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Supplements and cancer prevention

The bloggers here have been very critical of a law passed nearly 20 years ago, commonly referred to as the DSHEA of 1994. The abbreviation DSHEA stands for about as Orwellian a name for a law as I can imagine: the Dietary Supplement Health and Education Act. Of course, as we’ve pointed out time and time again, the DSHEA is not about health, and it’s certainly not about education. Indeed, perhaps my favorite description of this law comes from our very own Peter Lipson, who refers to it as a “travesty of a mockery of a sham.” Rather, it’s about allowing supplement manufacturers and promoters of so-called “complementary and alternative medicine” (CAM, with or without a preceding “s,” depending on your taste) who do not want pesky things like government laws and regulations to interfere with their selling of pseudoscience to market various compounds as “dietary supplements” with near-impunity. As Harriet Hall put it so accurately, the DSHEA is “a stealth weapon that allows the sale of unproven medicines just as long as you pretend they are not medicines.”

The DSHEA accomplishes this by making a seemingly reasonable distinction between food and medicine and twisting it in such a way that allows manufacturers to label all sorts of botanicals and various other compounds, many of which have substances in them with pharmacological activity, and sell them as “supplements” without prior approval by the FDA before marketing. As long as the manufacturer is careful enough not to make health claims that are too specific, namely that the supplement can diagnose or treat any specific disease, and sticks to “structure-function” statements (“it boosts the immune system!”), almost anything goes, particularly if a Quack Miranda Warning is included.

Not surprisingly, given what a big business supplements have become in this country largely due to the DSHEA, manufacturers and CAM advocates fight tooth and nail against any attempt to update the DSHEA to correct some of its more unfortunate consequences. Led by Utah Senator Orrin Hatch and Iowa Senator Tom Harkin, who together make up a bipartisan tag-team in defense of the supplement industry and do their best to block any effort to increase its regulation by the FDA. We saw that most recently when Arizona Senator John McCain, of all people, introduced a bill in 2010 to try to tighten up the DSHEA and was thoroughly slapped down by Orrin Hatch. More recently, not satisfied with how good things are for the supplement industry, another Utah Representative Jason Chaffetz reached across the aisle to Jared Polis, teaming up to introduce the Free Speech About Science Act, which basically seeks to allow the supplement industry to make more liberal claims about its products. All it will need is a “peer-reviewed” paper to support it (Mark and David Geier would do!), and you can claim almost anything. Anything to grow the supplement industry, which is currently around $30 billion a year.

That’s why it’s critical, from time to time, to look at actual evidence, and just last week Maria Elena Martinez, PhD, of the University of California San Diego, and co-authors did in a commentary published online in the Journal of the National Cancer Institute entitled Dietary Supplements and Cancer Prevention: Balancing Potential Benefits Against Proven Harms.

As several of us have pointed out before, there are science-based roles for supplementation. For instance, in the case of nutritional deficiencies, and Martinez et al point out the very same thing:

Clearly, dietary supplements are useful for the treatment of nutrient deficiencies; however, with the exception of select subgroups (2,3), such deficiencies are relatively uncommon in the United States and most industrialized countries today.

Of course, if you listen to CAM promoters and supplement manufacturers, you’d think that supplements are absolutely essential to preventing cancer. While it is true that there is increasing evidence that diet has a significant effect on our risk for various cancers, this evidence is nothing new. We’ve simply concentrated on it more in recent years, and a new generation of “natural health” advocates, such as Dean Ornish, have attributed near magical powers to diet as a tool for preventing cancer. As a byproduct of increasing evidence that cancer risk is influenced by lifestyle choices, it is understandably tempting to think that we could somehow “bottle” what’s in various foods as supplements that could reverse or ameliorate diet-associated cancer risks. Ironically, although CAM advocates would never concede it, this sort of thinking is the sort of thinking they themselves decry in conventional medicine when they make the exaggerated charge that all doctors do (or want to do) is to prescribe a pill to deal with health issues. Think about it: Even is supplement did what is claimed for them, is there any real difference between just prescribing a supplement to decrease cancer risk rather than recommending much harder lifestyle interventions and prescribing a statin to prevent heart disease rather than recommending much harder lifestyle interventions?

Martinez et al then go on to summarize the state of evidence as it currently exists for the use of supplements to prevent cancer. They conclude that there is precious little evidence for efficacy and existing evidence for harm. Their assessment of the evidence for antioxidants is particularly withering:

Several early observational studies (10–13) found that diets high in fruit and vegetables were associated with diminished risk of several cancers, including respiratory and gastrointestinal cancers. The importance of β-carotene and other carotenoids was suggested by both retrospective and prospective studies showing that low levels of β-carotene in the serum were associated with higher subsequent risk for lung cancer (14). At one point, research focused on retinoid supplementation, in light of the finding that β-carotene is converted to retinol (13). It was hypothesized that the lower risk associated with consumption of these foods, and with β-carotene, α-tocopherol, and vitamin C intake, might be attributable to the activity of antioxidants. In vitro and in vivo studies suggested that these compounds encourage growth of normal tissue and block growth of abnormal tissue (2). However, human experimental studies have uncovered the following: β-carotene does not prevent non-melanoma skin cancer recurrence (15); β-carotene and α-tocopherol with vitamin C do not protect against adenoma recurrence (16); β-carotene and vitamin A do not protect against lung cancer incidence (17); α-tocopherol and β-carotene do not prevent lung cancer (18); β-carotene does not prevent lung cancer (19); vitamins C and E do not protect against total cancer incidence (20); and α-tocopherol, vitamin C, and β-carotene do not protect against total cancer or cancer mortality (21). Based on a review of trial data, a Cochrane report (22) concluded that there was no convincing evidence that β-carotene, vitamin A, vitamin C, or vitamin E supplements, given singly or in combination, prevent gastrointestinal cancers.

That’s not all, though. An article such as this can’t go without mentioning the Selenium and Vitamin E Cancer Prevention Trial (SELECT), which was resoundingly negative. Selenium and vitamin E showed no evidence of decreasing the risk of prostate cancer, leading to the trial being halted after approximately 5.5 years of followup. Consistent with the results of SELECT, a Southwest Oncology Group (SWOG) trial showed that selenium supplementation in men with a premalignant precursor of prostate cancer showed no benefit, and another trial showed that selenized yeast does not prevent recurrence of stage I non-small cell lung cancer. As Martinez et al put it, “organic selenium appears to provide no cancer prevention benefit.”

Not every trial was negative. One exception noted by Martinez et al is a 20 year old prevention trial in China consisting of 30,000 subjects. This study showed a 13% reduction in cancer mortality, including a 21% reduction in gastric cancer mortality, compared to placebo controls in a randomized trial testing a combination of β-carotene, vitamin E, and selenium. This is, at best, a modest effect. However, similar studies looking at such cocktails were even less convincing, including a companion study of 3,000 subjects examining a supplement that contained 14 vitamins and 12 minerals, including β-carotene, vitamin E, and selenium. No statistically significant effect on cancer incidence was observed.

The counterweight to the weight of existing high quality evidence looking at antioxidants and cancer, which suggests no benefit in the vast majority of cancers studied this far and equivocal evidence even in the handful of studies that suggest a benefit is a cohort of studies that suggests the real possibility of harm due to antioxidant use:

Several antioxidant trials (17,18,30,31) have actually reported increased risks with supplementation. The most prominent example, β-carotene and lung cancer, was tested in two RCTs (17,18) in high-risk populations of heavy smokers and asbestos-exposed individuals. Individuals randomly assigned to β-carotene in the Beta-Carotene and Retinol Efficacy Trial (CARET) trial had a 39% increase in lung cancer incidence compared with those in the placebo arm (17); the ATBC trial found a 16% increase in risk of lung cancer associated with β-carotene (18). With prolonged follow-up, NPC investigators found that selenium supplementation statistically significantly increased the risk of squamous cell skin cancer by 25% and total non-melanoma skin cancer by 17% (30). The increased risk was particularly marked among individuals in the highest tertile of circulating selenium levels just before the start of the trial. The most recent illustration of the possibility that pharmacological doses of antioxidants may not have the intended effect comes from the extended follow-up in the SELECT trial, which reported that α-tocopherol increased risk of prostate cancer by a statistically significant 17%; these results led the authors to conclude that consumers should be skeptical of health claims related to unregulated over-the-counter products (31).

