How Long Do You Wait for a Therapy to Be Proven Effective (aka, Waiting for Godot)

waiting_for_godot_kings

Ian McKellan and Patrick Stewart in “Waiting for Godot”

Waiting for Godot (GOD – oh) is a play written by Irish playwright Samuel Beckett in which two characters named Estragon and Vladimir wait endlessly – and in vain – for the arrival of someone named Godot.*  They talk, they wait, they are understanding, they are patient – and Godot never shows up.  Great play.

“Good things come to those who wait,” is a time-honored saying, and there’s a lot to be said for it.  But at least one of the lessons of Beckett’s play have apparently been lost on some portion of the horse world.  One wonders:  at what point should one run out of patience, and should it start to dawn that nothing is likely to happen?

When it comes to many of the therapies that horse owners have to decide from I think that the time is long since past, including such things as “nutraceuticals,” as well as many of the “alternative” therapies (that’s not all of them, to be sure, but this article can only be so long).

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The Piazza Navona, inspiration for joint supplements

Lets start with nutraceuticals.  Words are constantly entering the English language.  In the 1960’s, “FAX” was just a mispronunciation of things that are said to be true; a “laptop” was where infants were bounced.  The word “nutraceutical” was coined by an MD, Dr. Stephen DeFelice, “While strolling at the Piazza Navona late at night in Rome in the early 80s.”  It’s a combination of the words “nutrition” and “pharmaceutical.”  Dr. DeFelice was instrumental in the formation of this huge industry – it includes products such as glucosamine and chondroitin sulfate (CLICK HERE to read about them).

Dr. DeFelice also has stated that, “The best way to establish the effectiveness of a nutraceutical is in a clinical study.”  Unfortunately, mostly, people seem to have forgotten about that (or don’t care).  More on that later.

scam-artist

In training for nutraceutical sales

Call me old-fashioned, but I like to think that if somebody is selling you something, they have an obligation to tell you the truth about it.  So, I think it’s not OK for someone to sell you a stereo, and then have you find out later that it doesn’t work, and that it was stolen two weeks ago.  People generally have a moral and ethical obligation to sell you a product that works, and that is what it says it is.

People in the nutraceutical industry seem to have forgotten this, however.  “Nutraceutical” products are food or food products that claim to be able to improve a horse’s health.  The products can include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites.  They’ve been loudly advertised for years – it’s pretty much impossible to walk into a tack and feed store without running into any number of attractively packaged bottles, canisters, or buckets.

self promoAccording to the North American Veterinary Nutraceutical Council (NAVNC), which is an organization set up by nutraceutical makers for their own products – it’s sort of like General Motors running the “People for Cars” movement – a nutraceutical is, “A substance produced in purified or extracted form which, when administered orally to patients, aims to provide them the necessary elements for their structure and normal function to better their health and well-being.”  That’s all well and good – and it means exactly nothing.  You can “aim” to do about anything – whether you can do it or not is a whole different thing entirely.

Anyway, all of these products do have a few things in common, no matter what it is that they are supposed to do.  In general, these are:

Lincoln-Assassination

Mrs. Lincoln’s enjoyment of “Our American Cousin” being interrupted

1.  They have wonderful, but somewhat vague, claims of effectiveness

2.  They are not subjected to testing for content or purity

3.  They are not subjected to regulation

4.  They are attractively, and sometimes even conveniently, packaged

5.  They don’t have to prove that they do what they say they are going to do

Other than those five things, there’s a lot to recommend these nutraceutical products.  Otherwise stated:  “Other than that, Mrs. Lincoln, how was the play?”

Try as I might, I cannot think of another industry that is so successful with so little to back it up.  And when I say, “Successful,” I mean “successful.” The worth of the nutraceutical industry in the US is closing in on $100 billion dollars, and the value of the industry is thought to be slightly higher in Europe and Japan.  The nutraceutical industry is big business.

If it seems like there’s a new product coming down the pike every few minutes, that’s only because there is; everyone seems to want to get in on a piece of the nutraceutical pie.  But what’s not coming along with these products is information that shows that they actually do anything.

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One of your vacation homes, should you be able to cure or prevent osteoarthritis

Anyway, possibly the biggest market for nutraceuticals is the osteoarthritis market.  Osteoarthritis is one of the more important problems facing horses – pain and inflammation in the joints is one of the main reasons that horses end up being unable to perform as their owners would like (CLICK HERE to read about osteoarthritis).  If someone could come up with a way to effectively prevent,  treat, or even slow down osteoarthritis, that person’s fortune would make the fortune of Microsoft’s Bill Gates look like chump change.  And, so far, even though are some things that we can do to help manage pain and inflammation, no one has an effective treatment to achieve those goals.

Of course, the sad fact that there’s no known treatment that can prevent the development of osteoarthritis doesn’t stop products for claiming that they can, and do.  Not directly, of course.  If they made direct claims, the products would be drugs, and would have to be tested as such.

Since they can’t make drug claims, they’ll make other claims.  For example, depending on the product, nutriceutical products for arthritis may say they offer:

blah copy– “Comprehensive, multi-faceted joint health management!”

– “Formulas designed to provide different levels of support depending upon the overall joint health of your horse!”

– “… high quality, cutting edge supplements that provide support in maintaining the health, performance, and longevity of our horses…”

Really, though, can anyone say what those words mean?

Anyway, recently, researchers in Belgium and Canada decided to get together and look at the scientific evidence in support of various nutraceutical products for the osteoarthritis in horses, dogs, and cats (CLICK HERE to read the paper).  They searched for all of the clinical trials published in English or French prior to December 2010.  They went through the best trials in horses, dogs, and cats, on stuff like glucosamine, and chondroitin sulfate, and soybean extracts, and avocado extracts, and green lipped mussels, and myristoleic acid (Cetyl-M), and methylsulfonylmethane (MSM) and here is what they found:

“The evidence of efficacy of nutraceuticals is poor.”  That’s pretty clear, isn’t it?

profit

Evidence is not allowed to interfere with the trajectory of the bottom line

The way I look at it, it’s only been a few decades that people have been selling this stuff to horse owners.  And they’ve been doing a very good job:  a good job selling, that is.  You’ve got nutraceutical companies sponsoring events and classes, and buying up ad space in horse magazines like it’s going out of style.  You’ve got them pushing their products through feed stores and even through veterinary practices.

But what you don’t have is an accumulation of good evidence that they do anything (and you have lots of evidence that they don’t)And, frankly, I wouldn’t hold my breath waiting for evidence – with the money these companies are making, why in the world would they want to fund studies that might cut into their profits?

So, back to the play.

ESTRAGON:  Nothing to be done.
VLADIMIR:  I’m beginning to come round to that opinion.

Really, at this point, you’ve got one of two options, when it comes to nutraceuticals and osteoarthritis.  You can read the labels, buy a whim and a prayer, and hope that your horse doesn’t get osteoarthritis, hoping that he gets somewhat better with the promised “support.”  Or, you can save your money, and wait for good evidence of effectiveness before you buy a products.  But given their commercial success, if you wait for that to happen, well, you might as well wait for Godot.

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* As a service to those of you that are really into theater, you can read the entire play if you CLICK HERE.

 

About Doctor Ramey

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