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Life Extension Magazine

LE Magazine June 2006

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Dietary Supplements Attacked by the Media


By William Faloon

Media may not have read glucosamine study

The media appears to have relied on a biased editorial that accompanied the actual scientific report on glucosamine. For instance, the New York Times said the following about this arthritis study:

“No effect was found for glucosamine, chondroitin, or the combination of both.” 60

Yet on page 804 of the study (which was published in New England Journal of Medicine, the following was stated about patients with moderate to severe arthritis of the knee who took glucosamine-chondroitin therapy:

“…combined treatment was significantly more effective than placebo” 59

The actual study went on to say that in those with moderate to severe arthritis, the combination of glucosamine-chondroitin resulted in a 24.9% to 26.4% improvement in pain relief. This result exceeded the 20% response to treatment measurement that the scientists themselves stated would prove efficacy. 59

As far as reversing the structural damage inflicted to the knee by osteoarthritis, the scientists stated:

“Treatment with chondroitin sulfate was associated with a significant decrease in the incidence of joint swelling, effusion, or both.” 59

In their concluding remarks, the scientists stated:

Our finding that the combination of glucosamine and chondroitin sulfate may have some efficacy in patients with moderate-to-severe pain is interesting, but must be confirmed by another trial.” 59

As anyone who understands the English language can read, even this different form of glucosamine, when combined with chondroitin sulfate, demonstrated efficacy in patients most in need, i.e., those with moderate-to-severe pain! The media overlooked these clearly written findings in their haste to viciously attack glucosamine and chondroitin dietary supplements.

Better than Celebrex®

One of the arms in this arthritis study was given 200 mg a day of Celebrex®, an FDA-approved arthritis drug.

In patients with moderate to severe knee pain, however, the only treatment that showed significant benefit was glucosamine-chondroitin.

The media, however, chose to tout the mediocre benefits that Celebrex® showed in this study. For instance, in a widely distributed Associated Press story, the following was stated about Celebrex®:

The drug Celebrex did reduce pain -- 70 percent reported improvement -- affirming the study's validity.” 61

The inclusion of Celebrex, in fact, did not affirm the study’s validity considering that 60 percent of the placebo group also reported improvement. The authors of this study stated that compared to placebo, Celebrex® was “ not significantly better.” 59

In the concluding remarks, these scientists stated:

“However, even the effects of celecoxib (Celebrex®) were smaller than those seen in other studies.” 59

The media exaggerated the benefits of Celebrex while vilifying glucosamine-chondroitin, carrying on a long tradition of bias against dietary supplements.

The arthritis study’s disappointing findings

The data that caused these negative media stories involved study subjects with mild knee pain. The scientists noted that in these patients, “differences between placebo and the various agents were relatively small.” 59

As compared to placebo, here were the pain score percentage point improvements for overall groups within this study: 59

Therapy

Improvement in Primary Pain Score

Improvement in Secondary Pain Score

Glucosamine HCL only (note this is not glucosamine sulfate)

3.9%

3.7%

Chondroitin sulfate only

5.3%

6.6%

Glucosamine HCL + chondroitin sulfate

6.5%

8.5%

Celebrex®

10%

10.4%

The scientists who conducted this study appropriately noted that only three of the above changes were significant overall. Furthermore, for the primary outcome in the combined glucosamine + chondroitin group, the results were very close to reaching statistical significance. For the secondary outcome, it did reach significance!

The media misinterpreted these findings and used them as ammunition to attack the efficacy of glucosamine and chondroitin supplements.

Conflicts of Interest

The New England Journal of Medicine recently enacted a policy of mandating disclosure of potential financial conflicts of interest amongst the authors of the studies it publishes. The reason for this was past instances of questionable articles supporting the safety-efficacy of drugs authored by doctors who were financially beholden to pharmaceutical companies that made the drugs.