The authors then looked at folate supplementation. The state of the evidence for whether folate can prevent cancer is similarly disappointing. In fact, it can be described as largely negative. Worse, like the case with antioxidants, contrary to the hypothesized benefit of folic acid supplementation, there is evidence that it can contribute to some cancers. For instance, there is one trial that showed that long-term supplementation with folic acid increases the risk of advanced colorectal adenomas (relative risk = 1.67) and the risk of developing three or more such adenomas (RR = 2.32). An elevated risk of prostate cancer was also observed. These results are consistent with preclinical studies in animals suggesting that folic acid can increase the risk of cancer, as well as observational studies that have linked higher dietary intake with an increased risk of prostate and breast cancer. Ironically, in the U.S. and other countries, the government has mandated folic-acid fortification of the food supply, which makes the question of whether folic acid supplementation is doing more harm than good particularly pertinent. True, there’s strong evidence that folic acid supplementation of the diet in pregnant women can decrease the risk of birth defects, particularly neural tube defects, but that is short term supplementation compared to long term supplementation. The question, then, is, as always: Is the balance of benefit versus risk due to folate supplementation favorable? There’s enough evidence out there to be concerned that the answer to that question might very well be no, except for pregnant women.

Finally, Martinez et al take on the case of vitamin D and calcium. Anyone who’s been reading CAM-friendly websites these days probably knows that vitamin D is currently viewed by many in the alternative medicine world as some sort of panacea that prevents all cancer. Heck, to listen to some CAM advocates tell it, vitamin D is supposedly so awesome that it prevents influenza more effectively than the influenza vaccine. Of course, as has been discussed on this very blog, the picture is, as is usually the case, more complicated than that, and Martinez et al try to communicate that complexity, referencing the Institute of Medicine’s recent recommendations for vitamin D and calcium intake published in 2011, in which the IOM concluded that there is insufficient evidence to conclude that there is a causal association between low vitamin D intake or low blood 25 hydroxy (OH) vitamin D [25(OH)D] levels and cancer. Martinez et al sum up this data thusly:

There have been many epidemiological investigations of blood 25 hydroxy (OH) vitamin D [25(OH)D] concentrations and cancer-related endpoints (45–49), and meta-analyses of these have shown statistically significant inverse associations between serum 25(OH)D and colorectal adenoma (46,49) and colorectal cancer (45), whereas the results for prostate cancer have largely been null (45,48). For breast cancer, the relationship with serum 25(OH)D levels varies by study design; case-control studies generally demonstrate inverse associations, and prospective studies have been null (45,47,50); because blood levels are collected after the onset of cancer in case-control studies, the potential for bias in these studies must be considered (47,50). Clearly, clinical trials are needed to elucidate any preventive effect of vitamin D (51,52). To date, three short-term RCTs of vitamin D and cancer endpoints (52–55) have been completed; one showed no direct effect of vitamin D supplementation on cancer mortality (53), the second showed no reduction in breast or colorectal cancer incidence by a vitamin D/calcium combination (54,55), and the third showed a reduction in total cancer incidence by a calcium/vitamin D combination vs placebo (56). As concluded in a recent meta-analysis, because of the potential confounding inherent in observational studies and the limited data from clinical trials, evidence is currently insufficient to draw conclusions about the efficacy of vitamin D supplementation for cancer prevention (57).

As far as cancer is concerned, there just isn’t a whole lot of data from well-designed randomized clinical trials testing the effect of vitamin D supplementation on cancer risk to hang one’s hat on. The same is true of calcium supplementation, only more so. Observational studies have, as Martinez et al almost drolly characterize it, “yielded diverse results.” In any case some of the diverse results with respect to vitamin D suggest a correlation between high vitamin D concentrations and pancreatic cancer, while a recent meta-analysis suggests a reduction in risk. In the case of prostate cancer, however, a recently published study suggests a statistically significantly increased risk of prostate cancer (RR = 1.56 for men in the highest quintile) among men who have the highest levels of 25(OH)D, a finding that was more striking for aggressive disease, leading the authors of the study to advise caution in recommending vitamin D for cancer prevention. Puzzlingly, these results are in contrast to a lot of basic science research that supports a beneficial role for vitamin D compounds in prostate cell proliferation and differentiation, prostate cancer cell growth and invasion, and tumorigenesis.

To say that the state of evidence in support of the use of various dietary supplements as cancer preventatives is unsettled is a gross understatement. Martinez et al discussed supplements that have been studied the most and, let’s be frank, that involve the purest supplements, most of which contain only a single ingredient, and they found little evidence of efficacy in preventing cancer but some evidence of potential harm. That’s not even counting the near innumerable supplements now being sold that are not pure substances but some form of extract from plant, fungi, yeast, or even animal origin. As I’ve said before time and time again, supplements that “work” (i.e., have some sort of biological effect) are drugs. They’re impure, adulterated drugs with highly variable potency because of their highly variable content of active ingredient. Obviously, supplements that don’t have such a biological effect are worthless (except for lining the pockets of supplement manufacturers). That’s why supplement manufacturers very much want consumers to believe that their supplements have a whole range of beneficial biological effects, and the DSHEA allows them to imply that, as long as they don’t do it too explicitly.

Martinez et al put the blame squarely where it belongs: On the DSHEA and another law. They also explain how supplement manufacturers get around even the weak prohibitions in the DSHEA:

Even without such direct statements, anticancer effects can be implied. For example, even though the manufacturers of Pill X cannot openly advertise that it prevents prostate cancer, they can create an advertisement that states that prostate cancer is a major health problem, that Pill X has a role to “support prostate health,” and that a particular study found that the compounds in Pill X reduced the growth of prostate cells in culture. Their website can then be accompanied by advertisements for Pill X and can contain links to testimonials that are free to expound the benefits of Pill X as experienced by real people. The absence of credible scientific evidence that taking Pill X confers anti-prostate cancer properties in men can be easily obscured by this constellation of claims that collectively suggest anticancer effects. As a result of limited regulatory authority, manufacturers who cannot overtly claim anticancer benefits of supplements without scientific proof are nonetheless free to imply those benefits in ways that make it difficult for the consumer to discern innuendo from scientific fact (82).

Indeed. Another recent review concluded that, with the possible exceptions of vitamin D and omega-3 fatty acids, there are no data to support the widespread use of dietary supplements in Westernized populations and that such supplements can even be harmful. Another recent study finds no effect from supplements on all-cause mortality and even found a negative effect from folic acid supplementation, consistent with yet another study. The bottom line is that, at present, it is quite probable that most supplements probably do more harm than good.

So why do so many people take supplements? Martinez et al also quite correctly point out:

Undoubtedly, use is driven by a common belief that supplements can improve health and protect against disease, and that at worst, they are harmless. However, the assumption that any dietary supplement is safe under all circumstances and in all quantities is no longer empirically reasonable. Believers in supplements are sometimes quick to discredit caution over supplement use, as they suggest that the tendency of mainstream science to ignore nonconventional evidence is tainted or that mainstream science is somehow corrupted by its link to a medical–industrial complex that seeks to protect profits rather than prevent disease.

Right on cue, our favorite quack apologist and supplement hawker, Joe Mercola, chimed in with an article entitled Over 60 Billion Doses a Year and Not ONE Death, But Still Not Safe? In it, Mercola in his usual frothing-at-the-mouth style (although not nearly as frothy as another favorite quack apologist Mike Adams) rants that a recent survey from the American Association of Poison Control Centers’ National Poison Data System reveals, there were zero deaths linked to nutritional supplements in 2010, amusingly citing the Orthomolecular Medicine News Service as its source. Orthomolecular medicine, you might recall, is a form of supplement quackery originally embraced by Linus Pauling when he concluded that high dose vitamin C was the cure for the common cold and cancer.

