and SAMe, in addition to over 80 other nondietary supplement topics, had been reviewed as of 2003 (AHRQ, 2003b).
The American Herbal Pharmacopoeia (AHP), a nonprofit organization, develops monographs on the quality, effectiveness, and safety of botanical medicines commonly used in the United States. The monographs include information on traditional use and information from scientific sources (Barrett, 1998). They are designed to provide consumers, health professionals, and botanical manufacturers with the knowledge required for using and manufacturing botanical products safely and effectively, and to provide regulatory bodies and researchers with guidance for integrating botanical products into the health care system (AHP, 2004b).
Botanicals are selected for monograph development based on judgment about the extent of use, the unique value of the botanical, and sponsorship by other interested organizations or companies (AHP, 2004b). Selection of a botanical for monograph development can be made by three methods. The first method is through a prioritization committee consisting of professional herbalists, botanical industry representatives, and herbal educators, which produces a list of priority botanicals based on the extent of their use or their unique values. A second method is through monograph sponsorship. Because AHP seeks funding and technical support for development of monographs from interested organizations or companies, a sponsored botanical may be given higher priority than was assigned by the prioritization committee (AHP, 2004b). Third, AHP considers what other groups have done. If there is an existing monograph of a botanical on the prioritization list, AHP may use relevant sections of that monograph as a starting point for its own monograph development (AHP, 2004b).
The monographs include botanicals with origins in Ayurvedic, Chinese, and Western traditions and include information from both traditional and scientific sources (AHP, 2002; Barrett, 1998). AHP monographs are relatively detailed compared with monographs produced by other organizations. They are released individually as they are completed, and 18 have been released since 1997 (AHP, 2004a).
In preparing the monographs, literature searches are conducted in order to review all reported side effects, contraindications, and negative interactions of the botanical (AHP, 2004b). According to AHP, primary literature is preferred, but secondary literature, such as review articles, may be used if considered acceptable or necessary. The search is not limited to English-language references. According to AHP, a review of the toxicological literature is done to address the safety of the botanical and includes data on acute and chronic toxicity; use during pregnancy, lactation, and fetal