphasizes the utility of planes as a camprorhecins currently in clinical develop­ strated to have anticancer activity in mice. source of drugs. In this post-genomic peri­ ment. In his role at the Cancer Chemotherapy od of biology, where scientists are faced The development of camprothecins is an National Service Center, Hartwell con­ with thousands of potential drug targets outstanding example of the partnership vinced Wall to send him 1,000 ethanolic that seek small molecule ligands, the contri­ between folk medicine and modern syn­ plant extracts for antitumor activity testing. bution of paclitaxel and camprothecin ro thetic chemistry because the naturally More than a year later, word came back that identify novel anticancer strategies cannot occurring molecule would have failed as a one possessed particularly potent activity: be understated. In the last century, only two drug if not for the intervention of medicinal an extract from Camptotheca acuminata. other pairs of discoveries are of the sa me chemistry. In fact, the discovery of camp­ Since ami cancer drug discovery was not a magnitude: the discovery of histamine H 2 tothecin (1966) preceded that of pacliraxel focus of the USDA, Wall's drive to identify antagonists and ~ 1-adrenocepror antago­ (1971). A. Robert Jeffcoat, Ph.D., RTI this plane's amicancer componem was tem­ nists, which earned Sir James W. Black, the director of bioorganic chemistry research, pered until July 1960, when he was recruit­ 1988 Nobel Prize in Medicine, and the dis- credits Dr. Wall's perseverance in the real- ed to establish a chemistry program and

64 I HerbaiGram 56 2002 www.herbalgram.org to be familiar with Bob's parents, Virginia ly and fri ends, the Blue Jays, won a cham­ and Lo ui e Saso of Saso Herb Garden fa me, pionship in his honor in November. He is formerly of Sa ratoga, Cali fo rnia. T he se nior survived by his wife Susa n, and their seven Sasos have touched many li ves within the children and stepchildren. herbalist community, sharing their bound­ Services for Bob we re held on February 2 less wisdom and love for the cultivation of at Sr. John's Catholi c Church in Felton. T he medicinal plants. Saso Herb Garden has church was fill ed to overfl owing wi th been an ico n in the growing medicinal herb fri ends and family members, attes ting to the movement fo r decades, educating many number of people who loved and res pected appren ri ce students and hosting herbal him. Memori es of Bob's enrhus iasm, great medicine classes for more than 25 yea rs. smile, and beautiful gardens continue to Bob followed in the footsteps of his par­ inspire all those who had the honor of ents on a parcel of land in the beautifu l knowing him. Robert "Bob" L. Saso Santa Cruz Mountains, reaching people Contributions in Bob's name may be 1943-2002 how to grow medicinals, teaching others made to the Hos pice Caring Project of about the beauty of plants, and otherwise Santa C ruz, 6851 Soquel Drive, Aptos, CA he Santa Cruz, California community simply loving the land. Fo r more than 20 95003 . .A Tof herbal ists lost a dear friend on Janu­ yea rs Bob cultivated herb gardens in Fel to n, - Darren Huckle ary 21 st of this yea r. Bob Saso, herb garden­ California where he welcomed people to herbalist er ex traordinaire, passed away at the young share in his botani cal bounty. Bob's enthusi­ Roy Upton age of 58 after fi ghting colon ca ncer for sev­ asm to teach the community about herb Executive Director, American Herbal Pharmacopoeia eral years. Bob stayed close to home with cultiva tion led him to start a nursery and his community herb work and so his name the Sierra Pacific school. He was also an may not be familiar to the herbalist com­ av id softball player. His coed team of fami- munity at large. However, many are likely natural products group at the newly created received their first paycheck." lecti on of Taxus brevifolia fo r the NCI Research Tri angle Institute. From this Susan Mayton, another close administra­ scree ning program. AS P also held the 3rd beginning, RTI has become an internation­ tive coll eague, remarked, "To the world, Or. annual Monroe E. Wall Symposium as parr ally recognized research park, employing Wall was a brilliant scientist, but to those of of irs 2002 annual research meeti ng, which more than 40,000 in government, pharma­ us who were privileged to see him on a per­ was conducted, appropriately, at Wall's al ma ceutical , chemical, and computing research sonal level , he was a warm and caring gen­ mater, Rutge rs Univers ity. organiza tions. Wall recruited to RT I a tl eman. That a man of his stature would John M. Pezzuro, Ph.D., dean of Purdue number of young scienrists, including have rime to express sympathy over the loss University Schools of Pharmacy, Nursing, Wani, many of whom wenr on to their own of my mother or concern over my grand­ and Health Sciences refl ected many shared distinguished scienri fic careers. C. Edgar son's leukemia touched my heart deeply. " sentiments in staring, "Having been affiliat­ Cook, Ph.D., who worked with Wall and In fact, as Drs. Wall and Wani received ed with Monroe over the las t 15 years has Wani on camptotheci n and later directed the 2000 Charles F. Kettering Prize fo r Can­ been one of the greatest honors of my li fe . the RT I Chemistry and Li fe Sciences unit cer Research, rhe highest honor in the fiel d Everyone recognizes him as a major icon of that Or. Wall founded, fondly describes rhe of cancer research, Wall remarked rhar the natural product drug discove ry, bur relati ve­ "Monroe Doctrine" as the basis of Wall's knowl edge that his discoveri es saved or ly few have had the privilege of knowing his success: "Get good people, support them improved the quali ty of life of, literal ly, mil­ incredible wit, sense of humor, and single­ with good facilities, do good science, work lions of people was far more sati sfYing than minded devotion toward bearing the cancer hard, and keep doing it. " any award or prize. problem. His passi ng is a great loss to soci­ Another Wall recruit who also headed the T his pas t summer, Or. Wall 's contribu­ ety and the scientific comm uni ty; I mi ss sa me unit, F. Ivy Carroll, Ph.D., remarked, ti ons continued to be recognized. Over a him greatl y. " .A "Or. Wal l was much more than a scientist yea r in development, RT I announced plans who conducted natural products research. in July to carry on his legacy by creating the - David J. Kroll, Ph .D. His coll eagues here at RTI and scientists al l Wall and Wa ni Fell owships in Natural Senior Research Pharmacologist over the world have been inspired by his Products Research. T hese fe llowships will to Natural Products Laboratory keen managerial ability combined with his enabl e yo ung scientis ts fro m around the Center for Organic and Medicinal Chemistry people skills and warm concern for others." world to train with Or. Wall 's group, now Research Triangle Institute Certainly, Or. Wall 's scientific accolades led by D r. Wani and Nicholas H . O berli es, with contributions from Dr. Oberlies and Dr. Wani and hard-nosed, no-nonsense exterio r Ph.D . (see http:/ /www. rri .org/wallwani). belied the warm heart within. Jane Righter, In August, with Wani and Oberlies in Other tributes to D r. Wall may be found his administrative assistant for the last 12 attendance, representati ves from rhe U.S. online at and the july 11, years of his career, recalled, "He gave regu­ Fores t Service, the USDA, and the Ameri­ 2002 issue of The New York Times. The web­ larly to charities and I have seen him offer can Society of Pharmacognosy (ASP) held a site ofthe American Society ofP harmacognosy loans to postdoctoral fell ows when they first plaque dedication ceremony in Washington includes Links to both. arrived at RT I, help ing them before they state near the site of the origin al 1962 col- www.herbalgram.org 2002 HerbaiGram 56 I 65 iodiversity and Traditional Knowl­ nating relationships in such diverse coun­ efit-sharing partnership in Vietnam that Bedge: Equitable Partnerships in Prac­ tries as , Norway, South Africa, Costa focuses on a "new" species of Vietnamese tice. edited by Sarah A. Laird. Earthscan Ri ca, Cameroon, Uganda, Panama, and ginseng (Panax vietnamensis Ha & Grushv., Publications Ltd., London; Sterling, Vir­ many others. Araliaceae), which was not ye t in inrerna­ gtnla, . 2002, The authors and co ntributors, all 75 of tional commerce. paperback, v-xxxviii + 504 pp. ISBN 1- them, are leaders in their fields of expertise. Both of these books illuminate the how, 85383-698-2 (not available through ABC). They bring a broad range of backgrounds to who, where, and why of creating and main­ he Commercial Use of Biodiversity: this complex taining equitable partnerships with local TAccess to Genetic Resources and Ben­ topic, including communities, national governments, and efit-Sharing. by Kerry ten Kate and Sarah law, ethnobotany, regional scientists while developing new A. Laird. Earthscan Publications Ltd., Lon­ conservation and products for a variery of marketplaces. don, UK, . 1999, v­ environmental These books build an excell ent foundation xvii + 398 pp., hardcove r. ISBN 1-85383- sciences, and the in the fast-changing world of international 334-7 (not available through ABC). perspective of ethics and benefit sharing. The next time T hese rwo books represent the state-of­ local communi­ yo u read a label, or hear a person or a com­ the-art knowledge on the links berween ties. This book pany describe the ethical and sociall y plants, people, cultures, products, profits, also provides an responsible way that they have created a and ethics. Any company, scientist, herbal­ in valuab le direc­ new product by working with the wisdom ist, consumer, lawyer, government official, tory of useful of indigenous cultures, you will be able to or curious perso n who wishes to learn how contacts and differentiate the short-term hustler from the to work with local resources, including national government more committed co mpany or perso n. co mmunities, tra­ access and benefit-sharing contacts in Both of these books clearly show the links ditional knowl­ Brazil, Ecuador, India, Costa Rica, Fiji, and berween the conservation of ecosystems, the edge, and govern­ eight other countries. It lists the websites of needs of local communities, and the influ­ ment agencies will inrer-governmental organizations, selected ence of the market economy. In this age of find that these NGOs, research insrirures, and organiza­ demonized globalization and events like books provide tions that work on biodiversiry research and 9/11 , we all need to strive to create a more information, case prospecting iss ues, as well as contact infor­ equitable, sharing, and collaborative busi­ studies, and a mation for indigenous people's organiza­ ness environment. My thanks to these wealth of detailed tions in many parts of the planet. authors for shining the li ght on how to do information. In The second book, The Commercial Use of so in our complex and ever-changing multi­ fact, when the Biodiversity, is the perfect companion vol­ cultural universe. A Convention on ume to Biodiversity and Traditional Knowl­ -Steven R. King, Ph .D. Biological Diversiry (CBD) marks its 10- edge, and a very readable and engaging Senior Vice President of Ethnobotany and Conserva­ year anniversary in Johannes burg, South overview of access to ge netic resources and tion , Shaman Botanicals.com Africa (called Ri o + 10) this September, benefit-sharing. Sections that focus on the these books should be provided to every botanical medicine industry, natural prod­ lants and People of Nepal, by Narayan official delegate. ucts for research, natural perso nal care and PP. Manandhar. 2002. 636 pp, illustrated These books will be of increasing impor­ cosmetic industry, and horticulture will hardcover. ISBN 0-88192-527-6. $69.95. tance to any and all companies that create likely be of great interest to Herba!Gram ABC Catalog# 8519. new plant-based products as well as to ethi­ readers. When Timber cally minded consumers who use botanical This book also provides numerous fasci­ Press puts its medicines, dietary supplements, and many nating case studies. One of the most inter­ 1mpnmarur on an plant-based health and bea ury aids. They es ting and germane to natural products ethnobotany could also serve as core tex ts for a wide vari­ companies fo cuses on the marketing of a book, the title ery of high school and college-level courses "public domain" plant species, annatto rypically estab­ on phytomedicines, globalization, ethics, (Bixa ore/lana L. , Bixaceae), a well-known li shes a new stan­ product development, anthropology, eth­ so urce of red dye from the Amazon basin. dard of excellence nobotany, and international law. T he case study describes the relationship tn 1t s ca tegory. Just recently published, Biodiversity and created by the Aveda Corporation with the Thus, when Traditional Knowledge is a spectacular con­ indigenous Yawanana people in Brazil , Narayan Man- tribution from the People and Plants Con­ detailing the entire process that Aveda has andhar's Plants servation Series, a collaboration of the undertaken to work with these people, and People of Nepal carne off the press, my World Wildli fe Fund (WWF), the Kew beginning in 1993. It is highly instructive expectations were high. Still, I was caught Royal Botanic Gardens, and the United to see the step-by-step evolution of such a off guard by the breadth of what is offered Nations Educational, Scientific and Culrur­ project undertaken by a socially res ponsible in this book. Like Daniel Moerman's Native al Organization (UNESCO). This edited company. American Ethnobotany, also published by volume contains 21 case studies from 16 Another case study that I found of great T imber Press in 2000, Plants and People of countries. The case studies examine fasci- interest discusses the development of a ben- Nepal is not only a vast body of work, but is