Never let it be said that Mercola isn’t good at intentionally confusing short term toxicity with long term effects in his eagerness to attack a straw man. He seems to think that when scientists point out that supplements can be hazardous that they are claiming that supplements will kill you fast when in reality most potential problems with supplements are long term health effects, although, I would point out, certain supplements can certainly cause serious problems more acutely. In any case, when Mercola asks, “Where are the bodies?” I’d answer that if a supplement increases the risk of a common cancer by 25%, that’s a lot of potential bodies. They just won’t be directly linked to supplements. Particularly amusing is Mercola’s outrage that the FDA is trying to impose the same limits on supplements as on aspartame, monosodium glutamate, and sodium nitrate.

What is infuriating Mercola and the supplement industry are draft guidelines from the FDA designed to assess new ingredients in supplements using safety standards similar to what are required for the approval of new food additives, as described in this recent New England Journal of Medicine commentary:

The proposed guidance clarifies the level of evidence the FDA would use to assess safety. Specifically, the safety of supplements would be evaluated according to three key factors: documented history of use (e.g., in foods or in supplements or herbal medicines sold outside the United States), formulation and proposed daily dose (e.g., more or less than was formerly consumed), and the recommended duration of use (e.g., intermittent or long-term). The FDA’s guidance provides a thoughtful framework for evaluating the safety of new ingredients (see table Required Safety Testing for New Dietary Ingredients Labeled for Intermittent Use.), and if implemented it would lead to substantial improvement in safety. For example, the FDA would require in vitro, animal, and tolerability testing for products that would be marketed for consumption at doses greater than those historically ingested.

In actuality, however, even these draft guidelines do not go far enough, and the supplement industry is vigorously opposing them, even though they strike me as an eminently reasonable strategy for trying to address at least one of the shortcomings of the DSHEA. After all, don’t supplement manufacturers themselves claim that their supplements are food, not medicine? Then why not require that new supplement ingredients without documented historical usage be subject to the same requirements for safety as any other food additive?

It’s important to remember that, in the end, supplements that have biological activity are functioning as drugs. As Martinez et al and a number of other studies strongly suggest, there is very little, if any, evidence that supplements improve health, at least in an already well-fed population, with a precious few possible exceptions that are far more narrow than anything CAM advocates or supplement manufacturers claim. Worse, at least as it stands right now, for most supplements, it is disturbingly likely that the harms probably outweigh the benefits for most people. This is one area where we probably do need more studies, but they need to be “strategically designed” studies, as Martinez et al put it, set up in light of existing evidence from previous studies that have been largely negative.

Posted in: Cancer, Herbs & Supplements, Politics and Regulation

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67 thoughts on “Supplements and cancer prevention

  1. MerColOzcopy says:

    While I am waiting for my green tea to cool a bit to take my supplements…..

    Replace CAM with SBM, and supplements with vaccines:)

    “It’s important to remember that, in the end, supplements that have biological activity are functioning as drugs. As Martinez et al and a number of other studies strongly suggest, there is very little, if any, evidence that supplements improve health, at least in an already well-fed population, with a precious few possible exceptions that are far more narrow than anything CAM advocates or supplement manufacturers claim. Worse, at least as it stands right now, for most supplements, it is disturbingly likely that the harms probably outweigh the benefits for most people.”

  2. sciencebehind says:

    I prefer science based regulation then fear based regulation or regulation for the sake of regulation. Your argument that supplements ‘have substances in them with pharmacological activity’ is true for many foods and I have no desire to have a physician prescribe every bite of food I take ;).

    As for your example of supplementation leading to cancer – folic acid – it’s physicians, particularly OBs, that are pushing this supplement and not as much health gurus. The CDC recommends women of reproductive age take folate supplements daily and increase the dose once pregnant. This recommendation has some science based medicine behind it because of the benefits to the fetus but the encouragement for all women between 15 and 45 to take daily it daily does not. http://www.cdc.gov/ncbddd/folicacid/recommendations.html .

  3. David Gorski says:

    I prefer science based regulation then fear based regulation or regulation for the sake of regulation. Your argument that supplements ‘have substances in them with pharmacological activity’ is true for many foods and I have no desire to have a physician prescribe every bite of food I take

    Nice straw man ya got there, bud.

  4. phaetkins says:

    The potential for cancer-flavored harm from folate is especially disturbing when you consider that the US government instructs all women who might get pregnant to take folic acid all the time.

    It makes me want to go off into a rant about how screwy it is that the US, at least, is increasingly treating all women like we’re pre-pregnant and incapable of making sound reproductive choices, but this is not the blog for that kind of foul language. Ahem.

  5. Jeff says:

    Concerning folate Dr. Gorski states: “These results are consistent with preclinical studies in animals suggesting that folic acid can increase the risk of cancer, as well as observational studies that have linked higher dietary intake with an increased risk of prostate and breast cancer.”

    Is the evidence that conclusive and one-sided? Consider these two studies:

    1. Higher levels of folate associated with a reduced risk of breast cancer:
    http://www.ncbi.nlm.nih.gov/pubmed/19116331

    2. High levels of folate associated with a reduced risk of colorectal cancer:
    http://www.gastrojournal.org/article/S0016-5085(11)00475-6/abstract

  6. David Gorski says:

    That first study showed a barely statistically significant effect in a retrospective study, plus what looks to me like a bit of post hoc subgroup analysis. The second one is even worse, at least if the abstract is any indication (unfortunately my university doesn’t subscribe to this journal); they look as though they really had to torture the data to come up with a barely statistically significant effect.

  7. Sigh. Look at the data on the decline in spina bifida and anencephaly once we started advocating that all women of reproductive ages take folic acid:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm

    @phaetkins, if you’re not sexually active, sure, don’t take folic acid. The only 100% effective contraception is abstinence, which very few people willfully practice. And if you’re so worried about it, then don’t take it, however, know that your child has an increased risk of neural tube defects, and that by the time you know your pregnant, it’s probably already too late. Also, why the rage against the US? No one is forcing folic acid down you’re throat, it’s merely a recommendation. A recommendation that is scientifically proven.

    Like everything, it’s risk vs. benefit.

    I almost think that these anti-medicine psychopaths hate their children. How else can you explain a parent that doesn’t want to protect their child from neural tube defects, and doesn’t want to protect them from deadly childhood diseases? Why aren’t we calling child protective services about parents that are so psychologically disturbed that they’ve manufactured these massive conspiracy theories in which the big bad government is injecting people with dangerous chemicals all to prevent non-existent diseases that are really just harmless, and everything written about the diseases and the hundreds of millions of death they previously caused is all a big lie, and that a good case of small pox builds character.

  8. sciencebehind says:

    I don’t think it’s a straw man when your basis for wanting increased regulation is that some supplements have pharmacological activity. That’s a reason that encompasses more than just supplements so my conclusion is that it’s weak reasoning.

    Your other reason was that some studies show negative effects but your example was of a supplement that physicians push on women.

    I just don’t think you made a strong well-reasoned case for increased regulation.

  9. @Dr. Gorski, you’ve going to have a field day with this post :) If there’s anything that drives the loonies out of the cracks its pointing out useless and potentially dangerous their precious little supplements are.

  10. David Gorski says:

    I don’t know. I’ve only had nine comments thus far; that’s hardly an avalanche, particularly given that two of them were mine. In fact, it’s probably below average for a typical SBM post thus far. I need someone to post this to an alternative medicine discussion forum. :-)

  11. MerColOzcopy says:

    Before this turns into a yawner…

    Over 60 billion doses of vitamin and mineral supplements per year in the USA, and not a single fatality.

    In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed.

  12. phaetkins says:

    Sigh. My specific issue is that women are handled as thought we will become pregnant at any time, and have recommendations made to us without thought given to potential long term repercussions for *us*, as well as any potential children we might have. i.e. We’re walking uteruses, no matter what steps we take to avoid pregnancy, up to and including not having sex with people who produce sperm.

    Long term folic acid supplementation is just an example of that – the focus is solely on the infant and the uterus is incidental. It’s a *good thing* that we know that something relatively simple can produce an excellent result, i.e. good bye spina bifida. It’s just worth talking about, imho, that rather than give access to reliable contraception and the ability to better control our fertility, we’re told to all take this pill as soon as we have our first period. Especially since for some of us, that would have meant starting at age nine or ten and continuing into our fifties. Short term usage when trying to conceive and actively pregnant? Really awesome and everyone trying to get/actually is pregnant should do it. Known too many people who lost wanted pregnancies due to spina bifida. :/

    So… Thanks for just assuming that I’m terrified of medicine and think pills are the root of all evil. Reality is, I just phrased a sideways thought (women’s health is currently focused solely around potential pregnancy, not extant woman) badly because my teratogenic morning meds weren’t helping with a neuralgia flare that’s eating my head. They still aren’t taking the edge off, but whatever.

