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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