Part II: The Politics of Vitamin Research, the conclusion

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This is a clarification of my original post on 'The Politics of Vitamin Research.'

Part II: The Politics of Vitamin Research, the conclusion
----------------------------------------------------------------------
Why were the plots in the original Star Trek movies so badly written? The answer of course is that
Hollywood is a business all about making money. The fact that a truly good movie occasionally gets
made, is what is truly amazing.

The health research publishing phenomenon is not much different from Hollywood. Research journals
are businesses all about making money. The fact that a truly good research study on vitamins
occasionally gets published, is what is truly amazing.

The Enron financial scandal on Wall Street has also taught us that commercial businesses are not
much different from the realities of not-for-profit operations, public utilities, or even
governmental operations. All forms of bureaucracies operate more for the benefit of their employees
than we would all like to believe.

While we all would like to believe that there is some grand plan governing the publishing of health
research, that it is motivated purely by the pursuit of philanthropy; Reality is anything but that.

So, whenever you deal with people you are dealing with their biases and prejudices. There are many
ways to adjust research conclusions to fit the biases of the research authors.

In general, a research paper does not get published unless it agrees with the biases of the editors,
or has very strong statistical results. Further, research journals do not like to published the
negative results of prescription drug studies. Hence, we all hear about their positive side, but
never read about the negatives of prescription drugs.

The operating assumptions of these people is that all of alternative medicine is quackery and that
the people advocating 'natural' methods are all frauds that kill people who have cancer, that
vitamins make expensive urine, that physicians are without fault and that their motives are pure as
the driven snow and that doctors can save everybody with their deadly chemotherapy, and that the
*only* thing that pays for the lifestyle that these editors and physicians want to maintain are
drugs that can be prescribed and preferably patented or procedures that require lengthy stays in
hospitals.

While Ester-C is an expensive form of vitamin C because it is patented and there are a few
vitamins that can actually be prescribed by a physician, most vitamins generate almost no revenue
for physicians. So, there is in fact very little financial incentive to either fund or publish
vitamin research. And, these people surely do not want people to stop paying through the nose for
prescription drugs, because that would impact upon their income. So it is very reasonable to
assume that in a few research journals at least their editors are naturally biased against the use
of vitamins.

Most of the new stories from 'MEDLINEplus' and 'Reuters Health' during the last year and a half have
tended to support the use of 'Vitamins and other Nutritional Supplements.'

During the last year and a half, there has been *only* five (5) key negative studies published
against the use of vitamins. Of these troubling research papers, two were published in The Lancet,
and one in JAMA, Ann Intern Med., and in Circulation. These four health research journals carry a
lot of prestige and many people incorrectly assume that these journals are speaking directly for the
medical establishment. :(

I will use the same methods used in the Ann Intern Med review study for the U.S. Preventive Services
Task Force (If that ain't an indication of a biased politically motivated study, what is?) to
discount every single one of these five obviously biased studies.

In the Ann Intern Med review study (Ann Intern Med. 2003 Jul 1;139(1):56-70. PMID: 12834320 [full
text available for free online]): "Two reviewers read titles and abstracts of 2758 identified
articles and selected 306 as possibly relevant. Full-text articles of these citations were retrieved
for further review. Of these, 38 articles, representing 10 cohort studies and 20 randomized,
controlled trials (RCTs), were selected for inclusion in evidence tables. An additional 25 articles
were included for background and context."

They use only two people. I will use only one, namely moi. :)

Out of a possible 2,758 studies they with their superior professional judgement skills selected only
63 or *only* 2.284% of all studies published on vitamin use. Ha, ... Hah, Ha! Yeah, ... Sure, Right!
They just had to be objective in their selection of studies for their review. So, much for that
political study. :)

The JAMA study (JAMA. 2002 Aug 14;288(6):715-21. PMID: 12169075) is canceled out by a similar study
that directly contradicts this study that was published in JAMA in 1997 (JAMA. 1997 May
7;277(17):1380-6 PMID: 9134944). :)

The Lancet. 2003 Jun 14;361(9374):2017-23 PMID: 12814711 study was another review or meta-analysis
of randomized trials study. So, much for that political study. :)

The Lancet 2003;361:101-106 (full text available for free online) study was another one of those all
vitamins are dangerous studies. Definition is everything. This study uses the broad term of dietary
supplements whereas I refer to a very restricted list of supplements which I call nutritional
supplements (ie, vitamins and minerals *only*). Aphrodisiacs, herbal abortions, dieting,
bodybuilding and athletic performance enhancers, and cultural remedies (ie, herbal medicines) are
the areas with the most danger. Ergo, this study was playing a word game. They were *not* writing
about the responsible and reasonable use of 'Vitamins and other Nutritional Supplements.' Thus, I
deem this study not relevant per the methods used in the above the Ann Intern Med review study. :)

That leaves only the Circulation study to be discounted. Ha, ... Hah, Ha!

