Barbara Wider

Complementary and alternative medicine use in England: results from a national survey.

Objectives:  In many countries, recent data on the use of complementary and alternative medicine (CAM) are available. However, in England, there is a paucity of such data. We sought to determine the prevalence and predictors of CAM use in England.

Quality of herbal medicines: challenges and solutions.

The popularity of herbal medicines has risen worldwide. This increase in usage renders safety issues important. Many adverse events of herbal medicines can be attributed to the poor quality of the raw materials or the finished products. Different types of herbal medicines are associated with different problems. Quality issues of herbal medicines can be classified into two categories: external and internal. In this review, external issues including contamination (e.g. toxic metals, pesticides residues and microbes), adulteration and misidentification are detailed. Complexity and non-uniformity of the ingredients in herbal medicines are the internal issues affecting the quality of herbal medicines. Solutions to the raised problems are discussed. The rigorous implementation of Good Agricultural and Collection Practices (GACP) and Good Manufacturing Practices (GMP) would undoubtedly reduce the risk of external issues. Through the use of modern analytical methods and pharmaceutical techniques, previously unsolved internal issues have become solvable. Standard herbal products can be manufactured from the standard herbal extracts.

Serenoa repens (Saw Palmetto) A Systematic Review of Adverse Events

Serenoa repens (W. Bartram) Small, also known as saw palmetto, is one of the most widely used herbal preparations for the treatment of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Although a number of randomized controlled trials (RCTs) and systematic reviews of the efficacy of S. repens for the treatment of LUTS and BPH have been published, no systematic review on its drug interactions or adverse events currently exists. This review assesses all available human safety data of S. repens monopreparations.Systematic literature searches were conducted from date of inception to February 2008 in five electronic databases; reference lists and our departmental files were checked for further relevant publications. Information was requested from spontaneous reporting schemes of the WHO and national safety bodies. Twenty-four manufacturers/distributors of S. repens preparations and four herbalist organizations were contacted for additional information. No language restrictions were imposed. Only reports of adverse events in humans from monopreparations of S. repens were included. Data from all articles, regardless of study design, reporting adverse events or interactions were independently extracted by the first author and validated by the second.Forty articles (26 randomized controlled trials, 4 non-randomized controlled trials, 6 uncontrolled trials and 4 case reports/series) were included. They suggest that adverse events associated with the use of S. repens are mild and similar to those with placebo. The most frequently reported adverse events are abdominal pain, diarrhoea, nausea, fatigue, headache, decreased libido and rhinitis. More serious adverse events such as death and cerebral haemorrhage are reported in isolated case reports and data from spontaneous reporting schemes, but causality is questionable. No drug interactions were reported.Currently available data suggest that S. repens is well tolerated by most users and is not associated with serious adverse events. The majority of adverse events are mild, infrequent and reversible, and include abdominal pain, diarrhoea, nausea and fatigue, headache, decreased libido and rhinitis. We found no evidence for drug interactions with S. repens. However, higher quality reporting of adverse events is essential if safety assessments are to be improved in future.

The Use of Garcinia Extract (Hydroxycitric Acid) as a Weight loss Supplement: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

The aim of this systematic review is to examine the efficacy of Garcinia extract, hydroxycitric acid (HCA) as a weight reduction agent, using data from randomised clinical trials (RCTs). Electronic and nonelectronic searches were conducted to identify relevant articles, with no restrictions in language or time. Two independent reviewers extracted the data and assessed the methodological quality of included studies. Twenty-three eligible trials were identified and twelve were included. Nine trials provided data suitable for statistical pooling. The meta-analysis revealed a small, statistically significant difference in weight loss favouring HCA over placebo (MD: −0.88 kg; 95% CI: −1.75, −0.00). Gastrointestinal adverse events were twice as common in the HCA group compared with placebo in one included study. It is concluded that the RCTs suggest that Garcinia extracts/HCA can cause short-term weight loss. The magnitude of the effect is small, and the clinical relevance is uncertain. Future trials should be more rigorous and better reported.

Acupuncture: Its Evidence-Base is Changing

The effectiveness of acupuncture remains a controversial issue. The aim of this article is to evaluate trends over time in the development of the evidence-base of acupuncture. A comparison of two series of systematic reviews was conducted. The first related to the evidence-base in 2000, the second related to 2005. Both employed virtually the same methodology and criteria for evaluation. The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.