What follows are the potential conflicts of the authors of the negative glucosamine study as reported by the New England Journal of Medicine:

“Drs. Bingham, Brandt, Clegg, Hooper, and Schnitzer report having received consulting fees or having served on advisory boards for McNeil Consumer and Specialty Pharmaceuticals. Drs. Brandt, Moskowitz, Schnitzer, and Schumacher report having received consulting fees or having served on advisory boards for Pfizer. Dr. Brandt reports having equity interests in Pfizer. Drs. Moskowitz and Weisman report having received lecture fees from Pfizer; Dr. Brandt, lecture fees from McNeil Consumer and Specialty Pharmaceuticals; Drs. Bingham, Clegg, Hooper, Jackson, Molitor, Sawitzke, and Schnitzer, grant support from Pfizer; and Dr. Bingham, grant support from McNeil Consumer and Specialty Pharmaceuticals. Dr. Brandt reports having received royalties from books related to osteoarthritis. Dr. Moskowitz reports having served as an expert consultant for Pfizer.” – pp. 807 “Dr. Hochberg reports having received consulting fees from Pfizer and Merck and speaker’s fees from Merck and Institut Biochimique.” 59

Arthritis drugs are (or have been) huge moneymakers for the pharmaceutical companies. These same companies have paid monies to doctors who designed, oversaw, and authored the New England Journal of Medicine study and the negative editorial about glucosamine. Readers can make their own determination if this represents frank bias or, at a minimum, a disingenuous approach to scientific research.

The encouraging findings from the arthritis trial

As noted earlier, significant benefits were seen in patients with moderate to severe arthritis of the knee in the glucosamine-chondroitin group. Compared to placebo, the pain score percentage point improvements in the moderate to severe arthritis group were as follows: 59

Therapy

Improvement in Primary Pain Score

Improvement in Secondary Pain Score

Glucosamine HCL only (note this is not glucosamine sulfate)

11.9%

17.1%

Chondroitin sulfate only

7.1%

10%

Celebrex®

15.1%

18.1%

Glucosamine HCL + chondroitin sulfate

24.9%

26.4%

In patients with moderate to severe knee pain, Celebrex® provided modest relief, whereas glucosamine-chondroitin showed significant reductions in pain scores. It is interesting that Celebrex® was not criticized by the media, even though it failed to produce the expected results in this sub-group of patients suffering with moderate to severe pain.

Wrong form of glucosamine used

A troubling flaw in this study is that the wrong form of glucosamine was given to the study subjects. Glucosamine sulfate is the most prevalent form of glucosamine used in dietary supplements. Most of the studies showing significant efficacy used glucosamine sulfate, but the form used in the New England Journal of Medicine study was glucosamine hydrochloride.

Since the study subjects received glucosamine hydrochloride, they were not obtaining the joint-protecting benefits conferred by the sulfur found in the “sulfate” part of the glucosamine compound. The anti-arthritis benefits of sulfur are so well documented that many arthritis patients find relief with a low-cost supplement called MSM (methylsulfonylmethane), which is a concentrated source of sulfur. 62-72 The anti-arthritic properties of SAMe (s-adenosyl-methionine) are also thought to be related to its high sulfur content. 73-79

In this New England Journal of Medicine study that made headline news around the world, the subjects taking glucosamine only were getting no supplemental sulfur. Even the group getting the glucosamine and chondroitin was only getting a small amount of sulfur (from the chondroitin sulfate only).

Why the media attacked glucosamine

In an editorial appearing in the same issue of the New England Journal of Medicine, glucosamine was harshly criticized. It was obviously a lot easier for the media to echo one doctor’s condemnation than to take the time to read the actual study itself.

This one doctor, by the way, receives consulting fees from Pfizer and Merck. In fact, a number of the authors of the glucosamine study published in the New England Journal of Medicine receive compensation from big pharma, mostly from Pfizer, which is the maker of Celebrex®. None of the study’s authors had an economic interest in glucosamine or chondroitin. Some in alternative medicine have said this is equivalent to having an opposing team’s referees dictate the outcome of a sporting event.

What most people don’t realize, however, is that it is not the obligation of the media to provide accurate reporting. The media is responsible for generating profits for its shareholders, which means they have to grab the public’s attention with sensational headlines that sell newspapers, TV viewing time, etc.

Reporting on the positive parts of the New England Journal of Medicine study would not have motivated many people to buy a newspaper. After all, there are dozens of studies substantiating the anti-arthritic properties of glucosamine sulfate and chondroitin sulfate. 59, 80-110 One more new study is hardly a newsworthy event.

There are now millions of Americans using glucosamine-based dietary supplements. These are the seventh most popular dietary supplement sold in the United States. There are over 20 million Americans affected by osteoarthritis. 111 So when the largest newspaper in the United States ran the headline, “Two Arthritis Drugs Found To Be Ineffective,” they knew it would catch a lot of attention. The fact that glucosamine and chondroitin were labeled as “drugs” is an indication of how little time this newspaper spent evaluating the actual study.

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