66 I HerbaiGram 56 2002 www.herbalgram.org a career summary of a prolific scholar and me wa nt more. boriginal Plant Use in Canada's researcher. Dr. Manandhar has handed us In his elucidation of the ethnobotany of A Northwest Boreal Forest, by Robin J. the keys to the botanical treas ury of the Nepal, Dr. Manandhar descri bes that coun­ Mari es, Christina C lavell e, Les li e Mo n­ Kingdom of Nepal, from its most remote try's history of plant use, agri culture, medic­ teleone, Natali e Tays, Donna Burns. Pub­ and inaccessible corners to the well-tram­ inal and fiber plants, and Aora employed for li shed by University of British Columbia meled Kathmandu Valley. yet other purposes such as dyes, deco ra­ Press and Natural Resources Canada, Cana­ Dr. Manandhar is no stranger to academ­ tions, and fi sh poisons. T hat materi al, plus dian Fo res t Service, distributed in the U.S. ic rigo r. Educated first at unive rsiti es in the preceding informati on, sets th e stage fo r by Uni ve rsity of Was hington Press, 2000. Kathmandu, Nepal, and Bihar, India, he the stunning centerpiece chapter of the 368 pp. , color illustrati ons, hardcover. earned his doctorate in economic botany at book, The Useful Plants of Nepal, whi ch, ISB 0-7748-0737-7. $75.00; softcover the Scientific and Medical University of along with two related appendices, occupies ISB 0-7748-0738-5 $24.95. G renoble, France . Upon his return to nea rly 500 of the remaining pages . Here, T he significance of Aboriginal Plant Use Nepal, he worked in that country's nati onal the reader is treated to a sprawling library, a in Canada's Northwest Boreal Forest li es not herbarium. He applied himself to the sys­ feas t for the botani cal intell ect. T he author just in its content and scope, but perhaps temati c survey of Nepal's people and plants, provides everything yo u might ex pect, moreso in what it represents as a participa­ a body of work that spanned 30 years. Then including Latin binomial and local names tory research partnership. he se t about to write Plants and People of of plants, morphological descrip tions, and Although ethnob­ Nepal. medicinal and other uses. Finely executed otany has gained Dividing the 600-page book into four line drawings by the author make the plant global pro minence large chapters, Dr. Manandhar es tablishes section of the book deli ghtfu l to browse, ove r the past few first a geographic foundation for the reader, and give visual depth to descriptions of the decades, studies describing the geography, climate, vegeta­ plants themselves. Clea rl y, he has worked focused on the plant tion zo nes, and conservation concerns of and re-worked each plant description. use of indige nous Nepal. H e maps and identifies all 75 dis­ If the plant descriptions in this book are peopl es of North tricts in the country, every single one of miss ing anything at all , it is more detailed Ameri ca are relative­ which he has visited. Early on, the author information on their preparati on. 1 would ly few, for a couple emerges not only as an astute scholar, but as have enjoyed more insight into specific of reasons. Firstl y, a a seasoned and understated explorer as well. methods by which va ri ous medicin al species view of so me stand­ While others have inves tigated As ia in large es pecially are juiced, mas hed, ground, and ing holds that most information about ex peditions (a Ia Roy Chapman Andrews of made into infusions or poul tices. But I fo od, medicine, and other as pects of aborig­ the ew York Muse um of Natural History, wo uld not say that this abse nce leaves the inal cul ture has already bee n reco rded, or is whose Central Asia Expeditions in the book lacking. Rather, it sets th e stage for a roo eroded by Euroameri can acculturati on 1930s electrified world imaginati on), Man­ va ri ety of future herbal compendia that can to merit further scholarl y attention. More andhar has inves ti gated the full length and delve more dee pl y into the specifi cs of that recently, considerations of intellectual pro p­ breadth of Nepal, including a number of country's botani cal pharmacopeia. erty and other aspects of indige nous rights ex tremely remote and difficult areas, largely lt's a tricky business to adequately sum­ have redefi ned the modes and paradi gms alone and on foot. mari ze a book like this, es peciall y consider­ through whi ch ethnobotany is conducted. Moving into a discussion of the people of ing that it represe nts the brilliant and appar­ Canada, where rel ati onships between First Nepal, Or. Manandhar reveals a broad ently tireless career of a world-class scholar. Nati ons communities and the larger society dive rsity of ethnic backgrounds and lan­ T hat sa id , Plants and People of Nepal remain politicized over iss ues of title and guages. A major cross roads of Asia, the emerges as a bedrock vo lume, a coll ector's sovereignty, might seem particularly unlike­ Kingdom of Nepal is home to 60 or so eth­ piece to be sure, but one whi ch eve ry col­ ly ground fo r original research, particul arl y nic communities, mostly divided into two lector should open and read and browse that touching on the contentio us iss ue of major groups, Indo-Nepali and Tibero­ again and again . W hile India has produced medicinal plants. T his vo lume admirabl y Nepali . Like native American or Amazonian a plethora of excell ent ethnobotanical dispels both of these asse rtions. tribes, these vari ous peoples have evolved guides, Nepal has remained comparati vely To their credi t, the authors, led by Robin unique customary uses of native plants, elusive until now. T hanks to decades of Mari es, built a preparatory research project which represent a vas t agricultural and eth­ travel, study, and fas tidious data collection, during several yea rs of progress ive coll abo­ nomedical variety. Narayan Manandhar has produced the ra tion among unive rsity scientists, govern­ Plants and People ofNepa l offers a full 36 definitive work on the ethnobotany of the mental resource and environment agencies, pages of color photographs, all of which Kingdom of Nepal. In doing so, he has and First Nati ons communities . In a non­ show the daily uses of va rious plants among es tablished a place at the apogee of that polemic manner, they simply got on with Nepalese people. T he photography is well region's botani cal knowledge, and has given the job and produced a volume that should done, and the number of pictures is quite other researchers a wo rthy reso urce that will be val ued by and acceptable to mos t parties . generous, but I still wanted more, to enj oy serve the interes ts of botanical scholarship In this case the level of education and polit­ a further glimpse of fascinating peoples in and ethnomedi cal research fo r a long time ical sophisti cation of aboriginal people in remote places with their medicinal plants, to come. Bravo! _A Canada beco mes more an asset than an yeast cakes, spices, fruits , grains, bas kets, - Chris Kilham impediment for scientific research as it sets and traps. But this is not a complaint bo rn Author, ethnobotany lecturer the groundwork for more equitable rela­ of any defi ciency in the book; it just made University of Massachusetts ti onships and research agree ments. www.herbalgram.org 2002 HerbaiGram 56 I 67 Members of indigenous co mmunl[tes a means to self-sufficiency on their own tion, the author uses common diagnostic actively involved themselves in the project land while threatening traditional values terms, rather than scientific and medical as srudents, interviewers, community lead­ and rel ationships with this environment. In terminology, ro foster lay readers' under­ ers, contriburors of information and co­ this book, the evaluation of a few of the standing (e.g., high blood pressure instead authors, and in the first instance, the result­ plants as offering appreciable commercial of hypertension). He also highlights many ant volume will serve as a resource most potential dispels this iss ue to a degree. of these terms to call attention to specific useful to the co mmunities. Not only does it Moreover, information that was deemed health conce rns, such as pregnancy, pro­ provide a wealth of information given by confidential for spiritual or proprietary rea­ longed use, or children. elders, but it places this information within so ns, including many details of the use of Several important changes have been the context of previously published ethnob­ medicinal plants, has been withheld. In fact, made ro this edition. To begin, the main otanical li terature and a broad range of much of the information co ntai ned is avail­ section of the text, which is devoted ro pharmacological, botanical, economic, eco­ able in published sources. While the consul­ herbal contraindications and drug interac­ logical, and other scientific data. Commu­ tative model embraced by the project goes a tions, has expanded to 249 herbals. Second, nities can draw on this body of information long way to allay concerns within aboriginal common herb names have been standard­ ro manage and use their own resources for communities, the end result is undoubtedly ized to the names designated in the second subsistence, and social and economic bene­ a compromise. Among the contending con­ edition of the American Herbal Products fit. In representing the wealth of traditional siderations of indigenous rights, economic Association's Herbs of Commerce. This culture, this book offers a potential source needs and sustainable resource manage­ should reduce confusion when searching for of pride and continuity to peoples facing ment, this volume strikes a successful bal­ information in the book. Third, drug inter­ complex problems adj usting to ongoing ance between the traditional generosity of actions have been categorized into four cat­ lifestyle changes. I would hope also that it First Nations people to share with others egories based on levels of evidence, includ­ inspires additional aboriginal youth who and the necessity to serve the best interests ing: (I) information obtained from human wish both to embrace their own culrure and of their own communities . --- or pharmacological studies, case reports, or ro seek education and career opportunities -Timothy Johns, Ph.D., clinical experience; (II) data obtained from in the sciences. Professor, School of Dietetics and Human Nutrition; animal research; (III) speculative data based The main body of the volume comprises Centre for Indigenous People's Nutrition and the on in vitro studies or evaluations based on a series of more than 200 short monographs Environment, McGill University known mechanisms of action; and (IV) on the economic plants of the boreal fores t dubious information based on fl awed or in an area defined principally by the north­ erb Contraindications & Drug Inter­ uncertain evidence. In addition, the appen­ ern half of Manitoba, Saskatchewan, and Hactions, 3rd Edition. by Francis dices have been expanded and include 614 Alberta and adjacent areas in the Northwest Brinker, N .D . 2001. 432 pp., softcover. herbs and 17 vitamins/minerals as ro their Terrirories and Nunavut, and representing ISBN 1-888483-11-3. $25.95. ABC Cata­ affect on organ systems, certain conditions the cultural heritage of C ree, Dene and log #B282. and in combination with speci fi c drugs . Metis peoples. Data complied from original An increasingly common question asked Lastly, several new appendices have been and secondary sources are combined under of healthcare providers is , "Will this herbal added to the book. the categories of vernacular and scientific product interact with the other medication The book is divided into six sections: an names; habitat; medicinal, technological, that I am taking?" This book compiles the introductory section, the mai n section of and ritual uses; properties including nutri­ voluminous amount the book, an appendixes section, a brief ent, roxie, and pharmacological con­ of scientific infor­ addendum (Complementary Interactions of stituents. Detailed botanical descriptions mation, making it Herbs with Drugs), the cited references, compliment high-quality color photo­ extremely useful and the easy-ro-use index that cross-refe r­ graphs; all information is well-supported by when answenng ences the entire text. The introduction references to original field data or published questions concern­ includes a forward on the need for informa­ literature and a practical glossary and index. ing herbal safety. tion on herb-drug information and co n­ Each entry finishes with an evaluation of The first two edi­ traindication written by Colin Nicholls, the potential of the plant for economic tions of Herb Con­ editor of the British Journal ofPhytotherapy . development. traindications & The preface and introduction provide an With its high level of scholarship and its Drug Interactions overview and introduction on how to use practical orientation, this volume will also have been widely the book. interest non-aboriginal scientists, entrepre­ used for basic infor­ The main section of the book provides a neurs, and resource managers. Certainly, it mation on herb-drug interactions and con­ wealth of authoritative information on supports the objective of sustainable use traindications. This third edition updates herbal contraindications and drug interac­ and management of the boreal forest, a pri­ and adds to the information found in the tions. T he entries are presented alphabeti­ ority for the Canadian Forest Service and earlier editions, and continues ro be an out­ cal ly (from Acacia to Yohimbe) by common other government agencies that funded the standing reso urce for healthcare providers, plant name, followed by the scientifi c bino­ project. especially pharmacists and physicians. In mial and a listing of common names used in Commercialization, whether by aborigi­ addition, the book will ass ist consumers other countries or by Native Americans. nals or others, presents a dilemma for many who self-administer herbal medicines. Con­ Each contraindication and drug interaction First Nations in that it simultaneously offers tinuing a feature that began in the first edi- is documented as to the category of evi-

