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A closer look at vitamin injections

Vitamins are magic. Especially when they’re injected. Roll up the sleeve, find a vein, insert a needle and watch that colourful concoction flow directly into the bloodstream. It may sound somewhat illicit, but that person infusing it is wearing a white coat, and you’re sitting in a chic clinic. There must be something to it, right? Intravenous vitamin injections are popular with celebrities and have even been described by Dr. Oz as “cutting edge”. Advocates claim vitamin injections can benefit serious conditions like cancer, Parkinson’s disease, macular degeneration, fibromyalgia, depression, and that modern-day obsession, “detoxification”. And vitamin infusions aren’t just for the ill. They’re also touted as helpful for preventing illness, too. A search for vitamin injections brings up millions of hits and dozens of advertisements. There is no question that vitamin injections are popular. But despite all the hype and all the endorsements, there is no credible evidence to suggest that routine vitamin infusions are necessary or offer any meaningful health benefit. Vitamin infusions are a marketing creation, giving the illusion you’re doing something for your health, but lacking any demonstrable efficacy. What’s more concerning, providers of vitamin therapies target their marketing at those fighting life-threatening illnesses like cancer, selling unproven treatments in the absence of good scientific evidence that they are beneficial.

The intravenous vitamin industry is a sideshow to science-based health care. Yes, there is an established medical role for injectable vitamins, though it’s no energy-boosting cure-all – they’re used to replace what we should obtain in our diet. As a hospital-based pharmacist I used to prepare sterile bags of total parenteral nutrition (TPN), a mixture of vitamins, carbohydrate, protein and fat that completely replaced the requirement to eat. TPN is effective, but not without risks, and far less preferable than getting your nutrients the old fashioned way – by eating them. There’s also the routine use of injectable vitamins like B12, or iron, all of which can be science-based when used to address true deficiencies, or to manage specific drug toxicities. And there is the therapeutic use of high-dose minerals like intravenous magnesium for acute asthma attacks. But there is no medical justification to infuse vitamins into a vein when you can more appropriately obtain those nutrients in your diet.

So if they’re not necessary, where does the demand come from? A review in the Globe and Mail illustrates the hype and the promise:

Alison Dantas, chief executive officer of the Ontario Association of Naturopathic Doctors, says people’s fast-paced, frenetic lives are what is prompting more interest in naturopathic medicine and IVMT [intravenous micronutrient therapy]. While underscoring the difference between a recreational boost like caffeine and the injections, which must be given by trained professionals, she takes no issue with their trendy turn. “It raises awareness about complement therapies and medicines that assist people in staying healthy,” she says.

Of the 867 practising naturopaths in her province, Dantas says, 156 are intravenous-certified. She expects that number to increase. “We see a growing need because of the lifestyle of the population; it’s very effective in mitigating the risks of chronic disease but also managing chronic disease,” she says of Myers’ cocktail.

A 2011 survey by Caulfield and Rachul observed that that IV therapies are among the most popular services advertised by naturopaths. If it’s not “Myers’ cocktail”, (the intravenous version of a multivitamin pill), it’s high-dose vitamin C, which is explicitly marketed to cancer patients (One naturopath even recommends a video “Vitamin C better for cancer than chemo“.) Nothing subtle about it. Like Myers’ cocktail, vitamin C infusions are also touted as a panacea for the prevention or treatment of pretty much everything. As noted above, naturopathy organizations explicitly endorse the practice, and have even created a certification for the service. Given naturopaths argue that naturopathy is scientific and that the services they offer are science-based, I took a closer look at the scientific evidence supporting these services.

The Premise
Blame Linus Pauling. Actually, to be fair, the idea of injectable vitamins precedes Pauling. But Pauling, with two Nobel Prizes, brought attention and interest to vitamin C far beyond what any evidence suggested. He seized on the observation that many species can produce their own vitamin C, while humans, apes and some other species lack this ability. Pauling surmised that some disease may be due to vitamin C deficiency, which could be addressed with massive supplements. Linus moved from vitamin C for colds and on to vitamin C for cancer, teaming up with surgeon Ewan Cameron to conduct a clinical “trial” which claimed efficacy, but was so poorly designed no conclusions could be drawn. He continued to tout the potential of vitamin C, wrote a few books on the subject, and founded the Linus Pauling Institute of Medicine, creating the foundation for the entire “orthomolecular” pseudoscience you see today. (Orac has more.) Unfortunately it seems Pauling was a victim of Nobel disease, where prize-winning scientists subsequently become enamored with scientifically unsound ideas. At the time of his death in 1994, Pauling’s vitamin C theories were considered quackery within the scientific community, but those ideas had gone on to be embraced and widely promoted by complementary and alternative medicine (CAM) purveyors.

Fast forward to today, and not much has changed. Pauling’s theories on the efficacy of vitamin C have never been substantiated. Despite the lack of evidence, the routine use of vitamins has continued to expand in popularity over the years. With the growth in sales of vitamin pills, there seems to be a similar rise (though admittedly hard to quantify) of intravenous vitamin injections. The most popular seems to be Myers’ cocktail, an arbitrary concoction of vitamins and minerals including magnesium and calcium. It’s named after Baltimore physician Dr. John Myers who apparently administered injectable vitamins to his patients regularly. After he died in 1984, the practice was taken on by another physician, Dr. Alan Gaby. Gaby admits that he doesn’t know what was in the original Myers’ cocktail, so he made up his own recipe and took on the practice of offering multivitamin injections for the treatment of various maladies. The use of Myer’s cocktail seems to have gained more prominence after an article by Gaby appeared in Alternative Medicine Review which is essentially a collection of anecdotal claims of benefit for conditions that include asthma, migraine, fatigue, fibromyalgia, depression, cardiovascular disease, upper respiratory tract infections, allergies, urticaria, narcotic withdrawal, athletic performance and hyperthyroidism.

The advertisements you’ll find online above make it clear – it’s not what vitamins are good for – they’re clearly good for everyone. Infusions run from $50 to $250 for a few pennies worth of vitamins delivered intravenously. You’ll find no shortage of explanations from providers as to why intravenous injections are superior to dietary sources, from food sensitivities and “intolerance”, to greater demand by the body in times of disease or recovery. There are even claims the higher levels in the bloodstream “coax” vitamins into the cells and mitochondria, where presumably they’re beneficial. It sounds impressive, but these claims betray a profound ignorance of physiology and biochemistry. Strangely missing from these descriptions is an explanation why pushing megadoses of vitamins directly into a vein (and bypassing the liver’s first pass metabolism) is somehow still considered a “natural” treatment.

The Villains
As expected, being a pharmacist, I’m blamed (along with other health professionals) with standing in the way of the widespread use of intravenous vitamins. Apparently it’s our bias against nutritional treatments of illness. Oh, and blame Big Pharma too – apparently you’ll never see research on a vitamin (unless you do) or on products you can’t patent (unless you do) or on cancer treatments that aren’t industry funded (unless you do). We love the prescription pad too much – but just for drugs, not for vitamins. (Never mind that it’s pharmaceutical companies manufacturing the injectable vitamins in question.) The fact that conspiracies are often cited should tell you all you need to know about the veracity of these statements. But I’ll risk the wrath of the Pharmaceutical-Industrial Complex™ and tell you the real reason science-based health professionals don’t recommend or use vitamin injections in routine practice. It’s because there’s no convincing evidence they are useful.

The Evidence Check
I looked in PubMed for evidence with injectable vitamins that would demonstrate a therapeutic or preventative effect. With respect to Myers’ cocktail, there is no published evidence to substantiate claims of efficacy for the prevention or treatment of any condition. The only paper in the medical literature is the review paper by Gaby (which collates impressive anecdotes, but no trials). Shrader published a study examining injectable vitamins for the use in asthma, but the study was unblinded with no placebo group. There is also a randomized trial by David Katz examining efficacy for fibromyalgia, which failed to show any efficacy. (Katz discusses this on Dr. Oz, and admits there’s a lack of efficacy). And that’s it for published evidence.

Looking specifically at vitamin C, there are hundreds of citations – there’s no question that vitamin C has been extensively studied. Advocates for vitamin C always find reasons to criticize the negative trials, so let’s look at the most positive trials only. Some of the “evidence” proponents of vitamin C like to cite includes the following papers:

On balance, the data supporting the use of vitamin C are unimpressive – it’s no wonder that few scientists are advocating for more use or even more research. An optimistic review article from 2009 reluctantly admitted that the evidence supporting efficacy is still lacking despite 50 years of research. When we look at current clinical trials, it’s equally unimpressive. Notably, two trials (NCT00441207 and NCT00626444) have concluded in the past few years but have still not reported any results, suggesting the results were negative.

Overall, the evidence for vitamin C seems to suggest that if there really is an anticancer effect, it is so modest that it’s not detectable in clinical trials. While there are lots of anecdotes claiming benefit, there are also ones claiming it’s useless:

Celebrated physicist Sir Paul Callaghan has ended his experimental intravenous vitamin-C treatment for cancer, saying there is “absolutely no evidence” it worked. He is concerned that alternative medicine advocates are now using his “unusual experiment” to promote the controversial treatment in a misleading way. The New Zealander of the Year, who has terminal colon cancer, began receiving high-dose intravenous infusions of vitamin C in June last year, along with several alternative herbal remedies. The 64-year-old began the treatment during a six-month break from chemotherapy, tracking its effectiveness through a blood test for protein carcinoembryonic antigen (CEA), which indicates cancer levels. Yesterday, he told The Dominion Post he had ended his experiment after analysing data from six months of blood test results. “I have, as a result, learned enough to say that there is absolutely no evidence of any beneficial effect of high-dose intravenous vitamin C in my case.”

