29 replies to this topic

[opales]

http://msnbc.msn.com/id/15387493/

Ignoring the failures of alternative medicine
The U.S. spends millions testing popular supplements. It's a futile effort.

COMMENTARY
By Robert Bazell
Chief science and health correspondent
NBC News
Updated: 8:54 a.m. ET Oct. 25, 2006

Call it swimming against the tide of alternative medicine. It is a futile effort costing taxpayers tens of millions of dollars a year.

Last week’s study showing that the widely touted and sold supplement DHEA does nothing to slow the effects of aging was only the latest major piece of research with powerfully negative results from the National Institutes of Health Center for Complimentary and Alternative Medicine. Previous placebo-controlled trials proved the uselessness of St. John’s Wort for depression and saw palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis.

But it doesn’t matter much — few seem to care.

The NIH launched its office of Complementary and Alternative Medicine (CAM) in 1991 in response to the public’s huge interest in finding ways around mainstream medicine. At first, those heading the effort brought dubious credentials. Much of the research ranged from mediocre (meaningless animal studies) to laughable (passing magnets over sore knees).

But, in 1999, with the name changed to the National Center for CAM, Dr. Stephen E. Straus took over. Straus, who spent much of his career at the National Institute on Allergy and Infectious Diseases, enjoys a reputation as an accomplished scientist. In his time as director, the Center for CAM has spent much of its $122 million annual budget on clinical trials putting most popular alternative treatments to the same rigorous tests as those required of pharmaceuticals and medical devices before approval by the Food and Drug Administration.

Except for acupuncture, already proven effective in China, almost all the research has come to the same conclusion: the stuff doesn’t work.

The powerful industry that sells these products ignores the results and often finds allies who believe in them because of an anecdote or advertisement.

After the chondroitin results appeared, Jane Brody, the longtime health columnist for the New York Times who has always prided herself in offering advice based on scientific research, wrote that she would continue taking chondroitin for her knee pain because “it transformed my 11-year-old spaniel from an arthritic wreck into a companion with puppylike agility, giving him nearly six more active years."

CAM means many things — often just the search for care beyond the 12-minute visit to a harried physician. Some treatments under the alternative medicine heading, like massage, clearly do no harm and could make anyone feel better. CAM can offer a vehicle for a sick person simply to spend time with someone attentive to their symptoms.

As long as it doesn't kill anyone So-called “dietary supplements,” such as DHEA, saw palmetto and chondroitin, present the biggest problem.

Marketers often sell them under the guise of a mom-and-pop alternative to big pharma. Yet the $29 billion-a-year dietary supplement industry wields such power that it got Congress to pass a law in 1994 that basically frees it to peddle almost anything that doesn’t kill people with claims of medical benefit that need not be proven.

No doubt some of the thousands of products sold as dietary supplements work well, but the industry that sells them has neither motivation nor desire to know which ones work and which don’t.

Neither do many of those who advocate their use, such as the guru of alternative medicine Dr. Andrew Weil.

On his Web site someone recently inquired if a supplement called NT was useful for fatigue. “I'm not convinced by the scant literature on the subject that there's anything to recommend taking NT Factor for fatigue,” Dr. Weil replied, in a surprisingly forthright response.

But, then he added that the fatigue sufferer might want to try “Siberian ginseng (Eleutherococcus senticosus), coenzyme Q10, the Ayurvedic herb ashwaganda or cordyceps, a traditional Chinese medicinal mushroom that may help fight fatigue and boost energy levels.” 

I can find no evidence that any of these relieve fatigue any better than NT.

It gets better.

Dr. Weill concluded his answer by advising that a better-studied treatment might be something called Juvenon. At the bottom of the Web page appeared an ad from the manufacturer of Juvenon with the quote “I take Juvenon every day — Dr. Andrew Weil.”

Such crass commercialism would put most big drug companies to shame.

Dr. Weill has claimed he approaches medicine with a new way of thinking. But, in the end, no matter what the hype, either something is effective or it isn’t. If no one really cares, maybe we should stop spending millions to find the answer.
© 2006 MSNBC Interactive

[biknut]

opales, This statement is the most important.

"No doubt some of the thousands of products sold as dietary supplements work well, but the industry that sells them has neither motivation nor desire to know which ones work and which don’t."

So what?

The industry may or may not know, but a lot of times the people that try supplements can tell which ones work for them. Not always, I know.

My doctor has prescribed medicine for my high blood pressure that hasn't worked too. Some things work for some and not for others.

[opales]

Subjective impressions are a poor guide when evaluating the efficacy of almost any drug/supplement, that's the whole idea of double blind studies. The effect would have to be quite drastic and preferably objectively quantified (such as blood pressure) for that approach to be viable. Safety is almost by definition impossible to evaluate subjectively, because that includes long term effects. Only acute extreme UNSAFETY can be detected subjectively rather easily, although it might be too late then.

Note that blood pressure medications HAVE been proven to work on average quite effectively, the amount of evidence is from another planet compared to any supplement. Because indeed everyone does not respond uniformly, I think commonly accepted strategy with blood pressure meds is to start with the least abrasive one (to minimize side effects, fully knowing they might not help everyone enough) and proceed from there on until some target blood pressure range is achieved.

[health_nutty]

This is unfortunately true. You have to shift through 99% of supplements and do your own research to get the 1% that does anything.

[opales]

Marketers often sell them under the guise of a mom-and-pop alternative to big pharma. Yet the $29 billion-a-year dietary supplement industry wields such power that it got Congress to pass a law in 1994 that basically frees it to peddle almost anything that doesn’t kill people with claims of medical benefit that need not be proven.

This sentence was IMO the most important one.

The "Big Pharma" is often potrayed as the evil money hoarding instance in the alternative health rhetoretic, ignoring the fact that the alternative industry itself is quite large (29 billion /year). The largest difference is that pharma companies play mostly by the rules (I am not saying they are not perfect though), produce the required convincing evidence (with cost ca. billion dollars/approved drug), unlike the supplement vendors which just generally appeal to laymen's wishful thinking and naturalistic biases, and inability to evaluate evidence. In addition to inflated claims and distorted presenting of evidence, supplement companies often do not even provide what the label claims.

[ajnast4r]

oh sweet jesus... yes, there is alot of BS out there for sure. but to write off ALL 'alternative' medicine based on what in reality is a very few, very pooly designed trials.... is just rediculous

most commonly overlooked factors that lead to failures of "alternative" trials:

chirality (cis- beta cartone as opposed to trans beta carotene)
nutrient forms (magnesium glycinate as opposed to magnesium oxide)
purity
complementing factors (b complex as opposed to single b vitamnin, full spectrum of catechins as opposed to isolated egcg)
proper methods of ingestion (zinc not being taken with binding minerals, herbs being taken on an empty stomach)



its your standard centrum vs. ortho-core argument... things that are RARELY if ever taken into that have huge influence on the effectiveness of the supplements. its amazing a small internet forum has this figure out, yet all the scientists doing the trials dont...

[DukeNukem]

Gosh, I'm tossing out all my supplements now. All that positive research I guess pulled the wool over my eyes. Where's my Crestor?

Edited by dukenukem, 14 November 2006 - 04:12 AM.