68 I HerbaiGram 56 2002 www.herbalgram.org dence and the reference sources are cited with in the text. Reference sisting of four categories of supporting research. Accordingly, cate­ sources include primary literature and authoritative secondary gory I of the book would include all four levels of the USP criteria. resources. In addition, English-language Therefore, category I of the book is too broad abstracts were used occasionally. and should be subdivided. As an example, care­ The second half of the book includes four gory I could be divided into category IA ("well "Drug interactions per se comprehensive referenced appendices: conducted" clinical trials, meta-analys is, epi­ Appendix A, herbs to be used with caution; are no threat to a patient; demiological studies), IB (less-well conducted Appendix B, herb/drug interactions, listed a physician's ignorance, clinical trails, meta-analysis, epidemiological on the basis of physiological effects; Appen­ either through lack of studies), IC (non-randomized studies), and ID dix C, herbs contraindicated in mothers and knowledge of interaction or (case reports). ch ildren; and Appendix D , vitamin/miner­ through lack of adequate The author does nor include the plant al/drug interactions. Appendix A is subdi­ observation of the patient authority with the scientific binomial name vided in to herbs that have a potential to pro­ and proper interpretation of which would help solve identification prob­ duce allergic response, photosensitization, new events, is dangerous." lems. Occasionally, the appendices are not in local irritation, acute inflammation of the alphabetical order. Even though the author urinary tract, irritation to the gastrointesti­ -Kenneth Lloyd Melman and includes more than 600 herbs, a few common­ nal tract, herbs that can affect the thyroid, Howard Fred Morreli, 1978. ly used herbs are not included (e.g., French and herbs that should only be used under maritime pine bark, also called Pycnogenol®, the supervision of a healthcare provider due and grape seed extract). to their potential to produce serious adverse effects. Even with these minor fl aws, the book is an invaluable resource Appendix B includes herbs that can modify absorption, affect for all health professionals, especially pharmacists, who should be pharmacological activities, and herbs that interfere with distribu­ on the front line when promoting the responsible use of herbal tion, clearance, and elimination. Appendix C includes herbs that medicines. This book belongs on the shelf of every pharmacy. The should be avoided during pregnancy, while breast-feeding, and in nominal cost should allow healrhcare students to purchase the children. Appendix D includes interactions between drugs and book for their libraries. Additionally, consumers will find the minerals with vitamin supplements. book useful to better evaluate their efficacious and safe use of The number of references has been expanded to a total of 1,099 herbal medicines. --'"' citations. T he author has highlighted significant references in the -Mary Chavez, Pharm.D. reference li st. Five free web updates to the text will be available at Director of Complementary and Alternative Medicine Research and Education . The updates are intended to supplement Midwestern University - Glendale the third edition so that users will not have to purchase a new print­ Meaicinat ana Aromatic Plants - Inaustrial Profiles ed edition annually, and should be a godsend to those interested in An Outstanding Series from Taylor & Francis the latest information on herb contraindications and drug interac­ NEW AND FORTHCOMING TITLES tions. Several key elements should be considered when evaluating infor­ ndividual volumes in the series provide both industry and acade­ mation sources on herbal medicine. Fo r instance, one should con­ mia with in-depth coverage of major medicinal and aromatic I plants of industrial importance in a genus. 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www.herbalgram.org 2002 HerbaiGram 56 I 69 CATNIP CONTRAINDICATED? upon the social setting, as well. So, in short, not I am cultivating N. nimmoniana on 40 was reading Herbal Gram 54 and found the "all " cars react. hectares in collaboration with M /S lndena spa, Iarticle on catnip being effective against mos­ The broad-spectrum action against many Milan, Italy, since 1994. The plantation is now quitoes interesting. I had read something about insects was pointed our in my review paper on matured and in flowering/fruiting stage. it in another herb magazine and was glad to read catnip and catn ip response in Economic Botany. 1 a more detailed account of the research. What is news is, that relatively nontoxic catnip is V.R. Pusalkar, Botanist However, I'd like to offer you the same caveat better than the relatively roxie DEET. The idea Aruna Planta Medica, Alagapuram I gave rh e other magazine, namely that catnip is here is rhar isomers similar to neperalacrones, Salem, South India attractive ro all species of cars, wi ld and domes­ but nor attractive to cats, may be an alternative tic. There was nothing in either article that to DEET. Since there is currently no commercial Clearly, we accessed an unreliable database when addressed this issue, producer of catnip oil with high neperalacrones, gathering information for this article. ~ appreci­ which could be a signifi­ don't worry about somebody spraying catnip oil ate the correction. -Editor cant problem to the com­ on yo ur car at the wild animal park. However, thi s is a line of future research to find an alterna­ mercial us e of catnip PARTS Is NOT PARTS derivatives as insect repel­ tive to DEET. have read wi th interest your article on the use Reference: lanr. It would be bad of artichoke leaf extract (ALE) for Irntable 1. Tucker AO, SS Tucker. Catnip and the car­ I enough to have every cat bowel sy ndrome [Herba!Gram 55] . In the course nip response. Econ Bot 1988;42:214-31. in your neighborhood of the article yo u mention the leaf, however, the follow you whil e you're picture you present is of the immature fl ower out jogging, bur it could DISTRIBUTIONAL RANGE CORRECTION head. We ea r the fleshy bases of the immature be downright dangerous lease refer to rh e article "New species may flower heads and rhe fleshy base of the large to go hiking in the Prevolutionize anti-cancer medications" in bracts. So I am trying to mountains where larger species of cats make HerbalGram 54. T he author mentioned that figure our if your picture their homes. Camptotheca acuminata is now also found in is just a mistake or if yo u Research has shown that one of the reasons India. I have been associated with the raw mare­ want us ro believe rhar catnip is so attractive to cats is that it seems to rials of camprorhecin since 1978 in India. C. rhe parrs of the artichoke mimic the sex hormones given off by females in acuminata does nor grow in India in the wild nor rhar we ear and/or rhar heat. Nor exactl y what you want to advertise under cultivation. are medicinal are the leaf when you're out for a walk in the woods. However, another plant, Nothapodytes nimmo­ or the flower head. It is a Catnip given to big cats in zoos has shown that niana (]. Graham) Mabb., lcacinaceae, syn. confusing picwre/article. the euphoric reaction is common to all members Mappia foetida (Wight) Miers, from the western Please cl arify. I am sure of the cat fam ily. A Siberian tiger gets just as ghats of India contain camprorhecin. All the that you would nor want crazy on catnip as rhe neighbor's tabby. Nor a parrs of this tree contain camprorhecin, merhyl­ yo ur readers to think that comforting thought to me. camprorhecin, and mappicine. These alkaloids if rhey are the usual part of the artichoke, the I'm glad to see researchers working on finding can be converted into camprorhecin and, fur­ flower head, rhar they would experience the herbal insect repellants bur I'd be very careful ther, into the anti-cancer compounds, toporecan relief from their complaints that they would have about employing catnip until more research is or irinorecan. The wood chips of this tree have if they had rhe ALE. done on what, if any effect the extract might been exported from India, mainly to Japan and In my ex perience, it is the leaf, and nor the have on members of rhe car fami ly, wi ld and some ro the United States, since 1978. Quire a "choke" (flower) that is the stronger of the domes tic. few Indian companies ex tract camprorhecin and medicinal parts. T he leaf is woolly and certainly export the value-added product. The Indian nor edible, bur can be dried an d used as rea for A. LaCroix company, Dr. Reddy's lab in H ederabad, many herbal uses. New Britain, CT launched the product with roporecan last year. jeanne Rose [Editor's note: ~turned to ABC Advisor Arthur Institute ofAromatic and Herbal Studies 0. Titcker, Ph.D., ofDelawareState University, for San Francisco, California response to this letter because of his extensive research into this very topic. His reply:] ~ appreciate Ms. Rose's clarification of the dis­ I have seen no research that says that nepera­ tinction between artichoke leaf and the immature lacrones are similar to "sex hormones given off flower {choke). The photo on page 16 of issue 55 by females in heat." Further, cars give off sex was chosen as a graphic representation of the arti­ pheromones, maybe, bur not hormones (so me choke plant's most distinguishing feature, just as we insect physiologists prefer restricting the term might show a photo of the distinctive echinacea "pheromones" to insects and applying "social flower to illustrate an article on Echinacea pur­ odors" to mammals). purea root. - Editor Actually, we don't know why cars react. We have an unpublished hypothesis (because it KUDO AND CORRECTION needs supportive evidence), bur all the reactions of the catnip response are displacement activities hank yo u for the positive rev iew of our pub­ from behavior involving both sex and food (sali­ Nothapodytes nimmoniana syn. Mappia foetida. T li catio n, the Natural Dietary Supplements vation is the first response, and my ca rs don't Photo © 2002 V.R.Pusa lka r Pocket Reference, wh ich appeared in HerbalGram salivate over sex .. . turkey cold cuts, yes, bur nor 54. We appreciate your affording INPR the sex!) . Yet another Indian plant contains camp­ opportunity ro make this compact reference Furthermore, of the family Fel id ae, cheetahs rorhecin - a small herb Ophiorhiza mungus work known to the readers of HerbalGram. I'm (Acinonyx jubatus) do nor react, and even within (Rubiaceae) - but it is a rare species in India certain that your review will do much ro boost irs the gen us Felis, rhis is generically determined. and rhus has not been exploited for this purpose visibility and wid er distribution. T he publica­ Some cars are unreactive, and reaction depends so far. tion, whi ch is intended to be a concise reference

