The placebo effect may explain success of some supplements

DEAR DR. ROACH: Are there any recognized benefits from taking either saw palmetto or glucosamine/chondroitin, both of which I have been taking — and paying for — for years. — P.F.

ANSWER: Saw palmetto has been used widely to treat prostate symptoms in men, but the data supporting its use are conflicting. A 2012 review of 32 randomized trials found no benefit in saw palmetto over placebo in urinary symptom scores, prostate size or urinary flow rates.

Glucosamine sulfate and chondroitin often are used together for the treatment of osteoarthritis. The data also are conflicting in the case of osteoarthritis. Some studies show greater improvement in symptoms for those taking glucosamine sulfate and chondroitin than in those taking a placebo, while others show equivalent results for both groups. However, in a large trial, 60 per cent of participants experienced at least a 20 per cent pain reduction whether they took placebo, glucosamine, chondroitin or both, which just shows how powerful the placebo effect can be.

Since the adverse reactions to glucosamine sulfate and chondroitin are negligible, it is certainly reasonable to give it a try. If it helps reduce pain, it doesn’t really matter whether it’s a “real” effect or placebo. The important thing is that it helps. Saw palmetto has rates of adverse reactions that are similar to placebo, so if it seems to help, and most importantly, if the improvement is worth the cost, you can continue.

DEAR DR. ROACH: I am a 69-year-old man in reasonably good health. I don’t take antibiotics very often, but when I do I am restricted to a small variety of drugs because of penicillin and sulfa intolerances. As a child I was given penicillin and suffered convulsions and hives. Currently, anything with a penicillin or sulfa derivative gives me the hives. Any alternative suggestions? — M.P.

ANSWER: The first answer is not to use antibiotics at all if you can help it. Often physicians prescribe antibiotics unnecessarily because we feel pressured by patients. I must admit that’s not a good excuse. We shouldn’t prescribe them unless there is a clear indication for their use. “Bronchitis,” most ear infections and most sinus infections are not good reasons to prescribe antibiotics. However, if you tell your doctor that you want to avoid antibiotics, it’s a lot less likely you will be prescribed them.

As for alternatives, there are many other classes of antibiotics. Cephalosporins, although related to penicillins, can usually be used in people with a history of hives to penicillin, but not in people with a very severe reaction, like anaphylaxis. Erythromycin-like drugs are an option. Tetracyclines are useful and often forgotten about. Ciprofloxacin and drugs like it have increasingly recognized problems but can be used when there are no other good options. There are a few others that are seldom used and then only for particular indications. The less you take antibiotics, the more likely it is they will work when you do need them, and the less likely you will have a side effect.