Those pharmacists are all con-men !

http://en.wikipedia.org/wiki/Osteoarthritis

[edit] Glucosamine
There is still controversy about glucosamine's effectiveness for OA of the knee.[17] A 2005 review concluded that glucosamine may improve symptoms of OA and delay its progression.[18] However, a subsequent large study suggests that glucosamine is not effective in treating OA of the knee[19], and a 2007 meta-analysis that included this trial states that glucosamine hydrochloride is not effective.[20]

waaa really meah ?? i just bought my mom a whole load of those stuff....

Did your mom's condition improved after so many years ?

dunno yet as only started taking them.

1st things first, have you read the references that wikipedia provided?

If you did, then lets go through the references one by one shall we?

The 1st reference (17) refererred to an expert opinion in the controversy of several Randomised Controlled Trials (RCT). The author had gone through several major RCTs and analysed them and put forward the conclusion that although older data support the use of glucosamine, the later trial, esp the one by Messier et al,2006, disputed this fact. However, the trial by Messier et al, 2006, only had a sample size of 89 patients. Hence reducing the reliability of the results. However, this expert review is quite relavant as the author sought through major RCTs and made a judgement. I've briefly gone through the figures of the RCTs pointed out and it seems to me that there are still controversies surrounding the use of glucosamine for OA, but it is still prudent to suggest patients with OA to give glucosamine a try to see if they respond to the medication, provided that there are no contra-indications and drug interactions.

The second reference (18) refers to a meta-analysis of several double-blinded RCTs. The data suggests that glucosamine is indeed beneficial in patients with OA. Now with that said, results from meta-analysis are less reliable from a proper large sample double-blinded RCT as they usually pool data from many smaller trials and analyse the data. Hence, due to the differences in the study design of these trials, the data tend to be unreliable. Also, smaller trials with small sample sizes tend to be biased.

The third reference refers to a study where 205 patients were recruited over the internet and authenticated though a review of their medical records. Apparently they did not have a criteria to which what kind of analgesics should be given to patients, instead they took the analgesics taken by patients into account by stratification. The results show that glucosamine offers no benefit over placebo. However, I reserve my comments on this article as I was not able to access a full version of the journal hence, unable to do a thorough analysis.

The fourth reference (20) references to a research in attempt to understand why do the trial results differ. After the analysis it concluded that this may be attributed to different glucosamine preparations, inadequate allocation concealment, and industry bias. Hence explaining the controversy.

With all that analysed. Let's get back to the pharmacist who advocated glucosamine. Pharmacist and Doctors alike are trained to read and analyse journals and research. They need this skill because there are research whose material is reliable and there are research where data may not be reliable. More than often, drug companies sponsor research papers, and hence there's always a risk of biasness. Therefore as professionals they are specially trained in discerning the data provided so as to provide patients with evidence based solutions/suggestions.

The pharmacist may be ill informed of the current research status of the glucosamine, he also maybe just witholding the wealth of information to which why he suggested glucosamine. I think most patients would be scared off if a pharmacist presented all the research data to a patient coming to look for some drugs to help him with his OA. Therefore I do not believe that pharmacist are con-men, although some might be (there's always black sheep).

With the above-mentioned evidence, I believe that pharmacists are right to recommend glucosamine to OA patients provided that there are no contra-indications and drug interactions as these patients may potentially benefit from this drug. I;m sure many doctors would recommend glucosamine to OA patients as well. Does this make them con-men as well?

I hope TS would do your research properly before making sweeping statements like this anymore. It brings harm and benefits no one.

Unless you have solid proof, they shouldn't have pushed it out into the market and claim they can cure osteo-athritis etc.

As can be seen from the references, the double/triple blind trials have proven they are not effective in recent years.

Nothing in the market is a sure cure in for a certain condition. Many medications is moved to the market when a good amount of trials support its use and the safety profile is acceptable.

And no one claims a cure for OA. Unfortunately its one of those chronic disease that you'll probably have for life.

Glucosamine only help relieve the pain by aiding the replacemnet of the synovial fluid that is lost.

You can have as many double/triple blind trials as you want. But as I said, are the results reliable? Have u actually scrutinised the papers?

Btw, I don't think you have read the references that I pointed out from wiki that there are two trials that have shown glucosamine in effective. Of which one had 84 patients, another 205.

Also, nobody is going to withdraw this medication from the market as many people have benefited from it and one thing that is constant throughout the papers is that the side effect profile is not significant. Hence are the healthcare professionals going to withdraw a potentially beneficial medication with little to no side effects from the markets just because of a couple of trials? Why not let the patient try it out 1st? Maybe the patient will benefit from it.

