The Pharmaceutical Journal
Vol 269 No 7222 p655
2 November 2002

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A useful book on balance but has some gaps and omissions

'Herbal medicines' 2nd edition, by Joanne Barnes, Linda A. Anderson, J. David Phillipson. Pp xiv+530. Price £39.95. London: Pharmaceutical Press; 2002. ISBN 0 85369 474 5. Also available as CD-ROM, price £75.00. ISBN 0 85369 500 8

The first edition of this book has already been highly successful, and one can assume that this second edition will be similarly valued. Pharmacists' need for factual information in the area of herbal medicines has grown in parallel with the acceptance of these remedies by consumers. The second edition is an extended and updated version of the first. It contains 148 monographs of medicinal plants in alphabetical order written by pharmacists for pharmacists. The structure of the monographs is logical, the information provided is concise and relevant, and the scope of the plants covered is laudable.

Even though the book is undoubtedly useful it also has, in my view, several flaws. First, there is no methods section (or equivalent) to inform the reader which information was included and which was excluded. Thus we cannot be certain that the approach used was systematic. In fact, several spot checks indicated to me that it is not truly systematic.

Secondly, the data presented (eg, results of clinical trials) are reported without critical evaluation. A study of a herbal medicine may yield a positive result because the remedy was effective or because the methodology was flawed. The authors of this book make no real attempt to differentiate between the two scenarios. This leaves the critical reader with a level of uncertainty that is both regrettable and avoidable.

Thirdly, this book lacks consistency. For instance, the section on clinical studies is included in some but not all monographs largely independent of the existence or absence of such data in the literature. Often the results of clinical studies, sometimes of highly dubious quality, are described. In other cases important clinical trials or systematic reviews are not mentioned at all. Such inconsistency is confusing and leads me to suspect that the research for this book was not as thorough as it could have been.

Fourthly, no clinical judgements are provided that could guide therapeutic decisions. Pharmacists, I imagine, want to know not only that herb x works for condition y but also whether its benefits outweigh its risks and, more importantly, how this risk-benefit profile compares to that of a conventional treatment option.

When I weigh the many strong points of this book against its few but important weaknesses, my final verdict is clearly positive. What we have here is a good reference text that will be of interest to most pharmacists. I therefore recommend it to these professionals. More clinically orientated professionals or individuals who look for critical assessments of the primary data, however, might want to look elsewhere.

Edzard Ernst