(Philadelphia, PA) -- Two primary-care physicians at the University of Pennsylvania Medical Center have developed a list of clinical guidelines to aid physicians in advising patients about herbal products as therapeutic agents. In a "Letter to the Editor" in today's Journal of the American Medical Association, the physicians urge their colleagues to acquaint themselves with the biomedical properties of various herbal products -- especially over-the-counter ones being purchased and used most frequently by the general public (including, but not limited to, echinacea, gingko biloba, St. John's Wort, saw palmetto, ginseng, and garlic).
The authors note that physicians should better understand how herbal agents operate independently, as well as how they react in combination with other agents (including other herbal products and/or prescribed medications). "Clinicians are in an excellent position to offer advice and discuss risks and benefits pertaining to herbal treatments," notes Michael Cirigliano, M.D., chief architect of the guidelines and associate professor of medicine at Penn's School of Medicine. "To that end, physicians should assume the responsibility of initiating a dialogue with their patients about any such products their patients may be using or may contemplate using."
Cirigliano believes that physicians should work aggressively to dispel the notion that "natural" is synonymous with "safe" ... and they should further understand and explain that some herbal products (such as garmander, life root, comfrey and pennyroyal) have extremely toxic effects and should be avoided altogether. In addition, several groups of people -- including pregnant women and lactating mothers, the very young and the very old -- should avoid using herbal products.
"Herbal products have significant potential for adding to the existing armamentarium of therapeutic agents," emphasizes Cirigliano. "However, more study regarding safety and efficacy is clearly needed."
Editor's Note: Dr. Michael Cirigliano may be reached directly at 215-349-8450.
Journal
JAMA