nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Wednesday, July 7, 2010

Back Pain: OTC, Or Placebo. Which Way To Turn?

For the Misleading Article By Someone Who Doesn't Understand Science case files. 

Just a short note, so you can see how easy it is to give a false impression about medical research.  Here's the title of a piece in the LA Times Booster Shots blog (July 6):
"Study finds that glucosamine is as good as placebo for chronic lower back pain"
Now tell me that doesn't sound too bad.  The way the sentence is phrased, taking glucosamine sounds just as good as something else.   The fact that it's being compared to "placebo" doesn't really penetrate...waaaay down there in the latter half of the sentence.

So, you're left in some doubt.  What does "good as" mean when compared to something we use as a control, or as a way to show that some people do better even when given a false treatment?

Glucosamine is an over-the-counter (OTC) product that's used to help people with degenerative arthritis in their joints.  Degenerative joint disease (DJD) is a result of many years of wear-and-tear, and we all get it.  Doctors have been telling people to try glucosamine, as an alternative to prescription drugs, for a decade.  The results have been ambiguous.

But back to the article.  Here's what the title should have said, in order to be clear:
"Study finds that glucosamine is no better than placebo for chronic lower back pain"
Now we know.  You might as well take a placebo, and you're wasting your money buying it (not cheap).

For the research-minded, the research study is here.

And, for the gluttons for punishment:  Onion Peelers, (boring statistics...reader beware)
At 6 months, the mean RMDQ [pain and disability] score was the same for the glucosamine and placebo groups (5.0; 95% CI, 4.2-5.8). At 1 year, the mean RMDQ scores were 4.8 (95% CI, 3.9-5.6) for glucosamine and 5.5 (95% CI, 4.7-6.4) for the placebo group. No statistically significant difference in change between groups was found when assessed after the 6-month intervention period and at 1 year: RMDQ (P = .72), LBP at rest (P = .91), LBP during activity (P = .97), and quality-of-life EQ-5D (P = .20).

**************Resume normal English**************

If you have DJD of the lower back, welcome to the club.  So do I.

Getting older has some benefits.  This aint one of them.

Doc D


The 50 Best Health Blogs said...

I think the headline writer was being sarcastic and making fun of the supplements. After all, the article did say:

"Based on these results, the study authors concluded that recommending glucosamine to people with lower back pain wouldn't be a good idea."

Of course, some marketing genius just might use that headline in their advertising, on the assumption that people are pretty stupid. Good assumption.


Doc D said...

Over the years, I've been interviewed by a number of journalists (and a few Congressmembers..altho those weren't interviews) and my impression is they just don't "get" what they're doing. They think any story that can be strung together is a good one, right or wrong (the daughter of a friend, who writes for Fortune, once told me that's true).

There's a philosophy of journalism, widely held, that it doesn't matter whether any one writer gets it right; in the long run the mass of articles will allow discriminating readers to separate the wheat from the chaff.

That's overly optimistic in my view. See Bryan Caplan's "The Myth of the Rational Voter."

For what it's worth.

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