A new meta-analysis (a synthesis of many randomized cinical trials) by Juni and colleagues published in the British Medical Journal this week has found that glucosamine and chondroitin supplements, popularly prescribed and taken for arthritis,are not significantly effective in reducing the joint space narrowing that comes from arthritis nor the pain intensity of arthritis.
10 years ago I was asked to answer a question on a Johns Hopkins "Intellihealth" question and answer site about whether glucosamine and chondroitin were effective for arthritis. I said that taking these things for arthritis would be expected to be about as effective as eating kidney would be for kidney disease, or brains for neurodegenerative disorders. I was very surprised, then, when some trials showed an effect of these compounds and I had to retract my answer. So I guess I can feel a little less concerned that I misled anyone in the past, seeing from this meta-analysis that the industry-independent studies show very little or no effect and even the ones funded by the pharmaceutical and supplement industries show very tiny effects of no clinical significance.
While there doesn't seem to be anything toxic about taking these compounds, and they may have very small effects, they are expensive. I agree with the authors that insurers probably should not pay for them given the hundreds of more effective preventive interventions in medicine which right now are not being paid for by health insurance which should take higher priority, which for arthritis would include exercise or yoga classes.
Friday, September 17, 2010
Thursday, September 16, 2010
Quality Improvement Needed
News reports just came out that a doctor had been shot at Johns Hopkins and that the shooter said he was upset about the treatment his mother had received there.
Having spent 15 years as a professor there, Johns Hopkins sees a spectrum of patients from all socioeconomic strata. Wealthy patients often try to improve the quality of care by donating money to various initiatives (for example, the famous case of the 2 year old burn victim who died of dehydration in the children's hospital, whose mother funded a quality and safety program there). It will be interesting to hear the shooter's story. While violence is never justified, the hospital may be able to learn something important about quality of care for the socioeconomically disadvantaged. AS Hopkins is a center for diversity research and the impact of race, ethnicity and socioeconomic status on the quality of care, many people on the Hopkins faculty should be well-equipped to help the administration find out some of the core triggers that in the presence of a violent man with a gun may endanger staff safety. It would be sad if the only thing that was done were more measures to protect staff from patients.
Having spent 15 years as a professor there, Johns Hopkins sees a spectrum of patients from all socioeconomic strata. Wealthy patients often try to improve the quality of care by donating money to various initiatives (for example, the famous case of the 2 year old burn victim who died of dehydration in the children's hospital, whose mother funded a quality and safety program there). It will be interesting to hear the shooter's story. While violence is never justified, the hospital may be able to learn something important about quality of care for the socioeconomically disadvantaged. AS Hopkins is a center for diversity research and the impact of race, ethnicity and socioeconomic status on the quality of care, many people on the Hopkins faculty should be well-equipped to help the administration find out some of the core triggers that in the presence of a violent man with a gun may endanger staff safety. It would be sad if the only thing that was done were more measures to protect staff from patients.
The value of a second opinion
One of my patients sent this joke to me:
The doctor said, 'Joe, the good news is I can cure your headaches. The bad news is that it will require castration. You have a very rare condition, which causes your testicles to press on your spine and the pressure creates one heck of a headache. The only way to relieve the pressure is to remove the testicles.'
Joe was shocked and depressed. He wondered if he had anything to live for. He had no choice but to go under the knife. When he left the hospital, he was without a headache for the first time in 20 years, but he felt like he was missing an important part of himself. As he walked down the street, he realized that he felt like a different person. He could make a new beginning and live a new life.
He saw a men's clothing store and thought, 'That's what I need... A new suit.' He entered the shop and told the salesman, 'I'd like a new suit.'
The elderly tailor eyed him briefly and said, 'Let's see... size 44 long.'
Joe laughed, 'That's right, how did you know?'
'Been in the business 60 years!' the tailor said.
Joe tried on the suit and it fit perfectly.
