More on Blue Cohosh and Perinatal Stroke

To the Editor: In their report on blue cohosh and perinatal stroke, Finkel and Zarlengo (July 15 issue) 1 cite a case that is well known to medical herbalists in the United Kingdom and the United States, since it was originally reported to the Food and Drug Administration (FDA) 10 years ago. Furthermore, the suggestion that blue cohosh ( Caulophyllum thalictroides ) might produce cocaine metabolites is not plausible, given what is known about the plant's chemistry. If the United States followed the current U.K. recommendations regarding the regulation of herbal medicine, 2 it would be illegal for physicians or other practitioners . . .