Thursday, December 9, 2010

Vitamins and the Search for Panaceas: The Institute of Medicine and Vitamin D

In the decades old movie “A Clockwork Orange,” a soulless sociopathic monster becomes the pseudo-beneficiary of medical-psychological re-engineering. Among the many modern treatments prescribed by the white coated clinician-experts are injections high doses of “veetamins,” (the British pronunciation for vitamins), which the main character (played by a youthful Malcolm McDowell) meekly accepts. The intervention ultimately fails and the viewer is left to ponder modern society's fixation on finding panaceas that can cure all that ails us.

During its career, the white coated Disease Management Care Blog has pondered its patients' passion for “veetamins.” Years of experience led it to eventually conclude that linear “if-then” thinking had blessed vitamins with a special place in our dietary mania: if a lack causes disease, then an abundance should lead to well being. Even the word “vitamin” conjures up notions of vitality. The DMCB eventually concluded that its patients were caught up in a perfect storm made up of our collective fixation on easy answers combined with a naïve delight in anything with the patina of "science." Little wonder, then, that gazillions of vitamins pills are being sold with little to show for it, other than gazillions of gallons of vitamin-rich urine.

Enter the prestigious Institute of Medicine (IOM) on the topic of Vitamin D. The IOM sponsors expert consensus panels, workshops, committees, forums and round tables that opine on a number of medical issues while striving to be science-based and non biased. According to their recently released Vitamin D report, there really isn’t much good evidence to support bulking up on high doses of oral Vitamin D. Since average blood levels of Vitamin D in the U.S. and Canada are adequate to meet metabolic needs, it appears persons are already getting Vitamin D they need from normal and fortified foods. Finally, the evidence favoring Vitamin D as a health supplement is mostly based on observational studies that are prone to bias. As a result, they're not willing to agree that Vitamin D can reduce the risk of diseases like cancer.

Which isn't surprising. Check out this very informative (Hat Tip to the Wall Street Journal Health Blog) American Journal of Epidemiology editorial that describes the high expectations and the bitter disappointment over notions that supplemental doses of Vitamins A, B, C and E could prevent cancer, lessen heart attack rates and prolong life. Based on the sorry track record of vitamin supplementation, the DMCB thinks the IOM deserves credit for its caution.

Of course, other scientists as well as interested lay persons - who have access to the same data as the IOM - have looked at all the studies on this veetamin and have the temerity to not take the IOM’s word on it (examples here, here and here). It is their right to interpret shaky science of panaceas for themselves, says the DMCB, though it points out that their zeal for vitamin supplementation shares a Clockwork Orange pedigree.

The pic of vitamin D's chemical structure is from Wikipedia

No comments: