Ernst (1) makes several valid and important points regarding complementary and alternative medicine (CAM) use. The benefit/risk ratio of CAM therapies should be evaluated in the same way that conventional therapies are. Patients often lack appropriate education to make these choices. Advice from untrained retail staff is often unreliable. The popular media often provides unsatisfactory coverage of health care issues.

However, through the use of anecdote, selective use of data, and oversimplification, Ernst reaches some unfounded conclusions. Consider that it would be easy to construct a similarly misleading portrayal of conventional medicine by focusing on the alarming rate of adverse drug reactions (the fourth leading cause of death in the U.S.) (2) and ignoring conventional medicine’s great benefits.

Significantly, Ernst dismisses the potential benefits of CAM therapies in diabetic care. Implicitly, CAM therapies have not enjoyed the scientific attention that conventional treatments have received. Increasingly, however, CAM therapies suggested for diabetes have been the subject of encouraging preliminary research into their efficacy, mechanisms of action, and safety (310). Each therapy should be rigorously evaluated using all available evidence, not dismissed collectively.

Ernst’s commentary bears a discouragingly hostile tone. The great majority of health care providers, whether alternative or conventional, are committed to serving their patients. Patients navigate a complex and shifting health care system to the best of their ability. Let all medical professionals strive to cultivate a cooperative relationship with their peers, respect their patients, and maintain an objective approach to medical science.

1
Ernst E: Complementary Medicine: its hidden risks.
Diabetes Care
24
:
1486
–1488,
2001
2
Lazarou J, Pomeranz BH, Corey PN: Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies.
JAMA
279
:
1200
–1205,
1998
3
Sotaniemi EA, Haapakoski E, Rautio A: Ginseng therapy in non-insulin dependent diabetic patients: effects on psychophysical performance, glucose homeostasis, serum lipids, serum aminoterminalpropeptide concentration, and body weight.
Diabetes Care
18
:
1373
–1375,
1995
4
Bursell SE, Clermont AC, Aiello LP, Aiello LM, Schlossman DK, Feener EP, Laffel L, King GL: High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type 1 diabetes.
Diabetes Care
22
:
1245
–1251,
1999
5
Sargeant LA, Wareham NJ, Bingham S, Day NE, Luben RN, Oakes S, Welch A, Khaw KT: Vitamin C and hyperglycemia in the European Prospective Investigation into Cancer–Norfolk (EPIK-Norfolk) study: a population based study.
Diabetes Care
23
:
726
–732,
2000
6
Vuksan V, Stavro MP, Sievenpiper JL, Beljan-Zdravkovic U, Leitter LA, Josse RG, Xu Z: Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes.
Diabetes Care
23
:
1221
–1226,
2000
7
Jain SK, McVie R, Smith T: Vitamin E supplementation restores glutathione and malondialdehyde to normal concentrations in erythrocytes of type 1 diabetic children.
Diabetes Care
23
:
1389
–1394,
2000
8
Montori VM, Farmer A, Wollan PC, Dinneen SF: Fish oil supplementation in type 2 diabetes: a quantitative systematic review.
Diabetes Care
23
:
1407
–1415,
2000
9
Namdul T, Sood A, Ramakrishnan L, Pandey RM, Moorthy D: Efficacy of Tibetan medicine as an adjunct in the treatment of type 2 diabetes (Letter).
Diabetes Care
24
:
176
–177,
2001
10
Hermansen K, Søndergaard M, Høie L, Carstensen M, Brock B: Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects.
Diabetes Care
24
:
228
–233,
2001

Address correspondence to Nathaniel P. Gibson, 108 11th Ave. East, Suite C, Seattle, WA 98102. E-mail: npgibson@hotmail.com.