(Callaghan died in 2012.)

Given the lack of efficacy, my take on the efficacy of vitamin C for cancer is along the lines of what the American Cancer Society recommends – get your vitamin C from your food. When it comes to the use of injectable vitamin C for other conditions, no obvious benefit has been shown. There is no evidence to support the use vitamin C infusions for the prevention of disease, or for general “wellness.” In light of the lack of documented benefit, vitamin C infusions should really only be offered (or accepted) as part of a research study, and only in situations where its use is not expect to delay the use of more effective treatments. For any other conditions, the science-based approach would be the same: maximize the consumption of vitamin C-containing foods like fruits and vegetables, rather than relying on supplements – injectable or otherwise.

The Risks
If you trust the sterile technique of vitamin infusion purveyors, and are willing to chance the small risk of infection, then the risks associated with the different vitamin infusions appear to be quite low. You generally don’t get adverse effects when there’s no effect, which may be why these products are well tolerated. While good data have not been compiled, there are also few case reports that document harms. Based on the ingredients themselves, that’s what we’d expect. Vitamin C infusions are generally well tolerated though the osmotic load (fluid shifts) from huge doses may be problematic. There are also case reports of kidney stones from intravenous infusions, an association also seen with vitamin C oral supplements. Of course there are the cases compiled at What’s the Harm?, but reassuringly, most of the documented harms seem to be the result of avoiding appropriate treatments, rather than due directly to IV vitamin therapy. There is some evidence suggesting high dose vitamin C may reduce the effectiveness of chemotherapy (reviewed in detail here). There are also specific concerns about concurrent use with bortezomib (Velcade). Given there is no demonstrable benefit to vitamin C infusions for cancer, it’s probably safest for cancer patients to avoid vitamin C infusions entirely.

The Bottom Line
With so many purveyors of vitamin infusions, one would hope the practice was grounded in good science. But it isn’t, and that shouldn’t be a surprise. Despite the lack of good evidence, there is a near-obsessive devotion to touting the benefits of intravenous vitamins while railing against the mysterious entities which are blocking The Truth. But the reality is more mundane. In the absence of a deficiency, vitamin infusions don’t do much of anything. To the worried well, intravenous vitamins are going to be a harmless panacea that just succeed in enriching the revenues of the purveyor. Just as That Mitchell and Web Look said of the homeopath, “Bottle of basically just water in one hand, and a huge invoice in the other.” So if you value health theater over health care, and don’t mind paying mightily for the illusion, vitamin infusions may be your thing.

I have a much different opinion when these products are promoted to patients fighting for their lives, particularly with illnesses like cancer. There is good evidence to show that delaying treatment or substituting CAM for established cancer treatments dramatically worsens outcomes. Touting unproven treatments and then profiting from their administration is appallingly opportunistic. Real diseases require real treatments, not fake ones. They may look sciencey, but the reality is that intravenous vitamin injections are modern-day snake oil.

Posted in: Herbs & Supplements, Naturopathy

Leave a Comment (126) ↓

126 thoughts on “A closer look at vitamin injections

  1. So I take it there are no injectable vitamins to be found in your pharmacy, Scott?

    There was a good segment on 60 Minutes about a man whose life was saved by IV injections of vitamins.

    What solution did our all-knowing allopaths had for this patient? A consent form to turn off his life support.

  2. Jann Bellamy says:

    In January, an Arizona TV station ran a story on a local “naturopathic doctor” selling expensive “nutrient bags,” given by IV, for flu prevention.

    http://www.kpho.com/story/20568926/iv-nutrient-bags-touted-as-way-to-fend-off-the-flu

    I found her ignorance about human physiology, which speaks to the poor quality of naturopathic education, as disturbing as the “nutrient bags” themselves:

    “These vitamins and minerals are the hammers and nails the body understands to put back, put itself back together again. . . For anybody, regardless of whether they’ve had flu shots or not, these IV nutrients work very well.”

    I wonder what else this “ND” doesn’t understand about the basics.

    (Perhaps keeping things sterile around the injection site. Is that a decorative pillow propping up the patient’s arm?)

    Thanks for this nice summary of another form of nonsense employed by NDs. This should be required reading for all state legislators contemplating voting for NDs.

  3. windriven says:

    “Notably, two trials (NCT00441207 and NCT00626444) have concluded in the past few years, but have still not reported any results, suggesting the results were negative.”

    The principal investigator for NCT00441207 is Christopher Lis whose LinkedIn profile describes him as “Vice President & Chief, Outcomes Research, CTCA®”. CTCA? That’s Cancer Treatment Centers of America®. ‘Nough said? Chirstopher Stephenson, DO, the ‘responsible party’ on the CT disclosure, is also associated with CTCA®.

    NCT00626444 is being managed by one Daniel Monti, MD, a psychiatrist specializing in adolescent and pediatric psychiatry. Dr. Monti is a graduate of “Republic University”, an institution that I’ve never heard of and a quick Google didn’t elucidate. You can entertain yourself with a three part youtube of Monti holding forth on the “mind-body connection”. http://www.youtube.com/watch?v=fx3h6H6vUs0 It’s a hoot, no kidding.

  4. goodnightirene says:

    And 60 Minutes is such a credible source of scientific evidence.

  5. StaphofAsclepius says:

    So you missed the part about TPN, Fastbuck? Perhaps you should reread it.

    In case that is where your confusion is:
    http://en.wikipedia.org/wiki/Parenteral_nutrition

    As to your second point:

    an·ec·dote
    /ˈanikˌdōt/
    Noun

    A short and amusing or interesting story about a real incident or person.
    An account regarded as unreliable or hearsay.

    Anecdotes are not evidence. 60 minutes is not evidence. The story is an anecdote with a flawed understanding of physiology and pathology.

  6. FYI: There’s an error on the Pauling link. There’s a trailing dot at the end that makes the URL invalid.

  7. Nutrient supplementation is only effective if a) there’s a deficiency in that nutrient AND b) an effective amount of nutrient is supplemented in an effective way.

    See also http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427206/

  8. WilliamLawrenceUtridge says:

    @Jeff

    The emphasis being, of course, on “studied” and “possible”. Whether there is any reason to believe it is or will ever be an effective main or adjunct treatment for cancer is a question for the experts…most of whom don’t seem to think so. In fact, Scott’s post links to and discusses numerous sources regarding the idea that high doses of vitamin C could ever be such a treatment. Not particularly promising.

    It’s a common CAM habit – that something might be effective, that there is a single suggestive study, are taken as gospel that something actually is effective and the only thing holding it back is conspiracy. In contrast, doctors and real medical care must advance cautiously because they are keenly aware that even apparently harmless treatments can be harmful or wasteful. That’s probably the greatest difference between CAM and real medicine, the different understanding of what “evidence” means.

  9. See http://ajcn.nutrition.org/content/85/6/1586.full.pdf

    This is a well-run (IMO) RCT by Lappe JM et al 2007 on the effect of Calcium + Vitamin D3 on bone health and all-cause cancers in post-menopausal women. Ignoring results from women who may have had undiagnosed cancer at the start of the study, the RR for all cancer diagnoses in the Ca + D intervention group was 0.232

    That’s a 77% reduction, if I’m not mistaken. Would Scott Gavura like to comment on this study?

    After having had an extremely bad experience with trolls on David Gorski’s Orac blog after asking the same question, I will not engage with anyone other than Scott Gavura. Sorry about that.

    1. Scott Gavura says:

      @Nigel:
      Lappe et al is an intervention with daily oral supplements of calcium and vitamin D. Not intravenous multivitamins or high-dose vitamin C. So the results, which are interesting, aren’t relevant to this topic.

  10. windriven says:

    @goodnightirene

    “http://wiki.eveonline.com/en/wiki/Republic_University_(NPC_corporation)”

    I saw that :-) I didn’t think I was lucky enough that that is where he actually went. I’m thinking this Republic University was either the DR or Uruguay.

  11. lilady says:

    Nigel Kinbrum lies.

    “After having had an extremely bad experience with trolls on David Gorski’s Orac blog after asking the same question, I will not engage with anyone other than Scott Gavura. Sorry about that.”

    http://scienceblogs.com/insolence/2013/05/16/the-quack-view-of-preventing-breast-cancer-versus-reality-and-angelina-jolie-part-2/

    The Respectful Insolence posts directed at him were not posted by trolls. He is fixated on that Lappe study…even after we explained the study to him. He engaged in egregious thread jacking and filthy insults; here at # 212 is his filth addressed to me:

    “Nigel Kinbrum
    May 18, 2013

    crazy cat lady miaowed…

    nigelpoo has a disclaimer on his blog…

    Hi!

    I have a BSc(Hons) in Electrical and Electronic Engineering and took early retirement from my job as an Electronic Engineer at Thales (formerly Racal) in September 2006.

    I have no qualifications in the field of diet, nutrition & fitness, which is why I back up what I write with as many clickable links to peer-reviewed studies as I can find.

    You can contact me on nigel.kinbrum@en tea ‘ell world.com (say it out loud!). No link or article requests, please!

    Cheers, Nigel Kinbrum BSc(Hons)Eng.”
    Yup, he’s definitely an OCD “Calcium/Vitamin D Cancer Cure-All Fixated” Troll.

    It’s Nigeepoo you twat, and you are most definitely a psychotic, projecting retard.”

  12. lilady says:

    @ Fast Buck Artist:

    I’m really, really, really interested in the *miraculous cure* of the swine flu virus case in New Zealand. Could you provide a citation/link to first-tier, peer-reviewed medical or science journal that details the anti-viral qualities of IV Vitamin C therapy that *cured* that patient?