[biknut]

I'm sure a lot of supplements are crap. I've tried many that I didn't think worked as advertised or even did anything at all. I quit taking them. Sometimes though, I discover by accident that a supplement has beneficial effects that I like.

A good example is Indiumease. I tried it because of claims of many different benefits. What I found was that none of them seemed to be true. At least if any were I couldn't tell, but what I did find out by accident was that It cured my miserable heartburn. That was not a mentioned benefit. I don't need a double blind study to tell me my pain is gone.

My doctor tells me to supplement potassium, because he believes the diuretic he has me on depletes it. Potassium is a supplement.

I like the idea that supplements are freely sold over the counter for me to try, and or reject as I please. I don't mind a little oversight to keep dangerous products off the market, but lets not get too carried away.

[doug123]

Geez, Olli; you are really giving me an opportunity here:

Ignoring the failures of alternative medicine
The U.S. spends millions testing popular supplements. It's a futile effort.

COMMENTARY
By Robert Bazell
Chief science and health correspondent
NBC News
Updated: 8:54 a.m. ET Oct. 25, 2006

Call it swimming against the tide of alternative medicine. It is a futile effort costing taxpayers tens of millions of dollars a year.

Last week’s study showing that the widely touted and sold supplement DHEA does nothing to slow the effects of aging was only the latest major piece of research with powerfully negative results from the National Institutes of Health Center for Complimentary and Alternative Medicine.

Although this sentence may be somewhat technically correct, it still leads up to a silly conclusion.

As I tried to illustrate in this topic, an obvious critical missing element was a true doctor/patient relationship where these hormone levels were optimized for individual patients. In my opinion (I'm not a Doctor, but I know quite a few good ones), it is sort of wreckless to administer random doses of hormones to patients that are 60 years of age or older. This study, as I pointed out here, patients were not permitted to take DHEA and testosterone at the same time. This might have caused some problems (in particular for the men) and might explain why the results weren't significant. Also: there is the question of dosage. This study arbitrarily chose doses and did not attempt to assess individual values, response, etc. Doses used in this study were: DHEA tablet (75 mg per day) and transdermal testosterone patch (5 mg per day; D-TRANS, Alza) and WERE -- again -- NOT customized to suit each individual, as is the usual clinically accepted practice for treating individuals for hormone deficiency. This study was, in a way, begging disaster as well because the subjects -- at minimum age of 60 y.o. -- are highly unlikely to have any real benefits -- because once one is 60 y.o. hormone levels have been on decline for as long as 30 years for many patients and by this time much of the damage associated with aging has already been done -- in many patients.

Once again, I got into that here.

To be 100% honest, the efficacy of "St. John’s Wort for depression palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis" stuff isn't at all surprising; and I don't know of many MDs who would prescribe or recommend these as medicines for their patients...

However, if one is looking for evidence from highly reputable, peer-reviewed journals, there have been quite a few new reports of supplements that can play a big role in getting a lifespan beyond 90.

Learn about these in the topic: Best Anti-aging value, Which supps are the best?

[maestro949]

The article is fair IMO. It highlights the fact that there is little scientific evidence for a vast majority of alternatives. This doesn't mean that some percentage of them do not have benefits but until either one of the following happen, the data will remain inconclusive on most:

1. Biomarkers that indicate the direction of long-term affects can effectively be predicted and alternative supplements can be tested against these.

or

2. Several generations pass and statistical trends can be gathered on populations of people who take and don't take various supplements/herbal remedies.

#2 is pointless for us but I certainly think we'll see much more accurate and affordable tests for biomarkers that indicate specific health parameters. People will eventually be able to apply their own personalized regimens not unlike some of here who already spend $thousands doping on nuetriceuticals and having blood panels to check the results. This will evolve into a more common practice as it becomes more affordable.

In the meantime we can simply pick over the science that is done and take our chances based on some level of study, sharing of notes and intuition... or not.

Edited by maestro949, 23 March 2007 - 07:33 AM.

[scottl]

Thank you Opales you've saved us wasting all our money.

[aikikai]

Why does some scientific stuides prove that some things works, and other scientific studies shows it doesn't work?

[doug123]

To be 100% honest, the efficacy of "St. John’s Wort for depression palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis" stuff isn't at all surprising; and I don't know of many MDs who would prescribe or recommend these as medicines for their patients...

According to research I've been exposed to for the first time, there does indeed seem to be an effective form(s) of glucosamine.

Indeed, if one can afford the best, the crystalline glucosamine sulphate seems to definitely be the best way to go. It is manufactured as a drug and not a supplement in Ireland so purity concerns are null; and the Dona product is now available without a prescription in the US...it's not too cheap...

I'm unclear of whether or not the real issue is making sure you get crystalline glucosamine suphate or if glucosamine sulphate works as well -- but I'm sure that both glucosamine hydrochloride and N-acetyl glucosamine seem to have a lot more sketchiness about their effectiveness.

It appears that the crystalline glucosamine sulphate form has the most research behind it and although it's expensive, there's peer reviewed literature from the Lancet and the Archives of Internal medicine to support it. However, caveat: in glucosamine trials -- oddly -- there seems to be about a 60% placebo response. This has inadvertendly given the FDA (I guess) a reason not to allow a health claim due to the fact that the trials that are used as support seem to have only marginally better response -- like about 70-75% I think...so although 75%>60%, I guess sometimes there is a question of statistical significance.

If any information here is inaccurate, I will do my best to edit it in wiki style; feel free to correct me; I'm not a doctor myself.

Take care. I feel like Art Bell talking about glucosamine now...LOL.

Edited by nootropikamil, 17 April 2007 - 09:37 PM.

[doug123]

To be 100% honest, the efficacy of "St. John’s Wort for depression palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis" stuff isn't at all surprising; and I don't know of many MDs who would prescribe or recommend these as medicines for their patients...

I also know of evidence to support:

1. St. John’s Wort for depression
2. Palmetto for enlarged prostates

...however, it is mostly copyrighted information by licensed health care practitioners -- mostly Medical Doctors -- from their slides at a CME conference -- so posting their work here might not make them too happy.

If you take a lot of supplements, there's a lot to know about interactions and such.

They're saying the "New" Medicine is integrative medicine -- should you choose to take 50+ supplements, from what I know now, you should probably be working with a professional to make sure you don't get any bad side effects, &c.

Click here to learn more about integrative medicine.

Take care.

[doug123]

From Dr. Sanford Levy's educational site:

Glucosamine (also see ‘chondroitin’ immediately below in this outline)

·  Glucosamine, an amino sugar, is a combination of glucose and glutamine,

·  Mechanism of action (presumed) - rebuilds damaged cartilage, by stimulating the synthesis and inhibiting the degradation of proteoglycans.

·  Chemical forms of glucosamine

o Glucosamine sulfate – most clinical studies have been done with this form.

o  Glucosamine hydrochloride - Dr. Theodosakis, author of The Arthritis Cure states that glucosamine hydrochloride is also effective.

o  N-acetyl glucosamine hydrochloride – Michael Murray, ND states that this form is not absorbed.

· Dose - the usual dose of glucosamine is 1500 mg daily of glucosamine sulfate or glucosamine hydrochloride. Most recent data suggests that once daily dosing is superior to twice or three times a day dosing.

