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Vitamin Cocktail with a Meme Twist (Supplement my gimlet with a dash of dissonance)

A trail of recent reports is trying to tell us something. But are we listening, and are “they” listening? If so, does it mean the same to “them” as it does to us?

The report trail is telling us that multiple vitamins fail as preventatives against cardiovascular disease, cancer, or even for anything other than for dietary vitamin deficiency. And that is what we were saying in the first place – forty and more years ago.

Here is a partial list of these recent reports –  followed by an odd turn

Vitamins E and C were ineffective in preventing `cardiovascular disease in men. Sesso HD, Buring JE, Christen WG et al. JAMA, 2008;300 (Physicians’ Health Study II, mong 14,641 male physicians. [...] The study participants were randomized to receive 400 IU of vitamin E every other day or a placebo and 500 mg of vitamin C daily or a placebo.

B Vitamins (B12, B6, folate) May Not Reduce Cardiovascular Events For Coronary Artery Disease Patients Ebbing M, et al, JAMA 2008, Aug 20 — In a large clinical trial involving patients with coronary artery disease, use of B vitamins B6, B12, folate was not effective for preventing death or cardiovascular events. Patients were randomly assigned to one of four groups receiving a daily oral dose of one of the following treatments: folic acid, 0.8mg, plus vitamin B12 , 0.4mg, plus vitamin B6 , 40mg (n= 772); folic acid plus vitamin B12 (n = 772); vitamin B6 alone (n = 772); or placebo (n = 780).The study was stopped early because of concerns among the participants about preliminary results from another similar Norwegian study suggesting no benefits from the treatment and an increased risk of cancer from the B vitamins. Daily supplementation combination that included folic acid and vitamin B6 and B12 had no significant effect on the overall risk of cancer, including breast cancer, among women at high risk of cardiovascular disease. Zhang M et al, JAMA 2008 Nov. 5.

Certain Vitamin Supplements May Increase Lung Cancer Risk, Especially In Smokers. November 11, 2008, from American Thoracic Society. March of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Selenium and vitamin E supplements, taken either alone or together, did not prevent prostate cancer; these results came from initial, independent review of study data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), funded by the National Cancer Institute. (publication  Feb. 1 in the Journal of Clinical Oncology.)

These reports, along with those showing inefficacy of vitamin E in CV prevention and others, all in recent months, dovetail on more reported over the past decade. Now for the dissonance. A popular Web portal posted a brief questionnaire following one of last week’s reports. It asked readers to answer if they took vitamins regularly, infrequently, or not at all.

The percentages at the time I answered were approximately:Regularly          68 percent

Infrequently – 18

Not at all – 14

The second question asked if the reported negative study surprised the reader, and the

answers were approximately:

Yes – 20 percent

No – 80

The answers to this simple exercise indicate for a large percentage of responders, at least lack of surprise at the negative report on vitamins for disease prevention, and imply prior knowledge of ineffectiveness. Yet a large majority of responders still take vitamins regularly or occasionally, and must have known the vitamins were ineffective.

There are lessons here on human nature, and implications for making of public policy about quackery. The human part is our old friend and nemesis, cognitive dissonance, “don’t bother me with the facts.” Despite having the knowledge of ineffectiveness, people still have a drive to take supplements or get something psychologically out of taking them. Perhaps, and likely, the results reflect effects of successful advertising and propaganda.

In either case, many people do things they know are irrational, and even ineffective. Perhaps some of them even resentt laws and regulations that would limit their freedom of action. We have seen this principle in action in many examples of quacks, quackery, and their following gulls.  The principles are being encoded in medical board policies and laws such as “Medical Freedom” acts.

Recognizing this limiting human factor some time ago, I have tried not to be personally upset about quackery, medical pseudoscience, and their embodiment as “CAM.” The attempt has been only partially successful, but easier since retirement and removal from first hand contacts with dissonant patients. I can tell myself to regard pseudoscience and pseudo medicine as objects of study, objects of interest, sociological aberrancies. Yet some degree of upsetness remains. I just cannot get to the point of feeling neutral about con artists who promote hese irationalities.

That’s about all I want to say about this little but revealing and confirming news offering. But it gives timely theatrical relief from the high tension feelings, suspicions, frustrations and satisfactions swirling around last week’s election. Cognitive dissonance, the effects of advertising, packaging, sloganeering, and selling are alive and healthy, and the mechanisms of heuristics and belief are still operating; recognizable in selling of supplements, if harder to recognize in politics. Thank goodness for quackery.

Posted in: Cancer, Clinical Trials, Health Fraud, Herbs & Supplements, Nutrition, Politics and Regulation

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50 thoughts on “Vitamin Cocktail with a Meme Twist (Supplement my gimlet with a dash of dissonance)

  1. qetzal says:

    The answers to this simple exercise indicate for a large percentage of responders, at least lack of surprise at the negative report on vitamins for disease prevention, and imply prior knowledge of ineffectiveness.

