Commission E

Abstract: American Botanical Council. Blumenthal M, Goldberg A, Brinckmann J, eds. 519 pages. Newton, MA: Integrative Medicine Communications; 2000. $49.95. ISBN 0967077214. Order phone 877-426-6633. Field of medicine: Herbal medicine and complementary and alternative medicine. Format: Hardcover book. Audience: Primary care physicians, trainees, and allied health care professionals. Purpose: To provide an up-to-date scientific pharmacopoeia of herbal medicines and to address criticisms and deficiencies of The Complete German Commission E Monographs. Content: The original Commission E monographs, which comprised more than 300 entries written from 1978 to 1994 by German scientific authorities, were published in English by the American Botanical Council in 1998. This new, expanded text retains about 100 of the original monographs as the skeleton of each brief chapter, but more useful information is also included. An overview of each herb's traditional uses is followed by a summary of the published clinical trials from the worldwide literature. New information on pharmacology, uses, cautions, and dosages and formulations used in the clinical studies is provided. Unlike the original monographs, this text is well referenced and cites the primary literature. Highlights: The book corrects many of the deficiencies and criticisms of the 1998 text; for example, it reviews the clinical studies published in the literature, updates information to reflect current scientific data, and is well referenced. The reviews are clearly written and current and provide a concise summary of the worldwide clinical literature that is difficult to find elsewhere in a single source. Limitations: Descriptions of the clinical trials generally include whether they are blinded or controlled, but few other details are provided. The authors are factual and objective, but they rarely analyze study methods or other potential biases. Older data from the original monographs are frequently corrected or contradicted in the text; much of this outdated information could have been deleted. Related reading: The second edition of PDR for Herbal Medicines (Medical Economics, 2000) is better formatted than the expanded Commission E monographs, but the entries are not as well written and are not inclusive of all the clinical literature. The World Health Organization's monographs on selected medicinal plants, published in 1999, contain similar information, but many of the 28 herbs discussed in the first volume are not common to U.S. consumers. Newall's Herbal Medicines: A Guide for Health Care Professionals (Rittenhouse Book Distributors, 1996) is an excellent source of scientific herbal information but is out of date. Fetrow and Avila's Professional's Handbook of Complementary & Alternative Medicines (Springhouse, 1999) is a useful quick reference for practitioners, but much of the data on adverse reactions are not evidence-based and thus are suspect. Peirce's American Pharmaceutical Association Practical Guide to Natural Medicines (William Morrow, 1999) is written more simply for consumers but balances the pros and cons well; it is a useful resource for clinicians as well as patients. Reviewer: Michael Rotblatt, MD, PharmD, Sepulveda Veterans Affairs Ambulatory Care Center, Los Angeles, California.

Abstract: The medicinal plants monographs are very important information collections about some of the most consumed plants all over the world that attend not only the regulatory agencies but also pharmaceutical industries and the general consumer. This manuscript reviews the origins, objectives and formats of the most important monographs, like Commission E, American Botanical Council, ESCOP, PDR and WHO. Two recently published Brazilian experiences organized by FIOCRUZ and the contributions from Brazilian Pharmacopoeia are also evaluated.

Abstract: Dietary supplements are prevalent worldwide and play a significant role in the treatment of human disease. In the United States, allopathic physicians are at the early stage of learning how to treat patients with natural remedies and other forms of alternative medicine. Elsewhere, however, alternative remedies have been embraced more fully. In Germany, for example, the German Federal Health Agency created Commission E, which has allowed for a more sophisticated approach to assessing the efficacy and safety of dietary supplements and herbal medicines. Health insurance in Germany frequently covers costs for doctor-prescribed herbal remedies. While there is strong evidence that many herbal products have therapeutic effects, there are also a large number of cases of severe adverse reactions due to some of the many thousands of herbal products. One of the first signs of potential toxicity is in the visual system, as in many cases patients notice loss of vision more than systemic side effects. In addition, ophthalmologists are able to detect objective findings through external eye exams and dilated fundus exams. Presented here are some of the more common ocular side effects from frequently prescribed dietary supplements. In most instances, stopping the treatment or decreasing the dose allows for full resolution of symptoms. In addition, comment is made on the regulatory confusion that exists for this industry, especially in the United States.