    (hint) Joe Mercola’s blog is not a first-tier, peer-reviewed journal.

    http://articles.mercola.com/sites/articles/archive/2010/10/29/high-dose-iv-vitamin-c-found-useful-for-near-terminal-swine-flu.aspx

  13. Narad says:

    Dr. Monti is a graduate of “Republic University”, an institution that I’ve never heard of and a quick Google didn’t elucidate.

    It appears to be Cumhuriyet Üniversitesi.

  14. windriven says:

    @Narad

    “It appears to be Cumhuriyet Üniversitesi.”

    Interesting. I wonder how he came to be schooled there. His voice does not betray an obvious accent. Perhaps he is second or third generation and speaks the language. Turkish is an unusual second language unless one has some connection to that culture.

  15. windriven says:

    @lilady

    The four letter word in question has a somewhat different meaning in the UK than in the US. Though it is still rude it is not filthy. I am certainly no apologist for that guy but I doubt he would have used it in the usual American sense. At least I hope not.

  16. goodnightirene says:

    @windriven

    Republic University of Turkey has 50,000 students according to Wikipedia and a “Vocational School of Foreign Health Services”. I’m not here to get all ethnocentric about education, but….

    Maybe he grew up here, but went home to go to university if he couldn’t get into med school here.

    @lilady

    Thanks for that hunk of hilarity!

  17. windriven says:

    @lilady

    Think of it as an amped-up version of twit.

  18. Grant Jacobs says:

    FastBuckArtist – I’ve looked into this, e.g. Reviews & IV vitamin C as treatment for severe pneumonia .

    I’ve also briefly written about Callaghan’s trial of IV vitamin C (see ‘Vitamin C as cancer treatment – Sir Paul Callaghan reviews his trial’) and whooping cough (see ‘Whooping cough, vaccines, cocooning and the IAS’).

  19. pmoran says:

    There was a good segment on 60 Minutes about a man whose life was saved by IV injections of vitamins.

    What solution did our all-knowing allopaths had for this patient? A consent form to turn off his life support.

    What is it that you wish to say? A defence can be mounted, but the medical system cannot come out of this totally unscathed whatever we say.

    It is still a very long way from that to confidently claiming that the intravenous vitamin C saved this man’s life. That is possible, but the odds are shifted only marginally, perhaps to the degree that someone else is now more likely to try the same treatment under similar conditions, simply on the grounds that 100G of anything intravenously could have unexpected pharmacological effects.

    There is nothing stopping anyone else from trying this, and this is how medicine sometimes advances. There is no basis for extreme dogmatism either way.

    We do know from extensive study that IV vitamin C has no reliable effect upon cancer and that oral vitamin C has no obvious effect on the viral illnesses against which it has been tested.

    Pauling, incidentally, was not an advocate of IV vitamin C. He didn’t know that it was poorly absorbed orally. Most of Cameron’s cases had oral vitamin C, although a few had a initial IV dose, especially if unable to take it orally.

  20. goodnightirene says:

    @Scott Gavura

    “Lappe et al is an intervention with daily oral supplements of calcium and vitamin D. Not intravenous multivitamins or high-dose vitamin C. So the results, which are interesting, aren’t relevant to this topic.”

    Okay, I get the distinction in method of delivery, but doesn’t that leave questions–not for me so much as for certain FBA types. It seems to me that your statement in the response is the kind of thing that leaves the door wide open for people with little understanding of science to make all sorts of conclusions. It also seems a little dismissive, which is certainly not something I would ever before have attributed to you. It’s probably a misunderstanding on my part. Still, if the “results are interesting”, why not discuss that a bit?

  21. lilady says:

    I’ve done an intensive internet search (including PubMed) for mega-doses of IV Vitamin C therapy for treatment of Swine Flu and cannot locate any case studies that indicate that the practitioner (Dr. Thomas Levy, M.D., J.D.) who was summoned from the United States to treat the patient, published a case study.

    What I found was a cult-like group that is reporting the *miraculous cure* of Allan Smith, the New Zealand farmer mentioned “FastBuckArtist, by this orthomolecular medical doctor and attorney:

    http://www.youtube.com/watch?v=k0GC9Fq8lfg

    I’m still not impressed, FBA.

  22. Narad says:

    There was a good segment on 60 Minutes about a man whose life was saved by IV injections of vitamins.

    This is hilarious. FBA, are you actually from New Zealand, or do you not realize that that’s not the same “60 Minutes” that many readers would associate with the name?

  23. Grant Jacobs says:

    Narad,

    Perhaps 60 Minutes takes a mixture of international and local content, i.e. those in the USA see international + USA content (or whatever is local content for wherever they happen to be) — ?

    As for Melanie Reid’s documentary, let’s just say was sooo telling a story rather than the story. (I’d say far less kind things about it and her, but that’s also the reason I never covered the documentary itself on my blog at the time. What I did write about was about a follow-on interview with a lawyer, Vitamin C, swine flu, media, lawyers , although I did make a few passing remarks about the documentary there. Couldn’t help say something I guess.)

  24. Narad says:

    Perhaps 60 Minutes takes a mixture of international and local content, i.e. those in the USA see international + USA content (or whatever is local content for wherever they happen to be) — ?

    I’d bet my bottom dollar that that segment never aired in the U.S. The production values are wholly different, so it would have to be re-edited. I’m going with deliberate conflation, perhaps to the point of FBA’s not even having bothered to watch the video or grasp that some qualification was in order.

  25. Grant Jacobs says:

    Narad – I wasn’t saying it aired in the USA. I know it’s conflated – I said so myself. (IMHO it’s terrible journalism.) I was just pointing out that 60 Minutes likely airs with local content in different parts of the world, e.g. that it’s local content you wouldn’t see in the USA and that similarly there will be local content in others settings, i.e. it is the “same” 60 Minutes, just that’s local content.

  26. @Grant Jacobs and Peter Moran

    Of course we’d like to have a scientific trial on humans to confirm this IV treatment as legit. Trials are expensive, a statistically-significant clinical trial costs tens of millions of dollars. Who is going to finance it for non-patentable vitamin treatment? There is no return on investment for it.

    So unfortunately many naturopathic treatments like vitamin injections are stuck with small case studies or anecdotal evidence. This gives us a reputation of being magic-wand-waving crystal-ball-gazing quacks who are against science, which is not true at all. We like science and our patients like science. But what do you do when science has no answers to your patients sickness? Turn off his ECMO and bag the body or you try a treatment where only anecdotal evidence is available?

  27. windrivenon said…

    @lilady
    The four letter word in question has a somewhat different meaning in the UK than in the US. Though it is still rude it is not filthy. I am certainly no apologist for that guy but I doubt he would have used it in the usual American sense. At least I hope not.

    You are correct. I live in the UK. See http://en.wiktionary.org/wiki/twat#Noun

    I was not using the term affectionately! :-D

    lilady likes to play the “misogynist” card, which merely reinforces that particular insult aimed at her. I did apologise to everybody on the other blog for using the “R”-word.

  28. Oh, and the many “explanations” offered to me on the other blog (to trick me into making too many replies) were riddled with inaccuracies, mis-quoting and Logical fallacies. That’s typical troll behaviour.

    Please see http://nigeepoo.blogspot.com/2013/05/vitamin-d-cancer-cliques-and-flouncing.html for a full explanation of what happened there.

    I am not obsessed by the Lappe study. I believe that the results are statistically-significant and warrant further investigation.

  29. David Gorski says:

    Nigel is, of course, obsessed with the Lappe study. It is not the be-all and end-all of vitamin D research, as has been pointed out to him in great detail many times.

  30. WilliamLawrenceUtridge says:

    This gives us a reputation of being magic-wand-waving crystal-ball-gazing quacks who are against science, which is not true at all.

    What gives naturopaths such a reputation is their support for impossible (homeopathy) and improbable (acupuncture, supplements) treatments, and the arrogant willingness to treat on the basis of shoddy evidence like the tiny, uncontrolled trials you mention. Meanwhile you ignore well-founded, well-justified, genuinely scientific trials with excellent prior probability and extensive positive results.

    So anti-scientific seems rather accurate.

    You still don’t seem to grasp the difference between medicine and alternative medicine – proof. If “alternative medicine” is tested and proven to be safe and effective, it becomes medicine. Alternative medicine is thus made up of all those modalities which lack convincing evidence for safety and efficacy. Which you still don’t seem to grasp.

  31. David Gorski said…

    Nigel is, of course, obsessed with the Lappe study. It is not the be-all and end-all of vitamin D research, as has been pointed out to him in great detail many times.

    That’s not correct. I asked you a polite question on your blog. I had nothing but rudeness and poor reasoning from you and your commenters. No-one provided any decent evidence to counter Veith’s enzyme kinetics article, or the evidence explaining why some trials fail and others show toxicity. I wonder why that was?

    See http://nigeepoo.blogspot.com/2013/05/prevention-vs-cure-quackery-bias-and.html for a possible explanation.

  32. David Gorski says:

    You asked a question on the blog, and commenters tried to explain where you went wrong. As they tried to explain, you became increasingly obnoxious and insulting, leading to several complaints about your behavior. Ultimately, you flounced off before you were banned.

    Be aware that we are much less lax here than they are at the other blog. There is one here who has already been placed on “automatic moderate.”

  33. Alia says:

    And I just wonder whether these vitamin cocktails include B group vitamins. Especially in the form of cocarboxylase. As my mother (a retired nurse) always claims that cocarboxylase is one of the most painful injections possible (and my cat would probably agree, she really hated, when we had to add it to her IV fluid).