  13. weing says:

    “Over 60 billion doses of vitamin and mineral supplements per year in the USA, and not a single fatality.”

    How would you know? You blame SBM for deaths. If a study of a statin vs a statin with supplements shows a decrease in benefit when given with a supplement, how can you say that? What if a study shows that women taking supplements, other than vitamin D have greater mortality than women who don’t? What do you call that? That’s just a couple of studies I recall off the cuff. Americans have the most expensive urines in the world.

  14. Jeff says:

    “Not every trial was negative.”
    Did the Martinez paper include this study:

    Chlorophyllin supplementation reduces risk for liver cancer (a randomized, double-blind, placebo-controlled trial): pubmed/11724948

    Dr. Gorski suggests the state of evidence in support of dietary supplements as cancer preventatives is unsettled. Of course this is true. There are researchers who think supplements may be effective for cancer prevention:

    1. Vitamin supplementation associated with a lower risk of colon cancer:
    http://www.nutraingredients-usa.com/Research/ACE-vitamins-may-reduce-colon-cancer-risk-Study

    2. “Vitamins and calcium supplements appear to reduce the risk of breast cancer, according to findings presented at the American Association for Cancer Research 101st Annual Meeting.”
    http://www.sciencedaily.com/releases/2010/04/100418155436.htm

  15. Go ahead and supplement with Vit A and get a stroke, or Vit E and get prostate cancer.

  16. lilady says:

    @ Mercolozcopy:

    “While I am waiting for my green tea to cool a bit to take my supplements…..

    Replace CAM with SBM, and supplements with vaccine”

    So, if you have to change the topic from supplements to vaccines…here’s a simple article for you to read, from the PKIDS (Parents of Kids with Infectious Diseases) website:

    http://www.pkids.org/immunization/consequences_not_vaccinating.html

    Pick a vaccine…any vaccine…and tell us how many infants and children are healthy and alive today, because of that particular vaccine.

  17. EricG says:

    @ mercolozcopy

    Over 60 billion doses of vitamin and mineral supplements per year in the USA, and not a single fatality.

    In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed.

    you mean that largely inert lotions and potions for the worried well are rarely associated with anecdotal negative outcomes (that is, exclusively saturated with warm-and-feel-good testimony) and people with chronic and/or terminal illness who take prescription meds sometimes die? Shocker…

  18. lilady says:

    According to Mercola…and other *natural health blogs* which have picked up on Mercola’s statement:

    “In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed – yet the FDA allows “fast-track” approvals and countless new additions to the marketplace. So why are dietary supplements on the chopping block?”

    Have I missed something here? I don’t see a footnote that provides a citation to back up that statement about the “125,000 deaths attributed to drugs taken correctly as prescribed”.

    Perhaps “mercolaozcopy” could provide a link or citation to back up Mercola’s, statement.

  19. @lilady, apparently the 125,000 is just some stupid extrapolation from a nonsense study or something. Of course it’s not backed with hard evidence or data. I believe it included things like patients who are admitted to the hospital for a heart attack, and are given medication but die anyway. Ridiculous.

  20. gippgig says:

    What do you think about Nature’s section on cancer prevention (which suggests that some supplements might reduce the chance of cancer; http://www.nature.com/nature/outlook/cancerprevention/index.html)?

  21. lilady says:

    @ SkepticalHealth: Don’t expect me to nominate you for today’s “teh internets” award for shouting out the answer to the “125, 000 deaths……” statement. I’m still waiting for mercolaozcopy to answer my question and provide a link or citation :-) (hint) I think I know where Mercola got that “125,000 deaths” statement from and he deliberately misinterpreted the study.

    @ gipppig:

    I cannot access any of your linked “Nature Supplement”. An interesting chapter, “Vaccines, know your enemy” *might* be referring to the Hepatitis B vaccine and the HPV vaccine…and their roles in preventing hepatitis B chronic infection which is strongly correlated with hepatocellular carcinomas…and infection with strains of human papillomavirus which causes cervical, penile and oral-pharyngeal cancers.

    I don’t see any reference in that Nature Supplement to H.pylori bacteriosis infections, that are implicated in gastric adenocarcinomas:

    http://www.ncbi.nlm.nih.gov/pubmed/20370726

    “The incidence rate of gastric adenocarcinoma in Asia tends to mirror the seroprevalence rate of H. pylori infection; however, there are populations with high seroprevalence rates of H. pylori infection that paradoxically have low incidence rates of gastric adenocarcinoma. These diverse clinical outcomes are related to bacterial virulence factors, concomitant environmental factors, host susceptibility and immune response. This review summarizes the current epidemiology of H. pylori infection in Asia and analyzes these data in the context of gastric cancer epidemiology.

  22. David Gorski says:

    That Nature cancer prevention supplement is a sponsored segment. It’s not peer reviewed. It’s basically an advertisement. I’ve complained about this sort of thing before, when Nature shilled for TCM:

    http://www.sciencebasedmedicine.org/index.php/shilling-for-traditional-chinese-medicine/

    Basically, in these supplements, Nature publishes what its sponsor wants it to publish.

  23. DavidRLogan says:

    AWESOME article Dr. Gorski!!! I will use these references alot, thanks so much for taking your time…

    Some random thoughts:

    1) B-carotene is extremely unsaturated and prone to attack…moreso even than the vegetable fats, if I remember. I think one’s asking for trouble taking that stuff (also will have the same problem as taking only vitamin A, which metabolically is very closely tied to zinc and vitamin D….body will struggle to assemble the metabolic complexes with a giant dose of b-carotene and none of the accessory nutrients…of which there are literally hundreds in eg carrots).

    A personal story: I took a huge dose of vitamin A in high school (sigh)…had a giant rash for a week and couldn’t go to school! Looking back I’m lucky…could’ve been much worse. I think you can even go toxic on liver…so I eat about once a week at most. People need to be very careful with this stuff!!!

    2) Actually I’m not very persuaded by the omega-3 craze, either (I realize some people consider that blasphemy…including people around my work). Fish oil, for eg., was used as varnish in lambs for almost 100 years…just saying. These things will be completely destroyed by free radicals unless there’re decent antioxidant protection…and in most brands there isn’t. I’ve got some good papers around my place showing the long term benefits are very questionable…will post later…can’t rememeber off the top.

    If fish oil is as bad as I think I’m not surprised there’s a short term benefit (let’s say, up to several months). The immune system will get a big boost in the short term while it clears all the rancid oils…has anyone tried to control for this in n-3 studies, to anyone’s knowledge? Checking for ACTH or IL-6 would be a good control for a fish oil experiment, I think.

    Anway, until I hear more I wouldn’t supplement with it…particularly in a sickly population and particularly if one’s thinking about using it over the long term. NOT TO MENTION if your source of these supplements is fish there is a possibly sticky moral question about how long we can afford to mass fish the oceans and use fossil fuels to carry this stuff all over/further support that industry (ok I admit to being a doomsday granola head…)

    3) Regarding your recent comment I agree 100%. There’s some work at U of Nebraska to identify potential (emphasis) agents from some of the traditional chinese herbs…mostly focused on research into the phys. of the various species. There’s so much crosstalk though it’s nearly impossible to figure what does what…not within 1000000 miles of actually saying what’s effective (at least from the work with which I’m familiar). Too bad to hear about that advertisement :*(

    Best,
    -David

  24. Angora Rabbit says:

    Thanks for highlighting an interesting article. Should make interesting teaching tool for the students when we run the vitamins class next year.

    Regarding the folate, the problem with NTD risk is we don’t know who those women are until after they’ve given birth to an NTD, which is a tragic way to identify risk. This is why the decision was made to fortify foods. That the increased folate might also increase cancer incidence was not news and was actually expected by those in the field. However, some posters seem to be under the misbelief that the folate causes cancer. Nothing further from the truth. A close parallel is to the rise in breast and prostate cancers when screening became widespread – it wasn’t the screen per se but the increased detection. With the increased folate, tumors that are already present get a bit more folate with which to grow (folate being needed for nucleotide synthesis, the building blocks of DNA). The tumor is still present regardless of the folate intake, it just grows better with the added folate. But on the flip side, making people folate deficient to reduce cancer risk* is not the wisest course of prevention. :)

    * Wait – we do. Methotrexate.

