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Editor's Note: It is not so long ago that herbal medicine was the norm for pharmacy dispensing.
Known as extemporaneous medicine, prepared from basic "galenicals", it constituted at least 80 percent of a pharmacist's compounding time, circa 1960.
I have often thought that the replacement of this area of medicine in pharmacy, with higher potency manufactured alternatives, was done with little thought or cost/benefit analysis.
As recently as 24th March, 2004, glucosamine was highlighted at the Australian Pharmaceutical Summit Conference as being an effective and cheaper alternative to orthodox preparations, particularly NSAIDs.
Val Johanson echoes these comments in providing the following article.

Extracts of Professor Marc Cohen's paper: Comparison of Treatments for Osteoarthritis,
(9th International Holistic Health Conference) edited by Christopher Dean, Chairman TP Health Ltd

Osteoarthritis accounts for some of the highest medical costs in our society and afflicts an estimated one million Australians, including 90% of people over the age of 60.
It is the leading cause of disability in the elderly.

The most common conventional treatment for osteoarthritis is the use of NSAIDs which are the most commonly prescribed medication world wide and which accounts for about 5% of all prescriptions in Australia.
NSAIDs merely treat the pain of osteoarthritis and may in fact accelerate the course of the disease (Rashad, S 1989) they are also associated with significant gastrointestinal side effects as well as both renal and cardiac toxicity.
One in fifty people suffer from gastrointestinal bleeding and 10% of these people die directly as a consequence. (Day, 1999)

Glucosamine has shown good evidence as being both effective and safe in treating osteoarthritis.
It not only significantly improves symptoms of pain but it may also modify the underlying disease process and slow the progression with a reduction in joint space narrowing.
This is one of many natural therapies which have evidence to support efficacy.
Products like Chondroitin, S-Adenosyl-Methionine (SAMe), vitamin supplementation, herbal medicines such as devils claw, white willow, boswellia, ginger, and many others have also been shown to offer effective relief for osteoarthritis.

The following comparison is both startling and revealing about the choices made today in Australia, which are prejudiced against the better and cheaper treatment, in favour of the more dangerous and more expensive, but heavily promoted drug therapy.

The cost of using NSAIDS for a range of conditions in Australia today is subsidised by taxpayers at around $800 million per year, and this medication which suppresses symptoms, but often allows the disease to progress, kills around1200 people each year and hospitalises thousands more.
The PBS subsidy seduces people away from the more effective and safer product because, for example, a pensioner need only pay $3.80 for a prescription, a fraction of the real cost, while the better safer natural product is charged at the full retail price, perhaps $30 a month plus GST.

Summary:

Natural treatments which work, are much safer, help to reverse the disease and cost much less, are taxed, unsupported, and face new inappropriate controls, even though they are already produced under GMP in the world's best practise for complementary products.

It is alarming to find the current government policy supports the use of high-risk, high cost therapy such as NSAIDs through PBS subsidies, but penalises the use of low cost low risk therapies such as glucosamine through the addition of GST.

The government needs to be encouraged to support the use of safe effective therapies through appropriate funding models and policies, for avoiding or ignoring these treatments deprives Australians of safe and effective options.

A campaign to educate doctors on how to access up-to-date information on complementary medicines is urgently needed to improve the health of all Australians.

Selected References (see Cohen's article for full list of 47):

Cohen, M. (2003). "Complementary Therapies for Osteoarthritis". AIMA Holistic Healthcare in Practice: 58-71

Day, R.R., R., D; Roughead, EE; (1999). "Towards the safer use of non-steroidal antiinflammatory drugs." J Qual CLin Practice 19:51-53

Rashad S, R.P., Hemingway A, et al. (1989). "Effect of non-steroidal anti-inflammatory drugs on the course of osteoarthritis." The Lancet 2 (519-522).

Segal, L. (2002). Priority Setting in Osteoarthritis. Natural Healthcare Summit, Darling Harbour, Sydney.