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LETTERS: E Ernst Marketing studies and scientific research must be distinct BMJ 2001; 322: 1249 [Full text]

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Proportionality and objective evidence please

Ron Law   (18 May 2001)

Proportionality and objective evidence please 18 May 2001
Ron Law Send response to journal: Re: Proportionality and objective evidence please	One can't argue with Professor Ernst's comments about objective/subjective evidence. Unfortunately, he spoils his objectivity by making the sweeping statement, "Ginkgo biloba has antiplatelet activity and thus can lead to serious bleeding for example, haemorrhagic strokeand an increase in bleeding tendency when taken concomitantly with oral anticoagulants." Having trawled various databases and read a number of adverse reaction reports, it seems that most of the few patients reported to have haemorrhaged were taking Aspirin. Given the exceedingly common occurance of bleeding with patients taking even low-dose Apsirin, how much confidence can anyone have in claims that Ginko Biloba is a significant problem? On the other hand, given the acknowledgement that Ginko Biloba has antiplatelet activity, and given the fact that there are only a handful of deaths even associated with the use of Gingko (and 4/5 of those were users of Aspirin) whereas about 50,000 deaths occur each year due to even low- dose Aspirin each year, we should be encouraging the use of extremely low- risk Gingko. After all, it has been used for how long without getting a reputation as a hazardous substance?