  34. Narad says:

    I was just pointing out that 60 Minutes likely airs with local content in different parts of the world, e.g. that it’s local content you wouldn’t see in the USA and that similarly there will be local content in others settings, i.e. it is the “same” 60 Minutes, just that’s local content.

    I misread your point previously. Yes, the trademark is rented out by CBS. Heaven help me should FBA cite Harlan Sanders.

  35. pmoran says:

    FBA:Of course we’d like to have a scientific trial on humans to confirm this IV treatment as legit. Trials are expensive, a statistically-significant clinical trial costs tens of millions of dollars. Who is going to finance it for non-patentable vitamin treatment? There is no return on investment for it.

    That is a factor, yet there are thousands of studies on non-patentable nutrients and herbs. Go find who finances those. Go to the NCCAM, for one.

    That’s not the real problem. The definitive research would be done if the anecdotal evidence was stronger — i.e. one or two other intensive care doctors (or even the same ones) were able to report similar outcomes in similar cases. That is how I have suggested the matter could unfold.

    It would help considerably if the surrounding science was stronger, for example if IV vitamin C was shown to possess in vivo antiviral activity or other useful pharmacology.

    Bias and economics are facts of life that we all have to deal with every day. Yet there is no level of bias and no economic factor that could not be overcome by sufficiently suggestive evidence of life-saving potential.

    Another fact of life is that every time funds are directed to one area of research, other promising ideas have to be rejected — a further reason why firming up the evidence is a far better strategy than the allegations of bias and bad faith that some members of your profession resort to.

  36. mho says:

    Clients are charged $125-$200 per infusion for IV vitamin C, which take 1-2 hrs to administer. These cancer clients get them 1-3 times per week.

    One of the ND’s who claims to have “expertise” in oncology likes to point to the U. of K. “study”, Drisco, from 2003; two patients were enrolled.

    Jeanne Drisco (at the University of Kansas) has had several trials involving cancer patients, ongoing since 2003. Clinicaltrials.gov says the results are supposed to be published, in one case by May 2013, in another by July
    2013. Ten years?

  37. David Gorski said…

    You asked a question on the blog, and commenters tried to explain where you went wrong. As they tried to explain, you became increasingly obnoxious and insulting, leading to several complaints about your behavior. Ultimately, you flounced off before you were banned.

    Be aware that we are much less lax here than they are at the other blog. There is one here who has already been placed on “automatic moderate.”

    That’s your opinion. I’ve already stated my opinion. lilady’s first comment attacked me and things with her went downhill thereafter. Funny how I got punished for replying to the barrage of troll comments, but the trolls went unpunished.

    As for the other commenters, the few who stayed on-topic gave explanations that weren’t backed up with any evidence. The IOM report was a crock, as it was based on studies with null results and studies using infrequent “standing on the moon” doses of Vitamin D. This has been covered by Lappe & Heaney, link on my blog. What substance other than Vitamin D can be taken at 5,000 x RDI (2,000,000iu/day) and survive?

    I didn’t flounce. I made a statement requesting no more comments aimed at me, a statement that was ignored by several posters – including you! I am never going to post a comment on your blog again. I am disgusted by what happened there. Your moderation there was appallingly bad.

    I’m as anti-quackery as you are, which is why I read your blog. I expected better from you. I asked for your expert opinion on it and I still haven’t had it. Why not? I’ve had a lot of inexpert opinions and logical fallacies instead.

    So, what do you think of the methodology, results and conclusions of the Lappe et al 2007 study? I will not ask you again.

  38. Grant Jacobs says:

    @ FastBuckArtiston 25 May 2013 at 4:51 am

    Of course we’d like to have a scientific trial on humans to confirm this IV treatment as legit.

    Just do it. (Provided you can get ethical approval, etc.)

    Trials are expensive, a statistically-significant clinical trial costs tens of millions of dollars. Who is going to finance it for non-patentable vitamin treatment? There is no return on investment for it.

    Other companies do trials with their products and get a return. Some IV treatment (of any kind) isn‘t some sort of ‘special case’ that gets to plead that it ‘can’t’ be trialled.

    By way of example, if a little company from southern New Zealand can develop, trial and sell bowel cancer testing from local finances, it’s hard to imagine a sincere effort for something with a larger market not being able to find funding unless the product was too dubious to invest in. (Smart investors would take advice and realise pretty quickly how sound or weak of the medical basis for the product is.)

    Don’t forget those large-scale commercial sellers of ‘naturopathic’ remedies make a lot of money. (Not putting things to trial can easily be viewed as a dodge to lazy riches.) Also, don’t forget that in this case it’s not selling consumers little bottles in a store, but a clinical procedure.

    So unfortunately many naturopathic treatments like vitamin injections are stuck with small case studies or anecdotal evidence.

    Only because those selling them choose not to, really.

    In the case of the research community taking it up, if there’s no lead for them to start to of course they won’t.

    This gives us a reputation of being magic-wand-waving crystal-ball-gazing quacks who are against science, which is not true at all.

    If you make claims without evidence backing those claims then it will be seen as hand-waving – and fair enough. (You’re writing is a bit hyperbolic and straw-man here: the thing people object to is the lack of evidence, the hand-waving claims, the begging for something to be ‘right’ in the absence of real evidence.)

    We like science and our patients like science. But what do you do when science has no answers to your patients sickness? Turn off his ECMO and bag the body or you try a treatment where only anecdotal evidence is available?

    You’re shifting away from what I my article writes about. I pointed out an easy way to learn the state of the research literature on a topic, in my example case – IV vitamin C treatment of severe pneumonia. Two different things in what you wrote: people choosing treatments that lack support and evidence. I wrote nothing about the first. Regards the latter, a single case can’t “prove” anything as it can’t test all the possible contributions to the person getting better. (More formally, control for confounders.)

  39. EEB says:

    My small intestine ruptured a couple years ago, and I only have a little over 3 ft left. So I’m quite familiar with vitamin injections, as my body has lost the ability to absorb a lot of vitamins, including B12. I would very much like to be able to avoid the frequent injections, and I would really like to avoid the not-infrequent-enough times when my potassium or calcium levels drop so low that I have to get IV infusions (especially because a few hours spent with potassium dripping into your veins should be illegal under the Geneva conventions).

    I can understand why people with incurable conditions or diseases would grasp onto the hope that vitamin objections would save them–what I can’t understand is why perfectly normal, healthy people want to go through so many of the things that I have to experience because of my medical condition! (Like vitamin injections, and a lot of the “detox” treatments and fasting just sounds like stuff I have to go through every once in a while for various reasons.) I would give quite a lot to be healthy and not have to go through all this. I just can’t see the attraction in making your life more difficult and uncomfortable than it needs to be. (To be honest, it kind of pisses me off, which I know is irrational, but there you go.)

    [Okay, possible TMI warning.] Ha. I just realized, though, that while some of the CAM types might imitate, unnecessarily, the medical treatments that keep me alive, one thing would have just destroyed them: I was on TPN exclusively for a little over six months. It sucked being NPO that long, but one consequence was that I didn’t have a bowel movement for over six months, either. I can’t imagine those detox woo types would be able to handle that very well–I’m still scarred after reading an Orac post where all these people lovingly described their daily BMs and their pathological fear that they were all “dirty” inside. Six months without would send them over the edge, I think (though I was pretty happy about it). Of course, now that I have the normal, expected result of a much-shortened and altered system, they’d probably consider me one lucky girl. Once again, I’d just rather be normal…it’s both obnoxious and amusing to see people paying hella money for “treatments” that mimic the consequences of a serious medical crisis–consequences I would love/i> to be able to escape! Oh, if only we could just switch insides…we’d both get our heart’s desire. (Although I would be afraid that I might catch Stupid.)

  40. pmoran says:

    While it may not be directly relevant to IV vitamins, I am not sure why it seems to be regarded by some as scientifically aberrant to be very interested in recent studies involving Vitamin D.

    I only follow this area medicine at some distance, but it seems to me that there is considerable data suggesting an association of low vitamin D with cancer, also that some populations (more than I would have thought) are vitamin D deficient, especially those with little exposure to the sun.

    So this is an important subject. It has almost nothing to do with the hostility between and reflex embattlement that occurs between the extremes of medical scepticism and of quackery, but somehow it seems to have become caught up in it.

  41. The search http://www.sciencebasedmedicine.org/?s=%22Vitamin+D%22 shows that Vitamin D has been discussed on SBM, including a post by David Gorski at http://www.sciencebasedmedicine.org/index.php/supplements-and-cancer-prevention/ I tackled most of the points raised by Gorski on my blog, i.e. the null results and toxicity.

    One point that I didn’t raise recently was the increased RR for CHD at high serum 25(OH)D levels. This is more a case of Vitamin K2 deficiency than Vitamin D toxicity, as under-carboxylated osteocalcin in bone Matrix Gla Proteins (MGPs) increases calcification in arteries, kidneys & brain.

    The searches http://www.sciencebasedmedicine.org/?s=%22Joan+Lappe%22 , http://www.sciencebasedmedicine.org/?s=%22Joan+M+Lappe%22 and http://www.sciencebasedmedicine.org/?s=%22Lappe+JM%22 produced no results.

    Therefore, can somebody please write an article on SBM about the Lappe et al 2007 RCT on post-menopausal women?

  42. @Grant Jacobs

    I am not sure you are aware of the huge cost of running clinical trials. I was involved in a couple myself, as an investor and investigator. The average cost of running a phase 3 trial exceeds $26,000 per each patient on trial. Thats just phase 3, not including all the previous phases.

