A systematic review of randomised clinical trials of individualised herbal medicine in any indication

pmj.gif  This systematic review of RCTs on individualized herbal medicine was just published in the October 2007 issue of the Postgraduate Medical Journal. The accompanying editorial is by one of the authors, Edzard Ernst. The authors state: The World Health Organization has estimated that 80% of the population in developing countries depends primarily upon herbal medicine for basic health care.

Ernst E. Herbal medicine: buy one, get two free [editorial]. Postgrad Med J 2007; 83(984):615-616. [subscription required]
Extract: In recent years, herbal medicine seems to have gone from strength to strength. However, not one but three types of herbal medicine exist-and we are confusing them at our peril. The first form of herbal medicine is perhaps best called phytotherapy. It is the scientific face of herbalism and the area where reasonably good data are available. … The second form of herbal medicine refers to the hugely popular over-the-counter (OTC) market of plant-based preparations currently sold as dietary supplements. …The third form of herbal medicine is the one practised by traditional herbalists worldwide. … If we want to minimise the risks of herbal medicine we should think of ways to limit the damage done by those who issue irresponsible advice in this area. In particular, health writers should be reminded that the promotion of nonsense is not entertainment but puts people at risk. In these days of political correctness few doctors or scientists dare to speak out against such abuse—but in the interest of public safety we should. We should challenge false or unsubstantiated health claims whenever we see them—in our daily papers, in windows of the Chinese herbal shops in our high streets, and even in government-supported, semi-official patient guides.

Clearer distinction of the three types of herbalism is urgently needed: phytotherapy has considerable potential for benefit, while OTC herbalism and traditional herbalism can harm those who use them. Without these distinctions we will fail to advance our knowledge about the potential benefits of herbal treatments. More crucially, we will also fail in our foremost duty—to protect the public from treatments that cause harm.

Guo R, Canter PH, Ernst E. A systematic review of randomised clinical trials of individualised herbal medicine in any indication. Postgrad Med J 2007; 83(984):633-637. [Open Access]
Aim: To summarise and critically evaluate the evidence from randomised clinical trials for the effectiveness of individualised herbal medicine in any indication.
Methods: Search of electronic databases and approaches to experts in the field to identify randomised, controlled clinical trials of individualised herbal medicine in any indication. Independent data extraction and assessment of methodological quality by two authors and best evidence synthesis.
Results: Three randomised clinical trials of individualised herbal medicine were identified. Statistically non-significant trends favouring active over placebo treatment in osteoarthritis of the knee probably result from large baseline differences and regression to the mean. Individualised treatment was superior to placebo in four of five outcome measures in the treatment of irritable bowel syndrome, but was inferior to standardised herbal treatment in all outcomes. Individualised herbal treatment was no better than placebo in the prevention of chemotherapy-induced toxicity.
Conclusions: There is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication.

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