Monday, December 23, 2013

Annals of Internal Medicine Claims Black is White: Further Explorations

The Annals of Internal Medicine today published an editorial titled "Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements". The editorial tells us that three separate research projects studied the effects of 'supplements' on different chronic illness, and found no significant disease benefit from 'supplements'.  

What's right with this picture? Seriously? What healthiness was measured? The editorial says: "most supplements do not prevent chronic disease or death". The use of supplements is not justified because they cannot prevent death? So who can prevent death? Medicines can extend life, but they can't prevent death. And chronic disease? What medicine can prevent the chronic diseases that were tested? None. Should we "stop wasting our money on medicines"? Well, maybe we should. 

The research studies, of course, selected 'specific supplements', and specific illnesses. They did not study 'all supplements' nor to 'all supplement combinations'.  They didn't try to identify which supplement products work better than others. And most importantly, they didn't study health.  But, the Annals of Internal Medicine sees fit to extend their conclusions from "we could not find a supplement that works" to "all supplements" and from illness to health. It's as if three clinical studies found that three medicines could not prevent chronic disease and death - so we should give up on medicines?

Black is not white. Healthiness is not illness.  Illness is the blackness in our lives.  It is simple and bad.  Healthiness is full of light, and colours, with beautiful hues, saturations, tones and harmonies of color. If we want to measure the effects of supplements on healthiness, we need to measure healthiness.  And if we are to measure the effects of supplements on health - we need to select what we believe are the BEST POSSIBLE supplements you can buy and test those.  Those are, after all, the most likely to provide benefit.

Did the studies test the best vitamins?  No.  One commenter at wrote: "The only MULTIvitamin mentioned was Centrum Silver, the most highly advertised and consequently the largest selling multivitamin... [which] is known to be compacted so tightly that it passes like a bullet through the digestive system." How good is Centrum Silver?  According to the Nutrisearch Comparative Guide to Nutritional Supplements, there are 32 products available in the USA that received a score of 4 stars. Centrum Silver received a score of 0.5 stars.  One-half of a star. Is Centrum Silver an appropriate 'representative product', on which to base general conclusions about multi-vitamin value? Certainly not.  Choosing Centrum Silver to study the benefits of multivitamins is like choosing a random third place athlete in a small school in the countryside for our Olympic competition. Nonsense. Is this what passes for science, in the Annals of Internal Medicine. 

Was health measured? No. Even in the studies related to patients who had suffered previous myocardial infarction, there was no attempt to measure the healthiness of the circulatory system before, during or after the study.  Duh...  

Seriously.  What might we learn, when we take the top ten BEST vitamins, according to the best vitamin researchers. Test the circulatory system health of patients and then administered the vitamins for 6 months, and then measure circulatory system healthiness again? 

But no-one will do this study, because no 'one' company will sponsor it.  There is no vested interest. 

But there's another problem with this technique. No-one knows how to measure circulatory system healthiness.  We can say that one person's circulatory system health is good, and someone else's is not so good - but we have no actual measurement techniques that are scientifically solid enough to be used in a research study. It's much easier, and more common, as in the study referenced, to simply select people who have had heart attacks, and study to see if they have more heart attacks. The study coordinators would have to invent measurements of circulatory system healthiness.  It's easy to measure heart attacks and death, much more difficult to measure health. 

Imagine if you will, a scientific study of the effects of supplements on health.  Here's how it would work:

1. Select a random group of people who are not sick. You could, if you wish, choose people of a selected gender and age group, but then the results would only be valid for that gender, for that age group.  So, select a random group of people, of varying ages and genders, who are not sick, and who are currently not consuming supplements.

2. Measure the healthiness of the people selected.  Measure their physical healthiness and their mental healthiness.  Measure their spiritual healthiness and their community healthiness.  Measure the healthiness of their circulatory systems, their respiratory systems, their hormonal systems.  Measure the healthiness of their teeth, their blood and more.

3. Have participants take one of the top ten high quality supplement products, or a placebo (or one of the supplements shown by the Annals of Internal Medicine to be useless), for three months, at least.  Six months preferred.  

4. Measure their healthiness again at the end of the study.

But, there's a problem.  We have many medical systems that can measure illness. But we have no standards for measurement of healthiness. We can measure blood pressure - for diagnosis of hypertension, but not blood health. We can measure cholesterol, for diagnosis of 'high cholesterol', but we can't measure cholesterol health - without reference to illness. We can measure tooth decay, but not tooth health. And we have virtually no useful techniques to measure spirit health, nor community health. Every so called 'health measurement' relies on measuring illness, not healthiness. 

The hierarchy of healthicine stretches from genetics to nutrients, to cells, tissues, organs, systems, body, mind, spirit, and community, but if you have no illness - our medical systems diagnose "health" - and that's the end of it.  

So, I have to laugh when the Annals of Internal Medicine say that supplements don't improve healthiness.  Frankly their statements have no basis in scientific fact. Their conclusion states "With respect to multivitamins, the studies published in this issue and previous trials indicate no substantial health benefit." But the truth is - no study measured health, nor health benefit. Medical studies are designed to study illness and illness benefit. Extrapolation from studies of illness, to conclusions about healthiness is unscientific and irresponsible. 

But seriously, what's really going on here?  Is the Annals of Internal Medicine encouraging health? No. Are they encouraging health freedom? Not.  It is clear that if three studies of medicines showed no benefit against chronic disease - studies would continue, with different medicines, until we get it right.  No one would be silly enough to recommend we 'stop wasting our money on medicines'.  In fact, if three studies of medicines 'failed', the studies would probably not be published.  Medical Journals don't publish 'failures' unless they are about supplements. 

Several years ago, I published a post The Food Myth, in which I noted the tendency of medical researchers to dismiss supplements in favour of foods (which they don't need to test via research).  Later, I wrote The Medicines Myth, where I noted that the top 10 selling medicines don't actually cure any diseases. Maybe it's time to write The Supplement Myth, and explore the myth that Vitamins are not 'vital' and 'essential minerals' are not really essential at all and besides, everybody who lives on the SAD (Standard American Diet) gets plenty of these essential nutrients in their fast foods. 

The Annals of Internal Medicine is simply wrong.  And the truth is - they are so wrong that the majority of North Americans know they are wrong.  Maybe it's time for some disclosure? It would be interesting to see some statistics on supplements consumed by contributors to the Annals of Internal Medicine.  How does their published "editorial opinion" compare with their actual behavior? 

to your health, tracy

This post is an expansion of a post initially published on  GreenMedInfo specializes in collecting and presenting evidence on non-prescription health products.  Eg. GreenMedInfo is dedicated to looking for, finding and presenting evidence that the Annals of Internal Medicine is officially denying with an unscientific wave of their editorial hand. I have been a GreenMedInfo supporter for just over 2 years - they do great work. They are widely recognized as the world's largest and most referenced health resource of its kind, receiving over 1 million visits a month.

Tracy is the author of two book about healthicine: