It appears that the herb Black Cohosh has come under fire by authorities again, this time in Canada. It is interesting to note that the alarm is being raised in markets where drug companies make -- and want to continue to make -- fortunes in profits from hormone replacement therapy (HRT). It may be that the large numbers of menopausal women in these places means that large amounts of black cohosh are consumed and therefore there is an incidence of the reported problems. However, knowing how the player work, I suspect there is drug company influence behind these alarms.
So now Canada, following similar recent moves in the UK and Australia, has issued an advisory about a possible link between black cohosh and liver damage. The herb is used widely in relieving menopausal symptoms, mainly because it works and increasingly women want to avaoid the serious risks associated with HRT. The US is notably missing from the growing list of countries which have flagged black cohosh.
Health Canada reports that in Canada there have been three cases of liver damage associated with the use of black cohosh, which resulted in death, and one published case in the US. The federal agency says the advisory is only “precautionary” while it reviews the safety and effectiveness of the herb.
Health Canada's advisory means manufacturers will have to notify consumers of the potential risk.
Black cohosh (referred to by Health Canada as actaea racemosa or cimicifuga racemosa)is a member of the buttercup family, and is a perennial plant native to North America. Traditionally used to reduce menopausal symptoms such as hot flashes, the herb has been a popular alternative to HRT.
Note that in its advisory Health Canada qualifies that “case reports of liver damage are rare and the link between black cohosh and liver toxicity is unclear”. It suggested: “Consumers should discontinue the use of products containing black cohosh and consult a physician if they have unusual fatigue, weakness, loss of appetite, or if they develop symptoms suggestive of liver injury such as yellowing of the skin or whites of the eyes, dark urine or abdominal pain.”
Unlike the recent announcements in the UK and Australia, Health Canada does not require products carrying black cohosh to carry warning labels.
In February 2006, Australia's Therapeutics Goods Administration (TGA) required all over-the-counter and alternative medicines containing black cohosh to carry a warning for the potential risk for the liver. In July, the United Kingdom's Medicines and Healthcare Products Regulatory Agency (MHRA) announced it will also introduce potential liver damage warning labels for black cohosh products. The announcement coincided with a public safety statement from the European Medicines Agency (EMEA).
If these alarms and alerts concerning black cohosh are more about eliminating effective competition for drugs it would appear to be working. According to a report from market analyst Datamonitor, sales for black cohosh experienced a decline of 42 percent in the United Kingdom between 2003 and 2005, owing to "negative publicity surrounding the functional qualities of the herb" which led manufacturers not to use it.
It is interesting to note that the very same health authorities overlook the massive harms and large numbers of deaths associated with drugs (mainly HRT) prescribed for relief of menopause symptoms. There is no way I want to recommend an unsafe herb or an incautious approach. However, I do point out the significant double standard. If black cohosh is indeed responsible for the reported cases of liver damage then it must certainly have warning labels, by all means. However, the harms it is alleged to have caused would be less that 1% of those caused by the drugs people replace by using it so let's keep some sense of proportion.