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Chondroitin, a dietary supplement used to treat osteoarthritis, is ineffective, a new meta-analysis -- a study of published research -- finds (Review, p. 580). The authors selected 20 trials comparing chondroitin to placebo or no treatment and found that chondroitin had little effect on knee or hip pain caused by arthritis. Although few adverse side effects were reported, the authors conclude that chondroitin use should “be discouraged.” In an accompanying editorial, a writer notes that the market in the United States for chondroitin and glucosamine (usually sold together in the U.S.) tops $1 billion/year (Editorial, p. 611), and writes that despite these findings, “chondroitin sulfate should not be considered dangerous. If patients say that they benefit from chondroitin, I see no harm in encouraging them to continue taking it as long as they perceive a benefit.”
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In a clinical trial testing two different ways to treat Helicobacter pylori infection (a common cause of stomach ulcers), researchers found that four antibiotics given sequentially cured the infection more often than standard treatment with three antibiotics taken together for 10 days (Article, p. 556). The cure rate for the sequential treatment was 91 percent compared to 71 percent for the standard treatment. The sequential regimen was also more effective than conventional therapy for patients with certain antibiotic-resistant H. pylori bacteria.
The line between human research, which generally is given oversight by Institutional Review Boards, and quality improvement (QI) practices, which generally are not, is blurry and troublesome. A group of 21 medical ethicists, health planners and administrators considers the situation and its consequences and suggests a method to analyze and oversee the ethics of QI activities. An editorial writer says that the degree of “scrutiny and oversight for an activity should vary, regardless of whether the activity is called QI or human subjects research,” and suggests an “oversight triage system” to decide what kind of review each activity requires. (The article and editorial are published online, www.annals.org, beginning April 17, 2007. They will be available in the May 1, 2007, print edition of Annals of Internal Medicine.)