The U.N. health agency issued advice to governments around the world on how to ensure that the $60 billion herbal medicine business is safe and sustainable.

"There is a huge increase in this market. Many people are paying a lot for traditional medicines, and some insurance systems have started to reimburse (for) traditional remedies," said Dr. Hans Hogerzeil, acting direction of essential drugs and medicine for the World Health Organization.

"At the same time, this is an area where it is sometimes difficult to regulate properly and get safety assurance for patients."

Medicines derived from plants, such as ginseng and echinacea, are becoming increasingly popular in rich countries and continue to be widely used in the developing world.

But the increase in popularity has been accompanied by an increase in the number of reported cases of damage to health from use of herbal medicines.

One cause is incorrect identification of plants. In the United States in 1997, people suffered serious heart problems after digitalis was accidentally substituted for plantain in dietary supplements. Fourteen cases of poisoning also have been reported in Hong Kong where the wrong root was used to produce an antiviral medicine.

Other problems include the use of poor quality plants, poor collection practices and the adding of other medications — such as steroids — to herbal remedies.

The growing demand also has led to fears that plants could be wiped out by unsustainable harvesting. Wild ginseng is reported to be declining rapidly, and other plants in danger include goldenseal, echinacea, black cohosh, slippery elm and kava kava.

The bark of the Pygeum, or African prune, which is used widely as a remedy for prostate disorders in southern Europe, can be cut without damaging the tree. But harvesters are taking too much and killing the tree, or simply cutting down whole trees.

WHO looked at the guidelines used in China, Japan and the European Union as a base for developing its own recommendations.

The 72-page document covers cultivating, collecting and classifying plants, with recommendations on quality control, storage, labeling and distribution.

"If we want to preserve the environment and if we want to preserve and sustainably supply these medicines in the future, we have to regulate that, in one way or another," Hogerzeil said.

Reference Source 102

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