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126 thoughts on “A closer look at vitamin injections

  1. David Gorski says:

    Oh, give it a rest!

    And my irony meter exploded in the face of one who perseverates about Lappe et al, as well as threatens to sue for libel over perceived slights.

    Oh, and my e-mail address for blog correspondence and the e-mail addresses of most of the editors are very easily found on this blog. If you can’t find the link that takes you to them, it’s really not my problem, because it would have been hard to make it simpler.

    And, no, I don’t read your blog. I looked at it once briefly and was able to conclude quickly that there are much better sources for information about medicine and vitamin D that I do read.

  2. David Gorski says:

    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.

    How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.

  3. Narad says:

    Funny how you allow trolls to comment freely on this (Steven Novella’s) blog and drastically reduce the Signal to Noise Ratio, though.

    No, Nigel, this is Dr. Novella’s blog. As for S/N, if you had spent any time here before making your debut, you would know just how foolish this complaint appears.

  4. WilliamLawrenceUtridge says:

    Nigel:

    Truly do you redefine the act of digging yourself a hole, reaching bedrock, then pulling out the dynamite. You should really stop. If you’re right – do some research, publish a literature review, start a discussion in the peer reviewed literature. Because a) this is just a blog, there are no public policy or health recommendations happening here and b) you’ve already lost the hearts and minds of pretty much everyone. Even if you’re right, your approach is so incredibly off-putting, you are unlikely to convince.

  5. David Gorski said…

    Oh, give it a rest!

    And my irony meter exploded in the face of one who perseverates about Lappe et al, as well as threatens to sue for libel over perceived slights.

    Mine exploded a long time ago. I used to respect you and your blog(s). Your behaviour there and here has been disgusting and unworthy of a professional. I am deleting my bookmarks/favorites to this blog forthwith.

    The shambolic moderation by you means that there can never be meaningful dialogue.

    Oh, and my e-mail address for blog correspondence and the e-mail addresses of most of the editors are very easily found on this blog. If you can’t find the link that takes you to them, it’s really not my problem, because it would have been hard to make it simpler.

    Which part of Scott Gavura’s statement “The best way to do this is via a submitted email request, which Dr. Gorski circulates to all contributors of the blog.” did you not understand?

    And, no, I don’t read your blog. I looked at it once briefly and was able to conclude quickly that there are much better sources for information about medicine and vitamin D that I do read.

    That’s your loss, not mine. Carry on quoting the IOM committee garbage and stay ignorant of enzyme kinetics, while you’re at it.

    On the British Medical Journal web-site, all commenters have to declare potential Competing Interest. Your failure to do so here means that nobody will know that they will never get an impartial opinion from you on the subject of cancer cures and/or cancer prevention.

  6. David Gorski says:

    Which part of Scott Gavura’s statement “The best way to do this is via a submitted email request, which Dr. Gorski circulates to all contributors of the blog.” did you not understand?

    It’s hard not to laugh at this statement, as it’s comedy gold.

    What Scott obviously meant was that when I get e-mail requests for topics to be covered, I circulate those requests to all the bloggers who contribute to SBM to see if any of them are interested in doing a post on it. That’s pretty obvious. It’s also pretty obvious that Scott did not mean that I circulate my e-mail address to all commenters on this blog. Why should I have to? My e-mail address right here on the blog for anyone who bothers to look?

    Seriously. Go back and reread the sentence.

    As for declared COIs, did you ever declare that you have an affiliate marketing partnership with a vitamin retailer and receive a commission from the sale of all vitamin products purchased using discount codes on your blog? On your blog it says:

    P.S. If you get a discount on supplements from iHerb and/or VitaCost by using the discount codes in my blog, I receive $10 reward when you save $10.

  7. David Gorski said…

    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.

    How so? It’s actually very, very relevant, as is the issue of cancer not being a primary outcome measure of the study. That you don’t understand why these issues are so relevant indicates to me that you don’t understand clinical research very well.

    1) The RCT used Ca + D. Therefore, the conclusions apply to Ca + D. If they’d wanted to test D alone, they would have. They didn’t. Why don’t you write a letter of complaint to Joan M Lappe about it?