  25. DavidRLogan says:

    varnish in lamps, I mean! Fish oil was varnish in lamps…lambs don’t need varnish. Long day, I’m out.

  26. llewelly says:

    SkepticalHealthon 30 Apr 2012 at 1:04 pm |

    “@phaetkins, if you’re not sexually active, sure, don’t take folic acid. The only 100% effective contraception is abstinence, which very few people willfully practice. And if you’re so worried about it, then don’t take it, however, know that your child has an increased risk of neural tube defects, and that by the time you know your pregnant, it’s probably already too late. Also, why the rage against the US? No one is forcing folic acid down you’re throat, it’s merely a recommendation. A recommendation that is scientifically proven.
    Like everything, it’s risk vs. benefit.”

    Folate supplements do not reduce the risk of spina bifida to zero.

    By implying people ought to choose between abstinence and folate supplements, you are promoting a double standard; you expect that those not taking folate supplements to meet a standard of zero risk, while knowing those who take folate supplements fall short of a zero risk standard.

    Furthermore, you fail to take into account that by reducing the probability of pregnancy, contraceptive methods also reduce the risk of a spina bifida birth. In fact a combination of contraceptive methods with abortion easily results in a lower chance of the woman giving birth to an infant suffering from spina bifida than the use of folate supplements without contraceptive methods.

  27. I love having words put in my mouth and then reading a rebuttal to an argument I didn’t make. My statement is 100% correct. The only flaw is in your comprehension.

  28. MerColOzcopy says:

    @weing

    Yah, the supplement is the killer, not the Statin.

    @skepticalhealth

    Suicide by Vit A, interesting.

    @lilady

    Replace healthy with “sick”, and alive with “or dead”.

    “Pick a vaccine…any vaccine…and tell us how many infants and children are healthy and alive today, because of that particular vaccine”.

    @EricG

    “drugs are known to cause well over 125,000 deaths per year” The drugs themselves, I thought that was pretty clear. With your extension, how about death by prescribed drugs that were not needed in the first place. Real Shocker!!!

    @lilady & SkepticalHealth

    try U.S. National Poison Data System’s, I suppose you want me to name all 125,000.:)

    @DavidRLogan

    Kiss Ass:)

    Hope I didn’t leave anyone out.

    @Dr. Gorski

    Guaranteed you’ll have 40+ posts.

  29. lilady says:

    @llewely: Just what do you have against fortification of white flour with folic acid?

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5931a2.htm

    Recent research has dispelled many of the myths associated with folic acid fortified white flour products, while confirming that folic acid supplementation…not folic acid fortification…leads to folic acid serum levels that exceed the tolerable upper level (UL).

    “Potential adverse effects. Concerns have been raised that intake of folic acid might cause harmful effects, including progression of nerve damage in B12-deficient persons; excess intake in children; accumulation of unmetabolized folic acid; blunting of antifolate therapy (methotrexate and phenytoin); accelerated cognitive decline in the elderly; epigenetic hypermethylation; and cancer promotion (11). Most of these concerns are associated with consumption of high levels of folic acid from supplement use rather than fortification. A 2010 study using NHANES 2003–2006 data showed that 6% of the U.S. adult population aged >19 years consumed more than the recommended 400 µg folic acid/day from supplements, and almost half of these persons (2.7% of the U.S. adult population) exceeded the tolerable upper level (UL) of average daily usual folic acid intake of 1,000 µg (12). Conversely, none of the remaining 94% of the U.S. adult population, who consumed ≤400 µg folic acid per day from supplements, exceeded the UL, regardless of folic acid intake levels from enriched cereal grain products and ready-to-eat cereals. No conclusive evidence exists to indicate that folic acid intake at recommended levels contributes to the causation of any of these conditions of concern; however, continued monitoring and research are needed to ensure that folic acid public health recommendations do not have unintended negative consequences.”

    I think you are confusing fortify white flour products with the intake of folic acid supplements. And, your simplistic solution…while again confusing folic acid fortification with folic acid supplementation…”In fact a combination of contraceptive methods with abortion easily results in a lower chance of the woman giving birth to an infant suffering from spina bifida than the use of folate supplements without contraceptive methods.”…is simply hideous.

  30. nobeardpete says:

    The fundamental problem is that people want to feel like they’re doing something for their health, even when they aren’t sick yet. It lets them feel proactive, like they’re taking charge, being responsible. And doctors insist of giving useless advice like “Eat your vegetables”, “Don’t drink so much alcohol”, “Quit smoking cigarettes”, and, worst of all, “Get some regular exercise”. Who’s really going to do any of that? Very few people, is who. This pretty much leaves empty gestures towards health, like most supplements, as the only viable option.

  31. lilady says:

    @ Mercolaozcopy:

    Have your heroes Joe, Mehmet…or anyone else, who fills your brain with fallacious arguments against science-based medicine…ever show you these pictures? :

    Take a look at the infant’s gangrenous left hand…it was amputated just after that picture was taken

    http://www.immunize.org/photos/hib-photos.asp

    See this infant with septicemia and gangrenous extremities due to invasive meningoccal disease.

    http://www.immunize.org/photos/meningococcal-photos.asp

    Here are more pictures including a picture of a human brain from a person who died of invasive S. pnuemonaie disease.

    http://www.immunize.org/photos/pneumococcal-photos.asp

    BTW…I’m still waiting for the citation or link to the study that you based your (parroted from Mercola’s website) statement on…”In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed.”

  32. lilady says:

    @ Mercolaozcopy…do stick around, I have a comment stuck in moderation…with some pictures that you might find interesting.

    Where is the link or citation to your copy pasta quotation from Mercola’ website about the 125,000 deaths yearly attributed to prescribed medicines taken correctly?

  33. lilady says:

    @# MerColOzcopy

    “drugs are known to cause well over 125,000 deaths per year” The drugs themselves, I thought that was pretty clear. With your extension, how about death by prescribed drugs that were not needed in the first place. Real Shocker!!!”

    and,

    “@lilady & SkepticalHealth

    try U.S. National Poison Data System’s, I suppose you want me to name all 125,000.:)”

    Do you mean this link from Joe Mercola’s website?

    2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report

    I’m going to make a wild guess Mercola fanboi…you never even read that long report…or even gave it a cursory review.

    The long report that Mercola and you reference is a review of all the types of calls that were received in regional Poison Control Call Centers in the United States during 2010. There were many types of calls from “civilians” from patients themselves and family members…and Emergency Room staff and… from law enforcement personnel.

    The “poisons” these people called about were certain prescribed medications where an adult inadvertently or deliberately took an “overdose”, chemical poisons that were ingested, inhaled or where the patient had skin exposures, children whose parents/caretakers were negligent resulting in a child ingesting an adult’s prescribed medicine/vitamins or supplements and a child ingesting household chemicals (cleaning products, barbecue starters and other toxins). Animal bites from household pets, snakes and potentially rabid terrestial animals were also “called into” the regional call centers.

    Illegal drugs…including opiates and street drugs, ETOH toxicity…and an assortment of injected substances by drug abusers…as well as the newer “bath salts substances” that kids are sniffing to get high…made up a huge proportion of calls received during calendar year 2010 at Regional Poison Control Call Centers.

    I see ONLY 1,730 fatalities listed…from all the above causes…documented in that report that Mercola and you referenced.

    We are still waiting for a citation or link to that quotation you are parroting from Mercola’s website:

    ”In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed.”

  34. lilady says:

    Let me see if this is a better link to Mercola’s reference about 125,000 deaths yearly from prescribed medicine used correctly:

    http://www.poison.org/stats/2010%20NPDS%20Annual%20Report.pdf

    Better now?

    Inquiring minds want to know where Mercola and his fanboi got that statistic from.

