A Review of the Benefits, Adverse Events, Drug Interactions, and Safety of St. John's Wort (Hypericum perforatum): The Implications with Regard to the Regulation of Herbal Medicines. GUEST EDITORIAL

For Irish herbalists, the millennium celebrations were nothing short of a wake. The effective banning in Ireland of St. John's wort (Hypericum perforatum) and a number of other botanicals on January 1, 2000, came as a seismic shock to herbal manufacturers, practitioners, retailers, and the Irish public alike. As there are no licensed products available on the Irish market and Irish doctors have no formal training in herbal medicine, the ruling that St. John's wort and other herbal remedies, including Ginkgo biloba, Caulophyllum thalictroides, Harpogophytum procumbens,and Tribulus terrestris, should henceforth be classed as prescription-only amounts to a ban on these herbs in Ireland. It is now illegal for herbal practitioners in Ireland who do have this training to prescribe these herbs. Since October 1999, when the new ruling's implementation was first threatened, a high-profile public campaign raged fast and furiously. Yet the Irish authorities remained obdurate in the face of daily airings of the issue in the Irish media and in the Dail (Parliament), plus a deluge of letters and petitions demanding that St. John's wort should remain as freely available in Ireland as in the rest of Europe. In all of the furor of this very public clash between the Irish Medicines Board (IMB) and the alternative health sector, it has not always been easy to see the forest for the trees and take a dispassionate view of the alleged and actual risks and benefits of St. John's wort. To complicate proceedings further, the dispute about St. John's wort has wider implications, calling into question the future of herbal medicine throughout the European Union (EU). Given the importance of this debate, it is surely time to stand back and make a cool appraisal of the issues involved.