70 I HerbaiGram 56 2002 www.herbalgram .org summari zing key information on the more pop­ the area of traditional Chinese medicine. How­ correct botanical identification of plant material ular herbal supplements and does not pretend to ever, I was arrested by photographs of T ienchi to be subj ected to clinical evaluation, is abun­ be comprehensive, does seem to appeal to health (Sanchi) gi nseng taken by the author and dantly supported by the taxonomic odyssey of care profess ionals, pharmacists, and others who respected herbalist/botanist Steven Foster, which this singular genus, here briefly excerpted. find a handy, pocket-size "quick reference" of designated the roots as deriving from Panax this sort useful in their daily activities. pseudoginseng var. notoginseng. Dennis V.C Awang, Ph.D. , FC!.C I did want to mention that the companion vol­ This species is most commonly encountered MediPlant Consulting Inc. ume to the Pocket Reference that is being pub­ today asP notoginseng (Burkill) F. H. Chen, as in White Rock, British Columbia, Canada lished in rh e Spring of 2002 by rh e Haworth Court's recent book, Ginseng: The Genus Pan ax. 1 Herbal Press, will appear under a different title Court acknowledges the work of Wen and Zim­ Reference: than the one quoted in your review. The new mer/ who clarified the complex and, historically, I. Court WE. Ginseng: The Genus Panax. title is Botanical Medicines: The Desk Reference often complicated and revised taxonomy of Amsterdam: Harwood Academic Publish­ for Major Herbal Supplements. The Desk Refer­ Panax, using sequences of the internal tran­ ers; 2000. ence, as irs name implies, wi ll be much more scribed spacers (ITS) and the 5.8S coding region 2. Wen J, Zimmer EA. Phylogeny and bio­ comprehensive than the Pocket Reference, at least of the nuclear ribosomal DNA repeat. Wen (at geography of Panax L. (the ginseng genus, for the 34 most popular herbal supplements that the rime associated wirh rhe Laboratory of Mol- Araliaceae) : Inferences from ITS sequences are covered in its mono­ ecular Systematics at Col­ of nuclear ribosomal DNA. Molecular Phy­ graphs. orado Srare University) and logenetics and Evolution 1996;6(2): 176-7. I would also like to rake Zimmer (of rhe Depart­ 3. Wen J. Species diversity, nomenclature, rhis opportunity to thank ment of Botany ar rhe phylogeny, biogeography, and classification yo u, and the other mem­ National Museum of Nat­ of the ginseng genus (Panax L. Araliaceae). bers of the ABC/ Herbal­ ural History, Smithsonian in: Punja ZK, editor. Utilization of biotech­ Gram staff for the wonder­ Institution in Washington, ~ ~~u.!!..~L~~,!!S nological, genetic and cultural approaches for ful job that yo u do, on a D.C.) settled upon 12 North American and Asian ginseng improve­ budgetary shoestring and T::""~"'"'· · ~=--=--·,·. species. Later, Wen (now at ment, Proceedings of the International Gin­ often under tight dead- rhe Field Museum of Nar- seng Workshop 200 I Simon University lines. HerbalGram and ural History in Chicago) Press, Vancouver, Canada. pp. 67-88. HerbCiip are both invaluable tools that use published a revised taxo nomy, whi ch recognizes 4. Tyler VE. Product definition deficiencies in 3 constantly in my own professional activities as II species and one variety, and includes the clinical studies of herbal medicines. Scien­ well as in the course I reach on botanical medi­ most recently characterized species, P vietna­ tific Review of Alternative Medicine cines at the University of Minnesota. I recom­ mensis Ha & Grushv. (Vietnamese ginseng), 1999;4(2): 17-21 . mend membership in ABC to all of my students which replaced P. omeiensis J. Wen and P. sinen­ and if l could make it a course requirement, I sis ]. Wen. In this latest taxonomic revision, P. Herbal Gram relies upon Herbs of Commerce, would do so 1 HerbalGram brings balance, com­ bipinnatifidus Seemann (synonymous with P. 2nd edition, as a primary resource for plant names. prehensibility, technical accuracy, cutting-edge pseudoginseng Wall. var. bipinnatifidus (Seemann) Herbs of Commerce is the authoritative source for science, and great graphic beauty on the subject Li and P pseudoginseng Wall. ssp. himalaicus common names and is a preliminary reference for of botanical medicines to a wide audience of Hara) replaces P major Ting, and P. bipinnati­ Latin binomials, in need ofadditional verification. both lay and professional people. I always read fidus Seemann var. angusti{olius (Burkill) J. Wen Regarding Latin binomials, the introduction of every issue from cover to cover and await the (syno nymous with P. pseudoginseng Wall. var. that book states, "... status ... [ofthese} are prone to next one eagerly. angustifolius (Bu rkill) Li) is included as formerly revision from time to time." (pp. xv} I honestly don't know how you manage to turn P. sikkimensis Banerjee. Wen has also altered the The editors of Herbs of Commerce agree with our such a high-quality and invariably fascinat­ authority attaching ro Sanchi/Tienchi gi nseng as the concerns raised by Dr. Awang, and their refer­ ing publication, rime after time; but however P notoginseng F.H. Chen ex C.Y. Wu & K.M. ence - the U.S. Department of Agriculture's you do it, please keep doing it. The world needs Feng. Agricultural Research Service Germplasm more publications like HerbalGram and more Curiously, HerbalGram and AHPA's 2nd edi­ Resources Information Network (A RS GRIN) dedicated people like the HerbalGraml ABC staff tion of Herbs of Commerce (H of C) use the long database - has been modified to reflect this to enable people to understand, appreciate, and outdated P pseudoginseng var. notoginseng G. information.- Editor benefit from the abundance of botanical medi­ Hoo & C.]. Tseng, H ofC actually citin g as syn­ cines rhar rhe world has to offer. onymous, P notoginseng (Burkill) F.H. Chen ex All my best wishes for your continued success. C.Y. Wu & K.M. Feng. Oddly also, H ofC gives Herba/Gram welcomes letters to the priority to P pseudoginseng var. japonica (C.A. editor as part of the ongoing dialog Dennis]. McKenna, Ph.D. Mey.) G. Hoo & C.] . Tseng, for Japanese gin­ that makes science so vibrant, and as Executive Director se ng, long recognized as P. japonicus C.A. Mey., 3 Institute for Natural Products Research, and which H of C relegates to synonymy; Wen, as part of our efforts to learn as well as to Senior Lecturer did Wen and Zimmer, ' recognizes P. repens educate. Please submit your letters to Center for Spirituality and Healing Academic Maxim as the most prominent synonym for P. Karen Robin, managing editor, via Health Center japonicus, bur rhe former author lists also P email [email protected]>, or quinquefolia b. japonica Siebold. Himalayan or University ofMinnesota by postal service in care of the Ameri­ Nepalese ginseng is P. pseudoginseng Wall. can Botanical Council, P.O. Box Ir is absolutely imperative when reviewing lit­ CONCERNING REGIONAL GINSENG$ erature on Panax species that one be thoroughly 144345, Austin, TX 78714-4345, AND THE TORTUOUS TAXONOMY conversant with the historical taxonomy of the USA. Be sure to include your contact OF THE GENUS PANAX genus, because very few researchers are punctil­ information so we may confirm. he recently published omnibus article on iously attentive to this as pect of herbal scientific The editors reserve the right to edit, Tginseng (The Nature of Ginseng by S. Dhar­ research. The exhortation of the late Professor clarify, or decline to publish. mananda, HerbalGram 54) I found interestin g Varro Tyler' that careful attention be paid to the and informative in many respects, particul arly in Latin taxonomic authority, in order to ensure

www.herba lgram.org 2002 HerbaiGram 56 I 71 November 9: Festival Hill's Herbal Seminars International, Consumer Hea lrhcare Products 2002 series: Creating a Garden of Your Own. Round Assoc iation, Council for Responsibl e Nutrition, Institute for Nutraceutical Adva ncement, National November 1-3: Integrative Cancer Therapies To p, TX. Se mi na r includes buffe t luncheo n, print­ Nutri tional Foods Association, ChromaDex, Virgo Symposium. Evanston, IL. Presented by the Uni­ ed materials and supplies, rasrings, ga rd en tour and Publ ishing, and th e Center for Public Health Edu­ versity of Illinois at Chicago Coll ege of Medicine plant treasures . $60 per person. Contac t: T he Herbal Forum at Round Top, P.O. Box 23 Round cation. More information at www.nsf. org/cphe/ds and The Institute for Integrative Cancer Research Top, Texas 78954. Ph: 979/249-3973. Fax: , phone 800/NSF­ and Education. 40+ speakers scheduled. Contact: 979/249-3961. Other seaso nal se minars set for MARK ext. 5723. Genevieve Hedl and, ICT Sym posium Office. Ph: Dec. 4 & 7, Feb. 22 & 23, Mar. 4, Apr. 8 & 23, 888/753-700 1. E- mail: . The Venetian, Las Vegas. Share new science or November 9-10: Green Festival. Sa n Fran cisco, research with a room full of industry execs. Con­ November 1-4: World Ayurveda Congress , CA. Promotes susrainabiliry of local gree n tact: 480/990- 110 I. Website: Swadeshi Science Movement, a unit of Vijnana practices, environmental responsibili ty, localized Bharari, in associa tion with Ministry of Health & December 8-12: Cucurbitaceae 2002 Confer­ cooperation, community building and accounta­ ence, Naples , Italy. Contac t: Don Maynard or Beth Famil y Wel fa re Govt. of India Congress. Contac t: bili ty. Produced by Global Exchange, Co-op Amer­ Miller-Tipton. Fax : + 1/352/392-9734. E- mail: Secretary General, World Ayurveda Congress ica and Bioneers. Ph: 877/727-2179. 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Also on Dec. 10, Mar. 12, Apr 16 grams on marketing and R&D as we ll as more sci­ 168; E-mail: . & 30, May 14. entific presentations and speakers from Europe, November 7: Distinguished Lectures in the Sci­ November 17-20: Worldnutra 3rd Asia, Australia and Latin Am eri ca. Website: ence of Complementary and Alternative Medi­ Annual Conference and Exhibition on . cine, Bethesda, MD. Arthur Kleinman, M.D., Pro­ Nutraceuticals and Functional Foods: "From February 3-7: 3rd World Congress on Medicinal fesso r of Social Anthropology, Harvard Uni versity, Laboratory to the Real World and the Market­ and Aromatic Plants for Human Welfare and Maude and Lillian Presley Professor of Medical place," San Diego, CA. Ms. Nedra Sneed, Confer­ (WOCMAP III), C hiang Mai , T hailand. Contact: Anthropology and Psychiatry, Harvard Medical ence Secretary, Worldnurra, P. 0 . Box 10 506, Col­ Dr. Araya Jarisa ri enr, Chiang Mai Uni versity, Dept. School , will present "The Global Transformation of lege Station, TX 77842. Ph/fax: 979-846-1951. of Biology, Facu lty of Science, Chiang Mai 50202, Health Care: Cultural and Ethical Challenges to Email: ; website: Thailand. Ph: +66 53 943346 or 943348, fax: +66 Medicine." Ph: 3011594-9632. . 53 892259, email: , November 7-10: Natural Products Organic Asia, November 27-30: 2002 World Neem Confer­ website: . Singapore. Congregates manu facturers, suppliers, ence: Neem for Sustainable Development, Mum­ February 28-March 7: 7th Annual AromaHerb distributo rs, agents, industry professionals and buy­ bai, India. Sustainable agriculture, human and ani­ Conference and Trade Show, Tempe, AZ. Leadi ng ers from all over the world. Contact: Ms. Sylwin mal health, constraints facin g Neem industry, pro­ companies in the essential oil industry, worldwide Angdrew, Senior Marketing Executive. Ph: (65) cess ing and more. Contact: Nee m 2002 Secretariat, essential oil distillers, renowned herbalists and 6534-3588; fax: (65) 6534-2330. Email: . Scheme, Mumbai - 400 049, India. Fax: +91 22 panies. Exhibiting only pure and natural products. November 8 -16: lncan Healers/Shamans 620 7508. Email: . mail.com>. mology of "Aya huas ca" as a rime-space medi ­ December 4: Current Issues with Dietary Sup­ March 22: The 8th Annual Herbal Forum at cine will be the foc us of this workshop. Con­ plements: Safety, Toxicology and California Round Top. Round Top, TX. A Celebration of tact: Ed and Tani a Turtle. Ph: 61 2/ 825-3792. Proposition 65, Venetian Conference Center, Las Herbs Featuring Bas il , Herb of the Year 2003! E-mail : . Web­ Vegas , immediately before SupplyS ide Wes r. Expert Includes lectures, demonstrations and exhibits, si re: . panel to discuss botani cal and ingredient safety extensive herbal book store, garden buffe r luncheon November 8-16: Shamanic Journeys to the issues, dietary supplement product liabili ty and risk and afternoon tea, giant plant sale, more. Optional Ecuadorian Andes, Amazon, and Pacific Ocean. assess ment, the impact of food sa fety securi ty legis­ wo rks hops March 21. Contact: T he Herbal Forum Contact: Ed and Tania Turtle. Ph: 612/825-3792. lation, and effects of adverse eve nt reporting. Spon­ at Round Top, P.O . Box 23 Round To p, Texas E- mail : . Website: so rs include America n Herbal Pharmacopoeia, 78954. Ph: 979/249-3973. Fax: 979/249-396 1. . American Herbal Products Association, AOAC

