In the "no f'ing kidding" department

[drwex]

This is me ranting about modern snake oil. Skip if easily offended.

Story in the NY Times today: Study Sees Little Benefit in Chondroitin for Arthritis. Detail: a review of 20 earlier studies had found that the benefit of the supplement was “minimal or nonexistent.”

Chondroitin is one of the popular remedies found in "dietary supplements" and favored by an alarming number of my acquaintances as miracle cures. Right up there with zinc, emergen-C, garlic and other such foolishness. Yes, healthful supplements, yum yum. Miracle cures for joint pain, making colds vanish? No.

Repeat after me: "There is no biologically plausible way that [chondroitin] can work to repair joints damaged by arthritis." OK, that quote is from Dr. Eric Matteson, chair of the division of rheumatology at the Mayo Clinic. Repeat after him, if it works for you.

Promotion of this product is twenty-first-century snake oil. That is, it's an item with plausible value in some situations that gets touted as the miracle cure-all, hey can't-hurt-to-take-it, my-friend-Joe-swears-by-it, whatever. And people shell out money time after time. Willing dupes at best.

Let me try to be plain: if you have a cold, pounding large doses of Vit C will not make the cold go away any faster, even if it is wrapped up in "32 different mineral complexes." It'll probably just make you pee funny. If you have injuries or arthritis or other joint pains, eating sugar and shark cartilage will not cure them. If you believe otherwise, demonstrate a biologically plausible way for it to happen.

It's unclear to my why so many people who are otherwise intelligent and rational, with fully functional critical thinking facilities, can fall prey to this kind of scamming. Is it because we desperately WANT there to be miracle cures? Sure, being sick sucks and arthritis hurts like hell. But that experience doesn't make me blind to my knowledge of biology, chemistry, and medicine. It's beyond me why people believe in this stuff.

It doesn't help me feel better at all when the Natural Products Association (there's an unbiased organization, yeah) responds that "Clearly, research has demonstrated..." Uh, no. No, it hasn't. That's the POINT, you charlatans.

For the record, I'm not speaking about herbal medicine. If you really want snake oil, take the actual stuff for your arthritis. The original snake oil (which I'm told you can still get in Chinese medicine shops) really does help join pain because it's an anti-inflammatory. Many years ago, I worked with a guy who took it regularly for bursitis. Said person wasn't miraculously cured of his condition but he did get relief with fewer side effects than western-style NSAIDS gave him.

There. I feel better now.

Comments

[woodwardiocom.livejournal.com]

I have no opinion or information whatsoever on chondroitin, but: You are blurring the distinction between, "There's no evidence this works," and, "There's no known mechanism by which this would work." The former is a justifiable reason to call something snake oil. The second (taken by itself) is not, 'cause in the history of things that are understood, there always was a time when they weren't understood.

[drwex]

I'm not "blurring the distinction", I'm "piling on". Or flaming. It's a rant, I get to be uncoordinated about it. :-P

[woodwardiocom.livejournal.com]

Ah, gotcha.

[louiseroho.livejournal.com]

Well, there is always the Placebo Effect. Emergency-C does that for me.

And it tastes yummy-nummy.

[docorion.livejournal.com]

Well, I read it more as "Given what we *do* know about how biology works, there is absolutely no way in which choindroitin can possibly work, unless we posit a completely new, undiscovered set of biologic premises which directly contradict the ones we know work".

Of course, "snake oil" is easier to say.

[feste-sylvain.livejournal.com]

I've found myself taking some "nutritional supplements" lately.

I've been warned that beta carotene has not been found to reduce incidences of cancer, "and may even cause it". That latter claim evaporates when you apply the self-selecting nature of people who were taking beta carotene for its ostensible anti-oxidant properties.

However, I take it to improve my night vision, and it has. Especially in the winter, I notice when I haven't been taking it by the amount of time it takes my eyes to recover from oncoming headlights.

Likewise, I just started taking niacin for my cholesterol. As I'm a lazy sod, I may even get another blood test before I finally get around to starting a regimen of aerobic exercize; at that time, I'll know whether I have the sort of cholesterol problem which is amenable to niacin.

But last I looked, both of those substances were vitamins (or more accurately in the case of beta carotene, a proto-vitamin, which is safer for the fat-soluable family). It offsets some of my bad diet.

I've already had my favorite decongestant banned by the FDA ostensibly because some jackasses managed to harm themselves trying to use it as a diet aid. (The real reason is more likely that it's a primary ingredient in meth production.) So because of some idiots abusing the substance, I can't breathe clearly in sprig.

It looked like beta carotene was about to be banned for similar idiocies. Fortunately, it appears that cooler heads have prevailed for the time being.