    Well, at least some of them are probably conspiracy theorists who are convinced these were fraudulent studies financed by big pharma to suppress ‘the truth’ about vitamins.

  2. Beowulff says:

    I think a lot of people take vitamin supplements “just in case”. They know that they probably don’t really need to, but they’re worried that their diet isn’t varied enough all the time, so just in case they take extra vitamins. Besides, the vitamin C tablets I remember from my youth were actually kinda tasty (lemon or orange flavor) :)

  3. Harriet Hall says:

    Some people still think vitamins give you energy.
    A pediatrician I used to work with said vitamins just give you expensive pee.

    I used to take a multivitamin for “psychotherapy” – it relieved me of anxiety about whether I was eating right. But I kept having to look for new formulations – after menopause, I had to eliminate any vitamin containing iron. Then I learned that excess vitamin A increases the risk of fractures in postmenopausal women. That was the final straw for me. I now take only vitamin D, and I’m not entirely sure about that. :-)

  4. overshoot says:

    Needless to say, the usual channels are full of the “they didn’t use the right form of _____” messages. Along, of course, with claims that the reason “they” didn’t use the right forms was to set up the tests to fail.

    Yawn.

  5. Wallace Sampson says:

    Thanks, all.
    I admit I had not considered the just in case case. That might explain much of the apparent dissonance. Telling the truth, I was not much in the mood for excting stuff this week, so the topic was old and mundane, and I tried to spice it. Perhaps I overdrew. But I thought you all might appreciate the meme twist and the rest of the title play, unless it looked too show-offy.

    WS

  6. Jules says:

    I have to agree with Beowulff: I don’t think people necessarily take supplements to ward off cancer or prevent heart disease. They might worry that their diets don’t include enough fruits and veggies. Women are prone to osteoporosis and anemia, so they’re more likely to take calcium* and iron supplements. That sort of thing.

    My memory of the Krebs’ cycle is a bit rusty, but it does require niacin–if you’re trying to “boost your metabolism/increase energy” the vitamin way (which of course doesn’t work) and you look up cellular metabolism, taking vitamin B would kinda-sorta make sense…the B12-folate-cysteine-plaque formation connection is also biochemically sound. It seems like there’s a disconnect between the clinical evidence and the biochemical data–I think that’s what people don’t quite get. Offhand, depending on how much biochemistry you know (or think you know), I’d say a fair amount of what I’ll call “vitamin theory” makes sense–on a celllular level. There’s a lot that can go “wrong” between cells and humans, though…

    *When are we going to get off of the “milk does a body good” train? I mean, I don’t have a problem with drinking milk, per se. I don’t even have a problem with the government recommendations for the amounts (and I’m slightly lactose-sensitive), although I think it’s a tad on the high end. I just don’t understand why people keep telling me “drink milk or else you’ll get osteoporosis” or some other crap like that.

  7. Karl Withakay says:

    The impression I get from my friends who take vitamins is that people generally think their diet is worse than it really is. People believe they have a poor diet, and supplement with vitamins.

    I would guess that most people’s diets are not as deficient as they think, and that typical multivitamins are overkill. Most people are unaware that some of what they eat already contains sufficient supplemental vitamins and minerals like breakfast cereals.

  8. Fifi says:

    Karl – Both mainstream and SCAM advertising promote the idea that it’s impossible to get adequate nutrition from food – usually due to some “peril of modern life” such as being “busy” or due to food not being as “good” as it was back in the day when everything was perfect in the Garden of Eden. (Of course, all the retrospective romanticism about food is nostalgia for a time that never really was – a sort of bucolic fantasy that’s sold by and to people who clearly like the idea of nature but not actual nature itself, hence the romantic but unrealistic fantasy that’s sold.)

  9. Fredeliot2 says:

    Wasn’t there a news item recently concerning a shorter life expectancy for persons taking daily vitamins?

  10. Karl Withakay says:

    Also concerning supplemental vitamins- it’s been said by more than a few that Americans have the most expensive urine in the world….

  11. urology-resident says:

    I don’t think anyone has mentioned Folic Acid and neural tube defects….

  12. The Blind Watchmaker says:

    Beware of doctors who sell vitamins at their office. I know a few that got involved in multilevel marketing schemes. They use their authority to sell these to patients, then call their colleagues on weekends to get them to be distributors. Talk about conflict of interest.

    Eat right and exercise. That advice does not require multilevel marketing.

  13. Harriet Hall says:

    EddieVos has not commented on this thread. On the JUPITER trial thread he recommends multivitamins along with omega-3s to prevent heart disease. He rejects the evidence for statins but apparently accepts the (now discredited) claims for multivits. Go figure!

  14. clgood says:

    Until recently I took multivitamins “just in case”. That was exactly what a neurologist I saw told me. I figured I was just filling in the base line.

    After reading this blog a while I stopped buying vitamins. But I kept taking them until the bottle ran out. Just in case.