Circulation 2002 106: 1453 - 1459. ABSTRACT: "The primary trial end point was the rate of change in
the common carotid artery far-wall intima-media thickness (IMT) assessed by computer image-processed
B-mode ultrasonograms. A mixed effects model using all determinations of IMT was used to test the
hypothesis of treatment differences in IMT change rates. Compared with placebo, -tocopherol
supplementation significantly raised plasma vitamin E levels (P<0.0001), reduced circulating
oxidized LDL (P=0.03), and reduced LDL oxidative susceptibility (P<0.01). However, vitamin E
supplementation did not reduce the progression of IMT over a 3-year period compared with subjects
randomized to placebo."

This study is a classic example of word games played by scientists. This study proved that vitamin E
works, yet because of the particular marker of success chosen by this study they claim that vitamin
E doesn't work. :(

If there is one thing that supplemental Vitamin E is reported to do is reduce LDL oxidation. This
study concluded "-tocopherol supplementation ... reduced circulating oxidized LDL (P=0.03), and
reduced LDL oxidative susceptibility (P<0.01)."

The marker used by this study was arterial plaque regression (ie, "carotid artery far-wall
intima-media thickness"). Next, to nothing is known to reverse arterial plaque in less than two
years. They could not have chosen a more dumber marker, IMHO. Hey, maybe those people were eating
too many peanuts?

I take vitamin E to reduce LDL oxidation. LDL oxidation is a major risk factor for atherosclerosis.
The study proved, once again, that Vitamin E reduces LDL oxidation. That is good enough for me.
Arterial plaque formation is a risk factor, but certainly not the only risk factor.

So, the results of my own personal meta-analysis of randomized trials study on my own biased
coverage of 'Vitamins and other Nutritional Supplements' in the news coverage of 'MEDLINEplus' and
'Reuters Health' over the last year and a half; shows that 100% of the studies deemed relevant by
moi were favorable towards the responsible and reasonable use of 'Vitamins and other Nutritional
Supplements' for improving your personal health over and above the consumption of a healthy balance
and varied diet. :)

My review concludes that the use of vitamin supplements is a lot more beneficial to your health than
the medical establishment would like you to believe.
--
John Gohde, Achieving good Nutrition is an Art, NOT a Science!

Get started on improving your personal health and fitness, today.
http://www.tutorials.naturalhealthperspective.com/ Offering 14 easy to understand lessons that will
change your life.

"N-H-P" <johngohde@naturalhealthperspective.com> wrote in message
news:16a9b594.0308201521.52f02a6f@posting.google.com...
> This is a clarification of my original post on 'The Politics of Vitamin Research.'
>

> The marker used by this study was arterial plaque regression (ie, "carotid artery far-wall
> intima-media thickness"). Next, to nothing is known to reverse arterial plaque in less than two
> years. They could not have chosen a more dumber marker, IMHO. Hey, maybe those people were eating
> too many peanuts?

No, you have misread the study, which seriously undermines you credibility in other matters.. What
they said was ---

> However, vitamin E supplementation did not reduce the progression of IMT over a 3-year period
> compared with subjects randomized to placebo."

"Reduce the progression" of ITM (intima media thickness) was the marker, not the "reversal" of
arterial plaque. You are correct that a longer study might have shown some influence, but it is very
difficult and extremely expensive to keep rigorous controlled research going for long periods. If
such studies had given suggestive results, longer term ones might have been planned, and are, for
all I know. The evidence of antioxidant activity reinforces the impact of this study, as it shows
that the vitamin E was doing what it was supposed to do in these patients.

I nominate the following paragraph for an award as the most elaborate ad hominem mischaracterisation
of the year ---

>The operating assumptions of these people is that all of alternative medicine is quackery and that
>the people advocating 'natural' methods are all frauds that kill people who have cancer, that
>vitamins make expensive urine, that physicians are without fault and that their motives are pure as
>the driven snow and that doctors can save everybody with their deadly chemotherapy, and that the
>*only* thing that pays for the lifestyle that these editors and physicians want to maintain are
>drugs that can be prescribed and preferably patented or procedures that require lengthy stays in
>hospitals.

