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The Prostate 37:194 (1998)
Editor-in-Chief Gerald P. Murphy, M.D., asked me
to write an editorial comment on the appropriateness
of The Prostate publishing a trial comparing Permixon威
to finasteride without a placebo control group [1]. The
article was accompanied by an editorial by L.J. Denis,
M.D., explaining some of the problems of publishing
articles on plant extracts and outlining the recommended standards of drug studies for benign prostatic
hyperplasia (BPH) patients [2]. Dr. Murphy’s request
for me to write a comment came about after many
criticisms about publishing the study were raised in
the general session of the Fourth International Consultation on BPH held in Paris, July 3–5, 1997. I had
also heard criticisms in a small working group that I
participated in from someone who had reviewed and
recommended rejection of the paper from a different
journal. The publication of this paper on the use of
plant extracts for BPH has obviously generated a lot of
strong feelings. I am pleased to comment on the appropriateness of the publication. I must disclose that at
this same Paris meeting, I attended a meeting of consultants for the Pierre Fabre Medicament and received
a modest honorarium.
It is the obligation of medical journals to share
knowledge with the scientific community. A scientific
journal’s function is to publish high-quality and scientifically sound papers. There is also an obligation
not to publish bad science. An original article should
make a contribution with new information. The scientific method should be sound and the manuscript be
written according to acceptable styles and formats in
good English. Editors of journals cannot let personal
prejudices interfere with a fair review and an evenhanded judgmental process.
There is no question that the Permixon威 study
would have been better with the inclusion of a placebo
control arm. It is well-known that 20–30% of BPH pa-
© 1998 Wiley-Liss, Inc.
tients will have some improvement in symptoms and
flow rates on placebo therapy. The paper submitted to
The Prostate did not have a placebo control but did
compare Permixon威 in a blinded fashion with finasteride. Dr. Murphy sent the article out to nine reviewers
because of the possible controversial nature of the material. Two reviewers gave a political opinion, and
seven reviewers scientifically reviewed the paper and
recommended acceptance after revisions. I have reread the article and Dr. Louis Denis’ comments. The
article is well-written and the results are not overinterpreted. Dr. Denis’ comments are appropriate and
clearly address the lack of a placebo control arm.
In my opinion, manuscripts on herbal (phytotherapy) should not be rejected out of hand. This form
of therapy deserves scientific evaluation like any other
medical therapy. Whether this paper without a placebo control would have a high enough priority rating
to publish is an editorial decision. The process was fair
and I would wholeheartedly back the Editor in his
Jay Y. Gillenwater
Hovey S. Dabney Professor of Urology
University of Virginia Health Sciences Center
Charlottesville, Virginia
1. Carraro J-C, Raynaud J-P, Koch G, Chisholm GD, Di Silverio F,
Teillac P, Calais Da Silva F, Cauquil J, Chopin DK, Hamdy FC,
Hanus M, Hauri D, Kalinteris A, Marencak J, Perier A, Perrin P:
Comparison of phytotherapy (Permixon威) with finasteride in
the treatment of benign prostate hyperplasia: A randomized
international study of 1,098 patients. Prostate 1996;29:231–240.
2. Denis LJ: Editorial review of ‘‘Comparison of Phytotherapy
(Permixon威) With Finasteride in the Treatment of Benign Prostate Hyperplasia: A Randomized International Study of 1,098
Patients.’’ Prostate 1996;29:241–242.
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