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Caveat Emptor

Judith Garrard, PhD; Susan Harms, RPh, MPH, PhD; Lynn E. Eberly, PhD; Amy Matiak, PharmD

Arch Intern Med. 2003;163:2290-2295.

Background  Patients who report use of herbs to their physicians may not be able to accurately describe the ingredients or recommended dosage because the products for the same herb may differ. The purpose of this study was to describe variations in label information of products for each of the 10 most commonly purchased herbs.

Methods  Products for each of 10 herbs were surveyed in a convenience sample of 20 retail stores in a large metropolitan area. Herbs were those with the greatest sales dollars in 1998: echinacea, St John's wort, Ginkgo biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian.

Results  Each herb had a large range in label ingredients and recommended daily dose (RDD) across available products. Strengths were not directly comparable because of ingredient variability. Among 880 products, 43% were consistent with a benchmark in ingredients and RDD, 20% in ingredients only, and 37% were either not consistent or label information was insufficient. Price per RDD was a significant predictor of consistency with the benchmark, but store type was not.

Conclusions  Persons self-medicating with an herb may be ingesting ingredients substantially different from that recommended by a benchmark, both in quantity and content. Higher price per label RDD was the best predictor of consistency with a benchmark. This study demonstrates that health providers and consumers need to closely examine label ingredients of presumably the same or similar herbal products.

From the Divisions of Health Services Research & Policy (Drs Garrard and Harms) and Biostatistics (Dr Eberly), School of Public Health, and College of Pharmacy (Ms Matiak), University of Minnesota, Minneapolis. The authors have no relevant financial interest in this article.

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