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

    Re-evaluating the risk of liver toxicity from black cohosh

    Researchers from Johann Wolfgang Goethe University of Frankfurt/Main, in Hanau, Germany, reviewed the evidence and believe the risk is less than suspected.

    First, the details.

    • 69 reports of liver disease suspected to be caused by black cohosh (aka Actaea racemosa and Cimicifuga racemosa) were reviewed and analyzed.
    • The sources of the reports were 11 published case reports and 58 spontaneous reports to national regulatory agencies.

    And, the results.

    • Re-evaluation raised serious doubts about the ability of black cohosh to cause liver disease.
    • The reports that served as the sources of the reaction were of poor quality.
    • There were major inconsistencies for the same patient regarding reported data.
    • All cases had confounding variables such as…
      • Quality of reported data
      • Uncertainty of the black cohosh product, quality, and identification
      • Undisclosed indication for it’s use
      • Insufficient adverse event definition
      • Lack of temporal association and dechallenge (did the reaction resolve when black cohosh was discontinued?)
      • Missing or inadequate evaluation of alcohol use or the presence of other drugs and diseases
      • Failure to re-exposure test to black cohosh, and alternative cause of the patient’s condition

    The bottom line?

    The authors concluded, “The presented data do not support the concept of hepatotoxicity in a primarily suspected causal relationship to the use of black cohosh.”

    In other words, conclusive proof of a cause and effect relationship between black cohosh and liver toxicity is not available.

    “Nonetheless,” advises, “Patients with liver disease should consult a licensed healthcare professional before using black cohosh.”

    4/17/10 20:15 JR

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