· Safety

oOverall safety - a Cochrane review of 20 RCTs in 2570 patients found the safety profile of glucosamine equivalent to that of placebo (Cochrane Database Syst Rev. 2005. CD002946).

o Diabetes – a 90 day RCT using glucosamine 1500 mg and chondroitin 1200 mg daily (Cosamin DS manufactured by Nutramax Laboratories) found no significant changes in HbA1c levels, leading to the conclusion that oral glucosamine does not result in clinically significant alterations in glucose metabolism in type II diabetics (Arch Intern Med. 2003. 163. 1587-1590).

oShellfish allergy – this is considered a relative contra-indication to glucosamine; however clinical experience is that most individuals with shellfish allergy do not have problems tolerating glucosamine. Reganasure is a brand name glucosamine product manufactured from corn instead of shellfish.

· Adverse effects (uncommon) - include sleepiness, intestinal gas, and stomach upset.

· Efficacy

o Symptom relief

§ A meta-analysis of 15 randomized, controlled trials of glucosamine sulfate (5 trials), glucosamine hydrochloride (1 trial) and chondroitin sulfate (9 trials) in the treatment of knee osteoarthritis concluded that these compounds offer significant benefit.  Limitations of the trials analyzed include relatively small sample size (17 - 329 patients), relatively short duration (generally 4-12 weeks), relatively low quality scores (12.3% - 55.4%), and manufacturer support for 14 of the 15 trials (JAMA. 2000. 283. 1469-1475).

§ A 3 year study in 212 Belgian subjects with osteoarthritis of the knee who received 1500 mg daily of glucosamine sulfate (Rotta Pharmaceuticals preparation) showed an average 11.7% reduction in WOMAC score in the treatment group compared with an average 9.8% worsening in the WOMAC score in the placebo group, statistically significant (Lancet. 2001. 357. 251-256).

§ A 3 year study in 202 Czech subjects with osteoarthritis of the knee who received 1500 mg daily of glucosamine sulfate (Rotta Pharmaceuticals preparation) showed a mean reduction of 26% in WOMAC scores, compared to a mean reduction of 16% in WOMAC scores in the placebo group, statistically significant (Arch Intern Med. 2002. 162. 2113-2123).

§ A Cochrane analysis of 20 RCTs in 2570 subjects found that (1) glucosamine outperformed placebo with a 28% improvement in pain and a 21% improvement in function using the Lequesne Index, but did not outperform  placebo when WOMAC scales for pain, function, and stiffness were used (2) RCTs with the Rotta brand (10 of the 20 trials) when analyzed separately showed greater benefit than RCTs in aggregate using other brands, and (3) in a separate subanalysis of the 8 studies with the highest-quality design, there was not evidence of improvement in pain or function (Cochrane Database Syst Rev. 2005. 2:CD002946).

o Disease progression – NOTE that determination of radiographic progression by X ray, as done in these studies, is imprecise, as the positioning of the patient as well as the positioning of the X ray beam can have substantial effects on the appearance of the joint space (Arthritis Rheum. 2001. 44. 1786-1794; Arthritis Rheum. 2002. 46. 1223-1227).

§A 3 year study in 212 patients with osteoarthritis of the knee (see details just above) showed less radiographic progression (Lancet. 2001. 357. 251-256).

§ Another 3 year RCT in 202 patients with mild to moderate osteoarthritis of the knee (see details just above) showed less radiographic progression (Arch Intern Med. 2002. 162. 2113-2123).

o  GAIT Trial – two part study. Six month trial examining differences in pain and function in 1583 patients suffering from osteoarthritis of the knee, and an ongoing 2 year trial in half the initial population evaluating for structure-modifying properties of glucosamine and chondroitin (N Engl J Med. 2006. 354. 795-808).

§  The arms of the 6 month trial included glucosamine HCL 500 mg three times a day (manufactured by Ferro-Pfanisteihl in Germany), chondroitin sulfate 400 mg tid (manufactured by Bioberica in Spain), glucosamine HCL 500 mg three times a day plus chondroitin sulfate 400 mg three times a day, celecoxib (Celebrex) 200 mg daily, and placebo.

§ Subjects (mean age of 59) were stratified at baseline based on symptom severity.

§ Acetominophen (Tylenol) 500 mg in doses up to 4 grams/24 hours was available to all groups as rescue medicine for pain.

§ The primary outcome measure was a 20% reduction in WOMAC score between baseline and week 24 – the only group in which the primary outcome measure was statistically different from placebo was the celecoxib group (70.1% versus 60.1% in the placebo arm). The response rate was 64% in the glucosamine arm, 65.4% in the chondroitin arm, and 66.6% in the glucosamine plus chondroitin arm, all statistically comparable to placebo.

§  HOWEVER, in the 348 patients with high WOMAC scores at baseline, the response to glucosamine plus chondroitin was statistically better than placebo whereas the response to celecoxib did not differ from placebo. In this subgroup, patients on average used 650 mg less acetaminophen per patient per day.

§  NOTE the placebo response rate was 60%, very high – possible explanations for this include (1) subjects knew they had an 80% chance of receiving active treatment, (2) each subject took 7 capsules per day, and (3) research staff called all patients frequently to help maintain adherence to the medication regimen.

§  Critique of the GAIT trial (editorial pp 858-860 and separate article by Dr. Theodosakis)

o  Permitted enrollment of patients who had previously taken glucosamine and chondroitin, and we don’t know how long the washout period is for these substances.

o  Enrolled only patients with primary osteoarthritis, and anecdotally patients with secondary osteoarthritis may respond better to glucosamine and chondroitin.

o  Most patients had relatively mild pain at the onset of the trial.

o  Attrition rate of at least 20% in placebo arm and dietary supplement arms.

o  Pharmacokinetics data available subsequent to the initiation of this trial suggests that once daily dosing is preferable to three times a day dosing.

o  Standard celecoxib capsules were used with a fitted outer capsule – if individuals opened the outer capsule this would compromise the blinding.

o  The 2 year extension examining structure modifying properties is highly likely to be negative, as the natural progression of joint space narrowing is about 0.1 mm per year, and the design of this study is such that a difference of greater than 0.2 mm per year is required for the difference to reach statistical significance.

Chondroitin

·  Chondroitin is a glycosaminoglycan which, like glucosamine, is an important constituent of normal cartilage.

·  Mechanism of action (presumed) - inhibits cartilage degradation.

·  Dose - the usual dose of chondroitin is 400 mg 3 times a day of chondroitin sulfate.

·  Absorption

o  Chondroitin sulfate molecules are 50-300 times larger than glucosamine sulfate molecules, and absorption is estimated at 0-13%, compared with 90-98% for glucosamine sulfate (Rheumatol Int. 1992. 12. 81-88).

o  Chondroitin contains a mixture of glycosaminoglycans with molecular weights ranging from 14,000 to 30,000 Daltons; a marine-sourced low molecular weight (<16,000 Dalton) product may be more efficiently absorbed.

o Dr. Theodosakis, author of The Arthritis Cure states that chondroitin molecules are known to be absorbed in fragments.

· Adverse effects (uncommon) - include indigestion, nausea, headache, rash, and hives.

