The significance of "nonsignificance" in randomized controlled studies: a discussion inspired by a double-blinded study on St. John's Wort (Hypericum perforatum L.) for premenstrual symptoms

Objectives: This study aimed to investigate the efficacy of St. John's wort extract (SJW) as a treatment for premenstrual symptoms. Design: The study was a randomized, double-blinded, placebo-controlled trial, with two parallel treatment groups. After a no-treatment baseline cycle, volunteers were randomized to either SJW or placebo for a further two menstrual cycles. Settings/location: A postal trial conducted from The University of Reading, Berkshire, England. Subjects: One hundred and sixty-nine (169) normally menstruating women who experienced recurrent premenstrual symptoms were recruited onto the study. One hundred and twenty-five (125) completed the protocol and were included in the analysis. Interventions: Six hundred milligrams (600) mg of SJW (standardized to contain 1800 mug of hypericin) or placebo (containing lactose and cellulose). Outcome measure: A menstrual diary was used to assess changes in premenstrual symptoms. The anxiety-related subgroup of symptoms of this instrument was used as the primary outcome measure. Results: After averaging the effects of treatment over both treatment cycles it was found that there was a trend for SJW to be superior to placebo. However, this finding was not statistically significant. Conclusion: The possibility that this nonsignificant finding resulted from insufficient statistical power in the study, rather than a lack of efficacy of SJW, is discussed. Following this discussion the recommendation is made that, in future, similar studies should be powered to detect a minimum clinically relevant difference between treatments.

A pilot randomised, open, uncontrolled, clinical study of two dosages of St John's wort (Hypericum perforatum) herb extract (LI-160) as an aid to motivational/behavioural support in smoking cessation

There is an association between smoking and depression, yet the herbal antidepressant St John's wort (Hypericum perforatum L.: SJW) herb extract has not previously been investigated as an aid in smoking cessation. In this open, uncontrolled, pilot study, 28 smokers of 10 or more cigarettes per day for at least one year were randomised to receive SJW herb extract (LI-160) 300mg once or twice daily taken for one week before and continued for 3 months after a target quit date. In addition, all participants received motivational/behavioural support from a trained pharmacist. At 3 months, the point prevalence and continuous abstinence rates were both 18%, and at 12 months were 0%. Fifteen participants (54%) reported 23 adverse events up to the end of the 3-month follow-up period. There was no statistically significant difference in the frequency of adverse events for participants taking SJW once or twice daily (p > 0.05). Most adverse events were mild, transient and non-serious. This preliminary study has not provided convincing evidence that a SJW herb extract plus individual motivational/behavioural support is likely to be effective as an aid in smoking cessation. However, it may be premature to rule out a possible effect on the basis of a single, uncontrolled pilot study, and other approaches involving SJW extract may warrant investigation.

Chestnut and mimosa tannin silages: Effects in sheep differ for apparent digestibility, nitrogen utilisation and losses

This paper reports effects of chestnut and mimosa tannins on N utilisation in sheep. Tannins were added to grass either at ensilage or incorporated into grass silage at feeding. The study used an 8 × 5 incomplete Latin Square design with eight mature wether sheep and five 21-day periods. Tannin additions reduced in vivo apparent digestibilities of dry matter (DM), organic matter (OM) and neutral detergent fibre (aNDFom) compared with the untreated control silage (P<0.001). Reductions ranged from 7.6% for DM to 8.5% for aNDFom. Chestnut compared to mimosa tannin silages produced higher values for DM intake (734 g/day versus 625 g/day) and in vivo digestibility for DM, OM and aNDFom (0.66, 0.68 and 0.69 versus 0.61, 0.63 and 0.62; P<0.001). A substantial shift occurred in the pattern of N excretion in sheep fed the tannin versus control silages. As a proportion of daily N intake, urinary N losses were lower (56.4 g/100 g N versus 65.1 g/100 g N intake) and faecal N losses were higher (40.2 g/100 g N versus 29.8 g/100 g N intake) for sheep fed the tannin silages compared with those fed the control grass silage (P<0.001). Nitrogen intake was higher in sheep fed the chestnut compared to mimosa tannin silages (16.2 g/day versus 13.4 g/day; P<0.001), reflecting the lower DM intake of sheep fed the mimosa silages. However, faecal N loss was lower for chestnut compared to mimosa tannin silage fed sheep (38.2 g/100 g N versus 42.1 g/100 g N intake; P<0.01), resulting in higher N retentions with the chestnut compared to the mimosa silage fed sheep (5.49 g/100 g N versus 1.38 g/100 g N intake). Faecal N losses were also higher when tannins were added during ensiling rather than at feeding (P<0.05). Although there was no overall effect of tannins on N retention in mature wether sheep, it is likely that productive ruminants with higher protein requirements would retain more N from silages containing chestnut tannins. Tannins added externally to grass silages may generate some benefits on N utilisation and environmental N excretions in sheep fed the silages.