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19 February 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656. Past highlights are accessible as well.

1. Glucosamine No Better Than Placebo In Reducing Hip Pain

A new, two-year, randomized, placebo-controlled trial found that glucosamine sulfate was no better than placebo in controlling hip pain, the ability to do normal activities and the progression of hip osteoarthritis (Article, p. 268). Glucosamine is a natural substance found in healthy joint cartilage.

Editorial writers caution that the 222 adults in the study had early arthritis, which might differ from more advanced and severe arthritis (Editorial, p. 315). The writers also say that osteoarthritis is a heterogeneous and chronic condition and the mechanism of action is still not known, so “its place in the treatment of osteoarthritis is still being debated.”

2. Lessons Learned: Taiwan’s Universal Health Insurance, Begun in 1995

Life Expectancy Improved for Least Healthy, but Only by Small Margin

A study of Taiwan’s ten-year experience with universal health insurance found that life expectancy increased most among the least healthy. Utilization and health care expenditures increased, although percentage of GDP spent on health care remained at five percent to six percent (Article, p. 258). The insurance program did not address prevention and lifestyle issues such as smoking, chewing betel quid, overeating and lack of exercise. Notably, a motorcycle helmet law cut deaths from motorcycle accidents, contributing to increased life expectancy, but death from cancer and diabetes actually increased.

Editorial writers note that the life expectancy figures are mitigated by that fact that in Taiwan about 57 percent of the population had health insurance before the universal plan took effect in 1995 (Editorial, p. 313). They say the study findings suggest that the most benefits accrued to those who were the least healthy and most vulnerable. The editorial writers delved into Taiwan’s combination of cost control methods and conclude that the long-run sustainability of the Taiwan health insurance system is in question. They offer suggestions about what the Taiwan experience can teach the United States.

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