PAIN-full lessons from medical school and NEJM misrepresenting Glucosamine for Osteoarthritis

Brilliant skillful detail-oriented medical school professors can be completely careless about details related to nutrition and biochemistry, even regarding topics that impact their own specialty.

Jun 28, 2022

“This night has opened my eyes, and I will never sleep again.”
Morrissey/Smiths (video below)

Continuing on the theme of pain and the successful/failing paradigms that guide our treatments of pain, I will here briefly mention a few coincident occasions that provided some insight not for the treatment of pain as was the supposed intent of the original communications but rather for the commitment to paradigm that was revealed; I will start each of these brief sections with the conclusion, then provide the details:

Medical journals will publish fraud and bad research if it supports the pharmaceutical paradigm and pleases their drug advertisers: This clinical trial (see image/abstract below from N Engl J Med 20061) was obviously bogus because they knowingly used an inferior form of the product (glucosamine hydrochloride) which had already been established to be inefficacious relative to the more effective form (glucosamine sulfate). Also and very importantly, glucosamine typically needs more time than does a faster-acting pharmaceutical drug, so the relatively short duration of this study is suspect because it clearly favored the pharmaceutical drug which was conveniently produced by the same drug companies that sponsored many of the authors of this paper.
- WHAT I WOULD HAVE PREFERRED: Medical journals should reject incompetent or overtly biased research so that the entire body of science is able to maintain its integrity without being contaminated by such obvious infomercials.
Most doctors and journalists/reporters in the mass media don’t know how to read for detail and/or don’t care about details: People who haven’t studied the details cannot know the details, in this case that glucosamine sulfate is superior to glucosamine hydrochloride.
- WHAT I WOULD HAVE PREFERRED: Legitimate journalism and legitimate editing would have prohibited the publication of data such as this, which eventually has consequences for millions of people worldwide and ultimately billions of dollars in healthcare expenses. Furthermore and perhaps even more concretely is the fact that relegating osteoarthritic patients to surgery obviously imposes great risk, pain and other burdens on them.
Lies published in medical journals are quickly echoed in medical textbooks and become part of medical education…and are distributed for free even when other articles from the same journal are available only via a paid subscription: Soon after this article was published it was cited in a medical textbook that we actually used in our medical education within that same year. This is very impressive – the speed at which this article was used within authoritative medical textbooks. In contrast, we see successful nutrition studies replicated and yet ignored for decades simply because they don’t promote the pharmaceutical model. Of additional note, the article being discussed here from the New England Journal of Medicine 2006 February (see hyperlink and image below) was provided to the public for free because it slammed nutrition and promoted drugs whereas most of the other articles from the same Journal are available only via paid subscription; obviously this tilts the balance and availability of information against nutrition and in favor of drugs and medical procedures, with obvious consequences against science, against informed patient choices, and in favor of drug sales and the sales of medical procedures.
- WHAT I WOULD HAVE PREFERRED: I would prefer that our medical education and medical textbooks weren’t so biased against natural products/treatments and were more focused on health and its maintenance and restoration rather than selling pharmaceutical drugs and medical procedures.
Brilliant skillful detail-oriented physicians and surgeons can be completely ignorant and careless about details related to nutrition and biochemistry, even regarding topics that impact their own board-certified specialization: Around this same time which would have been approximately 2008, during a lecture hosted by our medical school professor of orthopedics, who was himself a board-certified orthopedic surgeon who was very skilled both as a surgeon and as a professor of surgery, one of our fellow medical students asked him about glucosamine and specifically its use in diabetic patients. He responded that glucosamine was probably dangerous for diabetic patients because it contained glucose, as implied by its name: glucosamine. I suppose that I sat in the classroom audience somewhat dumbfounded that he could say something so ridiculous when the therapeutic dose of glucosamine sulfate is approximately 1500 mg per day which if the entirety of that was glucose would only carry 6 calories. Obviously 6 calories one way or another is not going to have any impact on diabetes, insulin resistance or obesity. Furthermore, several studies had already shown that glucosamine actually helped alleviate obesity and diabetes, either due to a molecular and biochemical effect or simply because people have less pain and therefore could engage more frequently in exercise which would help control their diabetes and lessen their obesity. Either way you look at it, from both of these angles, our skilled and revered professor of orthopedic surgery (specializing in knee replacement as a treatment for osteoarthritis) was completely wrong even on a topic (glucosamine treatment for osteoarthritis) that abutted next to his own specialty.
- WHAT I WOULD HAVE PREFERRED: Well in this simple example I would’ve preferred that our skilled instructor would have applied some of his skill to a more accurate answer to the student’s question. This is only one example of many similar events.
Medical school professors can be completely ignorant about their own topics as long as they are perceived as being competent and successful from the medical perspective, which is notoriously narrow:
1. Orthopedics: Our professor mentioned above specialized in the treatment of joint pain yet knew absolutely nothing about a reasonable treatment option for joint pain.
2. Cellular science, biochemistry, histology: One of our professors of cellular science explicitly told us during medical school class that melatonin should not be used whereas drugs that act on the melatonin receptor should be trusted and used. This is obviously absurd because melatonin functions at its receptor but also provides many other benefits whereas the drugs act on that same melatonin receptor but without providing the collateral benefits provided by natural melatonin, which I have reviewed here at the healthythinking.substack.com website.
3. Endocrinology: Our board-certified endocrinology professor in medical school told us on at least two separate occasions that the most abundant steroid hormone in the human body (DHEA) provided no function within the body and therefore provided no benefit when supplemented for clinical reasons. I was completely aghast at his comment and so I compiled a few documents and sent these to the 170 students in our class to gently “supplement” the course lecture – our aggressive exmilitary pitbull Dean of Medical Education immediately emailed me in response and said that I would never send an email to the class again that in any way contradicted our professor… even when our professor was lying to our entire medical class.
4. Medical Dean: When I asked our Dean of Medical Education (ie, Mr Big Man on Campus) if we were going to have any education about nutrition he said we would get everything that we needed within our basic science courses, magically supplemented by the unstructured hospital rounds and clinical rotations. I can honestly tell anyone and everyone that we never had a single word about clinical nutrition during our entire medical education, and I'm supremely confident in this conclusion because I of course was listening for anything related to my favorite topic and I was also an “Honor Student" scoring at the top 10% of our medical school class; if we had ever received any instruction on nutrition I certainly would have absorbed it like I did everything else. I WOULD HAVE PREFERRED that we had had some legitimate training in clinical nutrition just as we detailed molecules and electrons in every other topic.