  35. Ouch! MercOzQuackCopy is looking pretty ridiculous. You have to wonder if these goobers every experience a “realization” where they say “Wait a minute… I just threw out a completely wrong statistic that is not supported by any evidence what so ever, and now I can’t find any proof that it’s true. Perhaps I’m wrong?” I doubt it. :(

  36. mousethatroared says:

    Angora Rabbit – Thanks so much for the clarification on the folate – NTD, cancer issue.

    As an aside, folate also dismisses the incidence of cleft lip and palate, by (I think) 25-30%

    As usual, good stuff is all mixed in with bad stuff and we just have to muddle about try to figure out what’s the best course of action with what we know now.

    Be nice if things were simple, eh?

  37. passionlessDrone says:

    Basically, in these supplements, Nature publishes what its sponsor wants it to publish.

    This is a pitiful statement. *Very sad*

    - pD

  38. therling says:

    I seem to recall that in popular culture there was the portrayal of the avid vitamin-taker being a bit of a screwball? E.g., see Vitamin Flintheart from the old Dick Tracy comic.

    Another thing I wonder is, if rather than giving them such innocuous-sounding names like “Vitamin D,” they were instead called by the more descriptive terms “cholecalciferol” or “ergocalciferol,” the alt-med folks would start to cry “Chemicals! There’s chemicals in our food!”

  39. lilady says:

    @ therling:

    I forgot about Vitamin Flintheart in the Dick Tracy comic strip character:

    http://www.angelfire.com/art/dtstrip/vitamin.html

    How about this cartoon character?

    http://www.angelfire.com/art/dtstrip/measles.html

    Maybe Mercola should think about reviving these Dick Tracy characters for his products and his website.

  40. nybgrus says:

    @llewelly:

    By implying people ought to choose between abstinence and folate supplements, you are promoting a double standard; you expect that those not taking folate supplements to meet a standard of zero risk, while knowing those who take folate supplements fall short of a zero risk standard.
    Furthermore, you fail to take into account that by reducing the probability of pregnancy, contraceptive methods also reduce the risk of a spina bifida birth. In fact a combination of contraceptive methods with abortion easily results in a lower chance of the woman giving birth to an infant suffering from spina bifida than the use of folate supplements without contraceptive methods.

    I think you miss the point here….

    As SH pointed out only abstinence is 100% effective. And in practice, especially amongst young people, contraceptive efficacy is significantly lower or not used at all.

    However, the crux is that the effects of a lack of folate manifest before a woman even realizes she is pregnant. By the time she has missed a period and thought to check, the boat has already left the dock. By the time she considers taking some folate (if she does, for myriad reasons) the boat is long gone.

    In medicine, we do not advise women to take folate once they are pregnant, but long before for exactly that reason.

    So to fortify foods is actually the only way to ensure that NTD and other birth defects are decreased. Even with excellent education motivating women who were seeking pregnancy to take folate, that would leave an amazingly large swath of the population unprotected.

    And as Angora Rabbit aptly pointed out (before I had a chance – good on ya!) the folate is not a carcinogen – it merely acts as fuel if a cancer nidus were already present. Which is certainly not a good thing, but not as bad as actually triggering oncogenesis.

    And if some group or another wants to spin this as some sort of anti-woman rhetoric, there is little I can do about it except be angry myself – I am constantly raving mad at the current “war on women” myself. But the reality is that from a medical standpoint, this is not about reducing women to baby-machines. It is recognizing that constant fortification is truly the only reasonable mechanism by which to protect children because of the logistics of folate deficiency – not because women are somehow incapable of planning their own reproductive desires.

  41. anoopbal says:

    Hi David,

    One of the 8 recommendations for preventing cancer by World Cancer Research is NOT to take any dietary supplements to prevent cancer. I hope you have come across their report.

  42. Angora Rabbit says:

    Thanks, Nygbrus, for the shout out and backatcha. You’re absolutely right – the point of folate for NTD is that those events occur during weeks 3-5 of pregnancy and generally before the pregnancy is noticed.* This is why folate is needed prior to conception, so that levels are adequate should pregnancy occur. We put folate in the perinatal vitamins as much for the next potential pregnancy as for anything else. We can sing the same refrain for alcohol and FAS, that women need to consider their consumption before, if they are pregnant and don’t know it, significant damage can still happen. We aren’t treating women as wombs; we’re treating them as intelligent people who need the knowledge and power that, if they choose to carry the pregnancy, that every advantage for good health will be offered to them and the children.

    Since 50% (or better) of all pregnancies are unplanned, consideration of preconception health including folate status is a significant issue. And it’s a woman’s issue because, if something goes wrong in the pregnancy, 9/10 chances-plus it’s the woman who has primary caregiver responsibility for the child. In my book that IS a feminist issue.

    * Or as Lewis Wolpert liked to say, the most important event in a person’s life isn’t birth or marriage but gastrulation.

  43. nybgrus says:

    Or as Lewis Wolpert liked to say, the most important event in a person’s life isn’t birth or marriage but gastrulation.

    That actually made me laugh out loud. I am such a nerd.

    And tired and drinking a beer :-D

  44. MerColOzcopy says:

    Two days old and more popular than Dr. Hall’s G-Spot:)

  45. gretemike says:

    Regarding the discussion about whether ”In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed,” is correct or not, the discussion misses the point.

    What doctors do involves inherent risk that is not found in most other professions. The potential risks of a particular drug must be weighed against the benefit of taking it . . . that is a balancing act that doesn’t exist in most other professions. So when a patient’s heart is malfunctioning in such a way that there is a high risk of a stroke, taking a blood thinner makes sense even though there is a smaller risk of bleeding to death. Heck, just the other day I saw a doctor push an IV drug that by design stopped the person’s heart for a few moments, went totally flatline . . . and that was what it was supposed to do. What other profession does this sort of thing? It would be like a pilot routinely needing to decide whether to land on the runway with the huge cracks or the runway with the randomly placed landmine. Doctors take risks because they are forced to, it is an inherent part of their job, few other professions do that. And risks necessarily involve failures, otherwise there wouldn’t have been risk in the first place. And for that reason a huge amount of effort goes into balancing the risk versus the benefit.

    It’s probably true that dietary supplements kill fewer people, but that’s likely because they are generally more benign than what doctors give their patients (although they aren’t always benign: http://www.kmbc.com/r/30989154/detail.html). But that’s missing the point. What IS the point is the other side of the coin, the fact that as a result of the risk versus benefit analysis, a whole lot more patients are helped by those drugs than those who are hurt by them, regardless of whether the number harmed is 125 or 125,000 or 125,000,000. And most important: without anyone taking those prescribed drugs that supposedly killed 125,000 people, the body count would have been HIGHER than if nobody had taken the drugs at all. We know that to be true thanks to all the hard work studying the risk versus benefit of the drugs.

    None of that can be said of dietary supplements, which in most cases have not been shown to benefit people in the way their proponents claim. So even though the numbers of people harmed is perhaps likely smaller, those people were harmed in vain.

  46. MerColOzcopy says:

    Could you imagine if the penal system was run this way. Hundred death sentences, twenty five by lethal injections (keeping with the theme) to those that turned out to be innocent. Hey we got 75%, risk versus the benefit!!!

    And ten Vit A. injection for the SCAMmers:)

  47. Harriet Hall says:

    “Could you imagine if the penal system was run this way.”

    I can’t imagine a worse analogy.

  48. gretemike says:

    Well first of all, I think the ratio in medicine is much, much more favorable than your random 75/25. So your analogy is simply waaaaaaaaay inacurate looking only at the numbers.

    Second, corrections doesn’t compare well to medicine. Aside from the obvious fact that medicine deals with a population of people many of whom will die if nothing is done (more will die from whatever condition is causing them to take the medication than will die from the side effects of the medications), medicine also just has inherent risk as I mentioned previously. We strive to eliminate the risk of a wrongful death in corrections with all sorts of safeguards. But in medicine if you have a fellow who is at high risk for a stroke, he needs a blood thinner. And a blood thinner can cause bleeding, that’s just what it does, so you are forced to an extent to embrace the risk, you just make sure that you measure the risk against the benefit first.

    People aren’t taking prescription meds for the same reason that they are taking dietary supplements. People take a dietary supplement based on the lies put forth by their proponents, that they will prevent certain diseases from occurring. People take prescription medications in many cases because they are in fact afflicted with a particular disease and will die sooner than later without particular medications. And the success of prescription medications is undeniable, just look at HIV which thanks to “big pharma” has been transformed from a death sentence to a chronic disease.

