A “state-of-the-art” paper in a scientific or medical journal strongly suggests a review in which the authors are experts in the scientific or clinical discipline being discussed, that they have conducted extensive and appropriate research, that the article has been peer reviewed by experts in the specific field, and that the journal editors have applied all reasonable and appropriate diligence to ensure that the final publication is accurate, reliable, authoritative, and responsible.

Unfortunately, the Journal of the American College of Cardiology (JACC) appears to have bypassed this process when it published an article riddled with errors in its February 2010 issue.¹ Written by 3 physicians at the Mayo Clinic in Arizona, the paper does not meet any criteria necessary to merit the term “state-of-the-art,” i.e., unless the term art instead of “state-of-the-science” allows leeway to commit what, in our expert opinion, constitutes intellectual dishonesty.

The paper is an abortive attempt to educate the medical profession of the potential dangers of inter- actions between “herbs” and conventional cardiovascular medications. It falls far short of its intended objective. Presumably, any other respectable medical or scientific journal would be embarrassed to have such an irresponsible article in its pages and on its website. Apparently the JACC editors have little compunction about publishing what we consider junk science.

ABC sent a letter to the editor of JACC to note only some of the many problems in the paper.² ABC sent a second letter in July, again calling for the article’s retraction.³ The ABC letters were co-authored by a multidisciplinary group of experts in various fields of botanical medicine, herb-drug interactions, pharmacovigilance and herb regulation, and family practice medicine. (Two co-authors are members of the ABC Board of Trustees, and four are on the ABC Advisory Board.) ABC also offered to provide JACC with a full, peer-reviewed critique of the article. JACC’s editor-in-chief, however, has declined to publish ABC’s letter, claiming that the journal had already received similar letters, including an offer from Dr. Adriane Fugh-Berman at Georgetown University to write a critique of the article, possibly to be published online only. (The texts of both ABC letters are posted on the ABC website.)

Although this column does not provide sufficient space to catalogue all of the errors and omissions in the article, here are a few that might be of interest to HerbalGram readers: The article contains no Latin binomials, sometimes making it difficult to identify the specific plant to which the authors are referring. For instance, they occasionally refer to an herb simply as “ginseng,” yet 3 types of “ginseng” are referenced in the article. The paper states that an infant died whose mother ingested so-called “Siberian ginseng,” but the original reference deals with the infant’s hirsutism—not death. Herbs referred to as “common” erroneously include the toxic garden plants oleander and lily-of-the- valley (as commonly available on the market as supplements), as well as “chan su” (a toxic Chinese bufo toad!). Grapefruit, a common food, is listed as an herbal dietary supplement, which it clearly is not. Reliance on secondary sources, lack of critical evaluation of the primary literature, obvious lack of knowledge of botanicals—these problems, and many others, make this paper, and the inadequate editorial process which allowed it to be published, a case study on the nadir of medical journalism.

As stated in the first ABC letter, “The plethora of such errors, plus others, requires that this article be retracted. Future publications of this type should be properly reviewed by experts competent in medicinal plants, pharmacognosy, and related fields of science.”

We have discussed this issue with numerous experts in areas of clinical botanical medicine and related disciplines. All agree that in the interests of scientific honesty, JACC should acknowledge its regrettable error in publishing its article, fully retract the article, and issue an apology with the same level of public relations fanfare apparently used when the erroneous article was published. Anything less perpetuates confusion and is a disservice to the medical profession and the public.

ABC will publish a more thorough treatment of the article in an HerbClip and elsewhere on the ABC website (at:

—Mark Blumenthal

References

1. Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovas- cular diseases. J Amer Coll Cardiol. 2010;55(6):515-525.
2. Blumenthal M, Awang DVC, Balick MJ, Brinker F, Farnsworth NR, Hardy ML, Kingston R. [Letter to editor.] J Amer Coll Cardiol. March 9, 2010.
3. Blumenthal M. [Letter to editor.] J Amer Coll Cardiol. July 5, 2010.