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To the Editor: Dr Ang-Lee and colleagues¹ presented a series of recommendations for managing the use of herbal medicines prior to surgery. I am concerned about several of their conclusions.

First, I disagree with their recommendation that garlic be avoided 7 days prior to surgery. This conclusion was apparently based on 1 case report of an octogenarian who developed a spontaneous epidural hematoma following chronic ingestion of massive quantities of raw garlic cloves, as well as in vitro studies of isolated constituents of garlic. Results of in vitro experiments generally do not accurately reflect the effect of the phytochemicals that actually reach the bloodstream. Furthermore, they are usually conducted using concentrations that are several orders of magnitude higher than those achieved with oral ingestion.

Second, there is no credible evidence that echinacea is hepatotoxic. The authors perpetuate this notion based on an unreferenced statement made in a review article² that . . . [Full Text of this Article]

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RELATED ARTICLE

Herbal Medicines and Perioperative Care
Michael K. Ang-Lee, Jonathan Moss, and Chun-Su Yuan
JAMA. 2001;286(2):208-216.
ABSTRACT | FULL TEXT