  15. Charon says:

    I agree with the “just in case” idea. I sometimes took a multivitamin that way (a couple times a week). I’m not convinced that the idea is really wrong, either – a lot of people do have deficient diets. I lived for over a year with a housemate whom I never eat a vegetable.

    What I think what many people don’t appreciate enough, and should, is that vitamins are necessary to function, but more vitamins does not equal functioning better (past the point where you are no longer deficient). Indeed, with some vitamins very large doses are quite harmful.

  16. Charon says:

    “whom I never _saw_ eat a vegetable”

    gah

  17. Fifi says:

    Charon – Unfortunately people have gotten the impression that taking a vitamin is the same as eating a fruit or vegetable (this is promoted by mainstream and SCAM marketers). It isn’t even close. Many of the health benefits of eating vegetables just aren’t available from taking a pill since nutrition involves a lot more than just vitamins and minerals. (Not to mention that fruits and vegetables provide a good source of hydration and necessary salts and minerals.)

    Also, since many vitamins work synergistically with other vitamins and minerals, too much of one thing can hinder absorption of another. The other factor is that if people aren’t eating fruits and veggies, they’re eating something else instead….that isn’t fruit or veg so is either meat or carbs. We need protein and carbs too of course, we just won’t stay healthy if we only eat burgers, drink coke and take vitamin pills.

    Ultimately a lot of people are being misled about vitamins because it’s a hugely profitable industry with little regulation – not only Supplement marketers but also the food industry which is governed by the same very lax laws regarding promoting benefits and misleading packaging and advertising.

  18. wertys says:

    I love people who spend $20 a week on expensive Omega 3 supplements who could get the same benefit from eating a couple of 50 cent cans of tuna on their sandwich at lunch. It simply never occurs to them NOT to take a supplement….

  19. EddieVos says:

    Dear Karl Withakayon You say: “Also concerning supplemental vitamins- it’s been said by more than a few that Americans have the most expensive urine in the world….

    Clearly, this expensive urine is MAINLY caused by many things such as soft drinks and alcohol and in the drug department, mainly because of statin and blood pressure drugs –that, for example, have never extended the life of a female in any clinical study to date. That, manyfold more than vitamins makes for expensive excrements.

    Similarly, soap makes expensive sewage but nobody argues against its use. Vitamins do their job and then move on; no vitamins, no job and nothing moves on.

    What is the argument for taking a good multivitamin [I buy this one: http://www.vitacost.com/Twinlab-Daily-One-Without-Iron $0.11/day]?
    When eating everything raw like any animal, we’d get 3 or 4 times the micro-unutrients than we are actually getting from ‘the best’ diet. For example, grain refining [before cooking and storing] removes 70% of the vitamins that lower homocysteine, a life long artery toxin, and more.
    Nobody argues homocysteine is an independent risk factor for Alzheimer’s, heart disease and bone fracture.
    Only remedy to minimize it: a multi-vitamin/mineral pill.

    Do vitamins cure Alzheimer’s, bone fractures or artery decline: of course not. Can they prevent stroke and hip fractures versus placebo: yes they can, if you pick your patient group correctly and if the researchers understood what it took to find effects.

    Therefore, the biochemistry is solid for the life-long taking of a multivitamin to get back to the levels our genome developed on: Jules, above, is right, it’s the biochemistry the multi-vitamin makes right, trials in [too] advanced disease not withstanding.
    http://www.health-heart.org/why.htm [for those interested in the reason why taking a multivitamin is brilliant]

  20. EddieVos says:

    Dear Dr Hall, you say: “EddieVos … apparently accepts the (now discredited) claims for multivits. Go figure!.
    Question: How can a couple of short negative trials in those with existing atherosclerosis [as IVUS surely would have demonstrated in all] prove that not taking a multivitamin [-and therefore having higher than minimal homocysteine-] is NOT the CAUSE of arterial decline?

    Maybe I am not sure what you mean with the word ‘claims’ however, whose claims and what claims? Putting the car in the garage won’t fix the rust hole but would have prevented it. There are 3 issues here: cause, effect [my field] and cure [your field].

    Artery decline is a disease of the ground substance, the Extra Cellular Matrix, of which elastin is the master controller and structural agent, and collagen the main less elastic structural protein.
    Try and make or maintain either in the presence of high homocysteine and see what you get: arterial decline, as demonstrated in the 1950/1960′s in primates and other animal species later [do a Medline for P Charpiot], and no doubt in all patients enrolled in the JUPITER and other statin studies, NONE of which bothered to measure homocysteine [one study will on my suggestion but that's still unofficial and not completed].
    Your vitamin D prevents bone fracture [M Chapuy in NEJM] but it sure won’t fix a broken hip. Lowering Hcy reduces hip fractures by 80% vs placebo in a high risk group so what’s the danger of a multivitamin again?
    6 months of a very high B dose NO-IRON multivit is sold without prescription or child proof cap; the latter cannot be said for the tiniest bottle of aspirin.

