Glucosamine in osteoarthritis

Our company sells Arthro-Aid (glucosamine hydrochloride) because we believe that it is a valuable product that osteoarthritis patients want, for sound therapeutic reasons. Mark Adams

implies to the casual reader that glucosamine’s alleged effects are a creation of unscrupulous advertisers and merchants. In fact there is no more hype associated with glucosamine than anything else that uses the services of advertisers—including conventional pharmaceutical companies. Advertisers will always operate just within the bounds allowed-which here in Australia at least, are fairly restrictive and responsible.

Contrary to Adams’ assertion, there is plenty of rational information “out there” about glucosamine-including conservative judgment of its effects, and cautionary statements about possible effects on diabetes. For some reason glucosamine (which in 750 mg capsules is about as natural as paracetamol) has acquired a reputation as a complementary medicine drug. The result of such tagging of glucosamine is that a polarisation has occurred in the medical community; clearly the alternative label is a red flag to Adams, perhaps skewing his impartiality.

Adams uses the classic approach of damning with faint praise. For people in pain, even a mildly effective treatment is better than nothing, especially when they do not have adverse gastric effects from it. Similarly, although I look forward with interest to understanding glucosamine’s mechanism, how long its effects last, whether it can improve underlying disease, and so on, patients are probably going to care less for these aspects than for short-term pain relief. Adams forgets that many medical procedures are yet to go through the evidence-based medicine mill; none theless they still get used.

Caution is always recommended with any drug. If caution were always a reason to abstain there would not be much medicine practised or therapeutic drugs used. What is more relevant is the risk/benefit ratio, which for glucosamine seems rather better than for the NSAIDs.

Reputable pharmaceutical companies exist who produce high quality glucosamine. As Adams points out we should not confuse properties of glucosamine with its marketing and regulation. Unsatisfactory products are an important consumer issue, but not a scientific issue. It might be more constructive for Adams to encourage patients to choose quality products, while appealing to the Regulatory authorities to enforce quality standards. Certainly in Australia the Australian Therapeutic Goods Administration can and does regulate glucosamine with acceptably high levels of purity combined with restrained, responsible marketing; I fail to see why it cannot be done elsewhere.