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If the evidence supports it, so will I

Horse chestnut seed extract is an example of an alternative medicine for which there is good evidence - in this case for chronic venous insufficiency. And I've said so.

Horse chestnut seed extract is an example of an alternative medicine for which there is good evidence - in this case for chronic venous insufficiency. And I've said so.

Some people seriously see me as the "professor against CAM". The truth is that I am neither professor "for" nor "against" but "of" CAM.

My role is to critically analyse, and some CAM enthusiasts seem to find it exceedingly difficult to cope with critical analysis. But an uncritical scientist surely must be a contradiction in terms - and an uncritical GP, I would argue, wcould be a danger to patients.

41227323Being critical is quite different from debunking. If you have a look at any of my books (e.g. "Trick or Treatment: Alternative Medicine on Trial" or "The Oxford Handbook of Complementary Medicine") you will find many treatments that, according to our evaluation, are backed by good evidence. Horse chestnut seed extract (HCSE) clearly belongs in that category.

It is effective for chronic venous insufficiency, a condition for which there are not many options, as we all know. HCSE works by decreasing venous permeability, increasing vascular tone and reducing inflammatory activity. So, we understand how HCSE works but, what is more important, we know that it works.

Our own Cochrane review included 17 RCTs several of which were of high quality. The totality of this evidence shows that HCSEs reduce oedema, leg volume, leg pain and pruritus. Others have demonstrated that HCSEs are safe. Based on prospective data from large groups of patients, we are assured that the adverse effects are similar to those of placebo.

I'd like to draw two very different conclusions from all this.

First, HCSE is worth a try for chronic venous insufficiency.

Second, I am not a debunker of CAM – show me the evidence and, if it withstands critical evaluation, I will say so loud and clear.

Professor Edzard Ernst, professor of complementary medicine at Peninsular Medical School, University of Exeter Recent posts

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Just because a patient gets better, doesn't mean their treatment worked 28 April 09
Homeopathy for cancer is nothing more than placebo 23 April 09
Do complementary and alternative therapies do more harm than good? 20 April 09
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Natural doesn't mean safe. And CAM is neither 06 April 09

So-called 'integrated medicine' is disturbing nonsense 30 March 09


Why 'belief' in complementary medicine is misguided 23 March 09

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