    P.S. while 2000 IU/d vitamin E, an extreme dose, delays Alzheimer’s as well as a heavily promoted current drug [as per RCT], in that dose if on a CoQ10-lowering statin may just make the E an oxidant since Q10 is the reductant for E. A simple confounder not considered: bad science but famous**). The hick is always in the confounders.

    **) The moral: find ANYTHING ‘wrong’ with a vitamin and the world press will pave, camp on, and keep your driveway free of snow for the season and they’ll make you famous while science suffers.

  21. Harriet Hall says:

    EddieVos,

    If you think multivitamins prevent heart disease, the burden of proof is on you. You have given us speculation, but you haven’t given us evidence.

  22. EddieVos says:

    Dear Dr. Hall, I have a dozen scientific pathways of consistent supportive “evidence” that you call speculation but I don’t have a randomized controlled trial. If that is your only “evidence” of proof of cause you will accept [while I think such trial is unethical], get me half the $$ the JUPITER trial cost and get me 40 babies I can put in cages for 40 yeas to give half dummy vitamins and half the pill I take every day. Then remove half the arteries at age 20 and the balance at age 40. That is the time frame we’re looking at. I’ll be age 102.

    Second option: get me the same $$*) and I’ll organize 4000 inhabitants of New Delhi [that we know are deficient in at least 2 B vitamins and we give half some low dose vitamins we know not to affect affect homocysteine much, and the others the multivitamin I take + their traditional omega-3 mustard seed oil and we'll see in 10 and 20 years. Incidentally, that mustard seed oil study post MI was already done [Singh] and with excellent results in line with LYON.

    *) The money needed might be about 2.5% of what Americans spend on LIPITOR, a drug that will never save a human.

    So, what other kind of “evidence” would you want from me if you have a better hypothesis as to the enormous [66%] unexplained drop in CVD deaths since 1965. Some of my evidence is in the ‘why’ page with link above; safe and cheap but you have to start early.
    I have not given you PROOF, I have given you ‘evidence’, i.e. what you asked for in your one liner.
    Did you actually read that ‘why’ page and follow the references?

  23. weing says:

    EddieVos,
    Methinks you protest too much. We did not give the Jupiter people the money to do the study. They didn’t rip any arteries out like you want to do to the poor in Delhi. These trials can be done quite ethically. A little more creativity, please. There is no need to make people deficient in vitamins. We already know most of the consequences of deficiencies. You want to give extra doses above the RDA. You can run those tests. I am sure the vitamin makers are awash in cash. Apply to them to do the testing. Appeal to their altruism.

  24. weing says:

    Regarding the “unexplained” drop in CVD deaths. It is only unexplained if you ignore the advances of science based medicine in the prevention and treatment of CVD.

  25. EddieVos says:

    weing, I was brought into this discussion by Dr. Hall who brought up my name. I asked her what ‘proof’ or ‘evidence’ is to her. How would she like to define what is atherosclerosis and what trial would she like to do as to cause [in order not to treat symptoms].

    That decline, according to a conference in the mid 1970′s was unexplained. Statins as of the late 1990′s have NOT affected heart mortality while blood pressure drugs haven’t either, nor have revascularizations.

    WHAT medical treatment and science base are you referring to explaining this steady 43 year long stunning death decline. Others in medicine have claimed credit for themselves but there is zero evidence they have ever offered as to what they did. This, I agree is how it SHOULD be. Evidence?

    A ‘Delhi study’ does not need an autopsy design: the evidence in hard endpoints will be clear in mere decades. I could design a supplement for under $1/year so unless the NIH or a counter part supports such study [which they won't because of opposition from doctors like Dr. Hall --who maintains the cause is cholesterol], such trial won’t be done but there are some forces in India that are interested.

  26. Harriet Hall says:

    EddieVos,

    Don’t put words in my mouth. I don’t “maintain that the cause is cholesterol.” It’s not appropriate to speak of “the” cause when we are reasonably sure cardiovascular disease is multifactorial. I maintain only that we have evidence that treatments that lower LDL cholesterol reduce cardiovascular morbidity and mortality. We do NOT have any comparable evidence that taking supplemental vitamins reduces morbidity and mortality for patients who are not vitamin deficient.

    You are a member of THINCS, an organization that “opposes” the role of cholesterol. “Opposing” is not a scientific stance. We certainly don’t “oppose” multivitamins.

  27. EddieVos says:

    Dear Dr Hall. Multi-factorial, I agree. Would you agree that homocysteine would be one of these causes and that heart disease is simply not reported in people with Hcy <7 µM?
    I agree that reducing the production of mevalonate [statin therapy] reduces non fatal ‘events’ in younger males but rarely mortality and mortality not in women. To be precise that should be said. ref’s:
    http://www.ncbi.nlm.nih.gov/pubmed/15138247?dopt=Abstract
    http://www.ncbi.nlm.nih.gov/pubmed/15337211?dopt=Abstract
    Moreover, the numbers needed to treat are emornous and there is better therapy to reduce MI and deaths from CV diseases.

