SBM: Knee Osteoarthritis – Thumbs Down for Acupuncture and Glucosamine

Good article over at Science Based Medicine – Knee Osteoarthritis: Thumbs Down for Acupuncture and Glucosamine. They highlight the American Academy of Orthopaedic Surgeons (AAOS) 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery (see summary).

The report states that there is strong evidence against the use of acupuncture and glucosamine in knee osteoarthritis.

Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)

Exercise – strong evidence for effectiveness
Weight loss – moderate evidence for
Acupuncture – strong evidence against
Physical agents (TENS, ultrasound, etc.) – inconclusive
Manual therapy (chiropractic, massage) – inconclusive
Valgus-directing force brace – inconclusive
Lateral wedge insoles – moderate evidence against
Glucosamine and chondroitin – strong evidence against
NSAIDs – strong evidence for
Acetaminophen, opioids, pain patches – inconclusive (this is particularly interesting since acetaminophen is the standard first-choice drug)
Intraarticular corticosteroid injections – inconclusive
Hyaluronic acid injections – strong evidence against (and if injections are ineffective, those oral diet supplements certainly don’t have a chance)
Growth factor injections and/or platelet-rich plasma – inconclusive
Needle lavage – moderate evidence against
Arthroscopy with lavage and debridement – strong evidence against
Partial meniscectomy in osteoarthritis patients with torn meniscus – inconclusive
Valgus-producing proximal tibial osteotomy – limited evidence
Free-floating interpositional device – no evidence; consensus against

Exercise is at the top of the list – no easy shortcut folks!

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Acupuncture is a theatrical placebo

An interesting read: Acupuncture is a theatrical placebo: the end of a myth

Acupuncture is an interesting case, because it seems to have achieved greater credibility than other forms of alternative medicine, despite its basis being just as bizarre as all the others. As a consequence, a lot more research has been done on acupuncture than on any other form of alternative medicine, and some of it has been of quite high quality. The outcome of all this research is that acupuncture has no effects that are big enough to be of noticeable benefit to patients, and it is, in all probablity, just a theatrical placebo.

After more than 3000 trials, there is no need for yet more. Acupuncture is dead.

Acupuncture dead? Not in Asia, where I suspect it will continue to thrive, being the elaborate placebo it is and the fact that it is “culturally acceptable” in our midst.
The article concludes:

The best controlled studies show a clear pattern – with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are what define “acupuncture” the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.
The interests of medicine would be best-served if we emulated the Chinese Emperor Dao Guang and issued an edict stating that acupuncture and moxibustion should no longer be used in clinical practice.

Someone tell that to the MOH.

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xkcd: Cells

xkcd makes a good point:


Have you been sucked in by the Alternatives to Medicine hype?

(pic from the Age)


Alternative medicine has grown into a $2 billion industry under a regime of light regulation and increasing social acceptance. But with few products tried and tested, should we believe the hype?

Read more in the Age

Antioxidants, Omega-3 Fail to Halt Macular Degeneration

Sometimes what seems promising at first may not be true when studied further. AREDS2 unfortunately did not live up to the early promise of the initial AREDS trial to study if taking antioxidants would halt macular degeneration, an important cause of blindness. Medscape reports

SEATTLE, Washington — Antioxidant and omega-3 supplements do not reduce the risk for advanced macular degeneration, according to results from the highly anticipated Age-Related Eye Disease Study (AREDS2).

Although the primary results are disappointing, important clinical messages emerged during its presentation here at the Association for Research in Vision and Ophthalmology 2013 Annual Meeting. The results were published online May 5 in the JAMA: The Journal of the American Medical Association to coincide with their presentation.

The new data point to ways to change the nutritional formulation from the initial AREDS trial to reduce potential risks without sacrificing benefit for people at high risk for advanced age-related macular degeneration (Arch Ophthalmol. 2001;119:1417-1436).

Bottom line is we need evidence to substantiate what we recommend and clinical trials are important.

