Global hazards of herbal remedies: lessons from Aristolochia: The lesson from the health hazards of Aristolochia should lead to more research into the safety and efficacy of medicinal plants.

W e know from written and archeological records that humans have been using herbs for millennia to both prevent and treat disease. Today, herbal medicines remain widely popular, fueled by cultural factors, centuries-old tradition, and a burgeoning industry that claims that herbs (i) are gentle, safe, effective, and natural alternatives to pharmaceuticals; (ii) possess unique properties that are not found in drugs; and (iii) are less toxic and more effective when used in combination, a cardinal principle of traditional Chinese medicine (TCM). Yet, the history of herbal use also shows that not all herbs are benign and sometimes are deadly. Moreover, we cannot know whether all herbal medicines are safe because only a few have been tested systematically for toxicity or carcinogenicity. As an example, the potent toxic effects associated with the use of Aristolochia species— which came to light only after recent epidemiologic studies vividly demonstrated the health risks of this widely used family of medicinal herbs. This previously unknown toxicity provides a strong argument for more effective regulation of herbal medicine use in developed and developing countries to prevent similar dangers to public health. We will discuss the cultural, commercial, and political forces that restrict governments and public health authorities from instituting stronger regulatory measures for herbal use. We also will propose actions, which, if implemented, would help protect users of herbal remedies and promote global public health.