    For treatments where the therapeutic benefit is very clear, you can run a trial with 100 patients and get a significant result. For things like vitamin injections where the benefit is less obvious, to get a statistically significant result you need 500+ patients in the trial. for a total cost easily exceeding 20 million dollars.

    Who is going to fork out the money to run this trial? You cannot patent a vitamin, they are freely sold over the counter with no prescription already, there is simply no financial incentive to run any kind of trial involving vitamins.

  43. As my comment containing five links to SBM has gone into pre-mod, I shall re-post my comment with the links removed. I don’t know if the moderators here work on a Sunday. Fingers crossed!

    “The search on SBM for “Vitamin+D” shows that Vitamin D has been discussed on SBM, including a post by David Gorski. I tackled most of the points raised by Gorski on my blog, i.e. the null results and toxicity.

    One point that I didn’t raise recently was the increased RR for CHD at high serum 25(OH)D levels. This is more a case of Vitamin K2 deficiency than Vitamin D toxicity, as under-carboxylated osteocalcin in bone Matrix Gla Proteins (MGPs) increases calcification in arteries, kidneys & brain.

    The searches on SBM for “Joan+Lappe” , “Joan+M+Lappe” and “Lappe+JM” produced no results.

    Therefore, can somebody please write an article on SBM about the Lappe et al 2007 RCT on post-menopausal women?”

  44. David Gorski says:

    While it may not be directly relevant to IV vitamins, I am not sure why it seems to be regarded by some as scientifically aberrant to be very interested in recent studies involving Vitamin D.

    It’s not, and certainly none of the SBM bloggers has said it is. That’s a straw man. Some primary care docs I know now recommend vitamin D supplementation based on the evidence. What is scientifically abhorrent and frequently seen on quack websites is the claim that vitamin D is some sort of panacea, or combining claims about vitamin D preventing cancer with claims that “natural” vitamin D made when you are exposed to sunlight is better and dismissals of any link between sun exposure and skin cancer.

  45. David Gorski says:

    I didn’t flounce. I made a statement requesting no more comments aimed at me, a statement that was ignored by several posters – including you! I am never going to post a comment on your blog again.

    And the commenters there were (and remain) very happy about that, because, quite frankly, your behavior there was, in my opinion and the opinion of several other regulars, trollish and churlish, hence the complaints about you. So a word to the wise: Tread warily here on SBM. You’re not the first troll to have made the jump here from my not-so-super-secret other blog and ended up needing to be banned. You were well on the way to banning on the other blog, but decided to flounce away before it was necessary, saving a lot of trouble.

  46. David Gorski says:

    Please see http://nigeepoo.blogspot.com/2013/05/vitamin-d-cancer-cliques-and-flouncing.html for a full explanation of what happened there.

    BTW, I too, encourage reading of the blog post, particularly the comments, particularly Nigel’s comments. Also, you might be interested in this, where Nigel brags about suing a commenter and threatens to sue lilady:

    http://nigeepoo.blogspot.com.au/2013/05/am-i-being-unreasonable.html

    I also encourage comparing Nigel’s version of events to what actually happened, beginning with Nigel’s first post, and my description of what happened. See which is closer to the truth in your mind:

    http://scienceblogs.com/insolence/2013/05/16/the-quack-view-of-preventing-breast-cancer-versus-reality-and-angelina-jolie-part-2/#comment-257631

    Be forewarned. The thread gets out of hand fast, but I think it speaks for itself when placed in the context of Nigel’s legal threats.

  47. Grant Jacobs says:

    FBA –

    You’re missing my point: you’re making excuses. You’re also conflating selling over-the-counter vitamins and a clinical procedure — two different things as I did try point out.

    FYI, I’ve had my fill of people who only focus on one type of business activity to the exclusion of other ways of selling products or services. (I’ve had my share a daft discussions with IP lawyers who think everything “must” be a patent (and only a patent) – a real case of hammers looking for nails. Silly as.)

    All potential treatments start with tentative “possibles”. No-one says people have to jump straight to raising costs for final-stage trials. You claim to know this area, so you must know the pre-trial stages and early trials pave the way for further work and investment. Why then jump straight to pointing at final-stage costs? – it’s misleading and not how things happen.

    “For treatments where the therapeutic benefit is very clear” – you seem to be saying this has poor prospects. In that case there you are, but it’ll be the poor prospects (read: product unlikely to work / be “real”) that’ll be the issue. With poor prospects, of course investors will be reluctant – as I tried to point out. That wouldn’t surprise me in the least. With little basic science suggesting it’s worth investing in, wise investors would be rather reluctant! (Or should be.)

    I won’t be able to take this further (nor particularly want to); I have a very heavy workload to attend to.

  48. Grant Jacobs says:

    Apologies if my previous reads more bluntly than intended – just trying to “clear my desk” as it were, which tends to lend to me being more pointed!

  49. David Gorski said…

    I also encourage comparing Nigel’s version of events to what actually happened, beginning with Nigel’s first post, and my description of what happened. See which is closer to the truth in your mind:

    *link redacted*

    I also encourage people to read what I wrote. Which part of:-
    “What do you think about http://ajcn.nutrition.org/content/85/6/1586.full.pdf ? A 77% reduction in all-cancer RR is quite substantial. I did a search for “Joan Lappe” and “Joan M Lappe”, but got zero results.” is demanding, rude or snarky?

    I believe that Gorski is so biased that he passes everything that I write through “weird filters”. See http://nigeepoo.blogspot.com/2012/06/weird-filters.html

    I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery. Does a conflict of interest not have to be declared when debating alternative cancer cures or cancer prevention?

  50. WilliamLawrenceUtridge says:

    Who is going to fork out the money to run this trial? You cannot patent a vitamin, they are freely sold over the counter with no prescription already, there is simply no financial incentive to run any kind of trial involving vitamins.

    …so instead I’ll just sell these vitamins directly to consumers without feeling any need for some sort of proof.

    Because there’s no such thing as the National Institutes of Health.

    And because doctors aren’t interested in the health of their patients. They’re just in it for the money.

    Unlike naturopaths, who give away their vitamins and treatments for free.

    Ha, if that were true, patients would be getting what they paid for :)

  51. David Gorski said…

    Please see http://nigeepoo.blogspot.com/2013/05/vitamin-d-cancer-cliques-and-flouncing.html for a full explanation of what happened there.

    BTW, I too, encourage reading of the blog post, particularly the comments, particularly Nigel’s comments. Also, you might be interested in this, where Nigel brags about suing a commenter and threatens to sue lilady:

    Now who’s projecting? I made statements of fact. Any “bragging” is inside your head. This is the kind of garbage that I have to put up with from a respected cancer surgeon. Wow, just wow.

    Try to get your facts correct. In the UK, pursuing someone for libel/defamation/harassment begins with a “Letter of Claim”, which is like a “Cease & Desist” notice. If the recipient fails to comply with the terms within the specified time, then injunctions & court proceedings begin.

    My legal team decides what is libel/defamation/harassment and what isn’t, not me.

  52. windriven says:

    @Grant Jacobs

    “Apologies if my previous reads more bluntly than intended – just trying to “clear my desk” as it were, which tends to lend to me being more pointed!”

    Perhaps not pointed enough. The troll in question lacks a subtle mind as has been amply demonstrated with his own words. Engaging him is an exercise in pearls before swine. He appears ignorant of the scientific method, unwilling to cede ground he has clearly lost, incapable of intellectual growth and locked in a fantasy world of evil giant corporations and greedy unethical physicians.

    “I have a very heavy workload to attend to.”

    I would argue that clipping your toenails would be more useful and more intellectually satisfying than time wasted reasoning with trolls. This troll in particular has made a couple of interesting points in the days he has lurked here but those are lost in the deluge of stuff and nonsense gushing from his keyboard. It has been said that even a blind squirrel finds the occasional acorn and so with him. But acorns are aplenty and plucking a few from a foul midden isn’t good time management.

  53. David Gorski said…

    While it may not be directly relevant to IV vitamins, I am not sure why it seems to be regarded by some as scientifically aberrant to be very interested in recent studies involving Vitamin D.

    It’s not, and certainly none of the SBM bloggers has said it is. That’s a straw man. Some primary care docs I know now recommend vitamin D supplementation based on the evidence. What is scientifically abhorrent and frequently seen on quack websites is the claim that vitamin D is some sort of panacea, or combining claims about vitamin D preventing cancer with claims that “natural” vitamin D made when you are exposed to sunlight is better and dismissals of any link between sun exposure and skin cancer.

    You’ve made the error of referring to “sun exposure and skin cancer” without a) distinguishing between “exposure” & “over-exposure” also without b) distinguishing between chronic over-exposure & acute over-exposure.

    It’s obvious that sun over-exposure is harmful. What’s not obvious is the difference between chronic over-exposure (increased RR for basal & squamous cell carcinomas but reduced RR for other cancers including melanoma) & acute over-exposure (increased RR for melanoma but no reduced RR for other cancers).

    Guess where links to the studies supporting what I just wrote can be found?

  54. windriven says:

    @Nigel Kinbrum

    “My legal team decides what is libel/defamation/harassment and what isn’t, not me.”

    You might have your legal team explain that libel law here in the colonies is rather different than it is in old Mother England. Here we don’t go out of our way to protect the sensitivities of thin-skinned whiners. Here threats of litigation for the rough and tumble of public discourse is seen as akin to a sniveling brat screaming that ‘my big brother is going to come and beat you up.’

    Grow up.

    “I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery.”

    Oh, Bullrip! Dr. Gorski has made his work as a researcher and surgeon amply known. If he was a spokesperson for mastectomaster ™ scalpels and didn’t disclose it you’d have a point but that isn’t the case.