I can't take most chondroitin because it's derived from shellfish. Maybe it would have done something for my arthritis, maybe not. I do know that our society is shifting from the English "Everything not banned is permitted" to the Roman "Everything not permitted is banned", and that this is a Bad Thing.

[qwrrty.livejournal.com]

So what I have read about these items includes:

* chondroitin glucosamine, if taken on a regular basis over a long period of time (like, months to years), may help to avert the onset of arthritis. Not cure it.

* zinc, if taken immediately upon the onset of cold symptoms, can help to mitigate the severity and duration of the symptoms. Not cure them.

[ My (purely anecdotal, natch) experience with zinc is that it works as described here: if I take it as soon as I feel a cold coming on, the symptoms are much less prolonged and unpleasant than if I do nothing or just take antihistamines or decongestants. ]

That's not to say that they're not being marketed dishonestly as miracle cures, or that a gullible public isn't interpreting them that way because they desperately want a quick fix. Just that I thought there was established clinical evidence supporting the hypothesis that they have *some* effect on these syndromes.

[halleyscomet.livejournal.com]

Do you feel the same way about Glucosamine?

http://nccam.nih.gov/research/results/gait/qa.htm#c1 (http://nccam.nih.gov/research/results/gait/qa.htm#c1)

For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared to placebo--about 79 percent had a 20 percent or greater reduction in pain versus about 54 percent for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies.

In other words, there is some indication that people with mild joint pain MAY get a MILD benefit. This is consistent with my own experiences with Glucosamine. I regarded it as just another pho-medical absurdity until I saw the dramatic difference it made in my Rabbit Beanbag's joint pain. When he's had his daily dose, he's active and does his best to cause trouble. When he hasn't had any for a few days he sits in his litter box and has difficulty moving.

Of course, the citrus flavor or some other component in the liquid supplement could be responsible for Bean's increased activity. As far as my knee pain goes, I'm not about to discount the placebo effect, but I would think that unlikely given the raw skepticism I had when I tried it myself.

[halleyscomet.livejournal.com]

I tend to use Emergen-C as a cola substitute. Fewer calories, has some vitamins, it's fizzy and cheaper than a can of soda.

[imvfd.livejournal.com]

Hmmm. I can understand the need to rant but given that in it's based on the NY Times article, I'd like to point to the following line:

"Some studies have, in fact, reported a benefit. But the authors of the current report focused on three recent large studies that did not."

Plus the article offers no information about how these twenty studies were chosen. Overall, not really impressed.

As a side note on vitamin C mega doses, taking 3 grams a day all the time does decrease incidence of sickness. At least if you're an athlete. For everybody else, it just lowers cortisol levels, which may or may not provide enhancement of immune response.

[imvfd.livejournal.com]

It's not so much taking zinc. It's sucking on Cold-eze lozenges, which contain Zinc Gluconate. Basically need to have zinc ions on the actual mucus membrane to disrupt the virus from doing it's thing. And it only works on cold viruses, not flu (or at least has only been tested on colds). Taking zinc as a pill will not do much for the immune system. Although if you've got a deficiency it can boost testosterone levels.

[imvfd.livejournal.com]

I would strongly advise against attempting niacin therapy for cholesterol on your own. Only the regular form of niacin that causes the very unpleasant flushing works for reducing cholesterol and the dosages that are needed are high enough that they can cause severe adverse reactions including liver damage.

Also, beta-carotene can cause cancer if one smokes. For some reason, in this case it actually raises the incidence of lung cancer. But overall, it's rather more of an anti-cancer agent, it's true.

[http://users.livejournal.com/cgull_/]

Furthering your uncoordinatedness, I'll note that the quip about chondroitin not plausibly remodeling cartilage doesn't necessarily have much to do with whether it relieves pain. Still, the study's major point agrees with you anyway. :)

--jh

[sebastian-tombs.livejournal.com]

In a 100% of cases of an extremely small sample size of dogs (read, every old dog I have owned), there has been a very marked difference in the pain level and activity level of the affected animals when treated with glucosamine and chondroitin compared to the same animal when before the treatment is started, or in the rare times the treatment had lapsed. Keep in mind that the placebo effect is likely minimal in dogs too.

I have no sample size at all of humans.

I don't know why it works on dogs, but it does [wren13 can provide you with better information, and possibly statistically significant sample sized studies, regarding the efficacy in dogs and probably cats. If it does actually work on dogs, odds are good that it would work on people through the same mechanism (whatever that is).