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When alternative cancer therapy harms patients

Shocking that in this day an age, patients with a highly curable cancer like stage II Hodgkin’s disease can opt for “Alternatives to medicine” rather than conventional treatment which offers 80-90% probability of cure. From KevinMD

After a terribly painful and debilitating illness, Steve died. He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain. He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% chance of cure: chemotherapy.

We still see this in Malaysia, where patients have been frightened off conventional treatment by their friends and relatives, make their rounds of Sinsehs, Ayurvedics, Naturopaths, Ozone therapists and what-not, finally only to present to hospital in an advanced incurable stage of cancer. This is the real tragedy of Alternatives to Medicine.

Related posts:
The Cancer Sell

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A question about bovine colostrum


Eliz D’ Heart asked us in Facebook

Hi doc, can somebody explain or give any opinion about Transfer Factor? this is MLM product , and i need to know from medical person is it true the cow’s colustrum can boost the human imun system? Thanks!
and some doctors also sell it…
Please inform if this product hv any bad side effect too..thank you so much!

Hi Eliz

We answered this before in an old post but let us summarise it for you again

The “Transfer Factor” that is sold by MLM is in fact cow’s colostrum, which is the milk produced by cows in late pregnancy. Like human colostrum which is good for human babies, cow’s colostrum is good for baby cows.

Assertions that colostrum consumption is of human benefit are questionable because most ingredients undergo digestion in the adult stomach, including antibodies and all other proteins. Bovine colostrum and its components are safe for human consumption, except in the context of intolerance or allergy to lactose or other components. It shows promise in the treatment or prevention of a variety of diseases


However, the “promise” in the treatment or prevention of a variety of diseases remain largely clinically unproven and what you come across when you surf the web are “testimonial evidence” from people who “feel better” after taking products such as these. Testimonial evidence is very misleading because any improvement can come about from many other confounding factors such as natural recovery, lifestyle changes and even a placebo effect. You can cherry pick positive testimonials but you can also come across negative ones such as this

If you like, you can read more in WebMD

What about the side effects? WebMD states these:

Bovine colostrum taken by mouth or given rectally as an enema seems to be safe for most people. While most people don’t experience any side effects from bovine colostrum, there have been rare reports of problems in HIV-positive patients such as nausea, vomiting, abnormal liver function tests, and decreased red blood cells.

There is some concern about the possibility of catching “mad cow disease” (bovine spongiform encephalitis, BSE) or other diseases from products that come from animals. “Mad cow disease” does not appear to be transmitted through milk products, but it is probably wise to avoid animal products from countries where “mad cow disease” has been found.
Special Precautions & Warnings:
Pregnancy and breast-feeding: Not enough is known about the use of bovine colostrum during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Allergy to cow’s milk: If you are allergic to cow’s milk or milk products, you may also be allergic to bovine colostrum. In that case, it is best to avoid it.

The only positive note in the WebMD article is that it may be useful in reducing “infectious diarrhea in children and patients with a weakened immune system”, as listed under “possibly effective” in the Uses section. All others are listed as “insufficient evidence”.

Is this supplement it worth your money?

Our take is no. People should be focusing their effects on a healthy lifestyle – don’t smoke, exercise, diet rich in veggies, fruits, less red meat. “Miracle” supplements benefit mostly the people who sell them.

More caution before you consume Ginkgo Biloba

We know of folks who take Gingko in hopes of “boosting their memory” or even preventing Alzheimer’s (and the latter is not true as studies show Gingko does not prevent Alzheimer’s disease) . Now there is more data to suggest caution before you decide to take Gingko. NYT reports New Doubts About Ginkgo Biloba

