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St. John's Wort Ineffective? A Different Perspective on the Latest Controversy

by Rob McCaleb

A little more than a year ago, the Journal of the American Medical Association (JAMA) published an editorial blasting drug companies for research reporting practices that are "self-serving, wasteful, abuse the volunteer time of peer reviewers, and can be profoundly misleading" - and which ultimately call into question "the integrity of medical research."

Similar criticisms can perhaps be levied against irresponsible members of the media who unquestioningly accept the results of such biased research, confusing the public and in the long run depriving them of the opportunity to use effective, safer alternatives to prescription medications. With these issues in mind, the latest flap over St. John's wort (SJW) deserves a closer look.
Recent headlines have been blaring, "St. John's Wort is Ineffective," because of a single Pfizer-sponsored study published in the Journal of the American Medical Association (JAMA). The JAMA article claims that SJW had no effect against severe depression in a clinical trial conducted "between November 1998 and January 2000 at 11 academic medical centers in the United States." While this may sound impressive, the study actually involved only 201 patients. That's a small number compared to the almost 2,000 patients in the 23 high quality clinical studies that have consistently found SJW effective against mild to moderate depression.

That's a key difference. SJW has never been recommended as a treatment for severe depression, nor are any of Pfizer's products considered adequate as a sole treatment for this serious condition. The respected Merck Manual of Diagnosis and Therapy states that drug therapy alone may be used against mild to moderate depression, but not against moderate to severe depression. And wait. In the Pfizer-sponsored study, 14.3 percent of those taking SJW had remissions, compared with only 4.9 percent of the placebo group. For severe depression, that's a significant result, but the authors dismiss it on the grounds that "remission rates were very low." They go on to jump to the conclusion that their results also prove that St. John's wort is ineffective for mild to moderate depression. Without going into too much technical detail about how they reached this conclusion, I can only say that their reasoning was at best careless and at worst downright deceptive.

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