· Efficacy

o The meta-analysis described above for glucosamine (JAMA. 2000. 283. 1469-1475) included 9 RCTs in which chondroitin sulfate was used. In aggregate these studies showed that chondroitin was more efficacious than placebo. Note though that when the magnitude of efficacy of chondroitin was examined as a function of individual trial quality, the efficacy was less dramatic in the higher-quality studies

o A meta-analysis of  7 RCT's, all conducted in Europe, including a total of 703 patients with osteoarthritis of the hip or knee, mostly 3-6 months in duration, showed a drop in pain scores by about 20% with placebo and about 60% with chondroitin sulfate, a statistically significant difference. Global assessments by physicians and patients also consistently favored chondroitin over placebo (J Rheumatol. 2000. 27. 205-211).

o However, in a 2 year RCT with 300 participants, chondroitin sulfate 800 mg daily had no effect on pain, using an intention to treat analysis.  Only 73% of participants completed the two year study (Arthritis Rheum. 2005. 52. 779-786).

oThe GAIT trial (see above for glucosamine) also included a chondroitin arm, and in this trial chondroitin was not more effective than placebo.

·  Disease progression

o  An abstract of a 3 year RCT in 119 subjects with osteoarthritis of the hand treated with 1200 mg daily of chondroitin sulfate found fewer erosions in the treatment group (Osteoarthritis Cartilage. 1998. 6 [Supppl A]. 37-38). The full results of this trial have not been published.

o However, in a smaller 2 year RCT in 24 subjects with erosive osteoarthritis of the hand, both the placebo and treatment group showed worsening with regard to erosions (Drugs Exp Clin Res. 2004. 30. 11-16).

o The same 2 year RCT (see details just above) which failed to show benefit with regard to pain did show a slowing of radiographic progression of knee osteoarthritis (Arthritis Rheum. 2005. 52. 779-786).

[ageless]

With the experience and knowledge to back it up, I wholeheartedly agree with these statements.

oh sweet jesus... yes, there is alot of BS out there for sure. but to write off ALL 'alternative' medicine based on what in reality is a very few, very pooly designed trials.... is just rediculous

most commonly overlooked factors that lead to failures of "alternative" trials:

chirality (cis- beta cartone as opposed to trans beta carotene)
nutrient forms (magnesium glycinate as opposed to magnesium oxide)
purity
complementing factors (b complex as opposed to single b vitamnin, full spectrum of catechins as opposed to isolated egcg)
proper methods of ingestion (zinc not being taken with binding minerals, herbs being taken on an empty stomach)



its your standard centrum vs. ortho-core argument... things that are RARELY if ever taken into that have huge influence on the effectiveness of the supplements. its amazing a small internet forum has this figure out, yet all the scientists doing the trials dont...

EXACTLY!! This is the concept that many, many, some surprisingly well-educated people, fail to comprehend and it irks the bejesus out of me.

Who is doing some of these obviously flawed studies??? Studies that were designed to fail from the beginning, studies that had millions of governement sponsored funds wasted on inferior doses, inferior standardization (if any), inferior ingredient forms, inferior length, inferior methods, inferior synergy or lack of... simply INFERIOR!

To the average Joe reading the newspaper headline stating St. John's Wort ineffective, etc... that is all he believes even though I could read into the study further and see the obvious flaws to these studies.

How many people actually know what Hyperforin is and how important it is to the antidepressant effect... really though, it's absolutely crucial that its presence be identified and measured before a study could ever fairly state if St. John's Wort is effective of not.
http://en.wikipedia....wiki/Hyperforin

I can only say that for those who dare to take on the committments of time, money and self-education, the rewards of a properly designed supplementation protocol, coinciding with an equally impressive diet, are priceless.

If you haven't reaped the rewards you aren't doing it right and if you're putting your faith in the various pharmaceutical sponsored media giants, you are lost and out of touch with the truth. I'm sorry for some people... yet so many people... too many.

[doug123]

http://msnbc.msn.com/id/15387493/

Ignoring the failures of alternative medicine
The U.S. spends millions testing popular supplements. It's a futile effort.

COMMENTARY
By Robert Bazell
Chief science and health correspondent
NBC News
Updated: 8:54 a.m. ET Oct. 25, 2006

Call it swimming against the tide of alternative medicine. It is a futile effort costing taxpayers tens of millions of dollars a year.

Last week’s study showing that the widely touted and sold supplement DHEA does nothing to slow the effects of aging was only the latest major piece of research with powerfully negative results from the National Institutes of Health Center for Complimentary and Alternative Medicine. Previous placebo-controlled trials proved the uselessness of St. John’s Wort for depression and saw palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis.

But it doesn’t matter much — few seem to care.

The NIH launched its office of Complementary and Alternative Medicine (CAM) in 1991 in response to the public’s huge interest in finding ways around mainstream medicine. At first, those heading the effort brought dubious credentials. Much of the research ranged from mediocre (meaningless animal studies) to laughable (passing magnets over sore knees).

But, in 1999, with the name changed to the National Center for CAM, Dr. Stephen E. Straus took over. Straus, who spent much of his career at the National Institute on Allergy and Infectious Diseases, enjoys a reputation as an accomplished scientist. In his time as director, the Center for CAM has spent much of its $122 million annual budget on clinical trials putting most popular alternative treatments to the same rigorous tests as those required of pharmaceuticals and medical devices before approval by the Food and Drug Administration.

Except for acupuncture, already proven effective in China, almost all the research has come to the same conclusion: the stuff doesn’t work.

The powerful industry that sells these products ignores the results and often finds allies who believe in them because of an anecdote or advertisement.

After the chondroitin results appeared, Jane Brody, the longtime health columnist for the New York Times who has always prided herself in offering advice based on scientific research, wrote that she would continue taking chondroitin for her knee pain because “it transformed my 11-year-old spaniel from an arthritic wreck into a companion with puppylike agility, giving him nearly six more active years."

CAM means many things — often just the search for care beyond the 12-minute visit to a harried physician. Some treatments under the alternative medicine heading, like massage, clearly do no harm and could make anyone feel better. CAM can offer a vehicle for a sick person simply to spend time with someone attentive to their symptoms.

As long as it doesn't kill anyone So-called “dietary supplements,” such as DHEA, saw palmetto and chondroitin, present the biggest problem.

Marketers often sell them under the guise of a mom-and-pop alternative to big pharma. Yet the $29 billion-a-year dietary supplement industry wields such power that it got Congress to pass a law in 1994 that basically frees it to peddle almost anything that doesn’t kill people with claims of medical benefit that need not be proven.

No doubt some of the thousands of products sold as dietary supplements work well, but the industry that sells them has neither motivation nor desire to know which ones work and which don’t.

Neither do many of those who advocate their use, such as the guru of alternative medicine Dr. Andrew Weil.

On his Web site someone recently inquired if a supplement called NT was useful for fatigue. “I'm not convinced by the scant literature on the subject that there's anything to recommend taking NT Factor for fatigue,” Dr. Weil replied, in a surprisingly forthright response.

But, then he added that the fatigue sufferer might want to try “Siberian ginseng (Eleutherococcus senticosus), coenzyme Q10, the Ayurvedic herb ashwaganda or cordyceps, a traditional Chinese medicinal mushroom that may help fight fatigue and boost energy levels.” 

I can find no evidence that any of these relieve fatigue any better than NT.

It gets better.

Dr. Weill concluded his answer by advising that a better-studied treatment might be something called Juvenon. At the bottom of the Web page appeared an ad from the manufacturer of Juvenon with the quote “I take Juvenon every day — Dr. Andrew Weil.”

