Winnowing the Chaff of Charlatanism from the Wheat of Science

Experts and lay people alike can sometimes find it difficult to demarcate the absurd. Here I propose a set of criteria that may be helpful in achieving this in the realm of healthcare: falsifiability, plausibility and some hallmarks of pseudoscience. Applying this method is unlikely to be fool-proof but it might be a valuable aid in discriminating credible from incredible health claims.     

Drug-herb interactions with herbal medicines for menopause

Herbal medicine is one of most popular choices of complementary therapies for women, particularly as an alternative treatment for menopausal symptoms. The most commonly used herbal medicines for the menopause is probably black cohosh (Actaea/Cimcifuga racemosa); other preparations used include red clover (Trifolium pratense), dong quai (Angelica sinesis) and evening primrose (Oenothera biennis). Some of these herbal medicines have a very good safety profile with little or no suggestion of interaction with conventional drugs. For others, there are many and significant drug-herb interactions. This article outlines the major known and theoretical drug-herb interactions of herbal medicines thought to be of benefit for menopausal symptoms, as well as discussing the implications for the medical profession.     

Manual therapies for pain control: chiropractic and massage

OBJECTIVES: To evaluate the effectiveness of chiropractic and massage therapy for the reduction of any type of pain. METHODS: Systematic reviews of chiropractic and massage as a means of pain control were located and evaluated. RESULTS: Six systematic reviews were found, 4 of chiropractic and 2 of massage therapy. Promising evidence emerged from some of these reviews but neither for chiropractic nor for massage was there fully convincing evidence for effectiveness in controlling musculoskeletal or other pain. DISCUSSION: The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.     

Avocado–soybean unsaponifiables (ASU) for osteoarthritis – a systematic review

Patients suffering from osteoarthritis (OA) are often tempted to try alternative treatment options. Avocado/soybean unsaponifiables (ASU) have shown some promise for OA. This systematic review is aimed at critically evaluating the data from rigorous clinical trials of ASU. Six databases were searched for randomised, placebo-controlled, double-blind trials of ASU. Four studies could be included. Key data were extracted according to predefined criteria and tabulated as well as discussed in narrative form. The methodological quality of the four studies was high. They included patients with OA of the knee and hip. The dose of ASU was 300 mg/day and one trial also included a group treated with 600 mg/day. Three of the four trials suggested efficacy of ASU for improving the symptoms of OA. The majority of rigorous trial data available to date suggest that ASU is effective for the symptomatic treatment of OA and more research seems warranted. However, the only real long-term trial yielded a largely negative result.     

Complementary/alternative therapies for premenstrual syndrome: a systematic review of randomized controlled trials

Complementary/alternative therapies are popular with women who have premenstrual syndrome. This systematic review was designed to determine whether use of such therapies is supported by evidence of effectiveness from rigorous clinical trials. Trials were located through searching 7 databases and checking the reference lists of articles. Randomized controlled trials investigating a complementary/alternative therapy in women with premenstrual syndrome published in the peer-reviewed literature were included in the review. Twenty-seven trials were included investigating herbal medicine (7 trials), homeopathy (1), dietary supplements (13), relaxation (1), massage (1), reflexology (1) chiropractic (1), and biofeedback (2). Despite some positive findings, the evidence was not compelling for any of these therapies, with most trials suffering from various methodological limitations. On the basis of current evidence, no complementary/alternative therapy can be recommended as a treatment for premenstrual syndrome.