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According to a survey of trends in alternative medicine use that was published in the 1 1 November 1998 issue of the Journal ofthe American Medical Association, U.S. consumers were spending as much as $5.1 billion annually on herbal products as of 1997. In addition, about 18% of all prescription drug users reported using herbal remedies or high-dose vitamins along with their prescribed medications, despite the fact that much is currently unknown about the drug interactions and contraindications of the herbal products so readily available to the public. To compile the monographs, the WHO-UIC team, which also included Harry H. S. Fong, a professor of pharmacognosy in the Program for Collaborative Research in the Pharmaceutical Sciences in the College of Pharmacy, and Norman R. Farnsworth, director of the same program, systematically reviewed literature published around the world since 1975, relying heavily on another highly credible source of information on medicinal herbs, the Natural Products Alert, or NAPRALERT, database. This database, administered by the Program for Collaborative Research in the Pharmaceutical Sciences, contains over 100,000 citations from the world scientific literature on the safety and efficacy of herbal medicines, plants, marine organisms, and fungi. The writing team also reviewed various pharmacopoeias including the European Pharmacopoeia, the Deutsches Arzneibuch, and the Farmakope Indonesia, as well as monographs produced by other bodies such as Commission E, which researches and regulates medicinal herb use under the German government. The first part of each monograph includes pharmacopoeial summaries of quality assurance-a description of each plant's botanical features, correct Latin binomial, geographical distribution, methods to identify the plant, purity requirements, chemical assays, and a listing of the major chemical constituents. This information may help with one of the biggest problems with commercially sold herbal remedies, which is that there is little or no standardization of the therapeutic dose of many medicinal plants. As matters stand, herbal products may not contain enough of the purported key ingredient to produce any beneficial effect or the product may not contain the correct part of the plant. In other cases, experts say, remedies may contain herbal ingredients whose dangers outweigh any beneficial properties. The second part of each monograph describes medicinal uses, pharmacology, contraindications, warnings, precautions, adverse reactions, and dosage. This part is aimed at health care practitioners who may be faced with patients taking herbal products or who may wish to prescribe medicinal herbs themselves, and is written so that the busy clinician can quickly become familiar with each herb's medicinal properties without having to winnow through the entire pharmacology of the plant. The WHO-UIC team's work was reviewed by a panel of over 120 authorities from 40 different countries. The panel included academics, experts in the field of herbal medicine, industry specialists, and regulatory authorities, including representatives from the U.S. Pharmacopeia, which establishes standards to ensure the quality of medicines intended for human and veterinary use. The team has already completed a second volume of 32 additional monographs that is scheduled for publication in early 2000. The researchers and the WHO are discussing the possibility of a third volume.

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