The Pharmaceutical Journal
Vol 273 No 7329 p853
11 December 2004

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Letters to the Editor

Complementary medicine

A complicated topic

From Mr U. Jonsson, MPharmS

I would like to respond to the article by Edzard Ernst “Should we use powerful placebos” (PJ, 27 November, p795 PDF 45K). First, I guess readers will not need reminding that the phenomenon of placebo-controlled clinical trials not generating specific therapeutic effects certainly is not unique to complementary medicine. Sadly, disappointing results in trials have been the death sentence of many heralded “wonder drugs”. Some may have been effective but, maybe due to errors of judgement in trial design, appeared to be ineffective when tested. It can be argued that the randomised controlled trial has provided a convenient, practical and “cost-effective” way to screen numerous preparations for effect whereas scientifically valid, and arguably more accurate, procedures such as “n=1” tests in individual patients, may take longer to establish the true effectiveness of a product.

The so-called placebo, and, indeed, nocebo effect is worthy of the description “phenomenon”. This description is rather apt — a process known through the senses rather than intuition or reasoning. In other words, from a scientific perspective, it appears we know little, although a lot is written about it. It is a complicated topic that is difficult to explore, or come to conclusions on the ethical problems of giving placebos, in such a short article.

Although Professor Ernst is careful in his wording, there is a risk that his recent comments may be interpreted incorrectly. Readers of Focus on Alternative and Complementary Therapies (FACT) published by the Pharmaceutical Press, will be aware that some promising results have been reported, in recent years, for a number of complementary medicine (CM) modalities, including homoeopathy. It is important that pharmacists are not led to believe that CM is, generally, no better than placebo.

When evaluating clinical research involving remedies such as arnica, which is used both as a herbal and in homoeopathic medicine, it can lead to confusion both by the scientists performing the evaluation and their audience. Pharmacists and their assistants may be interested in the extensive and supportive literature for arnica in herbal medicine, which is reviewed in a recent ESCOP monograph.¹ Pharmacists can be reassured that they are recommending not just a tried and trusted traditional remedy, but also one that has been fully evaluated by an independent and expert European committee.

Ulli Jonsson
Director of Regulatory Affairs, Research and Development
Nelsonbach

Reference

1. “Arnicae flos.”. In: ESCOP Monographs: the scientific foundation for herbal medicinal products, 2nd edition. European Scientific Co-operative On Phytotherapy. Exeter/Stuttgart: ESCOP/Thieme Medical Publishers; 2003.

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