    The benefit of prescription medications can be demonstrated. The benefit from dietary supplements (except for those like B12 that are prescribed by MDs) cannot be demonstrated. That is the fundamental difference.

  49. gretemike says:

    We humans seem to have a very irrational method of choosing which risks to accept and which to reject. We’ll speed on a highway which puts us at much greater risk of death than living near a nuclear power plant, but typically it is the nuclear power plant that we will worry about the most, etc. This whole discussion about how many people die from prescription drugs, we’re talking about very low risk especially when measured against the risk of whatever triggered the need for the medication in the first place.

  50. MerColOzcopy says:

    How about these:

    “Whether or not the G-spot exists, you can buy a sex toy, a curved vibrator, specially designed to stimulate it.”
    Whether or not you have an illness, you can be prescribed a drug, a vaccine, specially designed to treat it, cure it.

    This is golden coming from a doctor:

    “One benefit of abortion is that it prevents the many health risks and complications associated with pregnancy. Abortion is safer than full-term pregnancy.”

  51. nybgrus says:

    lol. MerColOzcopy really is off his rocker.

    DFTT, IMO.

    Well said, btw, gretemike

  52. bgoudie says:

    Is there a vitamin supplement that helps with forming proper, logical analogies? If so you might want to give it a try MerColOzcopy.

  53. David Gorski says:

    One of the 8 recommendations for preventing cancer by World Cancer Research is NOT to take any dietary supplements to prevent cancer. I hope you have come across their report.

    Really? Do you have a link? I haven’t seen that report.

  54. squirrelelite says:

    anoopbal may be referring to this report from 2007.

    http://eprints.ucl.ac.uk/4841/1/4841.pdf

    The recommendation on supplements to prevent cancer is on page 386-387.

    The recommendations of this Report, in common with its
    general approach, are food based. Vitamins, minerals, and
    other nutrients are assessed in the context of the foods and
    drinks that contain them. The Panel judges that the best
    source of nourishment is foods and drinks, not dietary supplements.
    There is evidence that high-dose dietary supplements
    can modify the risk of some cancers. Although some
    studies in specific, usually high-risk, groups have shown evidence
    of cancer prevention from some supplements, this
    finding may not apply to the general population. Their level
    of benefit may be different, and there may be unexpected
    and uncommon adverse effects. Therefore it is unwise to recommend
    widespread supplement use as a means of cancer
    prevention.

  55. mousethatroared says:

    MerColOzcopy’s
    “Could you imagine if the penal system was run this way.”

    Harriet Hall – I can’t imagine a worse analogy

    I’m going to be a pain in the ass and say, actually the penal system is a reasonable analogy, but I don’t get how MCO is pursuing it.

    With the penal system, we imprison people in order to prevent death or injury in the public. We do this knowing that a certain percentage of people will be the victims of human error and will be falsely imprisoned (or put to death in some horrible cases).

    We accept the risk of being falsely imprisoned* because we want the benefit of a certain degree of safety from crime.

    In my mind common sense and morality suggests that we should continue to closely examine cases where people were falsely imprisoned by our justice system OR experienced death or injury from medical errors and attempt to learn and prevent similar future mistakes.

    In my mind, common sense and morality does not suggest that we should have allowed Jeffery Dahmer to remain free due to the fact that some people are falsely convicted.

    In my mind common sense and morality doesn’t suggest that we ignore the evidence surrounding a crime and choose an accused based on unsubstantiated rumors and anecdotes, similar to the way many supplements are recommended on many of the “health” sites I come across…

    That’s not such a bad analogy, is it? ;)

    *how willing you are to accept the risk of false imprisonment may depend upon your actual risk of being falsely accused based on your ethnicity, gender, etc..

  56. lilady says:

    @ MerColOzcopy: I’m still waiting for you to read the report on the link you provided from Mercola’s website:

    http://www.poison.org/stats/2010%20NPDS%20Annual%20Report.pdf

    We all want to know why you parroted Mercola’s statement, ”In striking contrast, drugs are known to cause well over 125,000 deaths per year when taken correctly as prescribed.”

    Where are the 125,000 deaths, Mercola fanboi?

  57. anoopbal says:

    Hi David,

    Here are the 8 recommendations: http://www.exercisebiology.com/index.php/site/articles/prevent_cancer_in_8_simple_steps/

    Here is the link to the website. You can download the specific reports by signing up: http://www.wcrf.org/cancer_research/expert_report/recommendations.php

  58. MerColOzcopy says:

    Hello lilady:

    I am touched, I have a following:))

    Sorry I made you wait, but some of us do not have the luxury of sitting in front of a computer all day long.

    I have to confess I didn’t know what “fanboi” meant, had to look it up:(

    It sort of ironic that any one here would think that. One would think from my Login name quite the opposite. Mercola, Dr. OZ, Colonoscopy= MerColOzcopy. It was meant to be an unflattering association with the two. I guess if I have to explain it it wasn’t a very good choice. What’s really amusing is that I am banned from posting comments on Mercola’s site for challenging his assertions. “I wasn’t keeping in the spirit of the Mercola Community”, I was informed:((

    What am I your search engine? I cannot believe you are making me take the time to explain my numbers, I’m missing prime realestate in the comment section of “Funding CAM Research”:((

    I am really surprised everyone is having trouble with the 125,000 number and not the 60 Billlion, I couldn’t believe that one myself. You would think out 60 Billion at least one would choke to death on a vit. or sup.

    I have the to confess my 125,000 wasn’t exactly right, before you start gloating, I would say it is bit higher. This information gives 106,000, keeping in mind data are derived from studies in hospitalized patients.

    For God’s sakes I hope this Dr. Barbara Starfield is not an escaped mental patient:))

    For your convenience……..

    Doctors Are the Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year

    Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health

    ALL THESE ARE DEATHS PER YEAR:
    12,000 – unnecessary surgery8
    7,000 – medication errors in hospitals9
    20,000 – other errors in hospitals10
    80,000 – infections in hospitals10
    106,000 – non-error, negative effects of drugs2

    These total to 250,000 deaths per year from iatrogenic causes!!

    What does the word iatrogenic mean? This term is defined as induced in a patient by a physician’s activity, manner, or therapy. Used especially of a complication of treatment.

    Dr. Starfield offers several warnings in interpreting these numbers:

    First, most of the data are derived from studies in hospitalized patients. Second, these estimates are for deaths only and do not include negative effects that are associated with disability or discomfort. Third, the estimates of death due to error are lower than those in the IOM report.1

    If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths And the next leading cause of death (cerebrovascular disease).

    Another analysis11 concluded that between 4% and 18% of consecutive patients experience negative effects in outpatient settings, with:
    116 million extra physician visits
    77 million extra prescriptions
    17 million emergency department visits
    8 million hospitalizations
    3 million long-term admissions
    199,000 additional deaths
    $77 billion in extra costs

    The high cost of the health care system is considered to be a deficit, but to be tolerated under the assumption that better health results from more expensive care.

    However, evidence from a few studies indicates that as many as 20% to 30% of patients receive inappropriate care.

    An estimated 44,000 to 98,000 among them die each year as a result of medical errors.2

    This might be tolerated if it resulted in better health, but does it? Of 13 countries in a recent comparison3,4 the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. More specifically, the ranking of the US on several indicators was:
    13th (last) for low-birth-weight percentages
    13th for neonatal mortality and infant mortality overall14
    11th for postneonatal mortality
    13th for years of potential life lost (excluding external causes)
    11th for life expectancy at 1 year for females, 12th for males
    10th for life expectancy at 15 years for females, 12th for males
    10th for life expectancy at 40 years for females, 9th for males
    7th for life expectancy at 65 years for females, 7th for males
    3rd for life expectancy at 80 years for females, 3rd for males
    10th for age-adjusted mortality

    The poor performance of the US was recently confirmed by a World Health Organization study, which used different data and ranked the United States as 15th among 25 industrialized countries.

    These estimates of death due to error are lower than those in a recent Institutes of Medicine report, and if the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

    Even at the lower estimate of 225,000 deaths per year, this constitutes The third leading cause of death in the US, following heart disease and cancer.

