The Best They've Got

The Best They’ve Got

I don’t want to sound like a wild-eyed tinfoil-hat conspiracy theory nut, but sometimes it really does seem like there’s an anti-dietary supplement scheme that employs researchers to produce studies designed to make supplements appear ineffective.

When you look closely at these mostly feeble studies that supposedly refute the usefulness of supplements, you have to wonder: Is this really the best they’ve got? But weak studies don’t actually have to hold up under scrutiny. As long as they produce negative headlines and sound bites in the mainstream media, they’ve done their job.

A new chondroitin sulfate study provides a perfect example of how this works (with some unintentional humor along the way).

Simple choices

By now, most HSI members are aware that supplements of chondroitin and glucosamine provide osteoarthritis patients with alternatives to non-steroidal anti-inflammatory drugs (NSAIDs), such as Alleve, and COX-2 inhibitors, such as Celebrex.

Glucosamine is an amino sugar that helps maintain healthy cartilage and connective tissue, and chondroitin sulfate promotes cartilage elasticity by inhibiting damaging enzymes and drawing water into the cartilage. Many studies and case histories support the usefulness of supplementary glucosamine and chondroitin, which are usually taken together.

The new chondroitin research is a meta-analysis that examined results of 20 different studies that tested chondroitin. Seventeen of these studies were excluded because, according to the researchers, the methodology differed too greatly. So only three studies were used in the final analysis that came to this conclusion: “The symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.”

Discouraged! Why should they be discouraged? Men with prostate cancer or a high risk of the cancer should not use chondroitin because it may cause the cancer to metastasize. But for women and those not at risk of prostate cancer, there are virtually no adverse side effects associated with chondroitin. So wouldn’t it be more appropriate to suggest that chondroitin use simply not be encouraged? Why actively discourage patients from using it? I know one reason: If a doctor convinces a patient to forget about trying dietary supplements, there are only two choices left: either suffer your pain with no treatment, or take drugs.

Of all the studies to choose from

The meta-analysis was published last month in the Annals of Internal Medicine, and was accompanied by an editorial by David Felson, M.D., of Boston University who supported the conclusion 100 percent. In fact, he went one better. He noted that the recent Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) concluded that the combination of the two supplements combined didn’t perform better than placebo, while Celebrex was effective.

That’s a nice little summary, Dr. Felson. But you left out some details.

I reviewed the GAIT study in the E-Alert “Big Bend” (2/13/07). The final results showed that Celebrex was the most effective painkiller for those with mild osteoarthritis pain. But for subjects with moderate to severe pain, the effectiveness of glucosamine and chondroitin combined was comparable to the effectiveness of Celebrex.

And did I save the best for last? Always.

The Archives of Internal Medicine notes this “potential financial conflict of interest” for Dr. Felson: “Grants received: Merck & Co.” Merck! And who made Vioxx, the notoriously dangerous COX-2 inhibitor? Merck!

Okay, to be fair, this is no smoking gun. We don’t know any details about Dr. Felson’s grant. But come on, couldn’t the editors of the Annals of Internal Medicine find someone with no direct connections to a major drug company to write this editorial?

I’ll let Dr. Andrew Shao (of the Council for Responsible Nutrition) have the last word. In a NutraIngredients report, Dr. Shao noted that the reviewers could have chosen from 300 different chondroitin studies. “With over 21 million osteoarthritis sufferers in the U.S. alone, a conclusion based on only three studies hardly seems representative of the population in question.”

This meta-analysis is more like a meathead analysis. If only the Annals of Internal Medicine and other leading journals would resist publishing studies like this that provide confusion, but not much else.