Such crass commercialism would put most big drug companies to shame.

Dr. Weill has claimed he approaches medicine with a new way of thinking. But, in the end, no matter what the hype, either something is effective or it isn’t. If no one really cares, maybe we should stop spending millions to find the answer.
© 2006 MSNBC Interactive

A similar attack?

BBC News: Source




There are over 60 complementary medicine courses taught in universities

COMPLEMENTARY MEDICINE
o The term complementary - or alternative - medicine covers therapies such as homeopathy, acupuncture or reflexology

o For a medicine to be used in conventional medicine, it must go through scientific trials where its effectiveness has to be proven

o But these techniques often fail to show how complementary medicine works

o Advocates say new research is beginning to prove the case, but many medics, including the British Medical Association, believe there should be tougher regulation of the practice

Alternative therapy degree attack

UK universities are teaching "gobbledygook" following the explosion in science degrees in complementary medicine, a leading expert says.

There are now 61 complementary medicine courses of which 45 are science degrees, the Nature journal reported.

University College London Professor David Colquhoun urged watchdogs to act, as complementary medicine was not based on scientific evidence.

But supporters of the approach said the views were a "sweeping generalisation".

Professor Colquhoun, of the university's department of pharmacology, cited the example of homeopathy.

He said it had barely changed since the start of the 19th Century and was "more like religion than science".

He also pointed out that some supporters of nutritional therapy have been known to claim that changes in diet can cure Aids.

He said the teaching of complementary medicine under a science banner was worse than "Mickey Mouse" degrees in golf management and baking that have sprung up in recent years as "they do what it says on the label".

"That is quite different from awarding BSc degrees in subjects that are not science at all, but are positively anti-science.

"Yet this sort of gobbledygook is being taught in some UK universities as though it were science."

He suggested it would be better if courses in aromatherapy, acupuncture, herbal medicine, reflexology, naturopathy and traditional Chinese medicine were taught as part of a cultural history or sociological course.

Degrees

And Prof Colquhoun said the Quality Assurance Agency for Higher Education (QAA) should be taking action to stop these courses being classed as science degrees.

The watchdog is in charge of ensuring the standards of degrees on offer; and, while it cannot demand universities change the courses they offer, its reviews can lead to funding being withdrawn.

A spokeswoman for the QAA said there were no serious concerns about degrees being offered.

The Prince's Foundation for Integrated Health, a group set up by Prince Charles to promote complementary therapy, said there was increasing evidence alternative therapies worked and where there was no proof it did not necessarily mean that there would never be.

Foundation chief executive Kim Lavely added: "The enormous demand from the public for complementary treatments means that we need more research into why and how patients are benefiting.

"Scientists should want to explore this rather than make sweeping, absolutist generalisations arising from deeply held prejudice as David Colquhoun does in this article."


Story from BBC NEWS:
http://news.bbc.co.u...lth/6476289.stm

Published: 2007/03/22 00:19:20 GMT

© BBC MMVII

[maxwatt]

What about ALL the failures from FDA approved meds. There have been deaths from Vioxx and birth defects from drugs like DES. There have been plenty of serious failures with FDA approved medications but how many deaths, births defects, suicides or any other problems have actually come about because of these "useless" alternative products? I think alternatives may sometimes be a waste of money for different reasons, but these products do not cause the same kind of damage that some prescription meds have been known to cause.

That is known as the "Tu Quoque" defense, or "you're doing it too".

What I find interesting about the situation is some small and intermediate sized European pharmaceutical companies are getting VERY interested in the US supplement market, and are beginning to do some good research and trials on plant extracts and small molecules. You don't need a patent, you can control the market or process for a botanical and still make money.

[DukeNukem]

Opales:

The "Big Pharma" is often potrayed as the evil money hoarding instance in the alternative health rhetoretic, ignoring the fact that the alternative industry itself is quite large (29 billion /year). The largest difference is that pharma companies play mostly by the rules

Keep in mind that they were strongly influential in the creation of these rules. Also, the economics are entirely different between the drug industry and the supplements industry, simply because drugs can be monopolized via patents, and that allows a single company to spend $100's of millions on marketing. Supplements are a free-for-all, and any price guaging is soon self-corrected by the market. Big Pharma employs price guaging as a legally protected fact of business.

(I am not saying they are not perfect though), produce the required convincing evidence (with cost ca. billion dollars/approved drug), unlike the supplement vendors which just generally appeal to layman's wishful thinking and naturalistic biases, and inability to evaluate evidence. In addition to inflated claims and distorted presenting of evidence, supplement companies often do not even provide what the label claims.

Whereas the supplement companies themselves (with few exceptions, like LEF) cannot afford their own research, too much of Big Pharma's research is manipulated in their favor. There's no question that Big Pharma's drugs are FAR FAR FAR more dangerous (and kill more people) than supplements. I predict on the order of 100,000 to 1. Most of Big Pharma is downright evil, thanks to their deceit of safety and effectiveness (and their constant desire to create new categories of illness/disease, creating even more drug market opportunities).

The supplements industry relies on [1] ancient beliefs in herbs often going back 2000 years (and more and more of these have been to some degree proven by recent research, like turmeric), and [2] non-brand specific research (i.e. cocoa, pomegranate and RSV) mostly conducted within the past 50 or so years. Non-brand specific research appears to grow weekly in favor of supplementation. The only real issue is whether the supplement makers can be relied upon to create quality standardized supplements. So far, several makers have emerged as mostly reliable, IMO, like AOR, New Chapter and LEF.

But, as with Big Pharma's drugs, a person should never take supplements without a significant investment in self-education. Never rely on another person's advice. Especially a doctor.

[narcissistic]

A common idée is that the modern medicine has saved humanity from its suffering I consider that naïve throw all time people have hade knowledge In herbs useful in different diseases. For every modern medicine, with weary few exceptions, there is a natural counterpart; wither its better or worse is probably weary hard to say, and need to be evaluated throw empirical studies (how ever no one would ever finance them, inparticulary not the medical companies how would undermined there one business), how ever more people every year (mostly well educated) do reject scholar medicine in favour for natural herbs and supplements, this might say something abbot the reality.

Herbs are different in the sense that they often consist of many active components creating a synergic effect this bin proven throw studies wear different components in herbs as a hole nun to be effect has fail to provide any effect or has bin significantly worse than the natural herb as a hole. The Chinese takes this principal on step further by combining many herbs where every single component In all the herbs has a synergic effect. This of cores wery complex and to analyse the effect of a herbal blend, and its effect on an organism, consisting of 100 more or less active components are simply impossible from a scientific perspective (how ever the chine’s medicine have philosophically and les exact approach, some thing often made fun of day). Modern siens prefers to take things out of there contexts analysing it than putting it back in its place and then presuming to know any thing abbot it.

This approach reflect it Self in all Medical research wear one active molecule with an as narrow effect as possible is in demand as a consecvens the side effect profile is presumed to be as narrow as possible. Apparently this doesn’t work to well it’s almost ironic that more and more medicines often are prescribed to get rid of the side effects (some one is content thaw). Is it even possible to create effective and side effects free medicines for a complex human being by this Newtonian approach witch is believed to explain the world? Maybe it is an as more will be none abbot the human organism and nervsystem maybe molecules with a extremely précis effect and there by minimum side effects will be created. how ever I doubt it.

