Some of my patients ask me if I “believe in” Eastern, or holistic, or homeopathic medication. The truth is I don’t “believe in” any kind of medicine. I need to be convinced. I’m not a Western medicine chauvinist; I’m an evidence-based medicine chauvinist. If there is a good study that supports that a medication is safe and effective I’ll use it. I won’t ask if it comes from the East or West, or if it’s natural or artificial, or if it’s a tablet or a crushed leaf. I just want the evidence.

That’s why I’m delighted when alternative therapies are rigorously tested. That lets me recommend them with confidence if their effectiveness is proven, or recommend against them with confidence otherwise. That’s why I was happy to review the evidence on acupuncture back in May.

The most recent issue of the ACP Journal Club [vol 145, no 1, p 12] reviews the best study yet done on saw palmetto for benign prostate enlargement, which was originally published in The New England Journal of Medicine in February. In the study, men with moderate-to-severe symptoms of prostate enlargement were randomized to receive saw palmetto or placebo. They were followed for one year and had formal measurement of their urinary symptoms as well as measurement of biological markers of prostate enlargement, like prostate volume, urine flow rate, and residual urine volume after voiding.

The men on placebo did as well as the men on saw palmetto. The symptoms and biological markers of men in both groups didn’t get much worse or much better. The reviewer concluded:

Saw palmetto does not improve symptoms or objective measures of benign prostatic hyperplasia. There is also no evidence that saw palmetto maintains prostate health or prevents development of urinary symptoms or prostate cancer. Its use should not currently be recommended.

Flomax is the first line treatment for benign prostate enlargement, because it has been proven to decrease the symptoms associated with that condition and has fewer side effects than other effective medication. For men who didn’t want to take prescription medication, I used to suggest saw palmetto. From now on, I won’t.