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To the Editors: The Editorial by Dr Chan,¹ which accompanied the randomized trial of use of Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents by Dr Weber and colleagues,² summarized the need for rigorous research on complementary and alternative medicine (CAM) interventions. It provided insights into some of the challenges in performing high-quality CAM research.

An additional challenge in studies of herbal remedies, which was well documented in the study by Weber et al but not emphasized in the Editorial, is the importance of the integrity and stability of biologically active components of herbal products. The study by Weber et al documented only at the end of the trial the oxidative degradation of the investigational product over time, such that the dose delivered during some portion of the study was less than half of the target dose. The article also acknowledged the challenge, encountered in studies . . . [Full Text of this Article]

Catherine M. Stoney, PhD
stoneyc@mail.nih.gov
National Center for Complementary and Alternative Medicine

Paul Coates, PhD
Office of Dietary Supplements

Josephine P. Briggs, MD
National Center for Complementary and Alternative Medicine
National Institutes of Health
Bethesda, Maryland

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