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February 16, 2000

The Herbal History of Digitalis: Lessons for Alternative Medicine—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):884-886. doi:10.1001/jama.283.7.882

In Reply: We agree with Dr Ritter and Mr Dembicki and thank them for reminding us that experiences with digitalis provide an important precedent for evaluating the current resurgence of interest in botanical medicine. Digitalis, one of the most effective drugs ever developed from a plant, underscores the difficulty of evaluating herbal products.

Indeed, many currently popular "natural products"1,2 have similar problems. These include: (1) little data concerning adverse effects and drug-herb interaction; (2) little or no evidence of efficacy; (3) inadequate scientific assessment of active chemical constituents and insufficient information concerning optimal preparation and dosages; (4) lack of consistency in chemical compositions between different manufacturers or between different batches of the same manufacturer; (5) chaotic or commercially determined forms of standardization; (6) contradictory and difficult to interpret traditional claims; and (7) poor monitoring for deterioration of potency, contamination, and adulteration. All these problems need to be addressed by increased research efforts, improved government regulation, and postmarketing vigilance.