72 I HerbaiGram 56 2002 www.herbalgram.org March 28-April 1: APhA Annual Meeting. New Meadowlands Exposition Center, Secaucus, N.J. 2003, PO Box 547, Greenfield, MA 0 1302, Ph: Orleans, LA. T itles and 200-word abstracts for IS­ Share new sc ience or research with a room full of 4 13/774-75 11 , ext. II ; fax: 4 13/774-4432. Email: minute podium presentations deadline Ocr. I, industry execs. Contact: 480/ 990-110 I. Website: [email protected]>. Website: 2002. Contact: Michael Montagne, 179 Longwood May 3-5: International Symposium on the Role Ave, Bosron, MA 0211 5. Ph: 608/262-5378. E­ May 8-10: 5th Coloquio Europeo de Etnofarma­ of Botanicals in Aging, New Brunswick, J. Pre­ mail: . cologia Congreso lnternacional. Valencia, Spain. sented by the America n Herbal Products Associa­ April 6-9: PhytoChemistry and Biology of Lig­ The program will focus on cultural inbreeding in tion & Rutgers University. Confi rm ed speakers nans, Conference Center Walberberg, Germany. erh nopharmaco logy. Contact: Blasco Ibanez, 15, include Jim Duke, Ph. D., and Jerry Con, Ph .D. Contact: Prof. Maike Petersen, Institute for Ph ar­ 460 I 0 Valencia, Spain. Ph : (00)34+963-86-47-64 CEUs offered. Contact: arasha Hall , AHPA, 8484 maceutical Biology, Philipps-Universrar Marburg, Fax: (00)34+963-6 1-39-75. Website: Georgia Ave Suire 370, Sil ver Spring, MD 209 10. Deurschhauss rr. 17 A, D-35037 Marburg, Ger­ . Ph: 30 i /588-1 17 1. Email: . many. Ph: 49-(0)642 1-2825821, Fax: ++49- May 10: Festival Hill's Herbal Seminars series: June 27-29: 66th Annual Natural Products Con­ (0)642 1-2825828, Email: , Website: . Includes buffer luncheon, printed materials and NNFA, 393 1 MacArthur Bl vd, Sre I 0 I ,Newport April 14-0ctober 17: UCSC Farm & Garden supplies, rasrings, ga rden ro ur and plant treasures. Beach, CA 92660. Ph: 800/966-6632. Website: Apprenticeship, Santa Cruz, CA. Intensive 6- $60 per person. Contact: The Herbal Forum at <.www.nnfa.org>. month co urse in organic ga rd ening and small-scale Round Top, P.O . Box 23 Round Top, Texas 78954. Oct. 1-3: Virgo Publishing's SupplySide West. farming. 35-40 trainees; UCSC is especially inter­ Ph: 979/249-3973. Fax: 979/249-396 1. Venetian Hotel and Sands Exposition Center, Las es ted in in creasing the divers ity of applicants. May 14: Herb Days at Festival Hill. Round Top, Vegas. Share new science or research with a room Application deadline is Nov. 1, 2002. Contact: Erin TX. Tours begin at !lam with luncheo n and lec­ full of industry execs. Contac t: 480/ 990-11 0 I. Barnett, Apprenticeship Coordinaror, CASFS, ture and last until 2pm. $30 per perso n. Contact: Website: . UCSC, 11 56 High Street, Santa C ruz, CA 95064. The Herbal Forum at Round Top, P.O. Box 23 November 27-30: International Ginseng Con­ Ph: 83 1/459-3240. E-mail : . Website: . 979/249-396 1. bourne, Vicroria, Australia. Organized by the Aus­ April 30: Herb Days at Festival Hill. Round Top, May 14-18: All Things Organic 2003, Austin, tralian Ginseng Growers Associa tion. Incl udes trade TX. Tours begin at I I am with luncheon and lec­ TX. The Organic Trade Association is the member­ and poster displays, technical program, and post ture and last until 2pm. $30 per person. Contact: ship-based business association representing al l sec­ conference tours. Contact: Conference Secretary, The Herbal Forum at Round Top, P.O. Box 23 rors of the organic industry throughout North IGC 2003, PO Box 250, Gembrook, Victoria Round Top, Texas 78954. Ph: 9791249-3973. Fax: America, and ir encourages global susrainabili ty 3783, Australia. Ph: 61 3 5968 1877; fax: 61 3 979/249-3961. through promoting and protecting the growth of 5968 111 9. Email: . May 5-7: Virgo Publishing's Supply Side East. diverse organic trade. Contac t: Lori Wyman, IGC