Complementary/alternative medicine for supportive cancer care: development of the evidence-base

AimThe aim of this article is to compare the evidence relating to the effectiveness of complementary/alternative medicine (CAM) in palliative cancer care as it existed in 2000 and 2005.MethodsOur comparison is based on systematic reviews using the same methodology at these two points in time.ResultsThe results reveal a buoyant research activity in this sector. Consequently, new evidence for 19 CAM modalities has emerged between 2000 and 2005. For some treatments, the evidence is encouraging but for very few, it is as yet fully convincing.ConclusionIt follows that further research is warranted, particularly in areas where the data already looks encouraging.

Food Supplements for Body Weight Reduction: A Systematic Review of Systematic Reviews

IntroductIon A wide range of complementary therapies is currently being promoted for reducing body weight, e.g., herbal and nonherbal food supplements, homeopathy, hypnosis, and acupuncture (1). Many patients perceive these therapies as easier to comply with than interventions such as diet and physical exercise (2) and as more natural than pharmacological options like orlistat, sibutramine, or liraglutide (3,4). Although mainstream drugs for body weight reduction must demonstrate efficacy before receiving a license, food supplements do not need to meet this requirement. Few food supplements have therefore been submitted to clinical trials, and many health-care professionals feel uncertain about their therapeutic value. The objective of this overview was to summarize and critically evaluate all available systematic reviews of food supplements for body weight reduction.

Akupunktur bei Rückenschmerzen

Zusammenfassung.Hintergrund: Akupunktur wird häufig zur Behandlung von Rückenschmerzen eingesetzt. Eine Metaanalyse von klinischen Studien zur Wirksamkeit kam zu einer positiven, ein Übersichtsartikel dagegen zu einer eher negativen Schlussfolgerung. Ziel: Ziel der vorliegenden Arbeit war ein Vergleich der Metaanalyse von Studien zur Akupunktur in der Behandlung von Rückenschmerzen mit dem angeführten Übersichtsartikel unter Berücksichtigung neuester Studien. Methode: Eine systematische Literaturrecherche wurde durchgeführt, um alle randomisierten, kontrollierten Studien zu allen Formen der Akupunktur bei jeglicher Art von Rückenschmerzen zu erfassen. Die Angemessenheit der Akupunkturbehandlung wurde durch 6 erfahrene Akupunkteure beurteilt. Primärer Zielparameter der Metaanalyse war die Anzahl der Patienten, deren Symptome sich zu Behandlungsende verbessert hatten. Diese Daten werden im Hinblick auf den oben genannten qualitativen Übersichtsartikel sowie unter Berücksichtigung neuester Studienergebnisse diskutiert. Ergebnisse: 12 Studien entsprachen den Einschlusskriterien, wovon 9 für eine Metaanalyse verwendbare Daten enthielten. Die Odds-Ratio für symptomatische Linderung durch Akupunktur verglichen mit Kontrollinterventionen betrug 2,30 [95%-Konfidenzintervall=1,28–4,13). Für scheinakupunkturkontrollierte, untersucherblinde Studien betrug die Odds-Ratio 1,37 (95%-Konfidenzintervall=0,84–2,25). Auch die Ergebnisse neuester Studien sprechen in der Mehrzahl für die Effektivität der Akupunktur bei dieser Indikation. Schlussfolgerung: In ihrer Summe implizieren diese Daten, dass Akupunktur verschiedenen Kontrollinterventionen überlegen ist; ihre Überlegenheit gegenüber “Plazebo” ist jedoch nicht ausreichend belegt.Abstract.Background: Acupuncture is commonly used to treat back pain. A meta-analysis of clinical trials of acupuncture for this condition came to a positive conclusion whilst a qualitative review was negative. Aim: To compare our meta-analysis of trials of acupuncture for the treatment of back pain with a qualitative review and the most recent studies on the subject. Methods: A systematic literature search was conducted to retrieve all randomised controlled trials of any form of acupuncture for any type of back pain in humans. The adequacy of the acupuncture was assessed by consulting six experienced acupuncturists. The main outcome measure for the meta-analysis was numbers of subjects who where improved at the end of treatment. These data are discussed in relation to the qualitative review and the most recent studies. Results: Twelve studies were included of which nine presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30 (95% confidence interval 1.28 to 4.13). For sham-controlled, evaluator-blinded studies, the odds ratio was 1.37 (95% confidence interval, 0.84–2.25). The results from the majority of the most recent studies also support the effectiveness of acupuncture in the treatment of back pain. Conclusions: Collectively, these data imply that acupuncture is superior to various control interventions, although there is insufficient evidence to state whether it is superior to placebo.

[Acupuncture for back pain: meta-analysis of randomised controlled trials and an update with data from the most recent studies].

