Stacking the Deck?
How to Get the "Right" Answer
in Clinical Research
There are three kinds of lies: lies, damn lies, and statistics. —variously attributed to
Disraeli and Mark Twain
IF YOU HAVE arthritis, an injection of "oil" to "lubricate" your joints sounds very alluring. Some of my (Rick's) patients have used just such a metaphor in requesting injections of hyaluronic acid, recently marketed for treating osteoarthritis (the common "wear and tear" kind of arthritis). Hyaluronic acid is the component of joint fluid that gives it lubricating qualities, and it's low in arthritic joints. "Adding a quart of oil" is an almost irresistible approach, and preparations of hyaluronic acid made it seem possible.
The results of a clinical trial published in 2002 seemed to support the notion. Researchers randomly assigned 120 patients with osteoarthritis of the knee to get injections of hyaluronic acid; an oral antiinflammatory drug; both; or neither. Placebos were used to assure that neither doctors nor patients knew who was getting active treatments. After several weeks of treatment, pain and walking ability were measured. The analysis and conclusions of the authors indicated that the hyaluronic acid injections were effective. The study was supported by