To the Editor:

In his editorial (1) Marcus criticizes “The Arthritis Foundation Guide to Alternative Therapies.” I share much of his criticism, but disagree with Marcus when he states that “the efficacy of herbal medicines has not been established by rigorous trials, and recommendations for their use are based on traditional beliefs and anecdotes.” The truth is that approximately 500 randomized clinical trials and 50 systematic reviews/meta-analyses of these data have been published (2). Herbal medicines that have been investigated for use in rheumatic conditions include devil's claw, ginger, blackcurrant, borage, boswellia, evening primrose, feverfew, garlic, and thunder god vine (2). In some, but not all cases, the results have been encouraging.

Edzard Ernst MD, PhD, FRCP*, * Department of Complementary Medicine University of Exeter, Exeter, UK.