The market for non-conventional, natural herbal medicines is growing. This marketing opportunity has been seized upon by some unscrupulous practitioners to sell potentially unsafe ‘herbal’ products. Several people attended a Chinese herbalist for weight loss advice and were sold ‘herbal’ preparations that contained fenfluramine, a drug which was withdrawn from sale in the West in 1997 after its use was linked to primary pulmonary hypertension and valvular heart disease. Adulteration of Chinese medicines with Western drugs is becoming an increasing problem, and deaths have been reported from Japan and other Far Eastern countries linked to Chinese slimming aids containing N-nitroso-fenfluramine.
There is a need for increased public awareness of such risks associated with the use of unlicensed medicines; a system of registration for medical herbalists is also required to protect both the reputable practitioners and the general public.
Eisenberg DM , Davis RB , Ettner SL , Appel S , Wilkey S , van Rompay M , et al . Trends in alternative medicine use in the United States, 1990-1997. Results of a follow-up national survey . JAMA1998;280: 1569-1575
2.
Kaufman DW , Kelly JP , Rosenberg L , Anderson T , Mitchell A.Recent patterns of medication use in the ambulant adult population in the United States . JAMA2002;287: 337-344
3.
Medical Control Agency . A Guide to What is a Medicinal Product. MCA Guidance Note No. 8. Medical Control Agency2000. Available online at: www.mca.gov.uk
4.
Huang WF , Wen KC , Hsiao ML.Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan . J Clin Pharmacol1997;37: 344-350
5.
Ko RJ.Adulterants in Asian patent medicines . N Engl J Med1998;339: 847
6.
Beyerstein B.Alternative medicine and common errors of reasoning . Acad Med2001;76: 230-237
7.
Haller CA , Benowitz NL.Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids . N Engl J Med2000;343: 1833-1838
8.
Metcalfe K , Corns CM , Fahie-Wilson M , Mackenzie P.Chinese medicines for slimming still cause health problems . BMJ2002;324: 679
9.
Brenot F , Herve P , Petitpretz P , Parent F , Duroux P , Simonneau G.Primary pulmonary hypertension and fenfluramine use . Br Heart J1993;70: 537-541
10.
Thomas SH , Butt AY , Corris PA , Egan JJ , Higenbottam TW , Madden BP , et al . Appetite suppressants and primary pulmonary hypertension in the United Kingdom . Br Heart J1995;74: 660-663
11.
Abenheim L , Moride Y , Brenot F , Rich S , Benichou J , Kurz X , et al . Appetite-suppressant drugs and the risk of primary pulmonary hypertension . N Eng J Med1996;335: 609-616
12.
Conolly HM , Crary J , McGoon MD , Hensrud DD , Edwards BS , Edwards WD , et al . Valvular heart disease associated with fenfluramine-phentermine . N Engl J Med1997;337: 581-588
13.
Fen-phen maker agrees to $3.75 billion settlement. CNN 1999, 8 October. Available online at: www.cnn.com/health/diet.fitness/9910/08/fen.phen/index.html (accessed 23 August 2002)
14.
Kernan WN , Viscoli CM , Brass LM , Broderick JP , Brott T , Feldmann E , et al . Phenylpropanolamine and the risk of haemorrhagic stroke . N Engl J Med2000;343: 1826-1832
15.
Mattei A , Bizollon T , Charles JD , Debat P , Fontanges T , Chevallier M , et al . Liver damage induced by the ingestion of a product of phytotherapy containing wild germander: four cases . Gastroenterol Clin Biol1992;16: 798-800
16.
Castot A , Larrey D.Hepatitis observed during a treatment with a drug or tea containing wild germander. Evaluation of 26 cases reported to the Regional Centres of Pharmacovigilance . Gastroenterol Clin Biol1992;16: 916-922
17.
Pauwels A , Thierman-Duffaud D , Azanowsky JM , Loiseau D , Biour M , Levy VG.Acute hepatitis caused by wild germander. Hepatotoxicity of herbal remedies: two cases . Gastroenterol Clin Biol1992;16: 92-95
18.
Stengel B , Jones E.End-stage renal insufficiency associated with Chinese herbal consumption in France . Nephrologie1998;19: 15-20
19.