  55. David Gorski says:

    You’ve made the error of referring to “sun exposure and skin cancer” without a) distinguishing between “exposure” & “over-exposure” also without b) distinguishing between chronic over-exposure & acute over-exposure.

    Funny, but the quacks to whom I refer don’t distinguish between any of these issues, and I don’t see you taking them to task. To them, all sun exposure is “natural” and therefore good, and it is virtually impossible to have overexposure, either chronic or acute, except perhaps for sunburn bad enough to produce blister. Even in that case, I’m not so sure.

    You remain a very silly man. In my opinion, of course.

  56. windriven said…
    @Nigel Kinbrum

    “My legal team decides what is libel/defamation/harassment and what isn’t, not me.”

    You might have your legal team explain that libel law here in the colonies is rather different than it is in old Mother England. Here we don’t go out of our way to protect the sensitivities of thin-skinned whiners. Here threats of litigation for the rough and tumble of public discourse is seen as akin to a sniveling brat screaming that ‘my big brother is going to come and beat you up.’

    Grow up.

    I don’t care what the law is anywhere but where I live.

    So, if (a) commenter(s) tell(s) readers that you are a liar (or much worse), you will do nothing? Do you run a blog?

    “I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery.”

    Oh, Bullrip! Dr. Gorski has made his work as a researcher and surgeon amply known. If he was a spokesperson for mastectomaster ™ scalpels and didn’t disclose it you’d have a point but that isn’t the case.

    See http://www.bmj.com/content/327/7429/1454?tab=responses

    See the “Competing interests: None declared” statements? That’s the way discussions should be conducted.

  57. David Gorski says:

    I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery.

    Ya got me! Yes, I’m a surgeon, and, yes, I specialize in breast cancer surgery, which makes up the vast majority of my practice. Only one thing, though. There’s no “try” about it. Surgery is the primary curative modality for breast cancer. Radiation and chemotherapy decrease the risk of its coming back and are very important, but breast cancer, when it is cured (a word we generally don’t like to use, but I’ll go with it here for a minute), is cured by surgery.

    Wow, and I had tried so hard to keep that a secret that I mention it when appropriate (as in this post) and in the “About” page about me for this blog! Damn! How did you discover my secret? :-)

  58. David Gorski said…

    You’ve made the error of referring to “sun exposure and skin cancer” without a) distinguishing between “exposure” & “over-exposure” also without b) distinguishing between chronic over-exposure & acute over-exposure.

    Funny, but the quacks to whom I refer don’t distinguish between any of these issues, and I don’t see you taking them to task. To them, all sun exposure is “natural” and therefore good, and it is virtually impossible to have overexposure, either chronic or acute, except perhaps for sunburn bad enough to produce blister. Even in that case, I’m not so sure.

    You remain a very silly man. In my opinion, of course.

    I’m not referring to them. I’m referring to you. Nice try at evading my point, though.

    I’m not sure what kind of a man you are. In my opinion, of course.

  59. David Gorski said…

    I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery.

    Ya got me! Yes, I’m a surgeon, and, yes, I specialize in breast cancer surgery, which makes up the vast majority of my practice. Only one thing, though. There’s no “try” about it. Surgery is the primary curative modality for breast cancer. Radiation and chemotherapy decrease the risk of its coming back and are very important, but breast cancer, when it is cured (a word we generally don’t like to use, but I’ll go with it here for a minute), is cured by surgery.

    Wow, and I had tried so hard to keep that a secret that I mention it when appropriate (as in this post) and in the “About” page about me for this blog! Damn! How did you discover my secret? :-)

    O.K. Forget the words “trying to” and change the word “cure” to “curing”. I’m hopeful that your success rate is 100%.

    I’m having difficulty finding the “About” page on your blog http://scienceblogs.com/insolence/ Perhaps you can help?

  60. Repost with link redacted.
    David Gorski said…

    I am raising the issue of conflict of interest. As Mr Gorski is presumably salaried, he receives payment for trying to cure cancer by surgery.

    Ya got me! Yes, I’m a surgeon, and, yes, I specialize in breast cancer surgery, which makes up the vast majority of my practice. Only one thing, though. There’s no “try” about it. Surgery is the primary curative modality for breast cancer. Radiation and chemotherapy decrease the risk of its coming back and are very important, but breast cancer, when it is cured (a word we generally don’t like to use, but I’ll go with it here for a minute), is cured by surgery.

    Wow, and I had tried so hard to keep that a secret that I mention it when appropriate (as in this post) and in the “About” page about me for this blog! Damn! How did you discover my secret? :-)

    O.K. Forget the words “trying to” and change the word “cure” to “curing”. I’m hopeful that your success rate is 100%.

    I’m having difficulty finding the “About” page on your blog Perhaps you can help?

  61. @Grant Jacobs

    “For treatments where the therapeutic benefit is very clear” – you seem to be saying this has poor prospects.

    The genetic diversity of viruses causing respiratory infections make it nearly impossible to find a clearcut cure for diseases like influenza and pneumonia. The treatments that are proposed, be it from the drug industry (Tamiflu, Relenza), or from the naturopathic industry (echinacea, vit C, l-lysine, garlic extract) offer marginal benefits like faster days to recovery, less symptoms, stuff that is hard to prove and requires large clinical trials to demonstrate.

    To give you a relevant example, the trial for efficiency of Tamiflu in prevention of influenza aimed to enrol 1250 patients from 120 different clinics. They only managed to enrol 450 patients and got very ambiguous results from this smaller sample size. Tamiflu is not a cure for influenza, it sports some marginal benefits, all of which are disputed.

    What I am saying is, to prove that injectable vitamin C benefits patients with pneumonia would require a large trial with many patients, a very expensive exercise. Who in your opinion should finance it? The private industry wont, they have no commercial gain from such a trial.

  62. I just took a look at the goings-ons in the Angelina Jolie part 2 thread on Gorski’s blog. I see that the trolls are freely continuing their “discussion” about me, even though (or perhaps because) they know that I will not be participating. Nice moderation work there, Gorski! Anonymous internet nobodies like them aren’t worth my time & trouble pursuing, as what they write means nothing. They stated that SBM is run by Gorski (in the UK, surgeons are referred to as Mr, which is actually a higher status than Dr).

    Looking at “Editorial Staff” at the top of this page:-
    Steven Novella, MD – Founder and Executive Editor
    David H. Gorski, MD, PhD – Managing Editor

    I’d better watch my step. I apologise to Scott Gavura for this discussion going off-topic. My defence is that I didn’t start the fire!

  63. WilliamLawrenceUtridge says:

    @Nigel Kinbrum

    Just so you know, and I’m not even bothering to read your actual comments, but following to a different blog to continue an argument, referring to your legal team when discussing libel, even having a “legal team”, all makes your credibility tank. Like, a lot. In fact, were it not for the lack of word salad, I’d suspect schizophrenia.

    But hey, good luck researching your pet topic and publishing in peer reviewed journals, a far more fruitful useful avenue in showing us what’s the what’s what on some blog.

  64. Todd W. says:

    @Nigel

    I don’t care what the law is anywhere but where I live.

    If you are going to threaten people with libel suits, then you probably should have at least a passing understanding of the law where they live. You might find, for example, that you would be unlikely to succeed in a libel suit due to their laws and international treaties. But I see that this has already been pointed out to you over on your own blog by flip.

  65. windriven says:

    @Nigel Kinbrum

    “I don’t care what the law is anywhere but where I live.”

    Fair enough. But this blog is based in the US and at least some of your tormentors are US nationals. So, whether you care or not the fact is: tough titties (if you’ll pardon the pun).

    “Do you run a blog?”

    I do not. But I have been thoroughly excoriated here from time-to-time, sometimes deservedly, sometimes not. People are welcome to think of me as they will. I stand with what I’ve written. Some here think me a shite. That is supposed to disturb me … why?

  66. WilliamLawrenceUtridge said…
    @Nigel Kinbrum

    Just so you know…
    …In fact, were it not for the lack of word salad, I’d suspect schizophrenia.

    I think you may be mistaking me for someone who actually cares one jot about what you think. You don’t know me at all. In your case, I’d suspect idiocy.

  67. Todd W. said…
    @Nigel

    I don’t care what the law is anywhere but where I live.

    If you are going to threaten people with libel suits, then you probably should have at least a passing understanding of the law where they live.

    I leave the legal stuff to the experts. The company that I have engaged specialises in Reputation Management law. You probably should mind your own damned business and stop posting off-topic comments.

  68. EbmOD says:

    Threatening people with legal repercussions is a clear sign that your argument has lost on merit. Trying hard to avoid a heaping dose of cognitive dissonance apparently?

  69. WilliamLawrenceUtridge says:

    I think you may be mistaking me for someone who actually cares one jot about what you think. You don’t know me at all. In your case, I’d suspect idiocy.

    My god, suddenly all your arguments make sense! You’re more convincing than CommonSenseBoulder!!!!!

    It’s funny, for someone who doesn’t care a jot what I think, you sure took some time to ensure I knew about it.

    Man, I can’t imagine why people find your comments so objectionable given the high standard of your calm, rational, civil discourse. I wish we lived in the same city so I could host a dinner party in your honor.

  70. David Gorski said…

    Wow, and I had tried so hard to keep that a secret that I mention it when appropriate (as in this post) and in the “About” page about me for this blog! Damn! How did you discover my secret? :-)

    I looked at the “About” and “Contributors” pages, but failed to spot your notice of competing interest. You should mention it every time you post on the subject of cancer cure/prevention, or have a permanent clearly visible display of it somewhere on the page. Just sayin’.

  71. Narad says:

    The company that I have engaged specialises in Reputation Management law.

