To the Editor:
With respect to the editorial on alternative medicine by you and Angell (Sept. 17 issue), (1) if we look outside our own borders at the policies of other developed countries, we find a more rational approach to herbal medicine. In Germany, physicians are required to have some training in herbal medicine. Considerable research on herbal medicine -- including double-blind, placebo-controlled trials -- is ongoing. (2) Physicians recommend and patients use herbal medicines extensively. Manufacturers are required to meet standards of purity and pharmaceutical activity. Commission E, which has had oversight of herbal medicines and has determined their safety and efficacy, has published 387 monographs (recently translated into English by the American Botanical Council). (2) Several other European countries (2) also have policies and procedures that allow rational oversight of herbal medicines.
In the United States, herbs are used either as dietary supplements, with minimal standards of safety and efficacy, or as drugs, which require expensive and cumbersome testing procedures. I would argue for a more middle-of-the-road approach that acknowledges the long history of use of many herbal medicines, examines data from many sources including other countries, insists on strict production standards, and requires absolute safety and a classification of efficacy that may vary from "unproved" for some conditions to "demonstrated" for others. The use of the translated Commission E monographs would be very helpful for patients and physicians.
B. Clair Eliason, M.D.
Medical College of Wisconsin
Milwaukee, WI 53226-0509