Complementary and alternative medicine

It is regrettable that the BJGP should publish obviously wrong medical information. In his paper,1 Professor Ernst states that a number of alternative treatments are as effective as conventional options. Presumably, Professor Ernst considers his view to be so well accepted and generally held to be true, that he provides no references to support his statements. There are examples below that clearly show that he is wrong.

He states that saw palmetto used for treatment of benign prostatic hyperplasia has similar effectiveness to conventional options. It is not stated if he means conventional medical treatments or conventional surgical treatments or both.

A 2002 Cochrane review of saw palmetto concluded that it may be better than placebo and of similar effectiveness to 5-α reductase inhibitors.2 In a recent high quality randomised controlled trial it was shown to be no more effective than placebo.3 To my knowledge, saw palmetto has not been studied in a head-to-head trial with α-blocker and therefore it cannot be assumed that it is of similar effectiveness. Regarding surgical treatment, I am not aware of any randomised controlled trial comparing saw palmetto to surgical treatments or sham operation. So, his statement is untrue whichever conventional options he means.

He also states that treatment of depression with St John's wort has similar effectiveness to conventional treatment. Untrue. In a well-conducted randomised controlled trial in patients with major depression, St John's wort was found to have effectiveness similar to placebo.4 To my knowledge it has not been tested against most medical treatments for depression, nor against cognitive-behaviour therapy. Certainly, it has never been tested against electro-convulsive treatment, by far the most effective of all conventional treatments for severe depression.

He states that hawthorn for treatment of heart failure has the same effectiveness as conventional options. Let us remind the readers about some conventional options.5 The proven ones include: diuretics, β-blockers, ACE inhibitors, nitrates, digoxin, bi-ventricular pacing, ventricular assist devices, and heart transplant. His statement seems so outlandish that I feel I need not provide any further references.

Presumably the article1 was peer-reviewed and approved by the Editor for publication. They singularly have failed in their duties on this occasion.

• © British Journal of General Practice, 2008.