I wonder where the medicine holds it future in laboratories or among the 1000 and 1000 of on discover herbs.

[doug123]

Ignoring the failures of alternative medicine
The U.S. spends millions testing popular supplements. It's a futile effort.

COMMENTARY
By Robert Bazell
Chief science and health correspondent
NBC News
Updated: 8:54 a.m. ET Oct. 25, 2006

Call it swimming against the tide of alternative medicine. It is a futile effort costing taxpayers tens of millions of dollars a year.

Last week’s study showing that the widely touted and sold supplement DHEA does nothing to slow the effects of aging was only the latest major piece of research with powerfully negative results from the National Institutes of Health Center for Complimentary and Alternative Medicine.

News published today seems to support the female use of HRT:

Reuters: News Source



Hormone Therapy Safe for Younger Women -Study
Wed Apr 4, 2007 12:02 PM BST

By Julie Steenhuysen

CHICAGO (Reuters) - Younger women may be able to safely take hormone replacement therapy to treat menopause symptoms based on a new analysis of a big U.S. study that had raised alarms about health risks and driven down sales of treatment drugs, according to a report released on Tuesday.

A second look at the highly publicized 2002 study called the Women's Health Initiative, or WHI, suggests that women who begin hormone replacement therapy within 10 years of menopause may have less risk of heart attack than women who start hormone therapy later.

The results are "somewhat reassuring," said Dr. Jacques Rossouw, lead author of the study, which appears in this week's Journal of the American Medical Association.

Rossouw, in a telephone interview, said hormone replacement therapy, known as HRT, still increases the risk of breast cancer and stroke in younger women but the absolute risk for that age group is low.

"Check your blood pressure and have regular mammograms. If you do those things, HRT is a reasonable option in women with severe menopause symptoms," said Rossouw, who is chief of the Women's Health Initiative branch of the National Heart, Lung and Blood Institute.

The original WHI study was designed to find out whether hormones protected menopausal women from heart attacks, a view that was widely held in the 1990s. Instead, the study found the therapy increased the risk of blood clots, heart attacks and breast cancer.

That led millions of women to abandon HRT, leaving them to face the hot flashes, sleepless nights and other menopause symptoms with few treatment alternatives.

Sales of Wyeth's <WYE.N> Premarin and its other female hormone replacement drug, Prempro, fell sharply after the release of the 2002 study.

Since then, however, the pendulum has been swinging back toward selective use of HRT as studies emerge suggesting the treatment may not be so dangerous for women just entering menopause.

The WHI study involved women with an average age of 63, long past menopause, which typically occurs between the ages of 45 and 55.

The new analysis combined data from two WHI trials of estrogen plus progestin, the 2002 study, and estrogen alone, a 2004 study. They looked at differences in hormone therapy effects in three age categories -- women in their 50s, 60s and 70s -- as well as by distance from menopause.

That analysis suggests that the health consequences of hormone therapy may vary. "It brings the picture into sharper focus," Rossouw said.

The study also revealed that older women on hormone therapy who are at increased risk for heart attack tend to be those who also have hot flashes and night sweats. These women also were more likely to have high blood pressure or high blood cholesterol.

It found a trend toward protecting younger women from heart attack, but that was not statistically significant.

"Most women require hormone therapy for only a few years to alleviate their symptoms and this analysis indicates that hormone therapy is generally safe for healthy women," Dr. Robert Rebar, executive director of the American Society for Reproductive Medicine, said in a statement.

"It's reassuring information for ... newly menopausal women who'd like to take hormone therapy," said Dr. Joseph Camardo, head of medical affairs at Wyeth.

Rossouw said it may be too late for women who abandoned HRT after the 2002 study to resume therapy.

--------------------------------------------------------------------------------

© Reuters 2007. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

To follow up on this, women might want to read the following post in the topic: "Is Professional Medical Care Worthwhile?" There's an excellent article by Denise Grady that was originally published in The New York Times: "Call to Increase M.R.I. Use for Breast Exam." Check it out -- it seems there are higher resolution scans available than the mammogram. However, it seems they aren't cheap!

"Is Professional Medical Care Worthwhile?" is probably worth a look at whether you're female or male (colonoscopy comes up...mmm...your favorite topic [sick]).

This post might help folks learn more about how to avoid (breast) cancer altogether.

Peace, love, and happiness.

Take care.

Edited by nootropikamil, 06 April 2007 - 01:21 AM.

[doug123]

To be 100% honest, the efficacy of "St. John’s Wort for depression palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis" stuff isn't at all surprising; and I don't know of many MDs who would prescribe or recommend these as medicines for their patients...

According to research I've been exposed to for the first time, there does indeed seem to be an effective form(s) of glucosamine.

Indeed, if one can afford the best, the crystalline glucosamine sulphate seems to definitely be the best way to go. It is manufactured as a drug and not a supplement in Ireland so purity concerns are null; and the Dona product is now available without a prescription in the US...it's not too cheap...

I'm unclear of whether or not the real issue is making sure you get crystalline glucosamine suphate or if glucosamine sulphate works as well -- but I'm sure that both glucosamine hydrochloride and N-acetyl glucosamine seem to have a lot more sketchiness about their effectiveness.

It appears that the crystalline glucosamine sulphate form has the most research behind it and although it's expensive, there's peer reviewed literature from the Lancet and the Archives of Internal medicine to support it. However, caveat: in glucosamine trials -- oddly -- there seems to be about a 60% placebo response. This has inadvertendly given the FDA (I guess) a reason not to allow a health claim due to the fact that the trials that are used as support seem to have only marginally better response -- like about 70-75% I think...so although 75%>60%, I guess sometimes there is a question of statistical significance.

If any information here is inaccurate, I will do my best to edit it in wiki style; feel free to correct me; I'm not a doctor myself.

Take care. I feel like Art Bell talking about glucosamine now...LOL.

Check out this report:

UPI: News Source



Chondroitin ineffective for osteoarthritis

BERN, Switzerland, April 17, 2007 (UPI) -- A European meta-analysis found that chondroitin, a dietary supplement used to treat osteoarthritis, is ineffective but not harmful.

Twenty studies that compared chondroitin to placebo or no treatment were examined, and the researchers found that chondroitin had little effect on knee or hip pain caused by arthritis, according to the meta-analysis published in the Annals of Internal Medicine.

Few adverse side effects were reported, and the authors concluded that chondroitin use should "be discouraged."

However, in an accompanying editorial in the same journal it said "chondroitin sulfate should not be considered dangerous. If patients say that they benefit from chondroitin, I see no harm in encouraging them to continue taking it as long as they perceive a benefit."

The authors said the supplement appeared to have some impact for those with low-grade osteoarthritis.

© Copyright 2007 United Press International, Inc. All Rights Reserved.

United Press International, UPI, the UPI logo, and other trademarks and service marks, are registered or unregistered trademarks of United Press International, Inc. in the United States and in other countries.

This recent report is analyzing chondroitin and not glucosamine...

If you take the time to review the literature on the matter, it seems there are indeed effective forms of glucosamine (and not necessarily combination products combining glucosamine and chondroitin) -- at least they appear that way in RCTs (randomized controlled trials).