    2) Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.

  8. David Gorski said…

    Which part of Scott Gavura’s statement “The best way to do this is via a submitted email request, which Dr. Gorski circulates to all contributors of the blog.” did you not understand?

    It’s hard not to laugh at this statement, as it’s comedy gold.

    I do comedy, too.

    What Scott obviously meant was that when I get e-mail requests for topics to be covered, I circulate those requests to all the bloggers who contribute to SBM to see if any of them are interested in doing a post on it. That’s pretty obvious. It’s also pretty obvious that Scott did not mean that I circulate my e-mail address to all commenters on this blog. Why should I have to? My e-mail address right here on the blog for anyone who bothers to look?

    Obviously.

    Seriously. Go back and reread the sentence.

    As I’m leaving permanently, what’s the point?

    As for declared COIs, did you ever declare that you have an affiliate marketing partnership with a vitamin retailer and receive a commission from the sale of all vitamin products purchased using discount codes on your blog? On your blog it says:

    P.S. If you get a discount on supplements from iHerb and/or VitaCost by using the discount codes in my blog, I receive $10 reward when you save $10.

    The fact that it actually says so on my blog means that I am declaring a small (and it is small) financial gain. Oh, I forgot. Nobody bothers to read my blog.

    Where’s your declaration of huge financial gain from being a breast cancer surgeon? Oh, there isn’t one.

  9. weing says:

    “Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.”

    Isn’t that like the kid who shoots arrows at a barn wall and then paints a bull’s eye wherever they landed? He got a bull’s eye every time. Amazing.

  10. windriven says:

    Nigel, Don’t go away mad but please, please do go away. You raised an interesting issue back in the beginning of this thread but any interest in your thoughts has long since been buried under a blizzard of threats and invective.

    One recurring theme that I can’t let pass without comment is summarized in this statement of yours:

    “On the British Medical Journal web-site, all commenters have to declare potential Competing Interest.”

    BMJ is a peer-reviewed journal. SBM is a blog. I will take it on faith that you are able to grasp the difference between the two.

    Now be a good chap and p|ss off.

  11. Narad says:

    BMJ is a peer-reviewed journal. SBM is a blog. I will take it on faith that you are able to grasp the difference between the two.

    Furthermore, anyone who has plumbed the depths of BMJ “Rapid Responses” should be aware that the gesture is essentially meaningless.

  12. David Gorski says:

    As I’m leaving permanently, what’s the point?

    Ah, flouncing off again. It’s probably long overdue. I’ve been getting a few complaints about you here as well. Perhaps you should ask yourself why complaints seem to follow you wherever you go.

    “Whether the outcome was primary, secondary, tertiary, quaternary or n’ary is irrelevant because the parameter in question (all-cancer diagnoses) was still accurately recorded. That you can’t understand such a simple concept boggles my imagination.”

    I rest my case that you do not understand clinical trial methodology and interpretation. I couldn’t have demonstrated it better myself to anyone who actually does understand clinical trial methodology and interpretation. Thanks!

  13. WilliamLawrenceUtridge says:

    I am deleting my bookmarks/favorites to this blog forthwith.

    Such is our tremendous loss to this community. Allow me to be the first to say goodbye.

    The shambolic moderation by you means that there can never be meaningful dialogue.

    In this case, the reason there can’t be a meaningful dialogue is because your end has long since sunk beneath the waves of both civil discourse and rationality.

    My end is floating on a raft of mockery.

  14. Todd W. says:

    @Nigel

    You probably should mind your own damned business and stop posting off-topic comments.

    See, it’s that kind of response that makes you look like a proper boor. I offered some advice that would, if you were to actually take it, make you look somewhat less a fool than you are already making yourself appear. Instead, you respond with insults.

    I am deleting my bookmarks/favorites to this blog forthwith.

    You resignation from this community is hereby noted. Please take care that the portal barrier does not strike you upon the posterior regions of your torso.

