NATURAL MEDICINES - Comprehensive Database by the Editors of Pharmacist's Letter & Prescriber's Letter, Published by Therapeutic Research Faculty, PO Box 8190, Stockton, CA 95208, 1999, 1168 pp, $92, WEB $92, Combined $132.

The Pharmacist's Letter, for those who fill our prescriptions, has enjoyed a huge circulation for nearly 15 years. The Prescriber's Letter for physicians is now in its 6th year. Recently, readers have been clamoring for reliable and practical scientific data on natural medicines. Hence, it would be a natural outgrowth of this comprehensive effort to put every available herbal medication, vitamin, and dietary supplement in an easy reference form. Nan Pheatt, MPH, Director of CE/CME program, who treks daily from Sacramento to Stockton, has been the editorial assistant of both publications and she made this compendium, Natural Medicines - Comprehensive Database available to me. The information is available on their Web site at the same price as the printed version I reviewed. The web version at is updated constantly. The printed version is a snapshot of the Web version and was up-to-date the day the snapshot was taken. New data, however, has been entered since then.

Jeff M. Jellin, Pharm. D., editor, states the goal of the editorial staff is to help patients. The staff felt this could best be accomplished by providing health practitioners with the best collection of data and scientific information on natural medicines. This first edition took more than two dozen pharmacists, physicians, researchers, dietitians, and pharmacologists one year to research and produce. As a work in progress, I believe the staff is achieving its goal.

For each product, an attempt has been made to provide data in 15 categories in order to address the questions that practitioners face most often. These include 1) Name of product; 2) This product is also know as; 3) Scientific names; 4) People use this for; 5) Safety; 6) Effectiveness; 7) Possible mechanism of action of the active ingredients; 8) Adverse reactions including known allergies; 9) Possible interactions with herbs & other dietary supplements; 10) Possible interactions with drugs; 11) Possible interactions with foods; 12) Possible interactions with lab tests; 13) Possible interactions with diseases or conditions; 14) Typical dosages & routes of administration that are commonly used; and 15) Comments. This takes up the first 988 pages and is easy to follow because every other item is highlighted.

The next 105 pages list the brand names of the products. Thus the natural medication, phosphatidyl choline, recently reviewed in this journal as The Memory Cure, is found in the first section. Five trade names for the product are listed in the second section.

Another section discusses the drugs with which the natural medication interacts. It is important that our patients realize, for example, that the natural medicine digitalis will cause difficulties if the patient is already on digoxin. Also, grapefruit juice causes interactions with HMG-CoA Reductase Inhibitors such as lovastatin and simvastatin, as well as benzodiazepines, buspirone, and carbamazepine. (I had not realized that grapefruit juice may cause a 300% increase in the effect of Zocar and Mevacor but not Pravochol.) Some of our patients might use grapefruit juice trying to lower their cholesterol. Some of the older bronchodilator combinations containing ephedrine, unfortunately, were not listed opposite ephedra. I expect them to make the next edition because this book is a work in progress.

Next, there is a section on natural medications and the drugs with which they might interact. This is a cross check on the previous section. If you know what natural medication your patient is taking, you can check to see if the drugs you are prescribing will interact with those herbs or natural medications.

The final section is a list of conditions and the possible natural medications that patients may take to self treat. This is also a cross check if something does not add up in our patient evaluations. The index is quite extensive with more than 100 columns-- in case you missed something, such as what is cocklebur used for. You are referred to Agrimony which in turn refers you to Agrimony. Ah, to have a computer without artificial intelligence is understandable. But one without the indexer program, Cindex? I'm sure the Web version will have all the corrections before you read this.

Overall, it would seem that patients are quite knowledgeable and reasonably cautious about self-treatment. Fish oils in cardiovascular disease, thiamine in beriberi, tea or coffee for mental alertness, podophyllum for warts, cascara and glycerol for constipation, iodine for goiter, iron for anemia, vitamin and calcium for osteoporosis, activated charcoal for poisoning, vitamin C for scurvy, etc. may not always be the best approach, but a reasonably appropriate approach pending further consultation in our office.

This is a first attempt to fill a large gap in our pharmacopeia. It is an increasingly important gap in patient care of which we need to be aware. This is an important work that we need. With the digital subscriber service available in Sacramento in the next month, we will be able to access the Web version quite readily and speedily--even while we're on the phone to the hospital waiting for the clerk to find the nurse that called.

Del Meyer, MD