    If they were any good, they would have long ago told you not to natter on about actual legal matters on random blogs. I tend to charitably conclude that “they” do not exist.

  72. WilliamLawrenceUtridge said…

    Nothing of any importance.

    Go away, you worthless troll.

  73. Narad said…

    If they were any good, they would have long ago told you not to natter on about actual legal matters on random blogs. I tend to charitably conclude that “they” do not exist.

    I have not published any information from my Letter of Claim, as requested within. I have merely made generalised statements. Therefore, you can do one too, you worthless troll.

  74. EbmOD says:

    Man, now laying on the ad hominem more and more. May I suggest graciously going down with the ship now that your arguments have failed . . .

  75. Narad says:

    Go away, you worthless troll.

    Therefore, you can do one too, you worthless troll.

    Nigel, I suspect that anyone of good will and sound mind would immediately leave a forum if asked to by the hosts. Orders delivered from unruly guests do not have the same standing.

  76. tpolevoy says:

    Ihave have monitored the naturopathic profession here in Ontario for years. When I have complained to the old Board (BDDT-N) nothing was ever done to curb the quack practices of some of their members. This was particularly true when scores of their members were approved for i.v. therapies. Now that they have become a regulated health profession, it is even more ridiculous. A month or so ago, I found a naturopath using a vegatest device, which has been “banned” from Canada for a decade. They told me that I would have to file a complaint to the old Board. Why is that? They are regulated under the RHPA and yet they won’t regulate their own members. Good luck to anyone who decides to file ANY complaint.

    Here is a link to a 2001 paper in the prestigious medical journal – Asthma & Clinical Immunology –
    http://www.aacijournal.com/content/7/1/14

    Supported by science?: What Canadian naturopaths advertise to the public
    Conclusions
    A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.

  77. tpolevoy says:

    I have have monitored the naturopathic profession here in Ontario for years. When I have complained to the old Board (BDDT-N) nothing was ever done to curb the quack practices of some of their members. This was particularly true when scores of their members were approved for i.v. therapies. Now that they have become a regulated health profession, it is even more ridiculous. A month or so ago, I found a naturopath using a vegatest device, which has been “banned” from Canada for a decade. They told me that I would have to file a complaint to the old Board. Why is that? They are regulated under the RHPA and yet they won’t regulate their own members. Good luck to anyone who decides to file ANY complaint.

    Here is a link to a 2011 paper in the prestigious medical journal – Asthma & Clinical Immunology –
    http://www.aacijournal.com/content/7/1/14

    Supported by science?: What Canadian naturopaths advertise to the public
    Conclusions
    A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science and evidence-based practice.

    Here are links to those who are supposed to regulate naturopathy here in Ontario:
    http://www.bddtn.on.ca/
    http://www.collegeofnaturopaths.on.ca/

  78. @tpolevoy

    What practice did you complain about to the board of naturopathy? I never heard of vegatest, is this some type of electroacupuncture device?

  79. Grant Jacobs says:

    @FastBuckArtiston 26 May 2013 at 11:21 am

    As I wrote, I don’t have time for more (so, obviously it’s impolite to ask more of me, eh?)

    You’re now rabbiting on about irrelevant things, then, somehow, making out that it makes your claim a fait accompoli. It doesn’t. You’re just making excuses and ignoring what was said.

  80. pmoran says:

    I had a quick look at the other blog and it is true that Orac did not respond to what looks like a reasonable query. Is a blog-owner under such an obligation? Probably not.

    It is true that others responded, but in a rather dismissive way for such an important study –important because it was an interventional RCT, rather than the usual observational one.

    Nigelpoo looks to have an unfortunate capacity to lose his cool when he feels he is being snubbed, and to then enthusiastically engage in his own ad hominem, name-calling and excessive troll-like postings, but he could have had a better response.

    I am not an acknowledged expert in the field but that might have run something like this: –

    “Yes, this is an important study because it is a properly controlled interventional RCT. It is stronger evidence of a real beneficial effect from vitamin D supplementation in any population than we have had previously. It is desirable to have confirmation from similar studies.

    Serious consideration is being given to advising vitamin D supplementation in certain populations, along with advising more solar exposure where that is absent. Advising universal Vitamin D supplementation is a much bigger step, as there is little information about the very long term-effects or risks of that. That may come after further study.”

  81. pmoran said…

    I had a quick look at the other blog and it is true that Orac did not respond to what looks like a reasonable query. Is a blog-owner under such an obligation? Probably not.

    I didn’t make any demands. I just wanted an expert’s opinion.

    It is true that others responded, but in a rather dismissive way for such an important study – important because it was an interventional RCT, rather than the usual observational one.

    Thank you for noticing.

    Nigelpoo looks to have an unfortunate capacity to lose his cool when he feels he is being snubbed, and to then enthusiastically engage in his own ad hominem, name-calling and excessive troll-like postings, but he could have had a better response.

    I admit that I could have conducted myself better, but I didn’t expect to get trolled on Orac’s blog, so I was initially sucked-in by the bait. Sorry about that. I know better, now. It’s Nigeepoo, actually! :-)

    I am not an acknowledged expert in the field but that might have run something like this: –

    “Yes, this is an important study because it is a properly controlled interventional RCT. It is stronger evidence of a real beneficial effect from vitamin D supplementation in any population than we have had previously. It is desirable to have confirmation from similar studies.

    Serious consideration is being given to advising vitamin D supplementation in certain populations, along with advising more solar exposure where that is absent. Advising universal Vitamin D supplementation is a much bigger step, as there is little information about the very long term-effects or risks of that. That may come after further study.”

    That sounds like a perfectly reasonable answer to me. I’m not advising universal Vitamin D supplementation, however. It’s more accurate to say that I would like there to be universal Vitamin D testing, as studies have shown that a high percentage of indoor workers and/or sunscreen users have Vitamin D insufficiency, even in sunny countries e.g. Thailand, where >90% of nurses in a hospital that was tested, had Vitamin D insufficiency.

    Thank you for your reply. If all commenters behaved like you, life would be so much better.

  82. Jan Willem Nienhuys says:

    fba:

    I never heard of vegatest, is this some type of electroacupuncture device?

    Yes, electroacupuncture as in Electro Acupuncture according to Voll (EAV), in which a kind of scientology E-meter is used to
    measure skin resistance in acupuncture points, to establish various kind of sickness in organs. It the measured current is too high or too low, or it drops off too much after an initial high, it is all supposed to be no good. The added improvement by GP Reinhold Voll (1909-1989) is the idea that if the measuring current passes close to closed glass vials containing homeopathic preparations that can be used as cure, then the current normalizes. Variants are called Dermatron, Interro or Accupath, Bio-Electronic Function Diagnostics, Indumed therapy, Vegetative Reflex Test (or Vegatest), de Segment Electrography according to Helmut Schimmel, Electro Skin Test, de Electro Focal Test according to Türk, de Decoder Dermography according to Jahnke and Bergmann, Electro Neural Diagnostics according to Croon, Ryodoraku or Electroacupuncture according to Nakatani, and Microcancer Detection according to Kobayashi.

    On http://skepp.be/rare-apparaten/alfabetisch you can find many, many more of this type of machines. The VEGA test is there, and among the newer oines I mention Prognos.

    It seems that fooling people with some kind of machine with elektrodes (started with the notorious Albert Abrams) is still very popular among quacks.

  83. elburto says:

    @EEB – I feel your pain. I cannot fathom why anyone would want to be ill, why they would convince themselves that they’re deficient in this, and that, and the other. The ‘Worried Well’ should get a bloody hobby.

    I need IM B12 too. Hydroxocobalamin in particular burns like lava as it goes in! I was deficient for too long, with undiagnosed gut damage that destroyed my parietal cells.

    Sadly I’m in the target group for ‘Functional Somatic Disorders’ (where mental distress can manifest as physical symptoms), so it took a while for them to just trust me, and to find out that my stores of B12 (and my B9 too) were virtually depleted.

    Sadly, because the quacks, wooligans and worried well have hijacked things like B12 injections, if you mention to someone that you’re deficient in B vitamins and need regular treatment for that, they think you’re a hypochondriac.

    What people don’t realise is that our end-point, without injections, is death. Before that comes neuropathy, sensory damage, loss of limb function, problems with memory and cognition, and digestive issues.

    Best of luck to you. Trust me, the sting of the jabs is nowhere near as painful as peripheral neuropathy, so it’s worth it!

  84. David Gorski says:

    Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing. Also, cancer was not its primary endpoint. Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.

    There is a recent review of the literature from the Endocrine Society, which includes Lappe et al and puts it into context:

    Despite biological plausibility for a role of vitamin D in cancer prevention, most recent systematic reviews and meta-analyses, as well as a comprehensive review by the IOM Committee, have found that the evidence that vitamin D reduces cancer incidence and/or mortality is inconsistent and inconclusive as to causality. Importantly, no large-scale randomized trials have been completed with cancer as the primary prespecified outcome, and trials with cancer as a secondary outcome have been sparse and generally unsupportive. Observational evidence is strongest for colorectal cancer but is weak or inconsistent for breast, prostate, other cancer sites, and total cancer. Moreover, concerns about potential increased risk for selected cancers with high levels of 25(OH)D have been raised. New trials assessing the role of moderate- to high-dose vitamin D supplementation in cancer prevention, including the large-scale VITamin D and OmegA-3 Trial (196), are in progress and should provide additional information within 5–6 yr. It is worth noting that many micronutrients that seemed promising in observational studies (e.g., β-carotene, vitamins C and E, folic acid, and selenium) were not found to reduce the risk of cancer in RCT and some were found to cause harm at high levels of supplementation (135, 163). Although future research may demonstrate clear benefits for vitamin D in relation to cancer and possibly support higher intake requirements for this purpose, the existing evidence has not reached that threshold.