  15. EbmOD says:

    To those who run the blog, there is a great silver lining to timesinks such as this response thread: it gives great insight to the mindset of those who push CAM. In my searches and perusals of this site, some of the best content has been how posters such as Pec or Gena Para were dealt with, the level of pseudo-intellect and fallacious thinking is laid bare for all to see. I realize it is a headache for those in charge, but it provides one hell of an object lesson . . .

  16. Andres says:

    I don’t think Linus Pauling was completely right nor that he was open to refute his hypothesis.

    Of course potential anti-cancer properties of vitamin C is the easy point to attack. Its viricidal potential isn’t so. It is somewhat strange to me that you cite Dr. Dalton’s paper. I am not certain if you haven’t read the paper of if you have read it and dismissed it because it is not a RCT. I don’t think Science is possible without curiosity though.

    I don’t think any double blind clinical trial on intravenous megadoses of vitamin C for virus infections is going to happen anytime soon. I don’t think it would require a big sample to show an effect if a big enough dose (20 grams or more) is used. I think so because it has being found effective beforehand, not on a proper double blind placebo controlled trial though. If we suppose that all similar cases arriving at Annie Penn Memorial Hospital were reported correctly by late Dr. Klenner in An ‘Insidious’ Virus then we have 5 deaths in those without vitamin C treatment versus two survivors in those with vitamin C treatment. The probability of it being completely by chance would be of (2/7)^2 x (5/7)^5 = 1.5%. I think that late Dr. Klenner deserves more than being ignored, he deserves being refuted.

    And no, it can’t be oral because of a very different blood concentration attained. See Figure 1 of Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use.

    Science calls for experiments in order to refute a formulated hypothesis, that is, the hypothesis must be falsifiable. It is even more necessary whenever there is already a supporting experiment result. Is there any supporting experiment (appart clinical experience) of the viricidal effect of high dose intravenous vitamin C? I have already pointed out properly conducted experiments results in vivo (experiments in vitro also exist), alongside the plausibility of the ascorbic acid effects given its Natural History.

    Conflicts of interest: none.

  17. norrisL says:

    I’m sure I read not too long ago that Vit D and E in a minor excess can both increase death rates from cardiac disease

  18. @Andres

    I don’t think any double blind clinical trial on intravenous megadoses of vitamin C for virus infections is going to happen anytime soon.

    The antiviral activity of ascorbic acid has been observed by many researchers. But a clinical trial? Not happening. There is no money to be made from this investment. And good luck convincing patients to inject huge doses of vitamin C, considering it doubles the risk of developing kidney stones.

  19. WilliamLawrenceUtridge says:

    Did you read the study you linked to? It’s in vitro. Are people a glass petri dish? Did you see Dr. Gorski’s post from last week? If you’re trying out things that kill viruses in petri dishes, have you tried reducing the liquid component of your patients to less than 3%? That’d kill a virus.

    Did you notice the statement “In the present study, ascorbic acid weakly inhibited the multiplication of viruses of three different families”? It’s the very first sentence. Perhaps someone else linked to it, and you didn’t bother actually reading it.

    Did you notice the study was primarily about dehydroascorbic acid, not ascorbic acid?

    When are you going to learn that people are neither petri dishes nor rodents? Big Pharma does lot of petri and rodent tests and report great results, why aren’t you latching onto that?

  20. Andres says:

    @FBA: I am quite skeptic of any epidemiology conclusion. Anyone should read Taubes’ Epidemiology Faces Its Limits. Nevertheless I am all in for some oral magnesium just in case.

    @William: I am not certain if you are addressing me since both FBA and me have linked to the same study in our latest comments. Just in case you are addressing me I will answer.

    Furuya et alter state (emphasis mine):

    There are many reports in the literature regarding the antiviral effect of ascorbic acid, however, these studies are mostly based on clinical trials or in vivo animal models and not under the defined conditions in vitro (8 and refs. therein). The results obtained from these studies must be influenced by
    inflammatory and immune responses
    , which makes it difficult to evaluate ascorbic acid as an antiviral agent at the cellular level.