    Lack of technology is certainly not a contributing factor to the US’s low ranking.

    Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population. (17) Japan, however, ranks highest on health, whereas the US ranks among the lowest. It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the US, high use of diagnostic technology may be linked to more treatment. Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among The countries ranked, whereas they are very low in Japan, far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.

    Journal American Medical Association Vol 284 July 26, 2000

    REFERENCES

    1. Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.

    2. Kohn L, ed, Corrigan J, ed, Donaldson M, ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.

    3. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.

    4. World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. Accessed June 28, 2000.

    5. Kunst A. Cross-national Comparisons of Socioeconomic Differences in Mortality. Rotterdam, the Netherlands: Erasmus University; 1997.

    6. Law M, Wald N. Why heart disease mortality is low in France: the time lag explanation. BMJ. 1999;313:1471-1480.

    7. Starfield B. Evaluating the State Children’s Health Insurance Program: critical considerations. Annu Rev Public Health. 2000;21:569-585.

    8. Leape L.Unnecessary surgery. Annu Rev Public Health. 1992;13:363-383.

    9. Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.

    10. Lazarou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA. 1998;279:1200-1205.

    11. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.

    12. Wilkinson R. Unhealthy Societies: The Afflictions of Inequality. London, England: Routledge; 1996.

    13. Evans R, Roos N. What is right about the Canadian health system? Milbank Q. 1999;77:393-399.

    14. Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics, 1998. Pediatrics. 1999;104:1229-1246.

    15. Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.

    16. Donahoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596-1607.

    17. Anderson G, Poullier J-P. Health Spending, Access, and Outcomes: Trends in Industrialized Countries. New York, NY: The Commonwealth Fund; 1999.

    18. Mold J, Stein H. The cascade effect in the clinical care of patients. N Engl J Med. 1986;314:512-514.

    19. Shi L, Starfield B. Income inequality, primary care, and health indicators. J Fam Pract. 1999;48:275-284.

  59. lilady says:

    @ Mercola fanboi…Now that you have apologized for quoting Dr. Mercola and providing Mercola’s link, are you now moving the goal posts by providing a different study touted on alternative medicine websites?

    “What am I your search engine? I cannot believe you are making me take the time to explain my numbers, I’m missing prime realestate in the comment section of “Funding CAM Research”:((

    I am really surprised everyone is having trouble with the 125,000 number and not the 60 Billlion, I couldn’t believe that one myself. You would think out 60 Billion at least one would choke to death on a vit. or sup.

    I have the to confess my 125,000 wasn’t exactly right, before you start gloating, I would say it is bit higher. This information gives 106,000, keeping in mind data are derived from studies in hospitalized patients.’

    It seems that Dr. Gorski has already written about Dr. Barbara Starfield’s study here:

    http://www.sciencebasedmedicine.org/index.php/be-careful-what-you-ask-for-larry-dossey-deepak-chopra-and-rustum-roy-declare-war-on-science-based-medicine/

    Before you start trolling and doctor-bashing on other threads, why not take the time to read Dr. Gorski’s excellent article about this latest study?

    BTW, your comments are ripped off completely from alternative medicine websites.

  60. pmoran says:

    The mainstream has had to take a lot of flack from elements of “alternative” medicine for its supposed closed-mindedness.

    Yet, here we are —. NCCAM experience has largely confirmed the predictive power of mainstream medical science regarding the intrinsic efficacy of many different treatment methods. Now the vitamin supplement story seems to be confirming that the mainstream has been quite right to demand very high levels of evidence before buying into other superficially well-supported medical claims.

    Considering the grandiosity of its early claims, the intensity of its promotion, and the ferocity of many of its attacks upon the mainstream, “alternative” medicine surely needed a major “win” by now. Yet here we are, some decades later, finding it difficult to think of any way in which it has made an important contribution to medical care.

    The public is not stupid. I think it is aware that AM has not performed up to the early hype. I sense that the tide is turning. Even deep, dark “alternative” cancer groups are less strident, even though they are still, as always, dominated by vocal extremists.

    The AM phenomenon probably has helped catalyze some beneficial changes in the mainstream, but that’s another story.

  61. EricG says:

    @ mercolozcopy

    I’m curious as to what the figures would be like if the roles were flipped – if unproven superstitions ran wild, allowing anyone to treat anybody so long as a complaint was matched with a cure. If ancient medicine ruled supreme, crushing and obfuscating the message of those foolishly adhering to evidence. If the norm for birth was in the home and supervised only by a midwife. if the standard of care was to take potions for mild distress and institute energy healing, coffee enemas, eye of newt and bloodletting for infectious disease. How many deaths, then, would occur at the hands of anyone describing themselves as a “medical professional?” Essentially, what would the world be like if CAM and naturopathy ruled surpeme? I wonder…

    O wait, no i don’t. that was EXACTLY the state of things 150 years ago. I suppose no one here feels unfortunate to be deprived the opportunity to test drive 1800′s era medicine? shall we have this conversation again in 150 years when your distant offspring meet my own on some magic discussion mindweb and they can lament how 6 people die each year at the hands of modern (future) medicine?

    Fortunately I take my supplements; I have been promised a cancer free lifespan of 2,819 full moon cycles – Maybe I’ll see you there! :).

  62. MerColOzcopy says:

    @liladay

    Wow, you literally were waiting up for me, how creepy.

    I apologize if I gave you the impression I was apologizing for something.

    Your admiration and fawning for Dr. Gorski is admirable but a little weird, you were probably blogging from Dr. Gorski`s bedroom closet last night, yikes.

    This “trolling” you refer to, if it is anything like fishing, it looks like I caught one.

    How sad and painful it must be living alone hopped up on antidepressants.

    Really, these numbers of medically related deaths are quite shocking. Clearly you are not a medical professional of any sort and have not caused the death of an individual, but quite certain you have made many very ill.

    This SBM site is like grade school all over again, the bullying and name calling, similar tactics as Big Pharma. It really adds to the credibility of this site. Actually it should be OSBM, Our SBM, never see any consensus with, or references to this site.

    That link, what ever it was, you might want to forward it to: Dr. Barbara Starfield, Johns Hopkins College, Wikipedia, IOM, National Academy Press, Oxford University Press, World Health Report, Erasmus University, Annual Review Public Health, Lancet, JAMA (The Journal of the American Medical Association), JAMA Using evidence to improve care, British Medical Journal, Routledge, New England Journal of Medicine, etc. Apparently they got it wrong and you got it right, you should set them straight.

    Since the inception of SBM, sales of Vit. and Sup. have, what, doubled, tripled, quadrupled, ten fold? You guys are doing a bang up job of getting the message across. Even Big Pharma is getting into Vit. & Sup.

    How ironic that here, “Drinking the Kool-Aid” comes with a prescription

  63. weing says:

    “Since the inception of SBM, sales of Vit. and Sup. have, what, doubled, tripled, quadrupled, ten fold? You guys are doing a bang up job of getting the message across. Even Big Pharma is getting into Vit. & Sup.”

    What are you talking about? Those Madison Ave boys in advertising know what they are doing. It works. You think Big Pharma is just getting into it now? Quite naive.

  64. lilady says:

    @ Mercola fanboi: I am a medical professional…but you would not know that…being that your entire base of knowledge is from the internet…and you quote entire articles from Mercola’s website.

    Why did you quote directly from Mercola’s blog and provide me and other readers here with Mercola’s footnoted citation? You never even scanned the study that Mercola footnoted, did you? (hint) He depends on his credulous “readership” to not read the studies and/or to not understand the studies he cites.

    Here’s just a few examples of people who used vitamins to treat diseases and disorders:

    http://whatstheharm.net/vitaminmegadoses.html

    Oh, and here’s some more instances of people who took herbs and supplements:

    http://whatstheharm.net/herbalremedies.html

    And, a few more cases of using “natural” treatments prescribed by naturopaths in lieu of licensed physicians:

    http://whatstheharm.net/naturopathy.html

    If you haven’t any education is human biology, physiology, chemistry or pharmacy, perhaps you don’t belong here.

    Don’t delude yourself famboi, I’m not waiting for your inane postings…I post on many science and medical blogs.

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