Millions of Americans take ginkgo biloba supplements to boost memory and prevent dementia. Studies have never found any solid evidence that ginkgo does any such thing, but it did not seem to be doing much harm.
But last month, scientists released the first government toxicology study of ginkgo biloba, which found that the extract — one of the top-selling herbal supplements in the country — caused cancer in lab animals, including an excessive number of liver and thyroid cancers, as well as nasal tumors.
The findings were somewhat surprising because ginkgo biloba has had a long and apparently benign history of human use. Although it has been associated with bleeding and cerebral hemorrhages in the elderly, there have generally been few reports of serious side effects.
The results of the study do not confirm that ginkgo biloba is dangerous to humans, but it is disturbing that the laboratory animals all tended to suffer the same sorts of injuries, said Cynthia Rider of the National Toxicology Program and the lead scientist of the ginkgo biloba study.
“We often see different targets depending on the sex of the animal or the species, finding one thing here and one thing there,” Dr. Rider said. “But with the ginkgo studies it was consistent across the sexes and the species. The liver was a target, the thyroid was a target, and the nose.”
“That consistency strengthens our conclusions,” she added.
The study concluded that there is clear evidence that ginkgo causes carcinogenic activity in the livers of mice and some evidence linking it to carcinogenic activity in rats’ thyroids.
The mice developed large numbers of multiple liver cancers, including a particularly aggressive type that is rarely seen in the rodents. The number of cancers exceeded the total in the comparison group. In some instances, the number of cancers exceeded the numbers ever seen in mice in the lab, the investigators said.

Findings in animal studies may not necessarily translate to humans but nevertheless it is disturbing to know that Gingko has carcinogenic activity. Before you ingest any herb, always ask yourself
– what are the proven benefits?
– what is the potential harm?
If in doubt, DON’T

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Do detox diets actually cleanse your body of toxins?


They’re one of the Red Flags of Quackery.  From Daily Life

The idea that the body is filled with pollutants that can be expelled by a severely restricted diet and detox supplements is not supported by science.

The above phrases are pseudo-science nonsense, designed to baffle consumers and make them think these products’ claims are based on science. Products often have celebrity testimonials, another sure sign there’s no evidence to support the claim.

Yes, chemicals can enter the body via the food we eat, the air we breathe and the drugs we ingest. But the body – specifically the lungs, kidneys, liver, gastrointestinal tract and immune system – is designed to neutralise nasties and remove waste.

It was difficult to find any large and recent peer-reviewed studies that had tested the claims of detox kits. But a group of early-career scientists, part of the group the Voice of Young Science, published a “detox dossier” that reviewed a bunch of popular detox products in 2009.

They found none of the product manufacturers were able to provide evidence for their kits’ claims, or even give a comprehensive definition of what they meant by “detox”.

“We concluded that ‘detox’ as used in product marketing is a myth,” they said.

“Many of the claims about how the body works were wrong and some were even dangerous.”

Australia’s consumer watchdog Choice came to a similar conclusion in their review of detox kits in 2005. They suggest consumers save their money.

“Detox supplements provide little or no known benefit over a healthy diet.”

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Eczema: Evening Primrose Oil, Borage Oil Not Helpful

EPO is not useful for eczema, according to a Cochrane analysis. Medscape reports

Evening primrose oil (EPO) and borage oil (BO) provide little benefit for the relief of atopic eczema compared with placebo, according to a new review published in the April issue of theCochrane Database of Systematic Reviews.

Joel Bamford, MD, from the University of Minnesota Medical School in Duluth, and colleagues identified 27 studies (19 EPO and 8 BO; 1596 adults and children overall) that evaluated the use of oral EPO or BO for treatment of eczema compared with placebo. The review authors searched the main scientific literature databases up to August 29, 2012.

A meta-analysis of 7 EPO studies showed no significant increase in symptom relief compared with placebo based on a visual analogue scale of 0 to 100 (mean difference [MD], −2.22 [95% confidence interval (CI), −10.48 to 6.04] among patients; MD, −3.26 [95% CI, −6.96 to 0.45] among physicians). Studies of BO also failed to show any significant symptom improvement; however, a meta-analysis of studies was not performed because of differences in study reporting.

Adverse effects were mild but similar for EPO and BO, were primarily gastrointestinal in nature, and ranged in frequency from 7% to 15%. One study reported that EPO may increase bleeding risk among patients receiving warfarin.

The last line is a warning to those who think EPO is “harmless”.

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