} >

ESCOP: 2

ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products

(Second Edition revised and expanded)

by ESCOP Scientific Committee

Herbal monograph collectors will recall that from 1992-1997 The Scientific Committee of ESCOP (European Scientific Cooperative On Phytotherapy) issued six “fascicules “of therapeutic monographs covering sixty herbs. “Fascicule” is the publishing term for installment; a serial publishing method intended to give readers or potential subscribers a preview of major works before they are finished – the Complete Oxford English Dictionary is perhaps the most famous published work ever issued in fascicules. The original installments from ESCOP were gathered, loose leaf, into a ring binder, which although functional, was rather down-market. Then in 1998, the ESCOP monographs were all but eclipsed in the USA by the publication of the English edition of the collected monographs from the German Commission E.

This new 2003 volume of collected ESCOP monographs comes as quite a surprise after a six-year gap. Firstly, it is not a compilation of the previous fascicules in a single first edition volume as might be expected, but an entirely new work from the ground up. It is unusual to have a second edition without actually ever having really published the first, but that is apparently situation here. The monographs have been completely revised and greatly expanded, and the ring binders have disappeared. Thanks to collaboration with medical publisher Thieme, now we have a rather attractive hard cover book with a solid 550 pages, printed on a good quality coated stock with clean typography in two column format that is legible and easy on the eye - an important issue in dense compilations of information.

Regulation of herbal medicines in Europe is currently undergoing a process of “harmonization” across member states of the EU, (as are herbalists.!). The ESCOP monographs are intended to provide a core scientific definition of herbal “products” based on scientific evidence to be approved by the Herbal Medicines Working Party, which will effectively become a pan European Committee for Herbal Medicinal Products. Presumably these products could ultimately be licensed. So essentially, this volume is the twenty first century Euro-version of Commission E, driven by industry and regulatory concerns, developed via an evidence-based approach to the literature.

In fact, the E-connection is more than one of political legacy. Several of the key personnel of the former German Commission are listed as Supervising Editors or Contributing Experts. These include Dr Karin Kraft, Dr Dieter Loew, and Dr Heinz Schilcher. Of the 29 expert contributors, 20 are from Germany, (including the popular Dr Rudi Bauer) and the chair of the board of ESCOP is also German - the eminent Dr Fritz Kemper. A strong British contingent includes Peter Bradley, Chair of the British Herbal Medicine Association, (and editor of the 1992 British Herbal Compendium), David Phillipson, Emeritus professor of pharmacognosy at London University (co-author with Newell and Anderson of “Herbal Medicines” 1995) , and Dr. Des Corrigan representing the Emerald Isle. Simon Mills is secretary of the Board of ESCOP, which also includes two English herb industry representatives, Hugh Mitchell and Victor Perfitt (Mitchfield Botanicals and Bio Health Ltd). A prefatory note reminds us that all contributors and reviewers gave their services free. Disclosures of authors and editors financial affiliations, grant awards, or consultancies are not offered.

The demographics of ESCOP member countries are interesting. Current members include Norway and Switzerland, neither of whom are members of the EU, while several EU states, such as Greece, Finland and Portugal, are not members. In May 2004, 10 Balkan and Eastern European states joined the EU, and Bulgaria, Romania and Turkey are all waiting applicants. Many of these countries are major suppliers of herbs and have traditional herbal medicine cultures that are significantly different from Anglo-German phytotherapy. . It will be interesting to see how, in future, if at all, these countries might contribute to, and affect or be affected by ESCOP. At this time however , ESCOP reflects the political alignment of the “core states” of the union.

Turning to the eighty monographs (with nearly 5000 accompanying citations): the various influences described above are obvious in the selection of herbs in the contents listing (which is by Latin proper pharmacopoeial name). There is some duplication and overlap. The anthraquinone herbs seem rather over-represented - there are three monographs on senna, (Senna Fructus Acutifoliae, Senna Fructus Angustifoliae, and Senna folium) in addition to rhubarb (Rei Radix) , Cascara (Rhamni Purshiani Cortex), and Frangula bark (Frangulae Cortex) as well as Aloe (Aloe Capensis). Given that there are also two monographs on plantain seed (Plantaganis Ovatae Semen, Plantaganis Ovatae Testa) and one each on psyllium (Psylii Semen) and linseed (Lini Semen) more than ten per cent of the listed materia medica will promote bowel movement. Further duplication arises with three Hammamelis monographs, one for bark, one for leaf, and a third for distilled witch hazel. The echinacea situation is predictably E-like, with separate monographs on purpurea root, purpurea flower and pallida root, but no mention of angustifiolia.

The inclusion of renal herbs Ononis spinosa (Spiny Restharrow) and Orthosiphonis (with the common name Starbuck’s would die for – “Java Tea”) will remind the North American reader that this is indeed mainstream European phytotherapy. Actually, not that many herbalists use either of these plants much. Omissions may perhaps be addressed in future editions, but for now, berberine herbs are missing entirely, as are stalwarts such as yarrow and red clover. There are no mushrooms, while the only East Asian representative is Panax ginseng ; in the twenty- first century the absence of non indigenous herbs such as astragalus, withania, Dang Gui etc is egregious. Personally, I have never understood why none of the major monograph authorities discuss the Thomsonian classics like cayenne and lobelia, while the absence of a kava-kava monograph speaks volumes about a lost opportunity to assert good science against opportunist regulatory initiatives based on largely spurious safety claims, presumably to avoid controversy, especially with the predominant German influence.

The ESCOP monographs omit even a cursory discussion of botany and natural history, and do not cover historical, folk, traditional or ethnobotanical uses, only indications supported by pharmacological research and clinical/preclinical studies where available. Analytical and quality data is largely absent, (this being the proper task of a different set of monographs, whereby data such from national pharmacopoeias DAB and BHP is being incorporated into the draft European Pharmacopoeial Monographs). Safety and toxicological data is covered only in brief., often repeating the type of portentous warnings found in Commission E (eg contraindicating echinacea in “ tuberculosis, leucoses, collagenoses, multiple sclerosis and AIDS or HIV” ) which sadly have now become established myths through repetition. Dosage data is largely drawn from clinical trials and is based on standardized extracts, this arguably bears little relation to current clinical prescribing of liquid extracts in herbal practice.

Is this a useful volume for North American readers? For the herbs covered , the research is comprehensively and precisely summarized, and is up-to-date as of 2001. For those needing pharmacological references it will definitely be useful, but will inevitably become dated before long. Whether abandoning the fascicule format will generate problems of revision and updating further down the line will have to be seen. The monographs may be more useful for those with industry or academic concerns, than for busy clinicians. For physicians, it is could be a useful summary of research on a good number of the major botanicals of commerce (with the exceptions and omissions noted above), but will teach little about how to use them. Ultimately, these limitations are as much due to the inherent shortcomings of the “scientific monograph” format per se, as anything specific with this ESCOP volume, which as far as monograph collections go, is not at all bad. Fortunately, students of herbalism can these days access authoritative works by herbal practitioners (such as Mills and Bone, or Hoffmann) that are more useful tools for actually integrating herbal science into clinical practice

The Herbal Bookworm • Herbal Hypotheses • Cancer & Herbal Medicine
What is Herbal Medicine • Herb/Drug Interactions
Plants of the Pacific NW • Consulting • Downloads • Herblog