Herbal medicines:physician's recommendation and clinical evaluation of St.John's Wort for depression

Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors, which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre ' were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in and, usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it.

Investigation of the potential antibacterial activity of Buddlja Madagascariensis extracts

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Some historical extracts relevant to the discovery and application of the diffraction of X-rays by crystals to contribute to the centennial celebration and the International Year of Crystallography

Illustrative extracts from the writings of Paul P. Ewald and of Max von Laue are presented. The latter in turn contains extensive text contributions from William Lawrence Bragg. These selections we have chosen so as to indicate the nature of the discovery of X-ray diffraction from crystals (experiments undertaken by Friedrich, Knipping and von Laue) and its early and prompt application in crystal structure analyses (by William Henry Bragg and William Lawrence Bragg). The platform for these discoveries was provided by a macroscopic physics problem dealt with by Ewald in his doctoral thesis with Arnold Sommerfeld in the Munich Physics Department, which is also where von Laue was based. W.L. Bragg was a student in Cambridge who used Trinity College Cambridge as his address on his early papers; experimental work was done by him in the Cavendish Laboratory, Cambridge, and also with his father, W.H. Bragg, in the Leeds University Physics Department. Of further historical interest is the award of an Honorary DSc (Doctor of Science) degree in 1936 to Max von Laue by the University of Manchester, UK, while William Lawrence Bragg was Langworthy Professor of Physics there. © 2012 Copyright Taylor and Francis Group, LLC.