Thursday, August 10, 2006

Alternative Med: Second Opinion (Reply to Wall Street Journal article titled No 'Alternative' )

Alternative Med: Second Opinion By Neil E. Levin, CCN, DANLA The op-ed piece on August 7 titled “No Alternative” leaves me with no alternative but to critique the selective facts presented. That article does not accurately represent the facts involved in these studies. The author begins by claiming that rigorous assessments of glucosamine and saw palmetto “failed to show clinical efficacy”. That statement is so over-generalized that it is demonstrably untrue. In the case of glucosamine, long term studies have shown that it helps to prevent narrowing of the spaces between joint structures. This is an important clinical determination of whether or not a joint is disintegrating or maintaining its cushioning structures. I have been told by leading physicians at Northwestern University’s Medical Center that glucosamine is an important component of their arthritis protocol for this reason, and the scientific evidence is convincing to these professionals. In the study cited in the article, the author was incorrect in saying that “there was no statistical benefit” for glucosamine. The actual study did note a statistically significant benefit, saying, “For patients with moderate-to-severe pain at baseline, the rate of response was significantly higher with combined therapy (glucosamine and chondroitin sulfate) than with placebo…” In other words, the supplements were effective for those with the worst arthritis pain! This was only a 24 week trial, and although longer term studies show that maintaining joint structure distances is not directly related to reducing joint pain, in this study glucosamine and chondroitin did help those suffering the most from arthritis pain. Other studies have shown the long term joint structure protection for patients given glucosamine. Another study was cited as proof that the herb Saw Palmetto “failed to show clinical efficacy”. That is not an accurate statement, as the herb was used only on those with more severe forms of benign prostatic hyperplasia (BPH), while it has historically only been used on milder forms. One study testing a dietary supplement on the sickest patients, when the herb has not even been previously thought to work on severe cases, is not in any way representative of the body of science that has found this herb to be successful in mild cases of BPH. Yet another example given was of the herb St. John’s wort. Yes, it was not successful against major depression, a use which no one had ever claimed. The previous science successfully used the herb against mild depression. More telling, a prescription drug –tested and officially approved for use against depression – was equally ineffective against major depression, a fact that was curiously absent in the article, implying a pro-pharmaceutical bias combined with a bias against dietary supplements and other alternative modalities. The study went far beyond known uses of either of these therapies, and no one should use the results as “proof” that the herb (or the drug) is ineffective for typical uses. The journal American Family Physician reviewed the medical literature and reported, “St. John's wort has been found to be superior to placebo and equivalent to standard antidepressants for the treatment of mild to moderate depression.” I find the unrepresentative samples of negative data used in the article to be extremely misleading, creating a false impression that natural products never work. It calls into question the objectivity of the author that there is no appropriate context to these few examples, and that large bodies of science are ignored in order to make his point. That is unscientific, not the tens of thousands of published studies on nutrition, dietary supplements and complementary medicine that were too unimportant to mention. It would be unfortunate if people do not consider the well-documented uses of alternative medicine and instead believe that the magic of conventional medicine can cure all. The good doctors at Northwestern are enlightened enough to endorse a science-based complementary care model that seems to work. I urge the Journal’s readers to check the facts for themselves before accepting this prescription for ignorance. Get a second opinion. REFERENCES: Clegg DO, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808. PMID: 16495392 Rovati LC, et al. Assessment of joint space narrowing with conventional standing antero-posterior radiographs: relief in mild-to-moderate pain is not a confounder in recent osteoarthritis structure-modifying drug trials. Osteoarthritis Cartilage. 2006;14 Suppl A:A14-8. Epub 2006 May 5. PMID: 16678450 Pavelka K, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002 Oct 14;162(18):2113-23. PMID: 12374520 McAlindon TE, et al. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000 Mar 15;283(11):1469-75. Review. PMID: 10732937 Wilt T, et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. Review. PMID: 12137626 Bent S, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006 Feb 9;354(6):557-66. PMID: 16467543 Fong YK, et al. Role of phytotherapy in men with lower urinary tract symptoms. Curr Opin Urol. 2005 Jan;15(1):45-8. Review. PMID: 15586030 Wilt TJ, et al. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000 Dec;3(4A):459-72. PMID: 11276294 Wilt TJ, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998 Nov 11;280(18):1604-9. Erratum in: JAMA 1999 Feb 10;281(6):515. PMID: 9820264 Szegedi A, et al. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ. 2005 Mar 5;330(7490):503. Epub 2005 Feb 11. Erratum in: BMJ. 2005 Apr 2;330(7494):759. dosage error in text. PMID: 15708844 Lecrubier Y, et al. Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial. Am J Psychiatry. 2002 Aug;159(8):1361-6. PMID: 12153829 Kasper S, et al. Superior efficacy of St Johns wort extract WS(R) 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial [ISRCTN77277298]. BMC Med. 2006 Jun 23;4(1):14 [Epub ahead of print] PMID: 16796730 Schulz V. Safety of St. John's Wort extract compared to synthetic antidepressants. Phytomedicine. 2006 Feb;13(3):199-204. Epub 2005 Nov 2. Review. PMID: 16428030 Lawvere S, Mahoney MC. St. John's wort. Am Fam Physician. 2005 Dec 1;72(11):2249-54. Review. PMID: 16342849

1 comment:

chaindropz said...

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