Assuming that "natural" remedies must be safe, 60 million Americans spent $3.24 billion medicating themselves with herbals in 1996. Yet there are reports within the last two decades of more than 100 herbiogenic deaths1(pp1799-1880) and dozens of serious complications—eg, those that required renal dialysis,2-5 renal transplantation,6 or liver transplantation,6-8 after taking botanicals. Dangerous herbs are less likely to be sold in Germany, thanks to strict surveillance by the German Commission E, founded in 1978. Of the 129 herbal drugs disapproved in Germany, the risky ones were immediately withdrawn, while others deemed nontoxic parvenus without "plausible evidence of efficacy" will be phased out by 2004.