    Yes, I am a member of http:www.thincs.org a group of about 80 professionals with combined probably 1000+ Medline listed publications who have in common the opinion that cholesterol the molecule has nothing to do with the cause of heart disease [and that ‘treating’ it is ineffectual if not harmful more than beneficial. I am not going to trip over the word ‘oppose’.

    Did you miss the last line of the 3:31 posting?

  28. EddieVos says:

    The above link should read http://www.thincs.org/members.htm for the pedigree of the current members. Their motto: ‘cholesterol: to fear or not to fear that is the question’.

    The urgency to fix [and study] the enormous vitamin problem with supplementation/fortification with multivitamins in India:
    http://www.ncbi.nlm.nih.gov/pubmed/12083316

    Now, don’t get complacent, anyone with homocysteine over 10 [or less] is not getting sufficient B vitamins for their genetics. Some may think this matters little but there is no proof thereof and unless you believe in reincarnation to get it right the second time around, this is your one chance.

    Dr. Hall stated “I think we CAN get optimum nutrition from food… That ‘optimum’ is certainly NOT the case in 90% of Indians and with the U.S. far from the top in longevity, this is a known issue in at least half the nutrients found in a common multivitamin pill. Her thinking is evidently speculation since it’s not shown in any trial to be the case.

    It’s ironic that members of a profession that kills 1 patient every 5 minutes from the ‘proper’ prescription of drugs in U.S. hospitals
    http://www.ncbi.nlm.nih.gov/pubmed/9555760
    argues the dangers of vitamins, the on-label use of which has never killed anyone as per the published data.
    THAT should be topic #1 as per the name of this website.

  29. weing says:

    EddieVos,
    Regarding danger of vitamins, I can think of vitamin K in a patient on coumadin who then ends up with a stroke. There were some studies a few years back with beta carotene, in Finland of all places, to prevent lung cancer that showed an increase in cancers. I think most of the danger is to the pocketbook. I see patients spending more money on vitamins than on drugs in the hope that they will stay aging, prevent cancer or heart disease. I think they feel if they buy the more expensive vitamins they will work better. None of these claims are proven, they are just a matter of faith. Therefore they cannot be disproven to them or to, I suspect, you. You will not accept the advances of scientific medicine in prevention and treatment of CAD and the drop in mortality will forever be unexplained. You will and do search for hypothetical biochemical mechanisms to explain the drop and will be convinced that must be the reason and that you will consider evidence. I have no problem with postulating a mechanism but you do have to do the testing. No one is stopping you. Get the funding from the vitamin pushers.

  30. EddieVos says:

    Dear weing there is no vitamin K in most of the common multivitamins [there is in green leafies of the cabbage family and others]; it just shows you the danger of coumadin [as rat poison it's called warfarin]. About 15th of a cup chopped broccoli gets you to the maximum amount ever in a multivitamin. In that context, broccoli would cause ~15x more strokes than a multivitamin.
    Framingham: low K, more hip fractures; most cell types have vitamin K receptors, and thus an apparent need.
    So, MD’s putting people on coumadin should check the INR and that takes care of some of the coumadin nasties. Coumadin is a potentially dangerous vitamin antagonist. I stood next to a fellow at ACC 08 whose INR was measured by an exhibitor as ~6; instant panic.
    I agree, there ARE vitamin pushers, like in the prescription business. I would not buy 95% of bottles in health food stores. ‘Special’ or patented formulations’ are effectively always hype and should be exposed. My best composition [my judgment] multivitamin costs $0.11, a fraction of any of the drugs doctors prescribe, so cost does not have to be an issue.
    About ‘vitamin’ scams, we’re on the same page: http://www.health-heart.org/comments.htm#6
    The issue is vitamins, by definition essential to life, and with hard biochemistry, no soft or hypothetical pathways.
    Beta-carrotene is NOT a vitamin and Pharma [Roche] promoted its use, in smokers a dumb idea if they had asked me. Some carotenoids prevent, some promote cancer .. playing with the carotenoids and their receptors is mostly a dumb idea.
    I asked you for your evidence that medical science caused that 43 year continuous mortality drop in CVDes. I have a coherent explanation, supported by 11 other pathways. What is your evidence published in Medline?

  31. weing says:

    Medline, we don’t need no stinking Medline. There. I always wanted to say that. Just look at all the statin trials to date, compare the treatments of MIs in the 1950s to now. Those are the coherent pathways. Do you want a good website for studies you can dive into? Try http://www.lipid.org

  32. EddieVos says:

    Stinking [sic] Medline, stinking National Library of Medicine?

    I take it you have no data supporting your point that the treatment of MI after 1965 [the peak] is related to the decline of DEATHS from heart disease and stroke. You’d think that modern medicine would have been extensively documenting such victory. They have not. Speculation as Dr. Hall would say.

