It is estimated that $2.5 billion were spent on herbs in 1996, and estimates for spending on all food supplements are as high as $12 billion a year. The amount is growing about 25 percent per year, according to studies in the November 11, 1998 issue of the Journal of the American Medical Association (JAMA).

With the onslaught of advertising for these products, it may be hard to tell just exactly what the difference is between herbs and botanicals, and actual pharmaceuticals.

So What?s the Difference?
Botany is the science of plants. The use of plants as medicine is referred to as botanicals and/or botanical medicine. The properties of botanicals are derived from the plant.

Pharmaceuticals are chemical preparations of medication that go through a process of study to determine safety and efficacy, and are regulated by the US Food and Drug Administration (FDA). Pharmaceuticals can be obtained either over the counter or by prescription. Some pharmaceuticals are made from plants.

Herbal medicine is the use of plants or plant parts as remedies for aches, pains, and illness. Herbs can be sold in a variety of forms?dried, finely chopped, powdered, or as liquid in a capsule. Despite the growing popularity of herbs, they are medications and are unregulated, and have not undergone the clinical testing necessary to prove they are effective and safe. With our current system of drug regulations, herbs are considered "supplements."

Herbal Remedies Used for Many Centuries
Consumers may find it comforting that herbal remedies have been used for thousands of years. For example, the herb ephedra, the main ingredient in some over-the-counter asthma treatments, has been used in China for 5,000 years.

In modern times, plants also have made a major contribution to the pharmaceutical industry. As many as one-fourth of pharmaceuticals have botanical origins. Taxol, made from the Pacific Yew tree, is used to treat patients with cancers of the breast and ovary. Vincristine, from the periwinkle plant, is prescribed for lymphoma, leukemia, and other cancers.

Most people take herbs in the hopes of preventing illness, however, patients also turn to herbal remedies in hopes they will cure an existing illness. Cancer patients can be particularly susceptible to the lure of herbal remedies or other non-medical therapies. They may perceive a lack of major advancements in cancer treatment and therefore see no reason not to try something else, explained Barrie Cassileth, PhD, a founding member of the advisory board of the National Institutes of Health Office of Alternative Medicine.

Growing Interest Prompts Caution
Despite the increased interest in herbal remedies, one of the biggest voids in information is knowing what side effects herbs can have. Known side effects include heart problems after discontinuing use of valerian root, an herb used as a sedative. Another known side effect is sensitivity to light in some people who take St. John's wort. It?s even possible to overdose on common vitamins such as Vitamin E, iron, or Vitamin B; or experience a reaction if the vitamin supplements are taken with standard pharmaceutical anti-depressants.

David M. Eisenberg, MD, and colleagues in "Trends in Alternative Medicine Use in the United States, 1990-1997" in JAMA sounded the alarm about patients who use these therapies. According to the article, of five patients taking prescription medicine, one is also taking herbs or high-dose vitamins. As many as 40 percent of people do not report their use of these therapies to their doctors.

Regulating Herbs The market for supplements was flung wide open after the Dietary Supplement Health and Education Act of 1994 eliminated the authority of the US Food and Drug Administration (FDA) to regulate vitamins, herbs and other food-based products. But the FDA is attempting to track adverse reactions to herbs through reports to its MedWatch hotline (800-FDA-1088). The FDA keeps a web site for the reported adverse effects and drug interactions called the FDA Dietary Supplement Information Page.

Prompted by the growth of the industry, another government agency, the Federal Trade Commission (FTC), has issued advertising guidelines aimed at the supplement industry. The new guidelines explain how truth in advertising applies to the supplement industry and spells out the kinds of claims manufacturers can and cannot make.

• Are Herbs Safe?
• The Most Popular Herbs
• FTC Dietary Supplement Guidelines
• US Food and Drug Administration