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.

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

~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

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.