I agree with Dr Sherman’s position in his Commentary, “Evidence-based common sense?”1 Clinical practice should not be excluded, nor should it be used in the presence of evidence to the contrary. While training, I observed a surgeon using an antibiotic powder to “dust” an abdominal wound before closure, despite a resident referring to the material as fairy dust and despite good evidence against the use of such an agent. Physicians in Europe have access to herbal products that have standard potency regulated by the government. In Canada, no such regulation for standardized potency exists; potency is determined by the label on the container. Confidence is not only in the product, but also in the manufactured entity that customers purchase.
A number of years ago, the federal government sponsored a large, multicentre trial on glucosamine. The researchers developed a protocol and, before proceeding, decided to replicate “real life” by purchasing glucosamine for the trial at a local store. Testing was done to determine the validity of the 500-mg dose stated on the label. Neither the initial purchase nor any of the other tested-brands had 500 mg of glucosamine per tablet. Each brand was inconsistent with its label. The trial was abandoned.
The herbal industry is one of the few industries in Canada where products are available on a “trust me, it’s good for you” basis. Should doctors be sceptical? Common sense says yes.
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