JAMA Study on Herbs & Surgery
Important, Timely, But Still Much to Do

WASHINGTON, DC, July 10, 2001 —The review by Dr. Ang-Lee and colleagues in the July 11 issue of the Journal of the American Medical Association (JAMA) provides a useful resource to the professional healthcare community. Their review recommends that during the preoperative evaluation physicians should discuss and document the use of herbal products by their surgery patients. Likewise, proper media reporting of this story can convey the same message to consumers who may become surgical patients.

"CRN has always advocated open and complete communication about dietary supplement use between consumers and their healthcare professionals," said John Cordaro, president and chief executive officer of the Council for Responsible Nutrition (CRN). "Dialog and open-mindedness must be a two way street, however. Physicians should know what supplements their patients take and understand the science behind those supplements, especially if prescription medications or surgery are likely options or necessities for those patients," added Cordaro.

The JAMA review provides tailored recommendations for discontinuing the use of certain herbal preparations before surgery. Older recommendations were more general and advised discontinuation of herbal products two to three weeks before surgery. Dispensing this advice to patients weeks before surgery may not be practical or possible. In contrast, the guidelines prepared by Dr. Ang-Lee and colleagues for suspending herbal use range from 24 hours to seven days.

"It is clear that some botanicals have the potential to complicate post-surgical recovery or to interfere with certain prescription medicines," said John Cardellina, vice president for botanical science at CRN. "CRN has been following developments in this area for some time; this latest in a series of reviews on the subject provides further impetus for our plans to hold an industry roundtable on possible label warnings and other consumer education materials." However, since the guidelines laid out in this review are based largely on anecdotal information and limited case reports, CRN feels that more research in this area is necessary.

As points of clarification, the JAMA press release statement that "...many add heavy metals, pesticides and drugs to the their products...", inaccurately paraphrases a statement in the text of the review. While prescription drugs have apparently been added intentionally to a very limited number of botanical and other preparations from China, there is no evidence that heavy metals and pesticides are intentionally added, as the release states. In addition, the authors' section on regulation and safety of herbal medications is largely flawed, having adopted the erroneous mantra that there is an "...absence of a standard regulatory mechanism for herbal medicine approval and surveillance..." when, in fact, there are clearly defined regulatory mechanisms for herbs, as medicines or dietary supplements.

The Council for Responsible Nutrition (CRN) is a science-based, trade association founded in 1973 and represents more than 110 companies in the dietary supplement industry, including ingredient suppliers and manufacturers. CRN members adhere to a strong code of ethics, comply with dosage limits and manufacture dietary supplements to high quality standards under good manufacturing practices.