ABSTRACT
Herbal medicines such as Echinacea, Ginkgo, Ginseng, Kava, and St. John’s Wort have become a major commodity in the US. In 1998, Americans spent $3.87 billion on herbals (Ernst, 2000). This is a remarkable sum, given that it is more than a tenth of what Americans spent out of pocket on all prescription drugs ($30.4b, Centers for Medicare & Medicaid Services, 1998), and more than half of the amount they spent at the box office on movies that same year ($6.9 billion). Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay, and Kessler (1998) conducted surveys of alternative medicine use in 1990 and 1997, and found that rates of use had increased for all 16 alternative therapies they studied, including chiropractic, homeopathy, and acupuncture, and that of the 16, herbal medicines showed the largest increase. In a nationally representative survey that we have conducted and to which we return below, 56 per cent of American adults reported having used herbal medicines. This figure does not include the use of ordinary vitamins and minerals, such as vitamin C or calcium. (The industry uses the term “herbal medicines” to refer to such remedies as Echinacea, Ginkgo, and St. John’s Wort and to dietary supplements such as amino acids. In what follows, we shall abide by that convention.)
Despite the fact that millions of people use herbal medicines, neither the US government nor any other agency regulates herbal products. The 1994 Dietary Supplement Health and Education Act removed herbal medicines and nutritional supplements from the aegis of the Food and Drug Administration (FDA) (Josefson, 2001), which can only investigate herbals and supplements if there is a formal complaint. Under the 1994 law, manufacturers of herbal medicines and supplements do not have to test their products for effectiveness or for safety, in contrast to the rigorous clinical trials the FDA requires for pharmaceutical drugs. Pharmaceutical drugs may not always prove effective, but at least they contain known, tested, and approved ingredients. Consumers, who are typically reluctant to ingest substances they cannot trust, have no such assurance when they take herbal medicines. Given the lack of effectiveness testing or safety controls, why are people so positively
inclined towards taking herbal medicines? This topic, involving an applied problem with potentially significant financial and social repercussions and a dose of suspect reasoning, is reminiscent of the sort of issues that have characterised Paolo Legrenzi’s research throughout the years. We thus decided to first summarise our explorations in this area in this volume, in Paolo’s honor.