International Symposium on the Role of Botan­ 25-27); Porrsrown , PA (Nov. 15-1 7); and San Fran­ The Pharmacopoeia of the People's Republic of icals in Women's Health proceedings document is cisco (Feb. 21-23) . Contact: Jea nne Rose. Ph: China (2000 English Edition), the Chinese Pharma­ now available from rhe American Herbal Products 415/564-6785. Email : . copoeia Commission's official and authoritative co m­ Association (AHPA). This February 2002 sympo­ Gene Conserve is an electronic journal devoted ro pendium of drugs, covers traditional Chinese medi­ sium fo cused on fundamental impact of botanicals conservation of crop generic resources with cines and most Western medicines and preparations. on a va ri ety of women's health conditions, clinical emphasis on cassava . Contact: Gene Conserve Contact: Chi Zhenguo, Rm . 604, Bldg. 7, Qian Hai observations made by leading practitioners, and Website/E-mail: . Web­ Hua Yuan , Tao Yuan West Rd ., Nanrou, Nanshan, emerging scientific research on red clover, bl ack sire: . , , P.R. China 5 18052. Fax: +86 cohosh , chas te tree, and soy. $ 100 + S/H. Contact: The Natural Heritage journal is ava ilab le online. 755 26161829 E-mail: . Narasha Hall , AHPA. Ph: 3011588- 11 7 1 x!06. Website: . . American Association of Homeopathic Pharma­ Alternative Perspectives, the newsletter of the Phytochemistry Reviews, a new journal containing cists' new webs ite provides accurate information National Foundation for Alternative Medicine, is the proceedings of the Phytochemical Society of rega rding the legal status of homeopathy, and rep­ available online and in PDF format. FAM seeks Europe, offers both paper and online subscriptions. utable manufacturers of homeopathic drug prod­ ro inform about the scientific potential of CAM ro Contact: Kluwer Academic Publishers. Ph : ucts. Contact: Eric L. Foxman, Secretary, AAHP, treat chronic diseases, in particular, cance r. Website: 866/269-9527. Email: [email protected]>. Web­ 3741 Mitford Lane, Clinton, WA 98236. Ph: . sire: . 800/478-0421 . . Current Topics in Nutraceutical Research, a new www.Herbalchem.net is a new websi te on herbal Herbal Medicines Safety Advice is available from scientific journal for the nurraceurical industry is phytochemistry for the herbalist/practitioner, gen­ the Uni ted Kingdom's Medicines Control Agency scheduled ro launch December 2002. This is inter­ eral public, heal th food/s upplement srore staff, and website, including herb/drug interactions, safe ty national, interdisc iplinary broad-based peer­ others. In formation ava ilable on Introductory, concerns raised by other agencies, quality control reviewed journal offers critical evaluation of Intermediate, and Advanced levels. alerrs , and derails of contamination or wrongful research on nurraceuricals. on some of its publications, including Ginseng, worklli censingmeds/herbalm eds/herbalsafety.hrm>. NatureServe is a non-profit organization dedicated Plant Biotechnology, and Plant Medicinals. Each The New York Botanical Garden's Fall 2002/Winrer ro providing knowledge ro prorecr rhe natural volu me facilitates technical understanding of a sub­ 2003 catalog includes hundreds of classes in seven wo rld. Formerly the Association for BioDiversity jeer's past and irs future potential. Contact Plants disciplines: botanical art and illustration, botany, Informa ti on (ABI) , arureServe works wirh The Personified, Inc, P.O . Box 18582, Eastside Station commercial horticulture, Aoral design, gardening, Nature Conse rvancy ro help meet local, national , 1600 18th Ave, NE, Minneapolis, MN 5541 8. horticultural therapy, and landscape design. The and global conservation needs, and helps ro gu ide Emai l: . largest and most diverse continuing ed ucation of any conservation decision-making and sound land use Jeanne Rose Aromatherapy Seminars include dis­ botanical garden. Contact: Leeann Lavin. Ph : planning. Contact: arureServe, I I 01 W ilson tillation, blending, rare perfumery, and fou ndations 7 18/8 17-8743. E-mail: [email protected]> . Blvd , 15th Floor, Arlington, VA 22209. Ph: of aromarherapy and essential oils. Learn from rhis 703/908-1800. Website: . mas ter herbalist and aromarherapist in Reno (Ocr. www.herbalgram.org 2002 HerbaiGram 56 I 73 flora. Offering an appealing blend of art and sci­ ance. Call today fo r free information 800/487- Correspondence Courses And Seminars ence, this 52-page quarterly examines all aspects of 8839. , . Aromatherapy and Herbal Studies Course/Jeanne popular botany in North An1erica from the rain Herbal Education - Rocky Mountain Center for Rose. Correspondence, certifi cation, in -perso n forests of Panama to th e mosses of the Arctic tundra; Botanical Studies, offering a diverse curriculum intensives . 160 CEU provided, California Board of from gardening with native trees, shrubs, wildflow­ with over 20 herbal mentors. Comprehensive one-, RN Provid er #CEP\1659. Info: 219 Carl St., San ers, and ferns to the latest projects in habitat and rwo- and three-year programs - Education for life. nati ve plant conservation. The green revolution Francisco, CA 9411 7 or FAX 4 15/564-6799. Recommended by leading herbalists. Colorado Stare begins in our own backyard. Subscriptions and Foundations in Herbal Medicine by Tieraona Low Certified. Call 303/442-6861 for brochure. membership are $35/1 yr. , $70/2 yrs. Sample copy RMCBS, Inc., PO Box 19254, Boulder, CO 80308. Dog, MD, AHG, is a video and text-based Corre­ $9. To subscribe, order from website: . spondence Course in Herbal Medicine with over flowermag.com> or by mail: Wildflower Subscrip­ 700 pages of text and almost 60 hours of video. Dr. tions, Box 335 Station F, Toronto, ON Canada The International Institute of Traditional Herbal Low Dog is a past president and founding member M4Y 2L7. Medicine and Aromatherapy - offers an interna­ of th e American Herbalist G uild. For more infor­ tionally accredited Residential Diploma Course in mation, visit our website (fi hm.com) or ca ll 888- Schools Aromatherapy and T herapeutic Massage in 857- 1976 for a free syllab us. Provence, France, starting June 2002. Includes the science and energetics of75 essential oils and educa­ Aromatic Plant Medicine Diploma Course, with tional tours of the region's aroma ric delights. 01144- Publications Jade Shutes and the Institute of dynamic Aro­ 120-639-3465 . marherapy. Other educational material is available. American Herb Association Quarterly Newsletter For a brochure: 360/65 1-9809 or email White Pine Healing Arts - Comprehensive 3-year - $20/yr. AHA, P.O. Box 1673, Nevada C ity, CA . program in C hinese Herbology, including academic 95959. and clinical components. Certification at profes­ Dominion Herbal College (Est. I 926) -- Careers sional level. Excell ent fac ulty, all trained in C hina Australian jounzal ofMedical Herbalism - quar­ in Herbal Medicine -- Run yo ur own Clinical terly publication of the National Herbalists Associa­ and able to read Chinese source texts. Accessible Herbal Practice-Classroom-Clinical Herbal Thera­ format. Distance lea rning options. 4 13/549-4021 tion of Australia (founded in 1920). Deals with all py-3 years full time classroom with 500 clinic hours. aspects of Medical Herbalism, including latest email Aromatherapy Consultant. Distance Learning­ . medicinal plant research findings. Regular features C hartered Herbalist, Master Herbalist, Herbal Con­ include Australian medicinal plants, conferences, sultant, Clinical Herbal Therapy for Phys icians, Travel conference reports, book reviews, rare books, case Clinical Herbal Therapy-4 yea r with 500 Clinic study and medicinal plant rev iew. AUD/$95 plus Hours & yearly Seminars. Continuing education, AUD/$ 15 if req uired by airmail. National Herbal­ Monthly Workshops, Herbal Field Experience, Hawaiian Herbal Education - Go beyond tradi­ ists Association of Australia, 33 Rese rve Street, Annual Seminar (July 2003). Full se rvice Herbal tional herbalism to learn Hawaii an plant medicine Annandale, NSW 2038, Australia. Clinic- Vancouver 604/ 521-5822. Info: 7527 secrets. 3-day hands-on workshops at Hi'iaka's HerbalGram- Quarterly journal published by the Kingsway, Burnaby, BC, Canada, V3N 3C1 Tel : Healing Hawai ian Herb Garden nea r Hila. Sched­ American Botanical Counci l. A benefit at all levels 604/52 1-5822. Fax: 604/526-1561. Email: uled for January, April, July, October 2003. Individ­ of membership in ABC. See page 3 for membership Web: . $11 0/day includes lodging on-sire. Detai ls and . P.O. Box 144345, Austin, images at . Phone 808/966- Earn Diplomas, Certificates, CE Credits for Vet­ 6126, email . TX 787 14. 800/373-7105 or fax 512/926-2345. erin arians and Pharmacists, and CEUs for Nurses Email . and Licensed Massage Therapists through Orego n Other Medical Herbalism - Subtirled "A C linical State Licensed College. Learn at your own pace wirh Newsletter for the Herbal Practitioner. " Edited by comprehensive distance lea rning or on-line courses. Paul Bergner. $36/yr, $60/2 yrs. 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DEAR READER not published; however it is available online SJW shows it does work in depression; but­ . early heart disease, and so much more. Bright al ly ignored by the media. Herbs for Menopause. But, where's the prospects in an otherwise bleak summer. Wall Street journal Article. Perhaps the good news, if any? The best comes in the Bottom line. Just as there are legitimate nadir of the present herb crisis is a highly aftermath of NIH's pulling the plug on a concerns about quality control and safety misleading article in the August 29 issue of long-term trial hormone replacement thera­ with some products, there are also problems the WSJ by Chris Adams, "More Research py due to cardiovascular and cancer ri sks. in the way the media reports on herbs. Many Is Questioning Safety, Effectiveness of Numerous articles in the New York Times, reporters have scant knowledge of the sub­ Herbs." The article m ischaracterizes the WSJ, and Washington Post noted that research jects they cover and biases against their sub­ state of the science regarding at least five supports the effects of black cohosh, red jects. The public deserves high quality, safe top-selling herbs: ginkgo, SJW, SP, echi­ clover, and soy to reduce symptoms associat­ and effective herbal products for their health nacea, and garl ic, and included this aston­ ed with menopause. ABC posted a new black care. T hey also deserve straightforward, bal­ ishing statement, "Indeed, research has co hosh monograph on our website anced, responsible reporting on the safety found that half of the dozen top-selling . their marketed purposes or dangerous." Lack of space here prohibits mention of ~~5~~'fk~ ABC's letter to the editor in response was other good news: a new French study on

74 I HerbaiGram 56 2002 www.herbalgram.org Educating the public on the use of herbs and phytomedicinals I Fall2002 Herbal Education Catalog Featured Books

New Encyclopedia of Herbs and Their Uses by Deci Bown. 2001. 2nd edition. The Royal Horti­ cultural Society's new edition of the most compre­ hensive illustrated encyclopedia of herbs. More than 1000 species, varieties, hybrids, and cultivars listed alphabetically by genus. Addresses culinary, medicinal, and eco­ nomic properties of each herb along with cultivation information. More than 1,500 color photographs by the author. Hardcover, 456 pp. $40. #Bl56 8J '' \Vl'''"'" ~ ':- Herbal Medicine

t 1,,,-.u I ch ltnn

Herbal Medicine - Classic Edition Rudolf Fritz Weiss. M. D. THE CLASSIC EDITION IS BACK! This is a key text in the field of phytotherapy, used by both herbali ts and medical professionals. Arranged by clinical diagnoses related to organ systems, with guidelines for prescribing herbal remedies, sections on dosage, application and precautionary measures. Proprietary formulations, full references, and a comprehensive subject index of almost 2,000 entries round out the coverage. Softcover, 362 pp. $49. #B006A Special Offer i} Thieme

Herba/Gram BackPackS Don't leave any gaps in your library. Her6a!Gram back issues provide a comprehensive store of information on herbs, book reviews, research, and conference reports, legal and regulatory developments. BackPacks are a set of Her6aLGrams from 1989, except the most current issue, and indude a complete Cumulative lndex. Order a complete et of BackPacks, Volume II, III and IV for 95 and y ou'll receive 2 slipcase at no extra charge to pro ect and tore tho e hack i ue . That' a 19 value.

To order, use the order form on the inside back cover or, for secure online ordering, please visit the Herbal Education Catalog section of our website: www.herbalgram.org ABC EXCLUSIVES

Botanical Educating the public on the use of herbs and phytomedicinals Herb ducationCatalog Booklet Series he Herbal Education Catalog is back The eight-page booklets in this Tby popular demand. You will note that series have reproductions of each plant and it is smaller and the number of items provide concise, authoritative, and accurate offered is fewer. This is, in part, a cost information on major medicinal plants. consideration. What we have listed here 301 Echinacea are newer items and the essentials - books 302 Siberian Ginseng and monographs that anyone interested in 303 Asian Ginseng herbal medicine should have in their 304 Ginkgo 305 Milk Thistle library. We have more items on our lndi,~dually priced at 306 Peppermint website: sale books, closeout items, and $100 307 Chamomiles special reports. Check them out at 308 American Ginseng www.herbalgram.org or contact us for a 309 Goldenseal All 15. Item #300 list of what is available. 310 Feverfew $1250 311 Garlic Don't forget that if y ou are a member of 312 Valerian the American Botanical Council, y ou get a 313 St. John's Wort 314 Black Cohosh 5% discount on y our purchases from our 315 Aloe catalog and website. For information on membership, see page 2 of this issue of HerbaL Gram . Retailers: Ca ll us about placing these booklets in your store for your customers' benefit. Complementary rack included.

Steven Foster Photography Medicinal Plants- Volume 1 CD-ROM

This royalty-free CD ROM contains 102 photos of some of the most popular medicinal plants in use today. Medicinal Plants - Volume 1 is designed for both

Macintosh TM and Windows T,\1 operating systems. The images are high resolution: 8xl2 inches at 300 dpi (20.3x30.5 em at 118 dpcm) and have excellent highlight and shad­ ow detail. Item #C008

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Alfalfa Calendula Dandelion Goldenseal Milk Thistle Sarsaparilla Tomato Aloe Cascara Sagrada Echinacea Goldenseal Root Mu!bort Saw Palmetto Turmeric American Ginseng Castor Bean Elecampane Grape Vine Mu lein Senna Valerian Angelica Car's C law Even ing Prim_rose Green Tea Niaouli oil Shepherd 's Purse Weding Willow Ashwaganda Catnip Fennel H awthorn Noni Shiitake Wil Yam Root Asian Ginseng Cayenne Fenugreek Horse Ches tnut Pale Pufte Coneflower Siberian Ginseng Witch Hazel Astragalus Chaparral Feverfew Kava kava Pass ion ower S lip~ery Elm Wormwood Bearberry Chaste Tree Flaxseed Kudzu Pau D'Arco Soy eans Wuweizi Bilberry Chickweed Fo-ri Lemon Balm Pennyroyal Squaw Vine Yarrow Black Cohosh Cleavers Fringerree Chionan- Licorice PePjerminr St. John's Wort Yellow Dock Black Elderberry Colt's Foot Flowers thus Lobelia Re Clover Srinfting Nettl e Yucca Borage Comfrey Garlic Maitake Reishi Sun ower Bugleweed Cranberry Gin fer Marshmall ow Rosemary Thuja Butterflyweed Culver's Root Gin go Mayapple Sage T hyme MONOGRAPHS