>While Ester-C is an expensive form of vitamin C because it is patented and there are a few vitamins
>that can actually be prescribed by a physician, most vitamins generate almost no revenue for
>physicians.

Neither do pharmaceuticals.

>So, there is in fact very little financial incentive to either fund or publish vitamin research.

So you could find only 2758 vitamin studies. Pitiful!

>And, these people surely do not want people to stop paying through the nose for prescription drugs,
>because that would impact upon their income. So it is very reasonable to assume that in a few
>research journals at least their editors are naturally biased against the use of vitamins.

There probably is some bias. It has been generated by extravagant, largely unsupported health claims
over many years.

Note also that it was scientific medicine, not alternative medicine that provided you with knowledge
of atherosclerosis, LDL, antioxidant effect of Vit E. Doctors and medical researchers are not
concealing any knowledge about these things and if you want to take Vitamin E on slender evidence
and with due regard to known ill effects such as the promotion of bleeding then no one is stopping
you.. The evidence simply remains insuffficient for medicine to support you in it.

Note too that alternative medicine has no mechanism, and has never had any mechanism, by which it
could possibly tell whether a vitamin would influence atherosclerosis, because only long term
careful epidemiological studies could prove that. You acknowledge with this project of yours that
testimonial and anecdote cannot show that.. You have to admit that the original claims appeared out
of essentially nowhere, promoted heavily by those with something to sell, and this is why there is
prejudice against AM claims..

It is also fairly certain from the information available so far that any benefits from supplements
will be modest relative to the claims that have been made, and possibly comparable to other
well-known recommendations for cardiovascular health. This is the opinion of someone who thinks that
statins and hypertension treatments are possibly also being oversold within conventional medicine
through the exact same influences that are much more obviously overselling supplements.

Peter Moran

Herman wrote:

>Why not? It contains antioxidants.
>
>Also, there is NO evidence at this time that low fat diets are more healthful.

This is incorrect, the low fat diet is the only diet I know of *that has been shown* to reduce the
risk of diabetes *better* than metformin.. (when combined with exercise)

>This is incorrect, the low fat diet is the only diet I know of *that has been shown* to reduce the
>risk of diabetes *better* than metformin.. (when combined with exercise)

that would be only 20min of exercise a day.

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med
2002; 346: 393-403.

perhaps a randomized clinical control of 3,234 nondiabetic persons with elevated glucose is not
enough evidence though..

"Peter Moran" <moringa@gil.com.au> wrote

> >While Ester-C is an expensive form of vitamin C because it is patented and there are a few
> >vitamins that can actually be prescribed by a physician, most vitamins generate almost no revenue
> >for physicians.

> Neither do pharmaceuticals.

So, you have never heard of cancer physicians buying cancer drugs wholesale and selling them
directly to their patients? It has been in the news recently. Your lack of knowledge seriously
undermines your credibility in other matters. :(

http://www.medicarerights.org/testimony13.html "Third, the AWP creates perverse financial incentives
that could result in inappropriate prescribing at the expense of people with Medicare's health and
quality of care (4). The difference, or "spread", between the AWP-based price and the price a
physician actually pays for the drugs is essentially profit. The greater the difference between the
Medicare price and actual price, the more profit a physician keeps (5). The government should not be
perpetuating a system that motivates doctors to prescribe drugs based on their own financial gain
rather than the best treatment for the thousands of people with Medicare like Mrs. Thomas (6)."

http://www.hansonbridgett.com/docket/archive/2003/012803.html "The litigation record indicates that
during the 1990s, TAP engaged in numerous marketing programs to encourage physicians to use Lupron,
including offering physicians free gifts, expense-paid trips to resorts and other expensive locales,
free mediations and unrestricted educational grants."
--
John Gohde, Achieving good Health is an Art, NOT a Science!

Health-with-Attitude is a support group for people trying to follow a Healthy Lifestyle.
http://groups.yahoo.com/group/Health-with-Attitude/

"Peter Moran" <moringa@gil.com.au> wrote

> I nominate the following paragraph for an award as the most elaborate ad hominem
> mischaracterisation of the year ---

> >The operating assumptions of these people is that all of alternative medicine is quackery and
> >that the people advocating 'natural' methods are all frauds that kill people who have cancer,
> >that vitamins make expensive urine, that physicians are without fault and that their motives are
> >pure as the driven snow and that doctors can save everybody with their deadly chemotherapy, and
> >that the *only* thing that pays for the lifestyle that these editors and physicians want to
> >maintain are drugs that can be prescribed and preferably patented or procedures that require
> >lengthy stays in hospitals.