The form of crystalline glucosamine sulphate seems to be the most safe and effective that I know of; then again, it appears that the glucosamine sulphate form may also be equally effective.

However, any time researchers mix in results from studies using what appear to be effective forms of glucosamine (with or without chondroitin) in what appear to be the somewhat (or more questionable) (or possibly ineffective) forms; namely the glucosamine hydrochloride and/or N-acetyl glucosamine, the results will be inconclusive. Apples are not oranges.

EDITORIAL

Chondroitin for Pain in Osteoarthritis

David T. Felson, MD, MPH

17 April 2007 | Volume 146 Issue 8 | Pages 611-612

David T. Felson, MD, MPH

17 April 2007 | Volume 146 Issue 8 | Pages 611-612


--------------------------------------------------------------------------------
Frequent knee pain affects about 25% of adults (1), at least half of whom have osteoarthritis (2). Persons with knee and other joint pain often take over-the-counter nutritional supplements available in grocery stores, in drug stores, or online for treatment of their joint pain. The most popular supplement is a pill containing a combination of glucosamine and chondroitin. The demand for the chondroitin component of this pill alone constitutes a $1 billion-per-year market in the United States.
The primary pathology of osteoarthritis is loss of hyaline articular cartilage. Chondroitin sulfate, a glycosaminoglycan, is a constituent of a large macromolecule in cartilage called aggrecan. Glycosaminoglycans like chondroitin have a high negative charge. During cartilage compression, the negatively charged glycosaminoglycan molecules are forced into proximity, increasing the electrostatic repulsive force among them. As compression ends, the electrostatic force predominates and they move away from each other, allowing cartilage to reassume its usual thickness. Thus, aggrecan and its constituents—including chondroitin—provide compressive stiffness to cartilage. The concept of ingesting a molecule found in cartilage so that it might be incorporated into cartilage is appealing, but the logic is misleading: Glycosaminoglycans are not synthesized from intact chondroitin molecules; therefore, it is unlikely that ingested chondroitin would be incorporated intact into cartilage.

There are 2 other practical concerns about the potential efficacy of chondroitin sulfate. First, because chondroitin is a large macromolecule, only about 12% to 13% of ingested chondroitin is absorbed intact into the bloodstream (3). Second, while chondroitin therapy supposedly targets cartilage, osteoarthritis affects the whole joint, not just cartilage. Pathologies include bone sclerosis, remodeling and deformity, ligamentous stretching and loss of integrity, muscle atrophy, joint capsular stretching, and even synovial inflammation. A molecule targeted only at constituents of cartilage is unlikely to affect all manifestations of osteoarthritis. Also, any treatment targeting cartilage alone would be unlikely to alleviate pain, the predominant symptom of osteoarthritis, because cartilage is aneural.

Animal studies suggest that chondroitin functions as an anti-inflammatory agent rather than being directly integrated into cartilage (3). If chondroitin does indeed have a modest anti-inflammatory effect, then it could alleviate pain. The link between pain severity and extent of synovitis revealed on a magnetic resonance imaging joint scan (4) and the superiority of nonsteroidal drugs over acetaminophen for alleviating osteoarthritis pain (5) both indicate that inflammation plays a role in causing osteoarthritic pain.

A series of randomized trials has compared chondroitin with placebo for treating pain in (usually knee) osteoarthritis. Until the past 2 or 3 years, such trials suggested that chondroitin was more efficacious than placebo, although actual estimates of efficacy varied widely from study to study. At least 1 trial reported that chondroitin was more effective than total knee replacement (6), a finding that lacks credibility. In a meta-analysis of these trials, McAlindon and colleagues (7) reported that chondroitin was more efficacious than placebo but also noted evidence for publication bias because small, null studies were unpublished. They also raised concerns about the quality of the chondroitin trials, noting that only 1 had an intention-to-treat analysis and most inadequately concealed the sequence of random allocation of patients from the investigators. To resolve uncertainty about the efficacy of both chondroitin and glucosamine, the National Institutes of Health carried out the Glucosamine/chondroitin Arthritis Intervention Trial, a large multicenter study evaluating glucosamine, chondroitin, glucosamine and chondroitin combined, celecoxib, and placebo for treating knee osteoarthritis. The results, published in 2006, showed that glucosamine, chondroitin, and the combination did not have statistically significantly greater efficacy than that of placebo, although celecoxib showed statistically significant efficacy (8).

In performing their meta-analysis published in this issue, Reichenbach and colleagues (9) adopted an interesting strategy for untangling the conflicting trial evidence. They quantified the substantial heterogeneity of the efficacy results in these trials and then identified a subset of large high-quality trials that showed similar estimates of efficacy, thereby hoping to provide convincing evidence on the efficacy of chondroitin. They selected 3 recent large-scale trials, all of which did intention-to-treat analyses and adequately concealed the sequence of random allocation. They noted that chondroitin was ineffective in all 3 trials. In their view, this evidence should convince skeptics and advocates alike. This editorial asks whether this evidence is, in fact, compelling.

Was it reasonable to select 3 recent large-scale trials and not summarize all of the evidence? In meta-analyses, marked discordance or heterogeneity among trial results is common (10) and is often ignored by meta-analysts in generating summarized results (11). Because the recent large studies showed that chondroitin was ineffective and the earlier studies suggested that it was very effective, Reichenbach and colleagues decided that combining such disparate studies and calculating a single measure of efficacy was inappropriate. I believe that, by identifying a subgroup of trials with high-quality, consistent evidence, they have provided a compelling estimate of the likely efficacy of chondroitin. The earlier trials constitute a group with heterogeneous results, mixed quality, and smaller sample sizes, all of which make their results less credible than those of the recent large, well-done studies. Furthermore, because publication bias was evident in the earlier trials (7), an aggregate measure of their results would also probably be biased.

Using meta-regression, Reichenbach and colleagues also explored why heterogeneity was so widespread among the trials. Sometimes such explorations yield insights about particular treatment regimens or types of patients in whom treatments are efficacious—for example, trials that found chondroitin effective could have been using a different preparation from those in trials that reported null findings. Unfortunately, Reichenbach and colleagues did not find an explanation for trial heterogeneity, but trial reports often do not contain enough information to allow the meta-analyst to identify important differences among trials.

Other meta-analyses of treatments have noted reports of impressive efficacy in initial trials that were followed by reports from later, larger, better-done trials that contradicted the earlier findings (12). Possible explanations for this recurring pattern include the selection of patients likely to respond in earlier trials and the tendency for trials of exciting new treatments that report positive results to be published even when other concurrent trials have negative results. Later trials also tend to be larger and more representative of all trial results (12).

Chondroitin, in the United States at least, is almost always sold in a combination pill with glucosamine. The meta-analysis by Reichenbach and colleagues included studies of chondroitin alone, not combined with glucosamine; therefore, the results of their meta-analysis might not apply to the combined product. In addition to the null effects of chondroitin, the Glucosamine/chondroitin Arthritis Intervention Trial (7) also reported that the hydrochloride form of glucosamine (the most popular formulation in the United States) and the combination of glucosamine and chondroitin were no more efficacious than placebo. Thus, for most patients, the combination of glucosamine and chondroitin is not likely to alleviate joint pain.