As Joe admired himself in the mirror, the salesman asked, 'How about a new shirt?'
Joe thought for a moment and then said, 'Sure.'
The salesman eyed Joe and said, 'Let's see, 34 sleeves and 16-1/2 neck.'
Joe was surprised, 'That's right, how did you know?'
'Been in the business 60 years.'
Joe tried on the shirt and it fit perfectly.
Joe walked comfortably around the shop and the salesman asked, 'How about some new underwear?'
Joe thought for a moment and said, 'Sure.'
The salesman said, 'Let's see... size 36.
Joe laughed, 'Ah ha! I got you! I've worn a size 34 since I was 18 years old.'
The salesman shook his head, 'You can't wear a size 34. A size 34 would press your testicles up against the base of your spine and give you one heck of a headache.'
New suit - $400
New shirt - $36
New underwear - $6
Second Opinion - PRICELESS
The doctor said, 'Joe, the good news is I can cure your headaches. The bad news is that it will require castration. You have a very rare condition, which causes your testicles to press on your spine and the pressure creates one heck of a headache. The only way to relieve the pressure is to remove the testicles.'
Joe was shocked and depressed. He wondered if he had anything to live for. He had no choice but to go under the knife. When he left the hospital, he was without a headache for the first time in 20 years, but he felt like he was missing an important part of himself. As he walked down the street, he realized that he felt like a different person. He could make a new beginning and live a new life.
He saw a men's clothing store and thought, 'That's what I need... A new suit.' He entered the shop and told the salesman, 'I'd like a new suit.'
The elderly tailor eyed him briefly and said, 'Let's see... size 44 long.'
Joe laughed, 'That's right, how did you know?'
'Been in the business 60 years!' the tailor said.
Joe tried on the suit and it fit perfectly.
As Joe admired himself in the mirror, the salesman asked, 'How about a new shirt?'
Joe thought for a moment and then said, 'Sure.'
The salesman eyed Joe and said, 'Let's see, 34 sleeves and 16-1/2 neck.'
Joe was surprised, 'That's right, how did you know?'
'Been in the business 60 years.'
Joe tried on the shirt and it fit perfectly.
Joe walked comfortably around the shop and the salesman asked, 'How about some new underwear?'
Joe thought for a moment and said, 'Sure.'
The salesman said, 'Let's see... size 36.
Joe laughed, 'Ah ha! I got you! I've worn a size 34 since I was 18 years old.'
The salesman shook his head, 'You can't wear a size 34. A size 34 would press your testicles up against the base of your spine and give you one heck of a headache.'
New suit - $400
New shirt - $36
New underwear - $6
Second Opinion - PRICELESS
Wednesday, September 15, 2010
Bah Bowflex
Nice article in LA Times on humbug that Bowflex puts out. Can't say anything better than this author did, and he has the abs to back it up (mixed metaphor?)
Tuesday, September 7, 2010
Questions to ask your doctor
Dr. Carolyn Clancy, head of the federal (U.S.) government's Agency for Healthcare Research and Quality (AHRQ) writes columns aimed at helping consumers obtain better health care. Her latest column refers people to a Question-builder site which helps consumers develop a list of questions her agency has developed which people may wish to ask their doctors. While there is no rocket science here, it is helpful to look over to remind ourselves of what we might want to ask, and most importantly, not to be intimidated or rushed into not getting your questions answered.
http://www.ahrq.gov/questionsaretheanswer/questionBuilder.aspx
http://www.ahrq.gov/questionsaretheanswer/questionBuilder.aspx
Friday, September 3, 2010
obesity and search engine advertising
When I searched today for BMI (body mass index) on Google (I was looking for a quick BMI calculator), the first thing you are directed to is an ad for Stanford's bariatric surgery program. I realize these placements just reflect advertising dollars, but there should be some sense of social responsibility at Google that should enter into the picture as well. How about putting some healthy diet and fitness information up front?
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