> It is also fairly certain from the information available so far that any benefits from supplements
> will be modest relative to the claims that have been made, ... through the exact same influences
> that are much more obviously overselling supplements.

Thank you for operationally demonstrating that my hominem mischaracterisations of the year were
anything but a misrepresentation.

They are in fact how most if not all science geeks view those advocating 'natural' methods.

Just thought that you might want to know. Your bias is showing! :)
--
John Gohde, Achieving good Health is an Art, NOT a Science! http://naturalhealthperspective.com/ The
ONLY Frauds in Health are those who couldn't care less about prevention.

"Peter Moran" <moringa@gil.com.au> wrote

> Note also that it was scientific medicine, not alternative medicine that provided you with
> knowledge of atherosclerosis, LDL, antioxidant effect of Vit E. Doctors and medical researchers
> are not concealing any knowledge about these things and if you want to take Vitamin E on slender
> evidence and with due regard to known ill effects such as the promotion of bleeding then no one is
> stopping you.. The evidence simply remains insuffficient for medicine to support you in it.

Go to PubMed at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Limits&DB=PubMed

and enter the following text in the search box and click on GO.

cam [sb]

You will get 339,805 hits.

All of these 339,805 hits have been classified as 'Complementary & Alternative Medicine' (cam)
health research by the powers that be at PubMed.

Just thought that you might want to know. Your bias is showing! :)
--
John Gohde, Achieving good Nutrition is an Art, NOT a Science!

Get started on improving your personal health and fitness, today.
http://www.tutorials.naturalhealthperspective.com/ Offering 14 easy to understand lessons that will
change your life.

mypcos@hotmail.com (wuzzy) wrote in news:d996c21a.0308211449.5a780288@posting.google.com:

> Herman wrote:
>
>>Why not? It contains antioxidants.
>>
>>Also, there is NO evidence at this time that low fat diets are more healthful.
>
> This is incorrect, the low fat diet is the only diet I know of *that has been shown* to reduce the
> risk of diabetes *better* than metformin.. (when combined with exercise)

I think we're drifting from the original point, which is that chocolate is not an "evil food" and
that recommending small amounts of it as a source of antioxidants is not inherently unreasonable. As
a concentrated source of calories and fat, its consumption needs to be *limited*, but that's not the
same thing as saying it should be *avoided* (people devoted to their particular versions of Dietary
Correctness seem to have a lot of trouble with this distinction). With the *possible* exception of
trans fats, there are no "bad foods" or "good foods," only "bad diets" and "good diets." It's a leap
of illogic to go from "pigging out on chocolate is bad for you" to "eating any amount of chocolate
is bad for you." It's dichotomous, rigid, puritanical thinking.

In article <d996c21a.0308211449.5a780288@posting.google.com>, wuzzy <mypcos@hotmail.com> wrote:
>Herman wrote:

>>Why not? It contains antioxidants.

>>Also, there is NO evidence at this time that low fat diets are more healthful.

>This is incorrect, the low fat diet is the only diet I know of *that has been shown* to reduce the
>risk of diabetes *better* than metformin.. (when combined with exercise)

According to the preliminary results on the Atkins diet, it does even better. In fact, it is hard to
see how a high carbohydrate diet can help diabetics.
--
This address is for information only. I do not claim that these views are those of the Statistics
Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University
hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558

johngohde@naturalhealthperspective.com (N-H-P) wrote in message
news:<16a9b594.0308202104.3a8b559f@posting.google.com>...
> "Peter Moran" <moringa@gil.com.au> wrote
>
> > >While Ester-C is an expensive form of vitamin C because it is patented and there are a few
> > >vitamins that can actually be prescribed by a physician, most vitamins generate almost no
> > >revenue for physicians.
>
> > Neither do pharmaceuticals.
>
> So, you have never heard of cancer physicians buying cancer drugs wholesale and selling them
> directly to their patients?

<snip>

I don't know if this is illegal, but it sure as hell sounds unethical, and most physicians would be
very annoyed if they discovered that a colleague was doing such a thing.

There's a doctor in my town who has a cupboard full of vitamin supplements in his office. He sells
them to the patients he "diagnoses" as being vitamin-deficient. Needless to say, this guy is looked
down upon by the rest of us in the medical community. It is NOT a common practice at all.

It IS illegal, however, for a physician to own a pharmacy to which he/she refers patients for
filling their prescriptions.

