Spontaneous reports of assumed herbal hepatotoxicity by black cohosh: is the liver‐unspecific Naranjo scale precise enough to ascertain causality?

@article{Teschke2011SpontaneousRO,
  title={Spontaneous reports of assumed herbal hepatotoxicity by black cohosh: is the liver‐unspecific Naranjo scale precise enough to ascertain causality?},
  author={Rolf Teschke and Wolfgang Schmidt-Taenzer and Albrecht Wolff},
  journal={Pharmacoepidemiology and Drug Safety},
  year={2011},
  volume={20}
}
Causality assessment of cases with herbal hepatotoxicity represents a major regulatory challenge and included, in the past, the application of a diagnostic algorithm consisting of causality evaluation methods with either liver‐specific or liver‐unspecific characteristics. To evaluate various causality assessing methods in cases with suspected herbal hepatotoxicity, two different scales were now used for reasons of comparison. 
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TLDR
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Confounding variables reduced causality levels for GC in reported cases of liver injury, but there is still striking evidence for herb-induced liver injury by GC with high causality gradings.
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