Edit: Also, glucosamine happens to be listed under supplements, so according to your theory, Vitamin C, Ginko biloba, Valerian, Cranberry juice etc should all be withdrawn from the market?

This post has been edited by Kain_Sicilian: Mar 3 2009, 08:35 AM

http://www.australianprescriber.com/magazine/27/3/61/3/
http://www.mja.com.au/public/issues/175_08...my/bellamy.html
http://www.bmj.com/cgi/content/extract/322/7300/1439?eaf=
http://www.nps.org.au/health_professionals..._osteoarthritis

TS, check the validity of your resources, wikipedia is well known for its inaccuracy among health experts. Despite of the fact that the information provided by wiki has certain truth, but you just dunno who wrote the information on that site, which resources he/she based on the info on, how reliable is the info, whether it is externally/internally valid or not.

http://en.wikipedia.org/wiki/Reliability_of_Wikipedia

According to various journals, the links to few of it are provided above, there are no strong evidences that glucosamine helps osteoarthritis. HOWEVER, at the same time, there is no proof that it will harm the patient as well. The only possible side effect to glucoasmine is allergy to shellfish.

The only real help for OA is glucosamine thus far, and most of the treatments focus on relieving the symptoms (knee pain) (excluding other complementary medicines). I wouldn't make a claim that glucosamine will harm the patient directly. It is just that there is no harm in taking glucosamine. And if it does help one's knee, then good for him/her, which means in other words, it may help some people and it may not.

The only catch in taking glucosamine is it needs to be taken for 4-6 weeks in order to help the knee.

In addition, TS, it is not easy to see the improvement in the symptoms of the knee if the progress is gradual and slowly increase over time.

Let me ask you a question, would you rather see your beloved one in pain rather than giving him/her a possible help which may improve his/her symptoms?



This post has been edited by nimloth32: Mar 3 2009, 08:48 AM

From the summary, isn't it obvious that the small trials conducted earlier were superseded by the larger, more accurate trials later ?

It is just like newton's laws of motions were found not to be accurate by einstein which founded more accurate laws. So latter theories supersede the earlier ones.

If many people have benefitted as you claim, then why do people still do trials ? And how do you know they are under controlled conditions ? Many factors can affect oesto. If you claim many people have improved conditions, then provide proof and details.



This post has been edited by pucman: Mar 3 2009, 08:50 AM

First of all, i did not claim that many ppl benefited, i merely stated that there is no harm in taking the medicine (if i mistype my answer, then i am sorry). Secondly, the purpose of the trials is to provide further evidences to the efficacy of the medicine. You are right in saying that we don't know whether they are under 'controlled conditions'. Hence, the results of the articles in BMJ, MJA, etc which i posted up are peer reviewed by other health experts to check its validity. The validity of those articles is undisputable. I mean, at least it is more reliable than wikipedia. No offence.

This post has been edited by nimloth32: Mar 3 2009, 09:00 AM

Ahh post about Glucosamine. How much does it costs nowadays? I remember seeing it for more than a dollar for 1 tablet years ago. What we can say now about glucosamine is evidence is inconclusive about the effectiveness of the medication. Perhaps more studies about the pharmacodynamics of the medication once ingested by human. As far as I know its readily digested in the gut. So essentially what we getting is sugar and amino acids. Its made from cartilages and is one of the natural organic building blocks of cartilages and bones. How useful is it? I don't know - Many are doing prospective studies about the efficacy of glucosamine and the usefulness is still debateble. What I can say is again, like other supplement out in the market, its harmless - well there is still no evidence of reportable incidence of the harmful effect up till date. The biggest disadvantage is the costs. Try to justify spending more than a dollar a day for a tablet that is not known yet for its usefulness.

Many doctors however, do believe in its usefulness of the medication and frequently prescribe it to patient base on anecdotal evidence. For people who can afford it, go ahead. Who cares if its not yet proven if it helps to you.

yea, but some glucosamine are made up from shellfish. If you are allergy to shellfish, then be wary of it.

~Sigh~

Here we go.

The PROOF you wanted was provided by wiki itself. Had you taken the time to actually read the references that wiki provided, you would realise that in fact the only large multi-centred RCT that really came up with glucosamine did not provide any benefit over placebo is the one done by Clegg et al,USA 2006. Its sports 1583 patients and shown that glucosamine or chondroitin alone does not show significant inprovement over placebo. However, when combined, the results are quite encouraging. And you ask for details for people who have benefitted. Go see the results. Glucosamine provided is 3.9% superior to placebo in the primary endpoint, while 11.4% superiority over placebo in the secondary endpoint. More patients have been benefited from glucosamine, however health care professionals consider them as insignificant beacuse p value is larger than 0.05. This is because the benefit maybe due to chance. Should the trial be scaled 10times to include more than 10000 patients and if the percentage of benefit remains, then the values may become significant.