Mark, MD

"N-H-P" <johngohde@naturalhealthperspective.com> wrote in message
news:16a9b594.0308202104.3a8b559f@posting.google.com...
> "Peter Moran" <moringa@gil.com.au> wrote
>
> > >While Ester-C is an expensive form of vitamin C because it is patented and there are a few
> > >vitamins that can actually be prescribed by a physician, most vitamins generate almost no
> > >revenue for physicians.
>
> > Neither do pharmaceuticals.
>
> So, you have never heard of cancer physicians buying cancer drugs wholesale and selling them
> directly to their patients? It has been in the news recently. . :(

If the doctors were profitting from this arrangement and not just trying to save patients some money
in your somewhat unique health care system, that is unethical. .

"Almost no revenue" is also a key phrase. In England, virtually none at all, and much less in
Australia than appears to be the case in America. In Australia under current guidelines drug
companies can now not even offer free meals at legitimate educational meetings.

None of this is relevant to doctors prescribing vitamins or not. What illnesses would doctors
prescribe them for, in preference to pharmaceuticals?

Peter Moran

"N-H-P" <johngohde@naturalhealthperspective.com> wrote in message
news:16a9b594.0308210615.17e3a39c@posting.google.com...
> "Peter Moran" <moringa@gil.com.au> wrote
>
> > Note also that it was scientific medicine, not alternative medicine that provided you with
> > knowledge of atherosclerosis, LDL, antioxidant effect
of
> > Vit E. Doctors and medical researchers are not concealing any knowledge about these things and
> > if you want to take Vitamin E on slender evidence
and
> > with due regard to known ill effects such as the promotion of bleeding
then
> > no one is stopping you.. The evidence simply remains insuffficient for medicine to support you
> > in it.
>
> Go to PubMed at:
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Limits&DB=PubMed
>
> and enter the following text in the search box and click on GO.
>
> cam [sb]
>
> You will get 339,805 hits.
>
> All of these 339,805 hits have been classified as 'Complementary & Alternative Medicine' (cam)
> health research by the powers that be at PubMed.
>
> Just thought that you might want to know. Your bias is showing! :)
> --
> John Gohde,

And?

I know this. You were the one complaining about no research into CAM methods, were you not?

Peter M

> Achieving good Nutrition is an Art, NOT a Science!
>
> Get started on improving your personal health and fitness, today.
> http://www.tutorials.naturalhealthperspective.com/ Offering 14 easy to understand lessons that
> will change your life.

"Peter Moran" <moringa@gil.com.au> wrote in message

> None of this is relevant to doctors prescribing vitamins or not. What illnesses would doctors
> prescribe them for, in preference to pharmaceuticals?

??????

If there is a prescription option than a doctor can prescribe them, meaning mainly that a Health
Insurance company would pick up the tab.

Of course, a physician can recommend that a patient do things like buy and take vitamins on their
own. In my opinion, that physician would thus be practicing Alternative Medicine or the more
politically correct term of 'preventive health services.'

What illnesses? Physicians have prescribed multivitamins to patients who are pregnant, Peter. Does
that qualify?
--
John Gohde, Achieving good Nutrition is an Art, NOT a Science!

Get started on improving your personal health and fitness, today.
http://www.tutorials.naturalhealthperspective.com/ Offering 14 easy to understand lessons that will
change your life.

"Peter Moran" <moringa@gil.com.au> wrote in message

> I know this. You were the one complaining about no research into CAM methods, were you not?

Under the rules of ng communication, REPLIES respond to QUOTES. What makes you think that I was
*not* responding to the quote of yours that I quoted in my reply? Was it denial, Peter?

Ha, ... Hah, Ha!

Why do pigs squeal, when they get stuck?
--
John Gohde, Patient Empowerment Advocate http://home.naturalhealthperspective.com/empowerment.html
Email: Ngs@NaturalHealthPerspective.com www.NaturalHealthPerspective.com - Pioneering
De-Medicalization by handing back the power to the people, encouraging self care and autonomy, and
resisting the categorization of life's problems as medical.

"N-H-P" <johngohde@naturalhealthperspective.com> wrote in message
news:16a9b594.0308220612.6fe82756@posting.google.com...
> "Peter Moran" <moringa@gil.com.au> wrote in message
>
> > I know this. You were the one complaining about no research into CAM methods, were you not?
>
> Under the rules of ng communication, REPLIES respond to QUOTES. What makes you think that I was
> *not* responding to the quote of yours that I quoted in my reply? Was it denial, Peter?
>
> Ha, ... Hah, Ha!
>
> Why do pigs squeal, when they get stuck?

The non sequitors seem to be piling up. If you have something more to say, could you put it
more clearly?

Peter