To the Editor:

We read the article by Zhang et al.1 with great interest. The authors assessed the methodological quality of randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) with the Jadad scoring system.2 However, we would like to comment on concerns that have been raised about the scoring system.

The assessment criterion adopted in the study is less comprehensive and outdated. Jadad scoring, though widely used in validating RCTs, has been attacked in recent years. Accumulating evidence suggests that Jadad scoring is flawed and overly simplistic, places too much emphasis on blinding, and has diminishing consistency with different raters.3, 4 Nowadays, the Consolidated Standards of Reporting Trials (CONSORT) statement encompasses various initiatives developed by the CONSORT group to alleviate the problems arising from inadequate reporting of RCTs.5 It offers a standardized way of preparing reports of trial findings that facilitates accurate and transparent reporting with critical appraisal and interpretation. More and more highly cited academic journals, including HEPATOLOGY, have adopted the CONSORT statement for standardization and integrity. In China, CONSORT for TCM has been developed and widely adopted; it provides more specificity and sensitivity for the assessment of TCM methodological quality.6 Therefore, it would have been much better if the CONSORT standard, instead of Jadad scoring, had been used in this meta-analysis.

In summary, the methodological quality of the analysis needs to be reassessed.


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  • 1
    Zhang L, Wang G, Hou W, Li P, Dulin A, Bonkovsky HL. Contemporary clinical research of traditional Chinese medicines for chronic hepatitis B in China: an analytical review. Hepatology 2010; 51: 690-698.
  • 2
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1-12.
  • 3
    Berger VW. Is the Jadad score the proper evaluation of trials? J Rheumatol 2006; 33: 1710-1711.
  • 4
    Clark HD, Wells GA, Huet C, McAlister FA, Salmi LR, Fergusson D, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 1999; 20: 448-452.
  • 5
    Moher D, Schulz KF, Altman D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001; 285: 1987-1991.
  • 6
    Wu TX, Li YP, Bian ZX, Li TQ, Li J, Dagenais S, et al. Consolidated standards for reporting trials of traditional Chinese medicine (CONSORT for TCM) [in Chinese]. Chin J Evid Based Med 2007; 7: 601-605.

Ming-Hua Zheng M.D.*, Yu-Chen Fan M.D.†, Ke-Qing Shi M.D.*, Yong-Ping Chen M.D.*, * Liver Research Center, Department of Infection and Liver Diseases, First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China, † Department of Hepatology, Qilu Hospital, Shandong University, Jinan, China.