Other studies range from 80+ patients to 200+ patients came up with glucosamine not significantly superior to placebo. On other hand many meta-analysis have proven glucosamine superior. But meta-analysis being meta analyses, the results are less reliable, but in depth reviews are required to appraise their worth.

As with my first post I've already gone through the 4 references provided by wiki in as layman as I can and you still ask for proof and details. As for proof, you have found them, the details, you have to go read it for yourself. I'm not going to go through with you how to appraise journals, and what are the strenghts and weaknesses of each paper.

Healthcare professionals have gone through much training in analysing these papers so much so that many have to repeat this module because english is not their native language, and statistics is not everyone's forte.

So if you've decided to sit down and read those papers, be sure you understand what is p value, odds ratio, hazards ratio, numbers to treat, confidence interval, WOMAC index and read up how to appraise journals before you start shouting for PROOF and DETAILS. Btw, read the other links that nimloth32 provided as well before making conclusions.

Please do not jump around and state claims with weak basis, and when educated otherwise, fail to see the points others made, scream for the obvious answer that you already have, and thus making a fool out of yourself.

That is all from me. Until you make an educated rebuttal with your own proof, evidence and analysis, I urge all healthcare professionals in this forum to ignore the TS as this is really a waste of time.

edit: typo

edit 2: Btw your anecdote on the Newton's Laws of Force and Einstien's Theory of Relativity is most inadequate. May I ask why Newton's Laws are still taught in schools? Because at non relativistic proportions, it is still very applicable. Not everyone can understand Einstien's Theory of Relativity, hence the still applicable and easier to manage Newton's Laws are still taught. Hence that may be the reason why your pharmacist asked you to try glucosamine for OA without showing you piles of research papers, because the average public doesn't need to know all the statistical jargon, and whether a paper is reliable or not.

This post has been edited by Kain_Sicilian: Mar 3 2009, 03:27 PM

since we r in this discussion, oso wanna ask..
glucosamine haf a high content level of sodium, is tat rite?

Not all.

+rep to Kain_Sicilian for having such unrewarded patience.

how do we check then?

The following are pretty comman brands in Malaysia

Blackmores Glucosamine 1500mg, contains 150mg sodium oer daily dose

http://www.blackmores.com.au/Products/Deta...?ProductId=1813

Whereas Kordel's Hi-Glucosamine 1500 plus Curcumin Complex is sodium free

http://www.kordels.com/product/food_supplements_details/56

Most of the time, the sodium content is written on the bottles, but some manufacturers do not state it down.

Yeah just the ingredients or nutrition information that written on the bottles.

My mother is consuming Nutrilite's Glucosamine HCl

Ingredient: glucosamine hydrochloride, micro crystalline cellulose, gelatin (from beef), water, acerola concentrate, magnesium stearate, grapefruit dehydrate, mandarin orange dehydrate, maltodextrin, silicon dioxide, lemon multiflavonoid dehydrate.

glucosamine is a compound which used in joint regeneration.

scientist believed that by taking ingesting one substance and raise the amount of that specific substance in our blood can promote production/joint cartilage formation.

the truth is that it doesn't really work that way, what we ingest is not equal to what our body synthesize. yes, you can take calcium pill to prevent early osteoporosis, but there's a few factors to be consider.
1. absorption - absorption of these substance require "carrier", different substance have different absorption rate, and age is also a factor. you can ingest a lot, but there's always a maximum limit you can absorp.

2. metobolisme- next is the metabolism of absorp substance, many things can happens in our body, metabolisme of these substance often require another compound to bind with...

3. synthesis - synthesis of joint cartilage is not as easy what ABC, it's a very very slow process. one is because the inner part of the joint is not supply by blood vessels, only the outer part is supply by blood. thus this makes cartilage very very slow, regeneration in old people is even slower.
when you have degenerative joint disease like osteoartritis, it's mostly because of your wear and tear of joint out balance the regeneration rate. sorry but to say, it's quite impossible for healing with you reach that stage, what you can do is prevent further damage of joint until the joint completed ruin, and you get yourself a joint replacement.

to make it simple using metaphor,

eating eyes doesn't make your eye see better
eat more heart doesn't makes your heart stronger..
almost same goes to glucosamine...it's better if you go knock off all the joint cartilage when you eat chicken next time