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HRF OPINION PIECE

by Rob McCaleb

JAMA bashes herbs for surgical patients
No one has ever accused the Journal of the American Medical Association (JAMA) of being overly objective about the topic of "alternative medicine." The article "Herbal Medicines and Perioperative Care," which appeared in the July 11 issue of JAMA, offers further proof that the Journal is willing to compromise its editorial integrity to attack herbs. The article speculates on potential problems that could arise for surgical patients using common herbal dietary supplements, including ginkgo, St. John's wort, garlic, ginseng, echinacea, kava, and others. However, the authors discredit themselves by making sweeping generalizations and warnings based on minimal evidence and outright speculation. It's unlikely that the editors of JAMA would accept such a flimsy article if it were about pharmaceuticals instead of herbs.

For example, the authors make warnings about the use of garlic supplements for surgery patients based on a single case that did not even involve the use of a garlic supplement, but rather extreme consumption of a food. One elderly man ate 15 grams of raw garlic-or about five medium-sized cloves-per day for an extended period of time, and subsequently experienced bleeding problems during surgery, possibly but not necessarily connected with the garlic. This one incident, more than a decade old, is the only case on record that supports the authors' argument against garlic. The JAMA article warns against using ginseng before surgery because of its blood sugar lowering effects based on a flawed study that failed to account for the sugar content of ginseng itself. The authors also advise patients not to use echinacea around the time of surgery, but offer no evidence whatsoever to support the recommendation.

In short, it is hard to understand how an article that runs from single case report to flawed study to no evidence at all was accepted for publication in a widely read, peer-reviewed medical journal.


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