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JM Jelin, F Batz, K Hitchens Eds
1310 pg $92.00, Web Version $92.00, both $132.00
ISBN 0-9676136-9

I have not been able to get a copy of this book myself so I will include here a summary of the excellent review done in JAMA, vol 283 No. 22 June 14, 2000 by Alan T. Marty MD. The text includes 964 natural medicines and subjects the data on their efficacy and safety to current evidence-based scientific standards. Using their grading system, the authors consider 46 of the 964 substances effective and 72 likely effective. Ratings of the other of the substances are as follows: 333 are considered possibly effective, 46 ineffective, 61 likely ineffective, 6 ineffective. Over 500 are unclassifiable due to lack of data. Since many of the substances are recommended for many different uses, an individual substance may be categorized several times for different indications. Only 147 of these natural substances are regarded as likely safe by the authors. The possibly unsafe, likely unsafe and unsafe categories total 294. The authors mention that overall, 15% of these products have been proven safe and 11% have been proven effective for the recommended indication.

The authors point out important interactions of these substances with both regularly prescribed medicines and laboratory tests. For example, St. Johns Wort can interact with cyclosporin, lower digoxin levels by 25% and also lower levels of some HIV retrovirals. Among the effects on lab tests, the review mentions that Vitamin C can bring about false elevations of amino transferase and bilirubin and false decreases in LDH and glucose. The monograph also includes common reasons why particular substances are generally taken, mentioning that goldenseal is often used to mask the results of lab tests for illicit drugs.

The web database (www.naturaldatabase.com), available to subscribers, is a source of more detailed information including things such as which specific formulations of the various medicines were used in the trials. The web database is also more current, being regularly updated. Substances may have their effectiveness or safety rating changed based in new data and this will be reflected on the web database.

Comment: With the increased use of these substances, this text would be a welcome companion to the PDR on the reference shelf. It seems to me that, barring a prohibitive fee, subscription to the web base database would allow easy, fast review of the effects, side effects etc. of the various substance which more and more people are taking (and administering to their children). As studies are done more will be learned about both efficacy and especially safety of these various substances and also their interactions with medications which could be of interest to anesthesiologists.

Reviewed by: Thomas J. Mancuso, MD, FAAP
Children's Hospital, Boston, MA