ESCOP Chinese Herb Monographs ESC 0 P Monographs Chinese Drug Monographs and Analy sis by H . Wagner, R. Bauer et a l. Monographs range from 8 to 17 pp. and include such Prepared by the European Scientific information as: pharmacopeias fo und in, publication first ci ted in , MONOGRAPHS Cooperative on Phy toth erapy official drugs, substi tute drugs, description of official drugs, falsifi­ (ESCOP), a group of herbal experts cation drugs, pretreatment of the raw drug, medicinal use, main o.n.. from academia and in dustry in the constituents, pharmacology, toxicology, TLC fingerprint analysis, \lwou""' u"" European Union. These monographs evaluation, HPLC fin gerprint analysis, and references. OrP\...Wf Otwt~' contai n indications, contraindica­ tions, side effects, dosage, interac- Radix Astragali (Huang Qi) Astragalus Item #0424A tions, and many other important therapeutic parameters of 60 leading herbs and phytomedi­ Fructus Schisandrae (Wuweizi) Schisandra #0424B cines in Europe. Well referenced. A must for physicians, phar­ macists, naturopaths, herbalists, industry, a nd researchers. Radix Rehmanniae (Dihuang) Rehmannia #0424C ESCOP monographs are published in looseleafform, for Radix Bupleuri (Chaihu) Bupleurum #04240 in sertion into a dedicated ring binder. ESCOP employs the Bulbus Fritillariae (Beimu) Fritillariae #0424E traditional pharmacopeia! name of the herb as the title of each monograph. Rhizoma Pi nell iae (Banxia) Pinellia #0424F

For a complete listing of mo nographed herbs and fascicule Herbe Houttuy niae Cordatae (Xuxingcao) Houttuy nia #0424G d ivisions, visit our website: for all6 fascicules Item #42 1 Herba Asari (Xixin) Asarum #0424H www. herbalgram .org/mono­ graphs.htm l $ 225 Radix Angelicae Pubenscentis (Duhuo) Angelica #0424J Rhizoma Atractylodes Macrocephalae (Baizhu) Atractalodes #0242K WHO Monographs on Selected Medicinal Rhizoma Belamcandae Sinensis (Shegan) Belamcanda #0424L Plants, Vol. 1 Herba Lycopi Lucidi (Zelan) Lycopus #0424M by the World Health Organi zation. 1999. Collection of 28 monographs covering the Rhizoma Seu Radix Notopterygii (Qianghuo) Notopterygium #0424N quality control and traditional and clinical Radix Angelicai (Danggui) #0424P uses of medicin al plants selected for inclu­ sion on the basis of thei r widespread use, Radix Angelicai Dahuricae (Baizhi) #0424Q particularly in countries that rely heavily Radix Ligustici Chuanxiong (Chuanxiong) #0424R on medicinal plants to meet primary healt h care needs. Ai ms to encou age standard­ Pericarpium Zanthoxyli (Huaj iao) #0424S ized scienti fic approaches to ensuring the safety, quali ty, and efficacy of medici nal plants and their products. Softcover, 287 $ 12 each Alll7 monog r a phs$ 185 ( S ave over 10%) #04241 pp. Item #428 American Herbal Pharmacopoeia Monographs • Comprehe nsive review of the therapeutic uses • Com p lete safety and toxicology data • Critical information on side effects, con traindication s, a ll Fitoterapia aspects of q uali ty control. h istorical use and mor e Extensive monographs and literature reviews from Filoter­ • Astragalus, Re is hi and Schisandra also include apia, a leading international botanical research journal, Traditio nal C hinese Medicine suppleme nt section founded by Indena, the leading European supplier of botanical derivatives. • Ashwagand ha includes Ayurvedic supp le me nt section • Fully referenced and peer reviewed by internatio nal a uthorities Bilbeny Vatruuiun m_vrtilluJ 26pp. hem #425A St. John 's Wort #5420 Ginkso Ginkgo bi/oba 48pp. #4258 Hawthorn Leaf with Flower #426 Grape Viti,. viniforo 25pp. #425C Astragalus Root #43 1

Horse Chestnut AM:ufu., bippocMianum 28pp. #4250 Hawthorn Berry #430 Valerian Root #427 $ 19?a~h Milk Thistle Si/ybwn marianum 39 pp. #425E Schi sandra Berry #434 Pumplc..in CucurbiJa P'P" II PP· #425F St. John's Wort Wi ll ow Bark #433 Pygeum Prunu.• africana 14 PP· #425G Ashwagandha Root #435 9 Saw Palmetto Sm:noa rrpMJ 14 PP· #425H $9 ?ach Black Haw Bark #436 St. John's Wort Hyf"ricwn f"rforoJum 25 PP· #4251 Chaste Tree Fruit #437 All 16 monographs Valerian Vakriana of!irina/i.J 13pp. Cramp Bark #438

Stinging ettle Urtica Jioiaz 16pp. Reishi Mushroom #439 29 Goldenseal #440 $278 (10% discoount) Bi lberry #441 Item #450 $1O each $98 for allll Item #425K Black Cohosh Rhizome #442 Cranberry Fruit #443

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The Clinician's Handbook of Natural includes name of product, also known as, scientific Cancer Research Medicine by Joseph Pizzorno Jr., names, uses, safety, effectiveness, possible mecha­ TheCI~'s Cancer and Natural Medicine by Handbook of Michael Murray, and Herb Joiner-Bey. nisms of action and active ingredients, adverse NATUiAL 2002. Provides an easi ly accessed set reactions including known allergies, possible inter­ John Boik. 1996. Known effects of MEDICINE '"''~" ' ·'""'• natural therapies on key biomechan­ of decision-making flowcharts and actions, typical dosages and common modes of summary information based on the administration, and other comments. Softcover, e~~ ·"""' '"• ical processes active during cancer best ava ilable evidence on natural 1,310 pp. $92. #B463 Access to web version for 1 ~..,.....,..'I progression. Based on published sci- entific data obtained from over medicine options, includin g herbs, year, updated daily. $92. #DOOB Both book and web 1,200 references. Com prehensive supplements and dietary advice. access. $132. #B463C ~...... ,.....,_. review of cancer physiology, cover­ Covers 74 common diseases and includes scientifi­ Principles and Practice of Phy­ ing such topics as differentiation, angiogenesis, cally verified therapies. Softcover, 522 pp. $39.95. #B506 totherapy by Simon Mills and Kerry apoptosis, invasion, metastasis, and immune and Bone. 2000. Detailed, practical, and hormonal interactions. Natural therapies reviewed ··,, ~ ~~ Delmar's Integrative Herb Guide for research-based approach to the use include herbs, vitamins, minera ls, enzymes, carti­ Delmar's , Nurses by Martha L1bster, MS, RN. of herbal treatments in a wide variety lage, Chinese med icine, electrotherapy, antioxi­ nteg rauve ~, 2002. Profiles 58 common herbs and of clinical conditions and problems. dants, flavonoids, and others. Soft cover, 315 pp. $28. ~ II E H B'! conditions they treat. Includes the Includes a clear description of the #B161 C u iiH ·~· latest biomedical research and clini­ principles and foundations for the Natural Compounds In Cancer For N: cal practice information and practice of phytotherapy; in-depth and detailed ' ~:~!: ,·~·~7~~~·~ Therapy: Promising Nontoxic Anti­ i""""-""'? practical information on how to inte- profiles of over 45 herbs, reviewing pharmacology, tumor Agents from Plants and .::"'(f grate plant-based therapies into research, and traditional use; therapeutics for actu­ Other Natural Sources by John Boik. patient care. Extensive cultural information al disease states, supported by case histories; and 2001. Presents a solid scientific basis includes folklore and traditional uses. Recommen­ coverage of cha llenging issues such as dosage, for the use of natural compounds in dations for addressing the safe use of herbs in safety, and drug-herb interactions. Fully referenced cancer treatment. Includes in-depth patient care. Softcover, 931 pp. $29.95. #B518 with more than 4,000 citations. Hardcover, 643 pp. discussions of cancer at the cellular level and the ,• ._...,.. The Desktop Guide to Complemen­ $82 .95. #B441 level of the organism, as well as clinical considera­ ~--;::::=:,:: tary and Alternative Medicine: an tions covering trace metals, vitamin C and antioxi­ ~...,...... ,...._-1 Evidence-Based Approach Ed. by Consumer Education dants, polysaccharides, lipids, amino acids and relat­ Edzard Ernst, Max Pittler, Clare Stevin­ ed compounds, flavonoids, nonflavonoid phenolic son, and Adrian White. 2001. Offers Jungle Medicine by Connie Gra uds. compounds, terpenes, lipid-soluble vitamins, and 200 1. Story of the author's spiritual :::::...= concise information on 64 popular the effects of natura l compounds on chemothera­ A CAM diagnostic methods and treat- journey from being strictly a western py and radiation therapy. Softcover, 521 pp. $32. '-"-----~-"--' ments; summarizes cl inical tri al data pharmacist, through her experiences #B494 on the effectiveness of CAM for 38 specific condi­ with an Amazonian shaman, to her tions; weighs the benefits and risks of each CAM rebirth as a shamana who combines Clinical/Therapeutic treatment; and includes a CD-ROM of the book that her knowledge of western medicine links to Medline. Softcover, 444 pp. $36.95. #B50 1 with what she learned in the jungle to form a new Botanical Influences on Illness by spirited medicine. Softcover, 206 pp, S14.95 . #B5 14 Melvi n We rbach, M.D. & Michael T. Evidence-Based Herbal Medicine by Murray, N.D. 2000. 2nd Edition. Michael Rotblatt, MD, and Irwin Making Plant Medicine by Richo Reviews of botanical treatments for Ziment, MD. 2002. Ana lyzes a large Cech . 2000. The medicine making 60 different ill nesses. Materia medica quantity of the primary literature on section includes: drying and process­ on 26 common phytomedicines and controlled clinical trials and provides ing herbs; making tinctures the easy annotated list of resources. Hardcov­ reliable and practical information on way; the mathematics of tincturing er, 622 pp. $59.95 #B074 the uses, pharmacology, efficacy, and and solubility factors; basic formulas adverse effects of approximately 65 for fresh and dry extraction, includ­ herbal medicines and a few non­ ing dosages; vinegar extracts, glyc­ herbal dietary supplements. Softcover, 464 pp. $29. erites, herbal succi and syrups; teas, decoctions, The Complete German #BS16 herbal oils, sa lves and creams; poultices, compress­ Commission E Mono­ es and soaks; and a section with more than 100 graphs-Therapeutic Herbal Medicine by Rudolf Fritz herbs that are readi ly cultivated in North America. Guide to Herbal Medicines Weiss, M.D. 2000. 2nd Edition. The The listings include conservation status, parts used, Ed. by M. Blumenthal, W. now classic text used by M.D.s in specific formulas, practica l uses, dosages, co n­ Busse, A. Goldberg, J. Gru­ Germany. An indispensable modern traindications and an overview of alternate species. enwald, T. Ha ll, C. Riggins, text in medical herbalism. Many Softcover, 282 pp. $14.95. #B490 and R. Rister. 1998. The offi- herbs are illustrated. Plant drugs are cial English translation of the monographs arranged by clinical diagnoses relat­ 111 0SEEA!tTH The One Earth Herbal Sourcebook: resulting from the German Federal Health ing to particular systems. Softcover, HIJI&II. SOllllJIOOI( Everything You Need to Know .___ .. _ _ _ About Ch inese, Western, and Agency's expert committee. The 2nd­ 362 pp. $59. #B006 Classic edition still available. ranked medical book of 1998 (Doody Pub­ $49.#B006A E; Ayurvedic Herbal Treatments by lishing). Contains 380 monographs, 190 Alan Keith Tillotson, Nai-shing Tillot- herbs and fixed combinations approved Herbal Medicine: A Concise ·········-· · son, and Robert Abel Jr. 2001. Section for therapeutic use, 150 indications, and Overview for Professionals Ed. by one provides basic information more. Hardcover, 685 pp. $89. #B18 1. CD­ Edzard Ernst. 2000. Evidence-based needed to understand the different types of herb ROM $49. #C181 look at herbal med ici ne that will doctors and herbal systems, manufacturing meth­ serve as a useful, fully-referenced ods, advertising and marketing, and safety and Herbal Medicine: Expand­ guide for physicians, medical herba l­ ed Commission E Mono­ environmental issues. Section two addresses herbal ists and other hea lthca re profess ion­ graphs Ed. by M. Blumen­ medicines, their components, and how to use them. als with an interest in plant-based thal, A. Goldberg, and J. Reviews 96 herbs, emphasizing the safest and most therapy. Addresses regulation in the Brinckmann. 2000. Expand­ effective ones. Section three covers herbal proto­ UK and EU, safety issues, efficacy of herbal drugs, ed content on the Commis­ cols for treating some common diseases and strate­ quality and standardization, synergy and more. sion E herb monographs for gies for healing via different traditions. Extensive Softcover, 120 pp. $39.95. #B509 the most widely used herbs resource guide. Softcover, 596 pp. $20. #B511 in the U.S.Includes updated, Natural Medicine Comprehensive Vegetables, Fruits, and Herbs in detailed information on their botany, his­ Database compiled by the ed itors of Health Promotion Ed. by Ronald Wat­ tory, chemistry, pharmacology, safety, effi­ Pharmacist's Letter and Prescriber's so n. 2001. Twenty well-referenced ca cy, and therapeutic use. Extensive list of Letter. 2000. 2nd edition. Contains a papers that present scientific evi­ published references. Hardcover, 519 pp. listing for almost every natural medi­ dence that increased consumption of $39.95. #B181E . CD-ROM $39.95. #C181 E cine sold in the U.S. and Canada and vegetables, fruits and herbs improve a listing for every product discussed hea lth. Specific chapters on herbs in any reputable reference. Information covered include "Phytomedicines: Creating B 0 0 K S