Zusammenfassung.Hintergrund: Akupunktur wird häufig zur Behandlung von Rückenschmerzen eingesetzt. Eine Metaanalyse von klinischen Studien zur Wirksamkeit kam zu einer positiven, ein Übersichtsartikel dagegen zu einer eher negativen Schlussfolgerung. Ziel: Ziel der vorliegenden Arbeit war ein Vergleich der Metaanalyse von Studien zur Akupunktur in der Behandlung von Rückenschmerzen mit dem angeführten Übersichtsartikel unter Berücksichtigung neuester Studien. Methode: Eine systematische Literaturrecherche wurde durchgeführt, um alle randomisierten, kontrollierten Studien zu allen Formen der Akupunktur bei jeglicher Art von Rückenschmerzen zu erfassen. Die Angemessenheit der Akupunkturbehandlung wurde durch 6 erfahrene Akupunkteure beurteilt. Primärer Zielparameter der Metaanalyse war die Anzahl der Patienten, deren Symptome sich zu Behandlungsende verbessert hatten. Diese Daten werden im Hinblick auf den oben genannten qualitativen Übersichtsartikel sowie unter Berücksichtigung neuester Studienergebnisse diskutiert. Ergebnisse: 12 Studien entsprachen den Einschlusskriterien, wovon 9 für eine Metaanalyse verwendbare Daten enthielten. Die Odds-Ratio für symptomatische Linderung durch Akupunktur verglichen mit Kontrollinterventionen betrug 2,30 [95%-Konfidenzintervall=1,28–4,13). Für scheinakupunkturkontrollierte, untersucherblinde Studien betrug die Odds-Ratio 1,37 (95%-Konfidenzintervall=0,84–2,25). Auch die Ergebnisse neuester Studien sprechen in der Mehrzahl für die Effektivität der Akupunktur bei dieser Indikation. Schlussfolgerung: In ihrer Summe implizieren diese Daten, dass Akupunktur verschiedenen Kontrollinterventionen überlegen ist; ihre Überlegenheit gegenüber “Plazebo” ist jedoch nicht ausreichend belegt.Abstract.Background: Acupuncture is commonly used to treat back pain. A meta-analysis of clinical trials of acupuncture for this condition came to a positive conclusion whilst a qualitative review was negative. Aim: To compare our meta-analysis of trials of acupuncture for the treatment of back pain with a qualitative review and the most recent studies on the subject. Methods: A systematic literature search was conducted to retrieve all randomised controlled trials of any form of acupuncture for any type of back pain in humans. The adequacy of the acupuncture was assessed by consulting six experienced acupuncturists. The main outcome measure for the meta-analysis was numbers of subjects who where improved at the end of treatment. These data are discussed in relation to the qualitative review and the most recent studies. Results: Twelve studies were included of which nine presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30 (95% confidence interval 1.28 to 4.13). For sham-controlled, evaluator-blinded studies, the odds ratio was 1.37 (95% confidence interval, 0.84–2.25). The results from the majority of the most recent studies also support the effectiveness of acupuncture in the treatment of back pain. Conclusions: Collectively, these data imply that acupuncture is superior to various control interventions, although there is insufficient evidence to state whether it is superior to placebo.

Effects of Ginkgo biloba on Blood Coagulation Parameters

A systematic literature review was conducted to investigate the effects of Ginkgo biloba preparations on blood coagulation parameters. Systematic literature searches were carried out using MEDLINE (via PubMed), EMBASE, AMED, CINAHL®, the Cochrane Library and PsycINFO to identify randomised, double-blind, clinical trials of G. biloba mono-preparations assessing at least one blood coagulation parameter as either a primary or a supplementary outcome measure. Five manufacturers of G. biloba preprations were asked to contribute any unpublished material. Data were validated and extracted independently by two reviewers according to pre-specified criteria.Eight trials were included, of which two included healthy subjects, four included patients with various conditions and two included participants taking concomitant anticoagulant medication, one with acetylsalicylic acid (ASA; aspirin) and one with warfarin. Overall results do not provide evidence that G. biloba does affect blood coagulation parameters in a clinically relevant manner. Out of many parameters assessed, four coagulation parameters from three studies were significantly different in the treatment group compared with the control. One study comparing the treatments of ASA and G. biloba with ASA alone confirmed that the two treatments were equivalent with regards to all but three coagulation parameters.Available evidence does not demonstrate that extract of G. biloba causes significant changes in blood coagulation parameters. A limited number of studies on concomitant use of G. biloba with ASA or warfarin also do not suggest that G. biloba has an additive effect to the clinical effects of these two drugs. Currently available evidence is limited and, therefore, further studies are needed to assess effects of G. biloba on a variety of blood coagulation parameters.