    No doubt the effect in vitro (without immune cells) they measured was minor. So it simply could mean that ascorbic acid antiviral effect is mainly achieved indirectly by its effect on the immune system, such as increasing interferon production (this paper or this one), enhanced fagocitic function (this paper), usefulness for white blood cells (this paper), increased cell-mediated immune response (this paper)… It is interesting to note that very ill patients have low concentrations of ascorbic acid even when receiving total parenteral nutrition with something like 200mg/day of vitamin C (this paper).

    So, it is NOT absolutely clear that high doses of intravenous sodium ascorbate is going to have a null or even small effect in viral infections. Moreover and as Furuya et alter acknowledge in their paper, there are animal experiments (I have commented here about guinea pigs) and some human clinical data (my previous comment) supporting vitamin C antiviral effects. A need for a refutation still stands.

    About the toxicity of ascorbic acid, it is already achieved in vitro with concentrations of 1.6mM (Figure 5 of Furuya et alter paper). Nevertheless in vivo results in humans exist for plasma concentrations of 1.2mM without any reported adverse effect (Figure 1 of Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use) and higher than 20mM (Figure 1 of Phase I clinical trial of i.v. ascorbic acid in advanced malignancy) in those given 1.5g of ascorbic acid for each kg of weight but with mild adverse effects reported (none in those receiving a dose below 0.4g/kg and achieving something like 5mM concentrations). Yes, Hoffer et alter state “High-dose i.v. ascorbic acid was well tolerated but failed to demonstrate anticancer activity” in their conclusions.

  21. WilliamLawrenceUtridge says:

    Nothing changes the fact that in vitro tests are a starting point (and a poor one) for a cancer cure, and that humans are not glass dishes. All these secondary measures are meaningless since what you’re looking for is an antitumor effect, ideally a curative one. And proving a specific intracellular or intravascular dose doesn’t result in immediate harms a) doesn’t mean there aren’t long-term harms and b) doesn’t mean it’s a cure for cancer.

    It’s barely promising and I’d much rather scarce research dollars be spent somewhere a little more fruitful.

  22. Andres says:

    @William: I am NOT defending ascorbic acid as a cancer therapy. From Dr. Hoffer’s paper (phase I clinical trial) it doesn’t seem to be a strong one. My first comment (my second too) in this post states clearly that I defend the need for a refutation experiment of the antiviral potential of intravenous vitamin C in big enough doses (20g at least). I don’t think probable that a short course of it is going to drive any long-term harm when they have not been observed in any of the patients of Dr. Hoffer’s study, some of them (two with stable disease) more than 6 cycles, each cycle 4 weeks, each week three treatments of 0.6g/kg.

  23. WilliamLawrenceUtridge says:

    My apologies for Anders, you were talking about antivirals rather than chemotherapy. My error.

    That being said, I am still skeptical of the effectiveness of such large doses of vitamin C for antiviral properties. I’m far from having enough knowledge to debate the specifics, but my basic familiarity with the literature is that the only time the results were promising were in high-stress conditions of elite athletes or military personnel in Arctic training (source). Other than that, ascorbic acid didn’t seem to improve recovery from rhinoviruses (beyond perhaps a mild antihistamine effect). Perhaps other viruses respond differently. Oral dosing, from what I can tell, is not particularly effective due to the upper limits of absorbability within the gut, and breaking the skin for an IV infusion seems questionable if the virus isn’t particularly dangerous and the benefits are not significant. Vitamin C is absolutely essential to human health, but I don’t think that automatically means higher doses are better, nor is it an a priori reason to think that they would be strongly antiviral within the body.

  24. Andres says:

    @William: I agree that a clinical trial of intravenous vitamin C for a simple cold would be overkill and results potentially inconclusive. I think that serious influenza cases would be appropriate. I agree that direct benefits from vitamin C seen in vitro don’t seem significant (Faruya et alter). Nevertheless we have in vivo (I already commented on it) and clinical experience supporting its role as antiviral agent in high enough doses (as I wrote in my first comment) that supports the hypothesis of its indirect effect through the immune system (as I said on my second comment). I think skepticism is a very sane quality that shouldn’t drive anyone to oppose the need for a refutation clinical trial but just the opposite. I am not in any position to bring it to reality though.

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