Vanherweghem JL , Depierrieux M , Tielemans C , Abramowicz D , Dratura M , Jadoul M , et al . Rapidly progressive interstitial renal fibrosis in young women: association with slimming regime including Chinese herbs . Lancet1993;341: 387-391
20.
Vanherweghem JL.A new form of nephropathy secondary to the absorption of Chinese herbs . Bull Mem Acad R Med Belg1994;149: 128-135
21.
Vanherweghem JL.Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese herbs nephropathy) . J Altern Complement Med1998;4: 9-13
22.
Pena JM , Borras M , Ramos J , Montoliu J.Rapidly progressive interstitial renal fibrosis due to a chronic intake of a herb (Aristolochia pistolochia) infusion . Nephrol Dial Transplant1996;11: 1359-1360
23.
Committee on Safety of Medicines . Renal failure associated with Aristolochia in some Chinese herbal medicines. Letter from Professor Breckenridge, Chairman of the Committee on Safety of Medicines, 27 July 1999. Department of Health CEM/CMO/99/8
24.
Medicines Control Agency . Proposals to Protect the Public from Unlicensed Medicines Containing the Herbal Ingredient Aristolochia. Consultation Document MLX 254. London: Medicines Control Agency , 1999
25.
Medical Control Agency.Herbal Safety News 2002, 19 July. Available online at: www.mca.gov.uk/ourwork/licensingmeds/herbalmeds/herbalsafety.htm
26.
US Department of Health and Human Services . FDA warns consumers against nature’s nutrition formula one. Press Release 28 February 1999. Available online at: www.cfsan.fda.gov/%7Elrd/form1.html (accessed 3 September 2002)
27.
Josefson D.Herbal stimulant causes US deaths . BMJ1996;312: 1441
28.
Hagiwara M , Tsuchida A , Hyakkoku M , Nishizato K , Asai T , Nozawa Y , et al . Delayed onset of pulmonary hypertension associated with an appetite suppressant, mazindol: a case report . Jpn Circ J2000;64: 218-221
29.
Hong Kong Department of Health. Department of Health instructs recall of “slimming health food”. Press Release 30 March 2001. Available online at: www.info.gov.hk/gia/general/200103/30/0330247.htm (accessed 3 September 2002)
30.
Dying to lose weight?The Straits Times Interactive 2000, May. Available online at: www.straitstimes.asia1.com.sg/women/story/0,1870,119355,00.html (accessed 27 August 2002)
31.
Hall K. Deadly diets. DietFraud.com 2002, 19 July. Available online at: www.dietfraud.com/HerbalNews/Diet-Teas/cbs020719chinesedeaths.html (accessed 23 August 2002)
32.
Japanese cities recall Chinese diet pills. Associated Press 2002. Available from Associated Press archive at: www.ap.org (accessed 23 August 2002)
33.
Death of Japanese man linked to Chinese diet pills. Reuters 2002, 1 August. Available from Reuters at: www.reuters.com (accessed 23 August 2002)
34.
US Food and Drug Administration . FDA warns public about Chinese diet pills containing fenfluramine. FDA News 2002, 13 August. Available online at: www.fda.gov/bbs/topics/NEWS/2002/NEW00826.html (accessed 23 August 2002)
35.
Lies E.UPDATE 1 - Chinese diet pills kills one, sicken 11 in Japan. Reuters 2002, 12 July. Available from Reuters at: www.reuters.com (accessed 23 August 2002)
36.
Cullen LT. Asia’s killer diet pills. Time Asia 2002, 12 August. Available on-line at: www.time.com/time/asia/magazine/article/0,13673,501020812-333902,00.html
37.
Fackler M.China’s thriving trade in fake drugs kills thousands a year. Associated Press2002, 28 July. Available from Associated Press archive at: www.ap.org (accessed 28 August 2002)
38.
McIntyre M. Thepossible impact of the proposed Directive on Traditional Medicinal Products on herbal products. London: European Herbal Practitioners Association , 2001. Available online at: www.users.globalnet.co.uk/%7Eehpa/TUDbrief130501.htm (accessed 23 August 2002)
39.
Medical Control Agency.Proposal for a Directive of the European Parliament and of the Council amending the Directive 2001/83/EC as regards traditional herbal medicinal products. Medical Control Agency2002, 17 January. Available online at: www.mca.gov.uk