What should clinicians take away from the study by Reichenbach and colleagues? As the authors suggest, the best current evidence is that chondroitin sulfate does not reduce joint pain in osteoarthritis. However, some patients are convinced that it helps, which could be because of a placebo response or even a therapeutic response resulting from enhanced absorption or limited metabolism of chondroitin. Because no frequent or severe adverse effects have been reported, chondroitin sulfate should not be considered dangerous. If patients say that they benefit from chondroitin, I see no harm in encouraging them to continue taking it as long as they perceive a benefit.

Author and Article Information

From Boston University and Boston Medical Center, Boston, Massachusetts.

Grant Support: Dr. Felson is supported by National Institutes of Health grant AR 47785.

Potential Financial Conflicts of Interest: Grants received: Merck & Co.

Requests for Single Reprints: David T. Felson, MD, MPH, Clinical Epidemiology, A203, Boston University School of Medicine, 80 East Concord Street, Boston, MA 02118; e-mail, jendez@bu.edu.

References 

1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91-7. [PMID: 11156538].[Abstract/Free Full Text]

2. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513-7. [PMID: 10852280].[Medline]

3. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998(6 Suppl A):14-21. [PMID: 9743814].[Medline]

4. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, et al. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol. 2001;28:1330-7. [PMID: 11409127].[Medline]

5. Felson DT. The verdict favors nonsteroidal antiinflammatory drugs for treatment of osteoarthritis and a plea for more evidence on other treatments [Editorial]. Arthritis Rheum. 2001;44:1477-80. [PMID: 11465696].[Medline]

6. Rovetta G. Galactosaminoglycuronoglycan sulfate (matrix) in therapy of tibiofibular osteoarthritis of the knee. Drugs Exp Clin Res. 1991;17:53-7. [PMID: 1914837].[Medline]

7. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283:1469-75. [PMID: 10732937].[Abstract/Free Full Text]

8. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354:795-808. [PMID: 16495392].[Abstract/Free Full Text]

9. Reichenbach S, Sterchi R, Scherer M, Trelle S, Bürgi E, Bürgi U, et al. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007;146:580-90.[Abstract/Free Full Text]

10. Engels EA, Schmid CH, Terrin N, Olkin I, Lau J. Heterogeneity and statistical significance in meta-analysis: an empirical study of 125 meta-analyses. Stat Med. 2000;19:1707-28. [PMID: 10861773].[Medline]

11. Petitti DB. Approaches to heterogeneity in meta-analysis. Stat Med. 2001;20:3625-33. [PMID: 11746342].[Medline]

12. Lau J, Ioannidis JP, Schmid CH. Summing up evidence: one answer is not always enough. Lancet. 1998;351:123-7. [PMID: 9439507].[Medline]


Related articles in Annals:

Reviews
Meta-analysis: Chondroitin for Osteoarthritis of the Knee or Hip
Stephan Reichenbach, Rebekka Sterchi, Martin Scherer, Sven Trelle, Elizabeth Bürgi, Ulrich Bürgi, Paul A. Dieppe, and Peter Jüni

Annals 2007 146: 580-590. (in ) [

So, to treat osteoarthritis, it appears the effective forms of glucosamine is/are the better way to go and not chondroitin sulphate/chondroitin.

Take care.

Edited by nootropikamil, 17 April 2007 - 10:18 PM.

[Mind]

More money going toward the study of alternative and complimentary medicine.

I definitely like to see this. The alternative market has exploded recently and I often profile some of the wilder claims during the snake oil segment on the Sunday Evening Update

“The research has been making steady progress,” said Dr. Josephine P. Briggs, director of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. “It’s reasonably new that rigorous methods are being used to study these health practices.”

The need for rigor can be striking. For instance, a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments — including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.

It turned out that only 40 percent of the studies used randomized controlled trials — the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective. In such trials, scientists randomly assign patients to treatment or control groups with the aim of eliminating bias from clinician and patient decisions.

Sat Bir S. Khalsa, the study’s author and a sleep researcher at the Harvard Medical School, said an added complication was that “the vast majority of these studies have been small,” averaging 30 or fewer subjects per arm of the randomized trial. The smaller the sample size, he warned, the greater the risk of error, including false positives and false negatives.

[Bghead8che]

<<Previous placebo-controlled trials proved the uselessness of St. John’s Wort for depression and saw palmetto for enlarged prostates, shark cartilage for cancer, echinacea for the common cold and glucosamine plus chondroitin sulphate for arthritis.>>

Other than St. John's Wort is this statement untrue? I know I would personally pass on the rest. I'm a big believer in supplements but I do think that 95% of the supplements on the market are a total waste of money. So I do agree in one sense with the article that a lot of people are wasting their money.

If you were to randomly pick 100 supps of a shelf you would find a good portion of them have scant evidence that they really work.

Like one poster said you really have to do your homework.

-Brian

Edited by Bghead8che, 01 October 2008 - 05:21 AM.

[luv2increase]

This article listed like 5 supplements and took them out of context from what they are really used for and tried to apply them on ailments which they are not normally used for...


Take one for instance --> coenzyme q-10 was determined not good for fatigue. The way this is written makes it that coq10 isn't good for anything! It is horrible and extremely deceptive! Coq10 has had 100's of studies which one can find on the NIH website, interestingly enough, which show how great it is for heart disorders in the treatment and in preventative measures. You won't see this listed though.


The others like siberian ginseng, ashwagandha, and rhodiola have 100's of studies listing how beneficial they are in disorders other than fatigue. This is typical. I don't know how many times I have to say it, but Don't listen to mainstream news for anything relevant on alternative medicine!

This article listed like 5 supplements and took them out of context from what they are really used for and tried to apply them on ailments which they are not normally used for...


Take one for instance --> coenzyme q-10 was determined not good for fatigue. The way this is written makes it that coq10 isn't good for anything! It is horrible and extremely deceptive! Coq10 has had 100's of studies which one can find on the NIH website, interestingly enough, which show how great it is for heart disorders in the treatment and in preventative measures. You won't see this listed though.


The others like siberian ginseng, ashwagandha, and rhodiola have 100's of studies listing how beneficial they are in disorders other than fatigue. This is typical. I don't know how many times I have to say it, but Don't listen to mainstream news for anything relevant on alternative medicine!

[Mind]

This is typical. I don't know how many times I have to say it, but Don't listen to mainstream news for anything relevant on alternative medicine!

I just think it is good that there are more randomized controlled studies in the works.

[Mind]

Study Of African Traditional Medicine Will Begin World-first Clinical Trial

Another good move to determine what is effective and what is bunk.

"The American and South African citzens have strong interests in complementary and alternative medicine practices, but little is known of their safety and effectiveness," said Bill Folk, senior associate dean for research in the School of Medicine, principal investigator of the grant and co-director of TICIPS.

Folk and U.S. research teams from MU, University of Missouri-Kansas City (UMKC), Missouri Botanical Garden, University of Texas and Georgetown University will partner with Quinton Johnson, director of the South African Herbal Science and Medicine Institute and co-director of TICIPS at the University of the Western Cape, University of Cape Town, University of Kwazulu-Natal (UKZ-N) in South Africa, and South African traditional healers. Together, they will study the medicinal properties, safety and effectiveness of several African plants in use today by traditional healers. South Africa is home to more than 200,000 traditional healers who care for more than 27 million people.