Correspondence

Herbal Medications in the Physicians' Desk Reference

N Engl J Med 2001; 344:1255April 19, 2001

Article

To the Editor:

The foreword to the 2001 edition of the Physicians' Desk Reference (PDR) states, “Each full-length entry provides you with an exact copy of the product's FDA [Food and Drug Administration]-approved labeling.”1 The foreword goes on to say, “For products which do not have official package circulars, the publisher has emphasized the necessity of describing such products comprehensively.” However, herbal medications with no FDA approval are now being listed in the PDR. For example, page 2843 of the 2001 edition of the PDR includes “Calm Colon” capsules, states that “Calm Colon is indicated for irritable bowel syndrome,” and lists the composition of the supplement, noting that “each Calm Colon capsule contains 500 mg of a 5:1 aqueous extract [of 20] herbs.” Some of these herbs have been associated with serious toxicity.2-6 The PDR should review its policies and should not list potentially toxic herbal medications with no proven efficacy.

Carl H. Lawyer, M.D.
Milwaukee Medical Clinic, Milwaukee, WI 53217-0300

6 References

1. 1

   Physicians' desk reference. 55th ed. Montvale, N.J.: Medical Economics, 2001.
   

2. 2

   Adam SE, Al-Qarawi AA, Elhag EA. Effects of various levels of dietary Artemisia abyssinica leaves on rats. Lab Anim 2000;34:307-312
   CrossRef | Web of Science | Medline

3. 3

   Shen M, Ge HL, He YX, Song QL, Zhang HZ. Immunosuppressive action of Qinghaosu. Sci Sin [B] 1984;27:398-406
   Medline

4. 4

   Prakash AO, Saxena V, Shukla S, et al. Anti-implantation activity of some indigenous plants in rats. Acta Eur Fertil 1985;16:441-448
   Medline

5. 5

   Mori H, Fuchigami M, Inoue N, et al. Principle of the bark of Phellodendron amurense to suppress the cellular immune response: effect of phellodendrine on cellular and humoral immune responses. Planta Med 1995;61:45-49
   CrossRef | Web of Science | Medline

6. 6

   Violon C. Belgian (Chinese herb) nephropathy: why? J Pharm Belg 1997;52:7-27
   Medline

Author/Editor Response

A spokesperson for the replies:

To the Editor: We concur with Dr. Lawyer that entries on products such as “Calm Colon” are inappropriate in the PDR. It is against our policy to include such entries, and we are taking measures to prevent similar oversights in the future.

We have attempted to address the recent proliferation of unapproved dietary supplements with the publication of two new volumes, the PDR for Herbal Medicines and the PDR for Nutritional Supplements. These references supply physicians with detailed information on the actions and pharmacology of specific herbs and supplements, including their potential for toxicity and the circumstances in which they are contraindicated. Both books present unbiased clinical findings drawn from the scientific literature and discuss which purported benefits have been verified and which are unfounded.

Mukesh Mehta, R.Ph.
Medical Economics Company, Montvale, NJ 07645-1742