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Miscellaneous thoughts and ramblings
Wednesday, August 03, 2005
Vitamins = Crap (Mostly)
I subscribe to The Medical Letter, a periodical that reviews the latest evidence on medications. It's entirely objective, not funded by advertisements, and a great way for a busy internist to keep up with the constantly expanding list of medications at her disposal. Because I'm a paperless, digital, twenty-first century kind of doctor, I get it on my Treo, so I can read it whenever the mood strikes me, like on the potty.

The July 18 edition featured an article that reviewed all the randomized evidence* about vitamin supplements. The article goes through each article and reviews the evidence about it. I copy below, entirely without permission and verbatim, their conclusions. (The second point I've been telling patients for years until I'm blue in the face usually to incredulous patronizing stares.)

Hear me now. Believe me later. Stop taking vitamins unless you have a specific deficiency for which your doctor recommends them, (or unless you're taking calcium and vitamin D for osteoporosis prevention). Send 10% of the money you save to some right-wing charity. That is all.

UPDATE on August 22: The Medical Letter actually just released this addendum:
The recent Medical Letter article on Vitamin Supplements (July 18, 2005; issue 1213) stated in its conclusion that there is no convincing evidence that taking supplements of vitamin C prevents any disease. We should have added, "...except scurvy."

* Randomized evidence is the most reliable medical evidence. A randomized trial is one in which subjects are assigned randomly to received the tested medicine (in this case the vitamin in question) or to receive placebo. Having your cold get better after taking vitamin C is not randomized evidence; don't tell me about it. All of my colds have gotten better. I've never taken vitamin C.
My previous reflections on doctoring:

You Should Know Better Than That
I Really Appreciated This Visit
If I could be a doctor...
If I could be an astronaut...
Gawsh, You’re Awful Purdy!
Going Around
What Is It?
The Secret To Longevity
Thank You, Doctor
Senior Sadness
"A balanced diet rich in fruits and vegetables "??? You sound just like my doctor - I asked him why I never have any energy, and he told me it's because I don't eat right, I don't get enough sleep, and I don't exercise. What a quack! What pill do I need to take to give me energy?
And what's with the "at her disposal"? Give me a break, you limp-wristed liberal pansy.
And to think that all these years that have "sailed" by, I've been taking Vitamin C to help prevent "scurvy." I declare MUTINY! (okay, you've had enough with the puns, have you...?) Wow, thanks for bursting that bubble!
Did you write the post on your Treo?
Always thought that all the supplement driven-macrobiotic mumbo jumbo was crap. I took vitamins once religiously for about a year. End result, when I stopped i started to gain weight in my wallet.

I DID think that you were supposed to get more C in you when you smoked- but I always figured it was better to eat an orange than to take a pill.
But Flintstones chewables are still good, right? Aren't they one of the four food groups?

Seriously, I hear you now and believe you already. But there might be some aftershocks in my family after I print this one up and pass it around. Thank you.
Ralphie: "What pill do I need to take to give me energy?" Viagra.

Toronto: Arrrggh! Another pun, and yall walk the plank!

TWW: Nope. Wrote it on my desktop 'puter at home.

Og: Interesting that you mentioned smokers. The content of the article mentions beta-carotene. Because it's an antioxidant, people have thought it might help prevent cancer, so they did a large controlled study in Finland where they randomized smokers to beta-carotene vs placebo. The subjects on beta-carotene had 15% MORE incidence of lung cancer, which was statistically significant. Looks like tumors need beta-carotene to grow strong!

Gavriel: I've seen your comments on Ralphie's posts but didn't have a chance to welcome you to the Coffeehouse myself. Welcome! Flintstone chewables are absolutely essential, but not for their nutritional value. They're importnant because (1) they taste good, and (2) Betty Rubble is such a drug rep.
You can't argue with people's experience. If a man has taken Vitamin C, and his cold went away, he'll never believe your twisted scientific study.

What was that earlier post, about why you went into medicine? Maybe you should have been a vitamin salesman.
I always find it amazing when patients tell me they can't afford their blood pressure medication, then pull out a whole sack full of supplements that probably run about $100 a month.
Q: That's exactly right. People are highly influenced by their experienced and we're hard wired to believe that if B happens after A, then it happens because A. That's such a common logical fallacy that the aincient Romans had a name for it, but it's in Latin and I don't remember it. (I think it's just Latin for "after this, therefore because of this".) I had a pretty female stranger compliment me about 30 minutes after a large bowel movement, so I've been taking laxatives ever since. And vitamins.

Psychotoddler: Don't even get me started. "I can't afford to go to Weight Watchers because I'm saving up for my total body CT scan." A consequence of the liberty I cherish in this great country is that people are free to be morons.

I'll have to bake you a cake with my favorite blue candy. You'll love it and you'll be amazed at how it makes you feel stiff and full of vigor.

It really works.
Jack: Hey. I thought I was supposed to be prescribing for you!
Thank you! You confirmed what I've always believed in, despite being surrounded by masses of vitamin-takers.
Irina: I'm here merely to confirm your pre-existing biases! It's nice to see you around again.
cum hoc, ergo propter hoc. I love Google.

And the welcome. Great, blogroll-worthy blog (if I ever summon the energy to crack open my template again).
Gavriel: Thanks! I was actually going for "post hoc, ergo propter hoc", but the essence is the same.

"Ergo propter" sounds like a very small unstable flying machine, but that's 'cause I never took Latin.

Shabbat shalom! [ = "peaceful Sabbath", for all our Hebreically challenged but valued readers.]
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