It’s all in the spin

Posted by Liz on Jan 19, 2009 in herbal medicine | 2 comments

I’d like to believe that researchers have patients’ best interest at heart but an article in this month’s British Medical Journal’s Drug and Therapeutic Bulletin has led me to believe that objectivity can be difficult.

The piece, entitled “Herbal medicine for menopausal symptoms,” positions itself as a review of the effectiveness and safety of herbal medicines commonly used for relief of vasomotor symptoms, including hot flashes and night sweats.  The herbs covered within the piece include black cohosh, red clover, dong quai, evening primrose, ginseng, and briefly wild yam, chaste tree, hops, sage leaf and kava kava.

However, within the first two paragraphs, it becomes abundantly clear that the review is aimed at attacking the validity of so-called “alternative” therapies and consequently, attempts to provide the evidence that does so.

The author correctly points out that the consumer might automatically deem such products safe since they are natural, and that many products on the shelves do not comply with good manufacturing standards. In fact, I’ve written on these very essential considerations.

However,  s/he blatantly (and incorrectly) states that “there has been a lack of studies of herbal medicines for menopausal symptoms,” emphasizing in particular (but not defining) the following:  faults in study design, number of participants and length of study. The author also criticizes the use of traditional herbal systems (e.g., Traditional Chinese Medicine), which s/he says has little published research that supports its use in treatment of menopausal symptoms.

Although I did not review each study individually, I would like to point out that the author’s claim of a lack of published studies can be easily  disputed. Using the search term:

• “Herbal medicine for menopause,” I pulled 6 pages (104 studies) of scientifically-designed, herbal medicine trials on the National Institute of Medicine’s Pub med database
• With the term “black cohosh,” I pulled 20 pages or 431 studies
• With the term “red clover,” I found an additional 76 studies
• Ginseng and menopause – 20 studies
• Traditional Chinese medicine and menopause – 47 studies
• Dong Quai – 24 studies
• Evening Primrose – 25 studies

Notably, I did not search databases that specialize specifically in complementary therapies or more importantly, the Traditional Chinese Medicine database.

The gist of the data cited within the DTB Review suggest that save for black cohosh, there is little or no evidence to support the utility or effectiveness of herbal medicines for  relief of menopausal symptoms.  Claiming that the “efficacy and safety of such products is under researched and information on potentially-significant herb-drug interactions is limited,” the author urges healthcare professionals to routinely ask their female patients if they are using such preparations.

A few bones to pick:

1) The author has reviewed only 8 trials on black cohosh, one meta-analysis of 30 trials on red clover, 1 trial of don quai, 1 trial in evening primrose, and 1 trial of ginseng. Yet, ten minutes on Pub Med revealed over 700 published trials.

2)The author has provided no indication of which database(s) s/he searched, which begs the question, is the identification of well-designed trials with ample numbers of participants been thoroughly conducted? What’s more, definitions of  “well-designed” or “ample numbers” are not addressed within the entire review, leading one to believe that this assessment is subjective.

Give me a well-designed, well-defined review of the evidence and let’s talk. Think about the following and let’s have an intelligent dialogue. And in the interim, check out the topics in this blog. I think that you’ll find plenty of evidence to support the utility and safety of alternative therapies to address menopausal symptoms.

It’s all in the spin, isn’t it?

What do you think?