At www.natrx.com.au we aim to offer natural therapies with the best available evidence. We intend that these products and the information about their evidence will assist the safe and effective prescribing of natural therapies.
Currently the majority of orthodox and natural therapies lack perfect scientific evidence to support their use in all the different clinical situations for which they are prescribed. Health care practitioners constantly have to recommend therapies based on the best available evidence.
By the end of the 20th Century, doctors began to push for more Evidence-Based Medicine to inform their clinical decisions. This is important because patients might be missing out on other therapies that are more effective, or they may be diagnosed or treated incorrectly.
Concerning natural therapies, if there is strong evidence to support its use, then doctors (and any other health care professional) should offer these “evidence-based” natural therapies to their patients.
Therapies are ranked according their strength of evidence. For example:
1) Strongest Evidence: would be a systematic review of all the research on a subject. Often there are conflicting results from smaller individual trials but when you combine the results, an overall answer can be determined. A meta-analysis is one technique for combining the results of many clinical trials.
2) Strong Evidence: would consist of at least one double-blind, randomised, controlled clinical trial. The word double-blind means that the patient and the researcher do not know which therapy the patient was given (i.e. both are blind). Randomised means that the patients are randomly allocated into the different treatment groups. A controlled trial means there is a group of patients who are given a placebo or another therapy for comparison with the therapy under investigation.
3) Medium Evidence: would be a well designed controlled trial that is not randomised, or blinded. Sometimes it is not possible to use the “gold standard”. For example, how do you blind a patient to having their appendix out? It would be unethical to expose people to cigarette smoke just to see if they develop lung cancer.
4) Weak Evidence: includes the opinions of respected experts that are based on clinical experience, descriptive studies, or reports from other expert committees. The traditional use of natural therapies where collective expert knowledge is passed down for many generations is another example.
5) Weakest Evidence: are patient testimonials, case reports, animal and cell experiments and expert opinions that are based on little proof of evidence.
Product Specific Evidence: Product Specific Evidence: Another important question to ask when reviewing the evidence for a natural therapy is whether the herb or supplement is the same as the one used in the clinical trial/s. Research has demonstrated significant differences between brands. Product specific evidence is also important when combining the results of clinical trials used in a meta-analysis. Ideally, a meta-analysis should only use data from clinical trials of one specific herbal extract or supplement. An excellent example is the conflicting results from glucosamine trials as discussed in Choice Magazine May 2008. There is equivocal evidence for all glucosamines, but good product specific evidence for DONA glucosamine.