Cartilage and

T he health care profession and patients continue to await solid evidence about the effects of shark or bovine cartilage in the treatment of angiogenesis-dependent disease states, Some evidence has accrued that shark cartilage may have efficacy in several common diseases, including but not limited to cancer. Zealots have made unsubstantiated claims about the benefits of therapy with shark and other types of cartilage, whereas skeptics have ridiculed apparent beneficial therapeutic observations with shark cartilage products. Although many observations of the beneficial effects of shark cartilage have been considered anecdotal, overall, I believe that a number of these observations are not explicable by chance alone. These prevailing contentions are the main reason an in-depth review of cartilage therapy should be commissioned. The manufacturers of shark cartilage who are selling cumulatively up to 50 million dollars of product worldwide should fund objective research. In October 1995, a group of scientists and clinicians assembled in Elmsford, New York, to review the current evidence for the safety and efficacy of shark and bovine cartilage in disease management and to determine new directions for cartilage research. This scientific meeting was led by Abraham Mittelman, M.D., of New York Medical College, Valhalla. My unpublished review of the world literature on shark cartilage provided a framework for discussion at the meeting. This meeting identified several issues, including the need for further controlled clinical trials of cartilage products in angiogenesis-dependent disease states and more basic science research to identify the active constituents of cartilage and their putative in vivo effects. The panel of scientists thought that early observations, in pilot trials, of shark cartilage for osteoarthritis were promising enough to justify larger-scale clinical trials to investigate potential efficacy. The notion that shark or bovine cartilage is effective in cancer treatment was regarded as still "unsubstantiated" by the group. I agree with this conclusion.