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    Monday, February 27, 2006

    February Blues: February was a bad month for alternative medicine, or at least for some popular herbal supplements. Reports this month appeared that suggested saw palmetto was no better than placebo for prostate symptoms, and that neither glucosamine nor chondroitin sulfate did much to help arthritis pain. Many of the news reports described them, too, as no better than placebo. But is that what the studies showed?

    In the case of glucosamine and chondroitin sulfate, no. Both drugs actually showed modest symptom improvement:

    As compared with the rate of response to placebo (60.1 percent), the rate of response to glucosamine was 3.9 percentage points higher..., the rate of response to chondroitin sulfate was 5.3 percentage points higher...., and the rate of response to combined treatment was 6.5 percentage points higher .... The rate of response in the celecoxib [Celebrex, a non-steroidal anti-inflammatory drug used for arthritis -ed.] control group was 10.0 percentage points higher than that in the placebo control group.... For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy than with placebo (79.2 percent vs. 54.3 percent, P=0.002). Adverse events were mild, infrequent, and evenly distributed among the groups.

    Notice the high response to placebo. Goes to show you that pain is a subjective measurement, not an objective one, and that our brain's interpretration of it is highly prone to the power of suggestion. But beyond that, the glucosamine and chondroitin groups didn't do all that badly - just a little less responsive than the Celebrex group. Far from proving that these supplements are worthless, this study just confirmed what we already knew about them. They help some people a little bit, but they aren't as effective as traditional arthritis medications. (Which apparently aren't all that spectacular, either.)

    What about saw palmetto? Well, it really didn't do so well. For one thing, prostate symptoms aren't subjective. They're either there or they aren't. A man either can or can't empty his bladder or hold his urine all night long. And we can actually measure the size of a prostate gland and the amount of urine left over in the bladder after voiding. As a result, in this case, both reported symptoms and objectively measured symptoms were about the same for both saw palmetto and placebo. This also confirms clinical experience. Urologists often recommend saw palmetto as a just-in-case adjunct, but they also always recommend tradtional medical therapy, too, because they know the saw palmetto doesn't do much.

    posted by Sydney on 2/27/2006 08:49:00 AM 2 comments


    When my supply of glucosamine and chondroitin run out, I'm definitely going to buy placebos instead. They ought to be a lot cheaper, and they obviously work almost as well.

    How does one buy placebos?

    - tobias robison

    By Blogger Daniel H, at 12:56 PM  

    How long does placebo effect last? That's the question I always have when I see these news stories. If placebo effect wears off, I'd like to see studies measure effects over time.

    Here is what I'd expect, based on nothing but my perception of human nature: 50% of pts who received placebo reported improvement in the first week, but return of symptoms by the thrid week.

    By Anonymous Skeptigal, at 8:16 PM  

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