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Health Report:

Universal Healthcare Insurance Study

Glucosamine & Arthritis



"A critical weekly review of important new research findings for health-conscious readers..."


By, Robert A. Wascher, MD, FACS


Photo of Dr. Wascher

Last Updated: 2/23/2008


The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

UNIVERSAL HEALTHCARE INSURANCE STUDY

As we continue to struggle with the explosive increase in healthcare-associated costs here in the United States, all the while more than an estimated 43 million Americans have no health insurance overage at all (and many millions more have grossly inadequate coverage), there is a growing consensus that some sort of universal healthcare insurance system needs to be implemented.  As I have discussed in previous columns, the two enormous governmental healthcare entitlement programs (Medicare and Medicaid) currently in place simply cannot be sustained indefinitely if the costs of these programs continue to rise at projected rates.  But there continues to be intense debate, among healthcare policy experts and politicians, regarding the best approach to implementing a universal healthcare insurance system in the United States.

A new report in the Annals of Internal Medicine provides a very useful glimpse of the results obtained, in Taiwan, after the 1995 implementation of a national universal health insurance system in that island nation (or, if you adhere to the Beijing’s perspective, a province of China).  Healthcare coverage in Taiwan increased dramatically, from 57 percent prior to the introduction of this national healthcare insurance system, to 98 percent of the population after its implementation.  Looking at a decade’s worth of public health statistics following the activation of this national insurance system, financed by payroll taxes, government subsidies and individual premiums, this research study specifically evaluated the impact of universal healthcare insurance on life expectancy and preexisting healthcare disparities throughout Taiwan.

The death rates for all 358 townships in Taiwan, with a total population of approximately 23 million, were analyzed, both before implementation of universal healthcare insurance and 10 years after implementation.  Modest decreases in deaths due to cardiovascular disease, infectious diseases, accidents and other illnesses were observed after implementation of universal healthcare coverage.  Significantly, the townships where death rates were highest, historically, appeared to benefit the most after universal healthcare coverage became available.  (Unfortunately, and unexpectedly, death rates due to cancer actually increased somewhat in these same townships following the introduction of universal healthcare coverage.)  Although overall utilization of healthcare services increased after the implementation of universal healthcare insurance, the overall cost of healthcare, measured as a fraction of gross domestic product, remained essentially the same, suggesting that increased healthcare services were delivered with, perhaps, greater efficiency after universal coverage became available. 

The authors note that while improvements in preexisting healthcare disparities among poorer regions of the country were observed after universal healthcare coverage was introduced in Taiwan, the magnitude of this improvement was relatively small.  They conclude their analysis by recommending that greater resources and efforts be invested in disease prevention programs, with more emphasis on lifestyle modification in particular, as a means of achieving more meaningful reductions in chronic illness and death rates, especially in regions where the rates of chronic disease and death are still very high.

 

I believe that the findings of this research contain some cautionary findings for us here in the United States as we struggle to find elusive answers to some very difficult healthcare questions and challenges that should have been addressed by policymakers long ago.  In my forthcoming book, A Cancer Prevention & Survival Guide for the Human Race, the overarching theme is our capability, today, to eliminate more than two-thirds of all cancer deaths (as well as deaths due to major non-cancer diseases as well), simply through prudent lifestyle modifications.  As the saying goes, an ounce of prevention is worth [at least] a pound of cure.  As our country searches for the right combination of improved access to affordable healthcare and a stronger preventive medicine culture, we should keep in mind that a more aggressive promotion of healthy lifestyles are likely to provide the greatest pay-off in terms of disease and death reduction, on the one hand, and reduced healthcare costs on the other hand.

 

GLUCOSAMINE & ARTHRITIS

As we age, the cartilage in our joints becomes progressively thinner and more desiccated, reducing the ability of our cartilage to absorb shocks and to resist injury.  Cumulative repetitive injuries to these natural cushions in our joints also results in progressive deterioration of the cartilage in our joints, leading to joint stiffness, pain and, sometimes, joint swelling.  Virtually all of us will develop these classic signs and symptoms of osteoarthritis as we grow older, which makes this condition a very common source of discomfort and disability in our aging population.

Glucosamine is a carbohydrate (sugar) molecule that plays an important role in the structure and function of the cartilage which lines and protects our joints.  For years, glucosamine supplements have been touted as an effective treatment for osteoarthritis.   Indeed, there have been many clinical studies that have purported to prove that glucosamine supplements reduce the symptoms of arthritis, especially in the hip and knee joints.  Unfortunately, most of these studies have been based on small numbers of patients; and on patient questionnaires, which are notoriously subjective in terms of the quality of the data collected.  However, a tiny handful of recent double-blinded prospective randomized trials (the most scientifically valid way of performing clinical research), using placebo pills versus glucosamine, have increasingly called into question the benefit, if any, of glucosamine sulfate supplements in patients suffering from osteoarthritis, including a new study just published in the Annals of Internal Medicine.

In this Dutch study, a total of 222 patients with osteoarthritis of the hip were randomized into two groups.  One group received 1,500 milligrams of glucosamine sulfate per day, while the other group received placebo pills (sugar pills that appeared identical to the glucosamine pills).  The patients in this study received these pills for a period of 2 years, and were repeatedly evaluated during this period with x-rays of their affected joints, and with previously validated pain and function survey tests.  In addition to looking for x-ray evidence of improvement in joint narrowing (as the protective cushion of cartilage in the joint is lost, the gap between adjacent bones, as seen on x-ray, becomes smaller), the researchers assessed these study volunteers for evidence of decreased joint pain and stiffness, and for improved function.

As was the case with another recent prospective randomized clinical trial, the results for this trial were very disappointing for those who had hoped to find some benefit from glucosamine supplementation.  In a nutshell, no differences in any of the outcomes studied were found between the two groups of patients.  Except for a possible and very modest benefit in a tiny sub-group of patients who had already undergone hip replacement surgery, absolutely no improvements in joint symptoms or functions were detected in the group of patients that had been randomized to receive glucosamine, and no improvements in joint space narrowing were seen on x-rays, even after 2 years of glucosamine supplementation.

This is the second recent randomized prospective study of glucosamine that has found no clinically apparent benefit in patients with osteoarthritis who take this over-the-counter dietary supplement.  Indeed, for many years, I myself took glucosamine supplements for painful joints, based upon the early, and admittedly weak, clinical data available.  As I struggled to swallow the huge, gritty “triple strength” glucosamine and chondroitin tablets twice a day, I wanted to believe that my aching joints were somehow benefiting from this supplement.  However, after the recent publication of another prospective randomized trial which, like this one, revealed no apparent benefit from glucosamine, I finally stopped taking these expensive supplements altogether.  Honestly, I have not noticed any difference in my joint pain and stiffness in the 12 months or so since I stopped taking these supplements.  (Which reminds me, when I find the time, a new book project of mine will be an evidence-based review of so-called “nutritional” or “dietary” supplements, a multi-billion dollar industry that is, essentially, almost completely unregulated by the FDA and other consumer safety government agencies….)

 


 
Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity.


Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html


Send your feedback to Dr. Wascher at rwascher@doctorwascher.net
 


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Copyright 2008.  Robert A. Wascher, MD, FACS.  All rights reserved.


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