    You sent me to a corporate website supported by corporate wealth [still] worth combined several trillion dollars: http://www.lipid.org/supporters.php Their newsletter is appropriately called Lipid Spin
    Why do you complain about vitamin pushers while lipid.org is the ultimate product of corporate pushers scaring people and prescribers about cholesterol and therefore into the stuff they sell.

    The only ‘lipids’ that affect heart disease BIG TIME are omega-3′s and to a lesser extent, trans fats. Cholesterol in [wet] foods and in non dried meat has NOTHING to do with the incidence of cardiovascular disease, that much is clear.

    Signed, Eddie Vos, member of ISSFAL, the International Society for the Study of Fatty Acids and Lipids, a not-for-profit group of only scientists http://www.issfal.org.uk/

  33. weing says:

    That was a reference to The 3 Amigos. I said, just look at all the statin literature in primary and secondary prevention and current treatments for CAD, that we have and you will see the reasons for the declines. I don’t know what corporation you are talking about. The NLA?. Anyway, since when does corporate sponsorship invalidate any study? Since when does non-corporate sponsorship validate any study?

  34. EddieVos says:

    Weing 3 Amigos .. you’re losing me here: evidently you have not clicked on the above link, and lipid.org is not a study, it’s a lobby group.
    Try again, click on
    http://www.health-heart.org/LipitorDoesNotSaveLives.gif and explain to me how America’s most popular statin has contributed to fewer deaths.
    Here’s stinking Medline in women [I care]
    http://www.ncbi.nlm.nih.gov/pubmed/15138247?dopt=Abstract
    http://www.ncbi.nlm.nih.gov/pubmed/15337211?dopt=Abstract

    And here is your website
    http://www.lipid.org/clinical/patients/1000005.php#heart_attacks from which I quote:
    Diet and cholesterol drugs do not change the overall size of atherosclerotic plaques very much at all [sic], so that the blockages improve very little.[!!] However, diet and cholesterol drugs have some kind of effect on plaques to make them much less prone to rupture. [or through the NO-synthase pathway, reduce non-fatal angina, make heart attacks more 'silent' rather than overt, while the decline on Lipitor continues as per the above .gif]
    So, the issue is: how to prevent the plaque in the first place, how to make collagen caps less ‘vulnerable’ [stronger] and how to keep the ticker going [think: omega-3, magnesium, natures defibrillators].

  35. Harriet Hall says:

    EddieVos said,

    Yes, I am a member of http:www.thincs.org a group …who have in common the opinion that cholesterol the molecule has nothing to do with the cause of heart disease

    His organization, THINCS, was founded to promote the opinions of a small minority of people, ignoring the huge majority who have looked at the same data and reached a difference consensus. THINCS is based on opinion and opinion is all they have; the weight of evidence favors their opponents.

    His bias is clear, especially after his comments about medicine being a profession that kills a patient every 5 minutes. There’s nothing to be gained by debating a true believer.

  36. EddieVos says:

    Dear Dr. Hall, that figure of 1 death / 5 minutes comes from my URL reference to JAMA. Why not accuse them of bias rather than this messenger of alarming data and that SHOULD be the primary topic of this website.

    I may be bias as per your diagnosis but you have not responded to a single piece of data I have proposed, none. You also have not said that you actually looked at any of the URL’s I provided. Be that as it may, you have not given them due consideration.

    Just because I participate in debate of the science with an outstanding group of scientists you may not like does not make my references irrelevant. Just because more people thought the earth was flat [or think statins prevent atheroma] does not make it so.

    I’m a fan of Medline, why not accuse Dr weing of a disregard of the science for calling that database ‘stinking’ while invoking ’3 Amigos’ [?]. However, let’s keep this debate science based rather than attacking me about my associations.

  37. hatch_xanadu says:

    You know, I was considering adding to my Amazon.com cart a potassium supplement for my husband, who is vehemently opposed to eating fruits and vegetables of nearly every variety and might not be getting all the potassium he should.

    Hoping for some answers about solubility and concentration levels in the powder (because I’d rather skip the supplement than *overload* my husband with potassium or, conversely, get ripped off), I read the one customer review. It was all, “WOW, this stuff really WORKS! I felt GREAT the next day!!”

    I think therein lies the problem. Folks expecting a singular effect, rather than, y’know, a supplement.

  38. weing says:

    I think Harriet’s correct. You are a true believer. You also aren’t familiar with one of the greatest films of all time. Well, at least in my opinion. Keep making drawings and enjoy your abstracts. I am sure you will find everything you need to confirm your biases.

  39. EddieVos says:

    Dear Dr. WEING sorry I don’t know your movies [my entertainment is science] and with surprise you disregard Medline and other sources of evidence based medicine. I can only pity your patients while you are on that high pedestal but without an over view of the science in support. Look back in your postings, is there a link to a study? Humbly yours, e.v.

