Sunday, September 11, 2011

CAM Watch Sept 2011

Here we go with the roundup of CAM trials from the last several months. While admittedly this is not a rigorous review, my methodology is to pull out all the trials of CAM from all the journals I read and then review them periodically.

1. Cranberries vs. Antibiotics for urinary infections: NEGATIVE
Beerepoot et al. reported on 221 patients with recurrent urinary tract infections (UTIs) in a randomized trial comparing daily antibiotics to daily cranberry capsules. Neither was very effective, but more women taking cranberry capsules had repeat UTIs (78.2% versus 71.1% with antibiotics). Average time until a repeat UTI was 4 months for cranberries and 8 months for antibiotics.

Yeh et al studied 100 patients with heart failure and randomly assigned them to Tai Chi or a series of educational lectures. The outcomes included how far a patient can walk in 6 minutes and concluded that Tai Chi improved walk distances more than the control lecture group. The accompanying editorial did not mention this at all, but it is hardly an adequate comparison to have one group do exercise (Tai Chi) and another group sit in a lecture (control group) and then measure their ability to exercise as your primary outcome. It would have been equally inadequate to compare Tai Chi to lectures with the outcome being how well they score on a written test about heart failure.

3. Glucosamine, chondroitin, or placebo for osteoarthritis of the knee: INCONCLUSIVE
Wandel et al performed a meta-analysis on these substances. They reviewed several databases of trials and selected 10 trials with adequate follow-up and similar outcomes for comparison. They found that glucosamine alone, but not chondroitin and not a combination statistically reduced pain, but not by a clinically relevant amount (0.4 points on a 10 point scale). The authors prespecified a reduction of 0.9 points to be the minimum that they would consider clinically meaningful, so they concluded that none of these agents was effective. The meta-analysis has received criticism and a review in Annals of Internal Medicine took issue with their methodology, and it is therefore difficult to be sure about the effect of glucosamine/chondroitin from this study. Thankfully we have other, less criticized meta-analyses to rely on which do show no effect of glucosamine/chondroitin.

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