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Edzard Ernst, MD, PhD; Francesca Borrelli, PhD

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The "systematic" review by Nedrow et al¹ seems less than reliable. The authors claim that they included all relevant randomized controlled trials and meta-analyses published in English. However, the exclusion of non-English articles seems not very systematic, particularly in areas that are dominated by investigators from non–English-speaking countries. Even accounting for this factor, we fail to understand why the authors only included 4 randomized controlled trials of black cohosh. Our systematic review published in 2002 (not mentioned by Nedrow et al¹) already included 4 randomized controlled trials.² It is now outdated, since several new studies have emerged. To make matters worse, the "Adverse Effects" subsection in the article by Nedrow et al¹ is woefully incomplete. Virtually none of the numerous treatments reviewed by Nedrow et al¹ is free of adverse effects.³ Yet the authors only mention those of soy, black cohosh, and . . . [Full Text of this Article]

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RELATED LETTER

Alternatives for Menopause—Reply
Anne Nedrow, Jill Miller, Laurie Hoyt Huffman, Peggy Nygren, Miranda Walker, and Heidi D. Nelson
Arch Intern Med. 2007;167(5):515-516.
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