Safer Choices, " "Herbal Remedies that Promote rent information on maj or co n­ and 42 scanning electron micrographs Hea lth and Prevent Di sease," and "Garl ic and ~~~~"f stituents and medicina l va lues, toxic­ ~ ~=~ · 11!!1• · which revea l the anatomy of secretory Health." Hardcover, 341 pp. $129.95. #B513 ~--,._._.~== ity or hazards, essential oil and their structures responsible for producing fractions, va lue-added products and and rel easing aromatic components General Herbals their possible uses, cultivation and and essential oi ls of 31 plant species. ha rvesting, and infectious diseases Extensive bibliography, li st of plant Natural Dietary Supplements Pocket and insects. Th ree appendices cross species used in aromatherapy, and Reference by the Institute for Natural reference major active ingredients glossa ry. Soft cover, 60 pp. $45. #8495 Products Research . 2000. Provides and their sources, essentia l oil s and their deriva­ thumbnail sketches of more than 30 tions, and the common and scientific names of the of the most popular and widely con­ pla nts ci t ed in the tables. Hardcover, 517 pp. Safety/To:\'icologv sumed natural dietary supplements in $149.95.#B510 Botanical Safety Handbook: Guide a convenient pocket-sized flipbook. Pharmacodynamic Basis of Herbal for Safe Use and Labeling for Herbs Includes common name, scient ific Medicine by Manuchair Ebadi. 2002. in Commerce Ed. by M. McGuffin, C. name, bot anical family, primary applica tions, HERBAL Demonstrates the beneficia l effects Hobbs, R. Upton, and A. Goldberg. dosage, key active constituents, side effect s, drug MEDICINE and adverse side effects of a large 1997. Provides safety data on more interactions, cautions, special precautions, and cl in­ number of herbal drugs, showing than 550 herbs as guidelines for prod­ ica l review. Softcover, 96 pp. $14.95. #B493 their actions and effects on organ, tis­ uct labels, including co ntraindica­ ... tions, side effects, and special warn­ _ sue, cellu lar, and subcellular levels. Legal/RegulatoiT Incl udes herbal medications whose ings. Each herb is classed as can be safely con­ pharm acodynamic parameters have been delineat­ sumed when used appropri ately, herbs with the fol­ Herbs of Commerce Ed. by M. McGuf­ ed at the molecu lar level. Discusses the potential lowing restriction s, for external use only, or not to fin, J. Kartesz, A. Leung, and A. Tucker. interactions of dietary supplements with prescri p­ be used during pregnancy. Hardcover, 256 pp. ~"" 2nd edition. 2000. Destined to be the tion medications. Hardcover, 726 pp. $129.95 . #B517 $44.95. #B275 "de facto standard by which all plant common and scientific names will be Quality Control Methods for Medici­ Essential Oil Safety by Robert Tis­ determined on all products containing nal Plant Materials by the World sera nd and Tony Balacs. 1995. Up-to­ .::::-::-..::-... herbs" (Christopher Hobbs), this edi- Hea lth Organization. 1998. A collec­ date research findings. Practical, com­ tion lists Latin binomials, Standardized tion of recommended test procedures prehensive guide. Detailed profiles of Common Names, Ayurvedic, Chinese (), and for assessi ng the identity, purity, and 95 esse ntial oils, including con­ other common names for 2048 species, including 25 content of medicinal plant materials stituents, hazards, dosage, toxicity fungi and 23 seaweeds. A must-have for anyone who intended to support development of data and contraindications; brief safe­ writes about or manufactures herbal products. Hard­ national standards based on local ty profiles of 311 essential oils and 135 esse ntial oil cover,421 pp.$95. #B475 market conditions. Includes macroscopic and components; safety guidelines, details of essential microscopic examination, thin-layer chromatogra­ oil absorption, metabolism and excretion; oil s phy, and tests for determination of many factors. which may react adversely with certain drugs; and Pharmacognosy Softcover, 11 5 pp. $31.50. #B406 extensive references. Hardcover, 279 pp. $55 . #B1 69 Pharmacognosy, Phytochemistry, IIII Quality Management of Nutraceuti­ Herb Contraindications and Drug Medicinal Plants by Jea n Bruneton. I cals Ed. By Chi-Ta ng Ho and Qun Yi Interactions by Francis Brinker, N.D. 2nd edition. 1999. Organized in four Zheng. 2002. 21 symposiu m papers 2001, 3rd edition. Information on 240 part s (primary metabolites, phenols, that examine the chemical and bio- trad itional therapeutic herbs explain­ terpen es and steroids, and alkaloids). logica l quality management of ing documented contraindica tions Phytochemical generalities, distri bu­ nutraceuticals. Reviews several impor­ and dru g interactions. Appendices tion, biosynthes is, extraction and tant classes of co mpound s, t:;;iiiiiii~. identify even more herbs as they affect quantization methods, and biological flavonoids, anthocya nin s, and marine ce rtain co nditions and medicines. properties. Origin, identity, production, composi­ nutraceutica ls. Di scusses the chemical analysis of Softcover, 432 pp. $25 .95 #B282 tion, uses, process ing, and optimization for each some products on the market such as goldenseal, raw material. Therapeutica l indication and re com­ saw pa lmetto, green tea, cocoa, and black cohosh. The Toxicology of Botanical Medi­ mended usa ge specifi ed for each product. Hard­ Addresses the bioactivity of several nutraceutical cines by Francis Brinker. 2000. 3rd edi­ cover, 915 pp. $218. #B 149 product s such as ginger and gum guggal. Hardcov­ tion. Provides essential information for er, 327 pp. $135. #B520 a basic knowledge of human reactions to certain plant toxins. A conci se com­ -····· ··--·-·· The Scientific and Technical Profile Research/Tecbnical pilation of traditional knowledge and of the Genus Thymus by Wudeneh Botanical Dietary Supplements: up-to-date information on the toxic Letchamo, PhD. 2001. Compre hensive Quality, Safety and Efficacy by Gai l effects of plants and plant extracts that and authoritative review of history, Mahady, Harry Fong, and Norman may be used medicinally. Reviews the toxicology of botany, taxonomy, chemistry, phar- Farn sworth. 2001. Based on a system­ medicinal plants as noted in American pharmacolo­ • ·-·- macology, toxicology, genetics, ecolo- atic review of the scientific literature gy, pharmacognosy and botanical medicine texts gy, cultivation, ha rves ting, quality from 1975-2000 on some of the top­ and is updated with recent publication and articles control, processi ng and commerce of the thyme sell ing botanicals worldwide. from medical journals. Softcover, 296 pp. $35. #8491 Includes, for each herb, a definition of species of the world. Summarizes data from over the crud e drug, geographi cal distribution, a li sting 700 references. Softcover, 305 pp. $100. #B515 of the major chemical constituents, medica l uses, Secretory Structures of Aromatic and Medicinal Support Herbal Education pharmacology, contrai ndications, warnings, preca u­ Plants: a Review and Atlas of Micrographs by Kateri­ Proceeds from the sale of catalog items fund tions, adverse reactions, and dose and dosa ge na Svoboda and Tomas Svoboda, micrographs by nonprofit education and research projects. form s. Fully referenced. Hardcover, 271 pp. $79.50. An drew Syred. 2000. Featu res 36 light micrographs #B505 Handbook of Herbs and Spices Ed. by - PDR for Nutritional Supple­ PDR for Herbal Medicines 2nd K. V. Peter. 2001. Consists of over 20 ments, 1st edition. 2001 . Provides edition. 2000. Updated to include cha pters covering key spi ces and detailed information on each the latest scientific findings, clini­ herb s, including definition and cl assifi­ nutritional supplement including cal trials (including abstracts}, cation to chemical structure, cultivation ~~=~~ clinical research summary; scien­ case reports, and meta-analysis and post-harvest processing, uses in tific and common names; chemi- results. More detailed monograph food processing, functiona l properties, i cal and physical attributes; indica­ sections on herb/drug interaction "'""'= ...... ;...-' regulatory issues, quality indices and tions and usage; pharmacology and pharmaco­ side effects, contraindications, precautions, methods of analysis. Hardcover, 319 pp. $225. #B508 kinetics; preca utions, adverse reactions and con­ adverse reactions, and dosage. Hardcover, 858 tra indications; potential interactions with drugs, pp. $59.95. #8474 Medicinal Plants: Culture, Utilization and Phy­ food, alcohol, and herbs; and dosage and admin­ topharmacology by Thomas S. C. Li . 2000. Presents istration. Hardcover, 575 pp. $59.95. #B500 data for more than 400 species in tables arrang ed in alphabeti ca l ord er by Latin binomia l. Includes cur-

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