The C.A.M. Report
Complementary and Alternative Medicine: Fair, Balanced, and to the Point
  • About this web log

    This blog ran from 2006 to 2016 and was intended as an objective and dispassionate source of information on the latest CAM research. Since my background is in pharmacy and allopathic medicine, I view all CAM as advancing through the development pipeline to eventually become integrated into mainstream medical practice. Some will succeed while others fail. But all are treated fairly here.

  • About the author

    John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.

  • Common sense considerations

    The material on this weblog is for informational purposes. It is not medical advice or counsel. Be smart, consult your health professional before using CAM.

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  • Recent Comments

    Black cohosh not associated with liver disease, again

    This is the second review published this year, and the second to conclude “there is no evidence for a causal relationship between treatment by black cohosh and the observed liver disease.”

    In 42 patients, there appeared to be the possibility of a relationship between taking black cohosh (Cimicifugae racemosae rhizoma) and developing liver toxicity. However, an assessment by EMEA (European Medicines Agency) showed it was possible or probable that this reaction was a direct result of taking black cohosh in only 4 of these patients.

    Reviewers from Goethe University of Frankfurt/Main in Germany evaluated those 4 cases.

    First, the details.

    • A diagnostic algorithm was applied in the 4 patients with suspected hepatotoxicity.
    • It included an causality assessment using the updated system of the Council for International Organizations of Medical Sciences (CIOMS).
    • This tool permitted the reviewers to objectively assess each case.

    And, the results.

    • Due to incomplete data, the 1st patient could not be evaluated.
    • The 2nd patient was treated with steroids, responded well, and was eventually diagnosed with autoimmune hepatitis.
    • The 3rd and 4th patients required liver transplantation, and were diagnosed as having herpetic hepatitis.

    The bottom line?
    The authors concluded that by using a thorough assessment, “there is no evidence for a causal relationship between treatment by black cohosh and the observed liver disease in the 4 patients.”

    Back in July, a review of 30 cases of presumed black cohosh-associated liver toxicity found that none of the cases were probably or certain to have been caused by black cohosh.

    11/20/08 17:02 JR

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