  85. elburto says:

    Now onto our ableist and misogynist troll friend, who apparently still doesn’t realise how rude it is to barge into an established blog’s commentariat, and start making demands, hurling insults, and threatening people.

    Beware of the Streisand Effect Niggle.

    WRT to the confusion that people across the Pond seem to have about we Brits and our swearing habits. I hear “Ah, but they’re British” mentioned as a sort of defence when someone’s using abusive language on an international forum.

    Despite what our TV output might suggest, swearing is still as hideously impolite here as it is the the US. In a group of friends down the pub? Whatever, knock yourself out*. In your own home? Be as profane as you wish. Anywhere else? Bad manners.

    ‘Tw*t’ is a misogynist insult here. It is not a slightly harsher version of ‘Twit’, it is not something to casually fling around at anyone and everyone.

    Just like ‘c*nt’, it’s using a slang term for the female genitalia as one of the harshest insults, to imply that someone’s inferior, disgusting, the worst of the worst.

    . How is that not rooted in misogyny?

    Both words are regulated by various broadcasting codes. There has to be justification for using ‘c*nt’ on television, and it can only be used a certain number of times in any one programme. ‘Tw*t’ isn’t as firmly regulated, but there still isn’t a free-for-all approach to it either, it’s on a par with ‘f*ck’

    So again, two of the most offensive words and worst insults in the English language are terms for female genitalia, but according to Niggle that’s not misogyny in action. Next he’ll be saying that ‘gay’ and ‘f*gg*t’ as terms of disgust or derision aren’t rooted in homophobia, and that using words like ‘r*t*rd’ and ‘sp*stic’^ to denote intellectual inferiority are not evidence of ableism.

    Although there are some lexical differences between AmEng and BritEng, most of it means the same thing wherever it’s being used. That includes profanity.

    If you wouldn’t generally say a certain word to a patient/customer/boss/authority figure, or expect to hear it on the evening news, then it’s generally considered vulgar.

    Being British is of no import whatsoever, and no excuse for hurling profanities, because the same rules apply here. The stereotype of all Brits (a large and very diverse bunch) as people whose speech is roughly 25% profane, is about as accurate as the stereotype of Southern Americans being rednecks called Cletus, who are married to their own blood relatives, and scream “Yee-HAAAW!” as they fire their rifles into the air on a daily basis.

    Apologies to any Cletuses (Cletii?) in the audience.

    I love a good swear-up, if I were a dinosaur I’d be a Profanisaurus Lex, but I’m not going to deny that the words I use have meanings, and I certainly wouldn’t say “Hello c*ntybollockchops!” to my doctor, or greet my parents with “Hiya tw*ts!”

    *In the region I live in there are signs in certain pubs that prohibit swearing and using offensive language or gestures. You can, and will, be thrown out on your arse for violating that rule. Yeah it’s quite antiquated, but it exists.

    ^ I know this is typically used to mean something like clumsy or hyper in parts of the US, but in the UK it is more offensive.

    It’s basically used as a way of comparing someone to a person afflicted with Cerebral Palsy, as that was once the medical term for someone with dystonic muscles.

  86. David Gorski says:

    I had a quick look at the other blog and it is true that Orac did not respond to what looks like a reasonable query. Is a blog-owner under such an obligation? Probably not.

    It is true that others responded, but in a rather dismissive way for such an important study –important because it was an interventional RCT, rather than the usual observational one.

    The owner of that blog, just as I do here, prefers to spend his free time generating new content, which can be (and often is) long and detailed. That is why I only occasionally dive into the comments. Most of the time, I don’t. Today is an unusual case. One also notes that by the time Nigel’s question was seen he had already started insulting and abusing other commenters who had tried to answer his question. I don’t recall whether he had already started to threaten to sue people or not by that point, but his trollish behavior had become apparent.

    As for Lappe et al, see my comment a couple of comments up. Lappe et al was an important study, but the picture is much more complex than any single study can show, and that particular study had significant methodological issues that made it at best a hypothesis-generating rather than hypothesis-confirming study.

    1. Scott Gavura says:

      I want to echo Dr. Gorski’s comments on how contributors to this blog spend their time. With very limited time my focus is on content creation, rather than engaging in the comments, especially when they veer off-topic. However in the interest of hopefully bringing some closure to this, I’ll add to the point made above. It’s important to consider the totality of the data when looking at a particular intervention and outcome. So a discussion of Lappe et al needs to be considered in the context of all the accumulated evidence. In addition to the Endocrine Society statement, there is an ARHQ systematic review from 2010 that includes Lappe (2007) (and considers its quality). The conclusion of that systematic review was:

      The majority of the findings concerning vitamin D, calcium, or a combination of both nutrients on the different health outcomes were inconsistent. Synthesizing a dose-response relation between intake of either vitamin D, calcium, or both nutrients and health outcomes in this heterogeneous body of literature prove challenging.

      We welcome suggestions for topics from readers. The best way to do this is via a submitted email request, which Dr. Gorski circulates to all contributors of the blog. I’d recommend that approach over demanding a response within the comments on an unrelated post.

  87. goodnightirene says:

    Thank you Dr. Gorski! Well done! (Although, no doubt, Nigel will find something to fault you with).

  88. elburto says:

    Hopefully Dr Gorski’s latest comment will shut Niggle up.

    One more thing Niggle, if you’re lurking, WRT “conflict of interest”.

    Here’s a tip for you, blogs are not any of the following:

    -Grant proposals

    -Research papers

    -Clinical trials

    -Journal articles

    -Professional endorsements.

    Blogs, and the posts therein, require nothing more than what the owner/writer wants to state or declare.

  89. David Gorski said…

    I had a quick look at the other blog and it is true that Orac did not respond to what looks like a reasonable query. Is a blog-owner under such an obligation? Probably not.

    It is true that others responded, but in a rather dismissive way for such an important study –important because it was an interventional RCT, rather than the usual observational one.

    The owner of that blog, just as I do here, prefers to spend his free time generating new content, which can be (and often is) long and detailed. That is why I only occasionally dive into the comments. Most of the time, I don’t. Today is an unusual case. One also notes that by the time Nigel’s question was seen he had already started insulting and abusing other commenters who had tried to answer his question. I don’t recall whether he had already started to threaten to sue people or not by that point, but his trollish behavior had become apparent.

    Oh, give it a rest!

    As for Lappe et al, see my comment a couple of comments up. Lappe et al was an important study, but the picture is much more complex than any single study can show, and that particular study had significant methodological issues that made it at best a hypothesis-generating rather than hypothesis-confirming study.

    Now, why didn’t you say that on your own blog? Why did you leave it until “a couple of comments up” on this blog?

    It would have saved everyone (you, included) a whole lot of aggravation. I’m happy, now. Ta-ra!

  90. David Gorski said…

    Regarding Lappe et al, one notes that that study is not the be-all and end-all of vitamin D research. It’s an old study, for one thing.

    Irrelevant.

    Also, cancer was not its primary endpoint.

    Irrelevant.

    Finally, there was no vitamin D alone group, as I recall, only a vitamin D + calcium group, a calcium group, and a placebo group.

    Irrelevant.

  91. windriven says:

    @elburto

    “‘Tw*t’ is a misogynist insult here. It is not a slightly harsher version of ‘Twit’…”

    I stand corrected. I based my comment on interactions with Brit friends and acquaintances. These were, in fact, generally of the pub sort. After reading your correction I consulted a number of online collections of British colloquialisms and did, in fact, find that they all made reference to female genitalia as a first or second definition.

  92. windriven says:

    Am I alone in wondering how it is that men, especially in their younger years, spend significant time and effort attempting to build a relationship with one or more instances of the female anatomy mentioned above, yet use various terms for that anatomy in decidedly pejorative ways? A little schizophrenic, no? ;-)

  93. David Gorski said…

    Despite biological plausibility for a role of vitamin D in cancer prevention, most recent systematic reviews and meta-analyses, as well as a comprehensive review by the IOM Committee…

    God Bless the IOM Committee. The be-all and end-all of reliable information. There may be sarcasm & irony in my previous sentences.

    I’ve already explained (with supportive evidence from PubMed) the reason why some studies produce null results or evidence of harm, on my blog. You don’t read my blog, do you? Tch!

    I’m not engaging with the troll elburto. Funny how you allow trolls to comment freely on this (Steven Novella’s) blog and drastically reduce the Signal to Noise Ratio, though.

  94. goodnightirene said…

    Thank you Dr. Gorski! Well done! (Although, no doubt, Nigel will find something to fault you with).

    Was the last part of that sentence absolutely necessary?

  95. My main response to David Gorski is currently awaiting moderation. Just in case you thought I’d forgotten!

  96. goodnightirene says:

    Well, I did say that Nigel would find fault didn’t I? No matter that such “fault” has no substance (as is the case with his blog). And elburto a troll–whaaaaa?

    @elburto (the “troll”)

    Thanks for the clarification. I lived in England for a couple of years in the 80′s and was under the impression that t*at was, indeed, more equivalent to twit than t*wat, although I can’t say how I came to be under said impression. I’m happy to be sorted on that one.

  97. Scott Gavura said

    We welcome suggestions for topics from readers. The best way to do this is via a submitted email request, which Dr. Gorski circulates to all contributors of the blog. I’d recommend that approach over demanding a response withing the comments on an unrelated post.

    For the record, I made no demands. I only made polite requests. I haven’t received Dr. Gorski’s email details. Somehow, I don’t think that I’ll be getting them.

Comments are closed.