U.S. Judge Dismisses Black Cohosh-Liver Damage Claim

SILVER SPRING, Md.On Sept. 8, the U.S. District Court dismissed a lawsuit filed by a Nebraskan couple against two manufacturers of black cohosh (Actaea racemes, syn. Cimicifuga racemosa) products after the wife needed a liver transplant five months after starting to use these products. In addition to ruling to exclude the testimony of both of the plaintiffs experts, the court also found no evidence to establish either general or specific causation.

In reaching its decision, the court considered testimony obtained from both the patient and her physician, who had been retained as one of her two experts, which contradicted a published case report of this event. As originally published, the authors of the case report, who included the expert physician, reported that the patient did not drink alcohol or use illicit drugs, and was not taking any medications, including other herbal medications, acetaminophen, or non-steroidal antiinflammatory drugs. However, the testimony revealed the woman regularly consumed wine, used ibuprofen on a regular basis and had been prescribed Valtrex®, a drug that lists liver enzyme abnormalities; hepatitis as a reported adverse reaction.

According to the American Herbal Products Association (AHPA), this case is important because it was one of only two that some health authorities have identified as presenting a probable causal relationship between black cohosh and liver damage. But, their analysis was based only on the published case report, which had inexplicably misreported an absence of drug and alcohol use by the patient, the group noted. This U.S. District Court ruling is therefore significant in the ongoing international attention to black cohosh, which has resulted in label requirements and/or consumer advisories in Australia, the European Union, the United Kingdom, and Canada for products that contain the herb. AHPA (www.ahpa.org) is urging these international health agencies to reconsider the relevance of this case.