    To hatch_xanadu potassium supplements are minuscule 99 milligrams maximum and NOT worth it. Average U.S. male intake 3100 mg. Prunes, beans, medium potato or banana are about 500 mg. Then there on the store shelf salt substitutes, one being NO-SALT. A cheap multivitamin is always worth it unless you’re an ‘unbeliever’ like many of the early-crop medical doctors.
    Low potassium can be lethal. Vegetarians may get 8000-11000 mg; RDA [effecitvely a minimum] 2000 mg. Ask MD when on some diuretic or if kidney failure. Source: “An Evidence Based Approach to Vitamins and Minerals” 2003.

  40. Harriet Hall says:

    Why is it that some people think they can overturn a reasoned consensus arrived at by evaluating all the published evidence by simply citing a few studies that support their opinion? Don’t they realize other people have read those studies already? Do they expect us to just disregard all the other studies that say something different? The mental processes involved here are fascinating.

  41. EddieVos says:

    Dear Dr. Hall, again no evidence/medline numbers or explanation why statins / reducing cholesterol foods does not reduce the atheroma, for example, as per the industry website lipid.org link above.

    Let’s talk consensus [in heart disease] as you call it, let’s look at our Adult Treatment Panel III update. I met 3 of the 8 of that select panel that is so dripping with pharma money [10 conflicts on average] that AT LEAST you’d expect them to know the existing study data. They don’t.
    One ‘updater’ had not even heard of the J-LIT study [finding more deaths in those, mainly women, most responsive to statin after 6 years] or that his slide of 4S also included 3 more female deaths in that poster child statin study.
    The other 2 I met did not know that the statin studies show no mortality benefit in women .. one of them waving to the to hundreds in the audience: “is there anyone here believing women don’t benefit from statins ha ha ha? It’s indeed a belief system everybody’s buying into however a first year actuary student can figure out we’re not saving lives in our most fatal disease.
    $m21 for Crestor in JUPITER and 6 cardiovascular deaths postponed.
    One of the ATP III guys, a now ex-NIH employee, pocketed $114,000 + ‘stock options’ while delivering ‘consensus’ to unsuspecting doctors.
    Consensus .. all ‘experts’ agreed that Ford, G.M, AIG and the economy are fundamentally strong.
    A wise Brit once said: the opinion of a consensus committee depends upon who is invited to sit on it.
    I thought doctors went with hard science instead.
    If you know of a person with more statin studies in his file, I’d like to know: I may have all placebo controlled studies ever done which of course does not make me right but it does make me informed.

  42. weing says:

    EddieVos,
    Now I see your problem. You are entertaining yourself. I don’t look upon science as entertainment. If you ever want to get serious about the science, simply check out some medical journals in your library. You can find all the studies published. Read them closely and learn. The website I gave you has a lot of studies published and reviewed but you probably don’t have access to those areas. It’s not for children who just want to play and draw pictures.

  43. oderb says:

    It’s interesting that there were no comments critiquing any of the vitamin studies cited, since presumably the conclusions reinforce the prevailing wisdom that vitamins are just expensive urine.

    Yet when one looks at the first study cited on Vitamin C and E, there appear to be major problems with the study.

    Among them are:

    500 mg of C were given despite the author’s comment that ‘“In a pooled analysis of 9 cohorts, vitamin C supplement use exceeding 700 mg/day was significantly associated with a 25% reduction in coronary heart disease risk.” If that is the case why was such a low dose used?

    Recent research has also shown that Vitamin C levels peak in several hours and rapidly decline, so any well designed trial should specify dosing at least three times a day, which was not done in this case.

    Only as few as 66% of the participants took their dose of Vitamin C, and 28% took less than the 66%, yet they were counted in the analysis.

    As far the Vitamin E portion why were participants given the vitamin only every other day, and they apparently were given the synthetic form, which is much less bioavailable than the natural form of Vitamin E.

    I could go on but my point is simple – over and over again I see uncritical evaluations of studies that ‘disprove’ the use of substances or techniques that go against the ‘scientific’ biases of the authors, and detailed critiques of any studies that support the use of vitamins, or other modalities not in favor on this site.

    This comment shouldn’t be interpreted as concluding that Vitamin C has been definitely proven to prevent CVD, but there are a number of studies, as indicated by the authors of this study, that suggest significant benefit from taking relatively high doses of C.
    And so as far as I’m concerned the jury is still out.

  44. EddieVos says:

    Dear Dr weing, your ignorance about my person and insulting attitude is uncalled for but you seem to take pleasure talking down to those who just possibly have a better overview than yourself. That appears a difficult concept, accepting that someone with >15 references regarding cardiovascular diseases in what you call ‘stinking Medline’ might just have a point that merits debate rather than insult.

    This site is to discuss science, not to insult users of this blog that provide links to the science out there.

    For the record, I subscribe to AJCN, NEJM and PLEFA and have access to ANY pdf from ANY journal within hours, a nice access to science to have!

