Herbs: have you had your plant today?

Quo vadis America? Shopping lists still include the usual food staples but also remind one to pick up the ginkgo biloba to boost memory, kava kava to relieve stress, evening primrose oil, black cohosh, and dong quai to relieve PMS and menopausal symptoms, echinacea to enhance immunity, feverfew to reduce migraines, St. John’s wort for depression, ginger for motion sickness or nausea, garlic to reduce cholesterol and blood pressure, and don’t forget the valerian to relieve insomnia. Four of 10 Americans are actively seeking alternative medicine therapies. The therapies that have increased the most include herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. Visits to alternative medicine practitioners increased from 427 million in 1990 to 629 million in 1997. This is a 47.3% increase in total visits. These visits exceed the total visits of 386 million to all U.S. primary care physicians. Additionally, in 1997 an estimated 15 million adults took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users.) Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid outof-pocket. This exceeds the 1997 out-of-pocket expenditures for all U.S. hospitalizations of $9.1 billion. Total 1997 out-of-pocket expenditures relating to alternate therapies were estimated conservatively at $27 billion, which is comparable with the projected 1997 out-of-pocket expenditures of $29 billion for all U.S. physician services. Considering the upper limit for total out-of-pocket expenditures in 1997, the fi ure is $34.4 billion. This includes $19.6 billion for professional services, $3.3 billion for megavitamins, $1.7 billion for commercial diet products, $5.1 billion for herbal medicine, and $4.7 billion for therapyspecific books, classes, and equipment. Two other observations on alternative medicine are noteworthy. In 1997, 42% of all alternative therapies were used for treatment of existing medical conditions, whereas 58% were used for prevention and maintaining health. Lastly, less then 40% of users of alternative therapies disclose this use to their physicians (1). These “all-natural” products are often referred to as nutraceuticals or botanicals. They are sold as nutritional or dietary supplements, not drugs. This allows these products to be sold directly to consumers without going through the Food and Drug Administration’s (FDA) approval process. The FDA can only remove a supplement from the market after it has been shown to be hazardous. Because herbal medicines do not pass through the FDA approval process, these manufacturers have not conducted well-designed scientific studies to demonstrate their safety and efficacy. Therefore, they may not claim that the product is intended to diagnose, treat, cure, or prevent any disease. However, a claim may be made that a product provides energy or enhances mood without referring to a specific medical condition. With the increasing use of herbal medicines by approximately 20% of the population who concurrently use prescription drugs, potential adverse interactions may become more commonplace. Correspondence to: Eric R. Salminen, MD, COL. MC, USA, Chief, Department of Obstetrics and Gynecology, Department of the Army, Headquarters, Tripler Army Medical Center, 1 Jarrett White Road, Tripler AMC, HI 96859-5000. Volume 55, Number 12 OBSTETRICAL AND GYNECOLOGICAL SURVEY Copyright © 2000 by Lippincott Williams & Wilkins, Inc.