Would it be a "miracle" cure that solves all problems? Of course not. Not even all the allegedly appropriate cases. But then again, [appropriate ]antibiotics [used properly] do not cure all infections, and very few other treatments work in 100% of the appropriate cases either.

Other items you mention:

"mega-doses of vitamin C" - well, what if the mega doses supplant regular vitamin C levels that are substantially lower than those generally recommended? Perhaps some of the symptoms being treated are actually malnutrition?

Zinc: appears to help prevent and help lessen the effects of colds.

Q-Ray bracelets: Ok, you are probably right here

acupuncture: seems to work for some people, but it sure looks like snake oil to me

etc. In other words, YMMV.

[drwex]

Sorry, but "YMMV" is precisely the kind of thinking I get irked by. In fact, my mileage doesn't change the biological bases of human metabolism. The precise point is that this is not something subject to whim; it's science. Which includes placebo effects and suchlike. But it's certainly not a matter of personal opinion whether or not something has statistical validity.

[drwex]

Sure, science reporting in the popular press sucks. NYTimes or not, their science reporting doesn't come close to what one would like. I'm not pointing to the story as an example of excellence. It was just a rant trigger.

[imvfd.livejournal.com]

True true. It's just the sort of article that helps swing the supplement pendulum. This one causes you to rant, the next one about how silicone helps build stronger bones will get old ladies chewing on their dildos. Huh, and apparently Firefox's dictionary is blissfully unaware of the world "dildos" and it's spelling suggestion was "evildoers" I think there might be some prudes working in the open source community. Anyway, I'd cry out "What ever happened to a responsible press?!?!" but I have doubts whether something like that ever existed.

[imvfd.livejournal.com]

Well... I've got a stats professor that might argue with you on the "it's certainly not a matter of personal opinion whether or not something has statistical validity"

[drwex]

*sporfle*

Too true.

[qwrrty.livejournal.com]

Right, the key (supposedly) is to let the zinc lozenge dissolve in your mouth, and that the zinc needs to be near where the virus is active in your throat or nasal passages. I knew that, I was just feeling lazy about typing it all out. :-)

[sebastian-tombs.livejournal.com]

See, here is where you are completely wrong.

When I take a beaker of one chemical, say hydrochloric, and mix it with another chemical, say sodium hydroxide, junior high school chemistry says:

HCL + NaOH -> HoH + NaCL

But that is not what happens. Real science tells you that you will have varying combinations of both sides of the equation (admittedly, more of the latter than the former). And then you also have the added complexity of the ionization of the salt in the water...

So, science. Right. So, is a low carb diet better for you than a low fat diet, or vice versa? I can throw at you a goodly number of studies that will say low carb, and a goodly number of studies that say low fat. First off, we apparently don't understand enough science to actually know which is better (in theory). Secondly, the statistics actually say "it depends". So, what's with the studies that give us categorical answers? Excellent question. The you get newspaper articles that quote these studies, saying "studies show" when, in fact, they should say "studies disagree, but the better sounding story is, 'studies show', and that is how I can sell more column space / newspapers / advertising (hmmm...perhaps there is a more direct link to the advertising sales....).

Statistical validity means you have to include all the tests, and it means that all the tests had to be valid in the first place. This is why the "science" of Cold Fusion (as reported in the media) lost the right to the word when no one could reproduce the results.

Another thing...would you say that aspirin is a pain-killer? I assume, yes. So, would you say that it works on *everyone*? I mean, science would seem to indicate that, wouldn't it? But it doesn't have any affect on me. Whereas wren13 loves ibuprofin and the like, but gets no help from other painkillers, such as vicodin or novocaine. Basic science says they should help, there is (as far as I know) no understanding of how tolerances like that work, esp. after only very limited exposure, and the reality is that they do nothing for her.

"But it's certainly not a matter of personal opinion whether or not something has statistical validity." Then we could discuss the use of statistics, a conversation for which my training leaves me poorly equipped. However, I do know that there are a great number of ways to play with your statistics before you release the study. I also will add that there are studies (I just lent the book with the references, so I can't provide them, but check the reference appendix of Michael Crichton's State of Fear) that show that studies are statistically likely to prove the point desired by the studiers (or, more to the point, those funding the study).

As someone who has taken a fair amount of chemistry, I will go back to the simple point that statistics and percentages is a huge deal in science - in fact, it is exactly why chemical engineers exist in the first place. "YMMV" is really a statistically relevant comment.

[drwex]

Your discussion misses the point, which is that "your mileage may vary" is not a valid scientific method. If you're trying to make a different point then I'm not getting it.

[sebastian-tombs.livejournal.com]

Actually, you're missing the point, which is that in the case of very complex systems, YMMV actually is a valid scientific result.