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Bandolier leads this month with a report of an alternative medicine intervention in depression. This sound systematic review shows that St John's wort was more effective than placebo, performing as well as (low) doses of antidepressants.

Time and effort

There is a problem here. Much time and effort goes into writing a systematic review of this calibre, and the number of people who can do it is finite. But choosing this topic means that another topic will not be reviewed. Limited resources mean that if something is done something else will not be. We need to be clear about our priorities. For which topics should money be provided? Should we put our limited resources into investigating alternative medicine remedies, knowing that that choice necessarily excludes other work?

Alternative medicine

Bandolier is puzzled about the origin of the pressure to receive alternative medicine into the church of conventional medicine. Is it due to the (sensible) realisation that much of shop-floor medicine is about coping with self-limited disease, and that alternative medicine remedies can help at least as well in this setting? Or is it due to a wider consumer pressure, a desire to wrest control from the professionals? The reality is that people choose to spend vast sums of money on these remedies, and systematic reviews like that on St John's wort help us to advise on which may be effective. We also have 9 systematic reviews of acupuncture on file, at least one of which is helpful.

Returning, like your tongue to a hole in your tooth, to our quandary about priorities, where do you think that the spotlight should shine? Has alternative medicine too high or too low a profile? Those of you who also read the Lancet will know that Bandolier welcomes your letters.

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