A Dose of Caution

Scanning the shelves of an herbal medicine shop in Los Angeles’ Chinatown, the drug sleuth had no trouble spotting contraband. Richard Ko, a pharmacologist in the drug safety branch of the California Department of Health Services, zeroed in on a red, gold and white box of pills called Ansenpunaw.

The package insert says in English that the “herbal medication� treats “headache� and “vertigo� and has other benefits such as “strengthening muscles,� “blackening hairs� and “lubricating the intestines.�

Unfortunately for anyone attracted by those claims, the product contains mercury sulfide, a mineral long used in China as an antibiotic, which can cause nerve and kidney damage, Ko said. Because of that, Ansenpunaw is subject to state import restrictions.

In a sample of the pills that Ko and colleagues tested, the mercury level was more than 1,000 times higher than the U.S. safety threshold for a drug.

“There are problem herbal products out there, especially imported products,� Ko said.

With the growing interest in Asian herbal medicines--part of America’s tightening embrace of alternative therapies--some health experts worry that a growing number of consumers are buying and ingesting products that may not only be worthless but also possibly dangerous.

Underscoring that problem is a newly released state health department study of 260 Asian patent medicines in California by Ko and his colleague Alice Au, a health department chemist. They found that more than a third of the products tested violated at least one import restriction.

Ko, who has doctoral degrees in pharmacology and pharmacy from USC, said he believes in traditional Chinese medicines. Indeed, his wife used them after a bout with cancer. But his report underscores some potentially serious dangers for consumers.

Some medicines the state tested contained unsafe levels of the toxic metals arsenic, lead or mercury. Some contained prescription drugs--often without saying so, which can be very dangerous to an unsuspecting customer. Other products violated Food and Drug Administration regulations against claiming to cure a disease without having proved it. Still others were made with material from endangered animal or plant species.

One example, according to the state report, is Cow’s Head Brand Tung Shueh Pills, said to improve “circulation of blood� and “strengthen bones and muscles.� Lab tests found the pills contain three prescription drugs, including the tranquilizer diazepam, or Valium, and the muscle relaxant chlorzaxazone.

Someone unwittingly taking that “herbal� remedy would not be aware of the known side effects of those powerful prescription drugs, from potential birth defects to falling asleep while driving.

In addition to Chinese patent medicines, packaged Latino folk remedies also have come under scrutiny. The state health department is warning consumers to avoid imported products containing lead or mercury, including Azarcon, Azogue, Greta, Rueda, Coral, Liga and Maria Luisa.

“Any exposure to these remedies, internally or externally, is extremely dangerous,� the health department said in a consumer alert.

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During Ko’s visits to four Chinese herb shops on Broadway in Los Angeles, he readily found contraband products in two of them. He did not go into any back rooms, where he said illicit products are sometimes kept.

Browsing in the Van Hoa Duong Ginseng and Herbs Co., he found two prescription-only antibiotic ointments being sold over the counter; a male virility pill supposedly made of herbs that the health department says contains the prescription-only synthetic hormone methyl-testosterone; and pills containing marijuana seed extract.

An employee said she was not aware the products violated import restrictions. “The shipper brings the product in and we just put a price on it and sell it,� Tracy Diep said, adding that she planned to take the offending products off the shelves.

Raymond Chu, secretary of the Oriental Herbal Assn., a Southern California trade group, downplayed the dangers of Asian patent medications. Problems arise, he said, because consumers sometimes overdo it and “take more than they should and [do] not follow directions and dosage.�

The state does not aggressively enforce prohibitions against imported patent medicines because the health department cannot police all herbal medicine shops, Ko said. Instead, health authorities try to persuade herbal medicine trade groups not to import contraband.

Another danger, Ko said, is that foreign manufacturers do not necessarily adhere to the same purity standards that U.S. companies must follow. Adding to the problem is the rather ambiguous regulatory status of herbal medications: Even though people consume them to treat symptoms and diseases, the products are generally classified as dietary supplements, and so do not have to be proven safe and effective as long as the label makes no explicit medical claims.

“Just because a label says a product is ‘natural’ does not mean it is safe--or even that it is natural,� Ko said.

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Top-Selling Herbs

Estimated U.S. sales of herbal supplements have increased dramatically, from $2.5 billion in 1995 to $3.6 billion in 1997, according to Nutrition Business Journal of San Diego. Here, the top-grossing products, in millions of dollars.

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Herb 1995 1997 % Increase Echinacea $180 $310 72 Ginseng 210 270 29 Ginkgo biloba 160 240 50 Garlic 150 200 33 St. John’s wort 10 200 1,900 Goldenseal 60 160 166 Saw palmetto 40 130 225

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Popular Herbs

In a 1997 mail survey of more than 29,000 U.S. households for the market research firm Hartman & New Hope of Bellevue, Wash., these were the most commonly used herbal supplements:

% of U.S. Households

Garlic: 11%

Ginseng: 10%

Ginkgo biloba: 9%

Echinacea: 7%

St. John’s wort: 5%

Top-Selling Vitamins

Estimated sales of vitamin and mineral supplements rose 20% between 1995 and 1997, from $4.3 billion to $5.1 billion, according to Nutrition Business Journal. The biggest sellers, in millions:

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Type 1995 1997 % Increase Multivitamins $2,160 $2,690 25% Vitamin C 704 830 18 Vitamin E 560 650 16 B vitamins 480 600 25 Vitamin A/beta carotene 152 190 25

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