  45. weing says:

    EddieVos,
    I am sorry if my irreverent attitude offends you. Arguments from authority do not work well on me. I know I can have the effect equivalent to red hot pepper pods on people. You clearly missed my attempt at humor. Our differences, I think, boil down to 1) accepting speculation of possible mechanisms as evidence for that mechanism and 2) evaluating the validity of studies based on sponsorship, ie, it’s invalid if a drug company sponsors it and valid if not. I utilize statins personally and in my practice because my evaluation of the data supports it. I do not prescribe them to everyone. I also utilize diet and fish oils. The new Jupiter study is compelling and I am still working on integrating the information there into my practice. If I see a good vitamin study with compelling evidence, not speculation, I will use them. I used to recommend them in the past, I no longer do now.

  46. EddieVos says:

    weing, apologies accepted. We agree on ‘possible’ mechanisms and that they may vary. Re sponsorship, I know several men who became wealthy doing statin studies and whom I admire; that, per se, does not invalidate a study.
    My hair stands up however, for example in JUPITER, when the authors forget to list ‘cardiovascular deaths’ with a P value, part of their 5 value combined primary endpoint yet they report another, ‘hospitalizations for unstable angina’ with a P value.
    They also omit to state that FATAL MI + Fatal stroke + deaths from CV causes was not altered by statin [based on their confusing Table 3]
    Then, elsewhere, they report ‘deaths on known date’ and totals [73% of unknown cause], a strange way of reporting, again without that primary fatal endpoint being listed.
    Yet, they extrapolate their result to 5 years and report a low 25 NNT for ‘event’ benefit, having cut the study at 1.9 years. That means 24 or your patients spend a total of $150,000 in order for the 25th to be spared an ‘event’ that may be as insignificant as a hospitalization for unstable angina -if the study continued in the same fashion, a big question.
    I don’t know who wrote the report but it reads like an infomercial. They embellish the good while not reporting the failures. The NEJM Editorial was good.

    Question remains: what’s better for the patient: a reported $20 – $50 hs-CRP test or a $20 homocysteine test. Here we differ.
    Kind regards, vos{at}health-heart.org

  47. EddieVos says:

    The “epidemic” / “pandemic” of heart disease deaths, adjectives used in this article review its rise and fall that is still current, as per a reference on page 2252 in Nov 20 2008 NEJM
    http://content.nejm.org/cgi/reprint/337/19/1360.pdf

    Clearly, ‘medicine’ has improved and is better than before in preventing deaths in an ongoing event but there is not much about how to affect the epidemic fundamentally at its root.

    Pandemics can be caused by microbes or by changes in “the milieu”: some say stresses, some say faturated fat and cholesterol, and I say micro-/minor-nutrients we no longer ingest due to food changes. Pan or epidemics are not usually halted by medical interventions although they may improve survivability.

    Interesting in the above link is a reference #43, a study with the word MULTIVITAMIN in the title. Guess what: 2000 IU of E [hypothetically possibly harmful in a statin user], beta-carotene [NOT even a vitamin and without ANY justification in a population getting angioplasties] and some vitamin C.
    ERRORS: This is NOT a multivitamin, there was NO biological role of action of the 3 ingredients and NO justification for their conclusion that MULTIVITAMINS are not beneficial.
    Bad science [like most studies that started this debate] by interventionists who have NO clue as to what a particular vitamin does, and written with complete lack of over view of biochemistry. Trust me, I know one of the authors.

    Finally, the U.S. was 55% from the top in heart mortality in 38 industrialized countries in spite it spending at least 50% more on health care while embracing more medicines and certainly getting more invasive ‘interventions’.

  48. EddieVos says:

    From Nov. 27 2008 http://content.nejm.org/cgi/content/full/359/22/2309
    : The $2.1 trillion the United States spends annually on health care yields a poor return on its investment. The 2008 National Scorecard on U.S. Health System Performance evaluated 37 performance indicators and gave the United States a near-failing score of 65%. Rapidly increasing health care costs, which have affected all aspects of the economy, have become a top domestic-policy concern. Yet our fee-for-service system encourages the use of expensive but unproven medical devices by generously reimbursing for new procedures without regard to their benefit. Although randomized clinical trials are expensive and time-consuming, these costs must be weighed against those of procedures (and downstream tests) that may have little or no benefit or, worse, harmful consequences.

    This is $7000/year per head, $19/per day, to not live as long as the majority in similar countries. This is more than one spends on food and this for a profession that is the #3 cause of premature death [what if it would be 4 or 5?].
    So, while ‘cure’ is elusive, the wise use of a single multivitamin, omega-3 use and generally a magnesium supplement [to prevent disease from manifesting itself in the first place] costs maximum $0.25/day and is balance of evidence based. However, above we have the medical profession unaware of the 95% consistent and supportive nutritional benefit in journals they are supposed to read [AJCN, Circ., NEJM other] proposing ‘dangers’ from supplements .. Ah, well. Why first expose ‘quacks’ [and there are plenty] in other fields, rather than stopping the ‘quack’ actions [link above] of medical colleagues and where the real deaths and side-effects happen. Then, there are drug-nutrient interactions that, my guess, 95% of doctors have no clue about.

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