New attack on herbal medicine by Prof Ernst and colleagues

Guo, Canter and Ernst saw their paper entitled ?A systematic review of randomised clinical trials of individualised herbal medicine in any indication? today in the Postgraduate Medical Journal (Postgrad Med J 2007;83:633?637).

To read the full paper click here.

ANH Comment:

Prof Ernst and his colleagues have done it again

It seems they have wanted to find an excuse to can the practice of patient-specific herbal medicine, a healthcare approach that spans several millennia in different, often extremely diverse, parts of the world. In the authors? minds they may have succeeded as, lo and behold, they have got themselves headlines in newspapers across the globe which suggest that such herbal medicines are ineffective.

However, when you read between the lines, it?s not hard to see where the hocus pocus truly lies.

Science or hocus pocus?

Guo, Canter and Ernst have entitled their paper: ?A systematic review of randomised clinical trials of individualised herbal medicine in any indication.? You would be forgiven for thinking that this was a review of dozens or even hundreds of studies. But just three? Yes, although Prof Ernst and colleagues started their review with a hopeful 1345 references in the peer reviewed literature, their particular and harsh inclusion criteria managed to whittle away some 98.8% of the references leaving just 0.2% – i.e. three! How the journal allowed this paper to be titled a ?systematic review? and how they allowed the title to include its relevance to ?any indication??is anyone?s guess.

Of the three papers, one ran for 16 weeks and involved IBS sufferers, another for just 10 weeks concerning patients with knee osteoarthritis and the final one covered durations between 12 weeks and 6 months, in the case of patients suffering breast or colon cancer. Can these three trials really be extrapolated to apply to ?any condition? and all forms of individualised herbal medicine? Of course not! And more importantly, are they scientifically meaningful as compared when they apply to just three types of condition and cover such short durations, when the real knowledge about these products is among practitioners who have benefited from thousands of years of clinical practice.

One step closer to the medicalisation of herbs?

So while Guo et al may have donned their anoraks and applied their scalpels to an arbitrary package of research that happened to have made it through the peer review publication process, it is the authors? choice of blatantly incorrect title and conclusion that appears to have been carefully selected to do damage to the herbal medicine sector. Strange as this might seem, regulators around the world are looking for excuses to medicalise herbal products?..wouldn?t this be just the ticket, or at least another nail in the coffin, to try to show that the evidence base is weak, that herbal medicines might be dangerous and that they, in any case, don?t work? Although the authors claim to have consulted herbal practitioner associations during the course of their work, judging by the reaction we?ve heard just today, on the day of release of the study?s findings, we?re not convinced many herbal medicine practitioners will support the study?s conclusion, which states:

?Individualised herbal medicine, as practised in European medical herbalism, Chinese herbal medicine and Ayurvedic herbal medicine, has a very sparse evidence base and there is no convincing evidence that it is effective in any indication. Because of the high potential for adverse events and negative herb?herb and herb?drug interactions, this lack of evidence for effectiveness means that its use cannot be recommended.?

We have a fundamental problem

Scientists like Prof Ernst have become so introspective over their worship of their reductionist methods that they fail to see how they do or don?t relate to the much, much bigger picture of how extremely complex and diverse, natural substances interplay with even more complex and diverse genomes. This truly is an abuse of science.