Thursday, January 28, 2021

Vitamin D, false nostrums, and conspiracy theories: The world has enough real problems

Near the end of December, Tiffany Hsu, writing in the NY Times, discussed “Dubious COVID Cures”. She compared them to the similar nostrums popularly recommended for the 1918 influenza epidemic, when ‘a spate of ads promised dubious remedies in the form of lozenges, tonics, unguents, blood-builders and an antiseptic shield to be used while kissing.’ She quotes the head of research at MyHeritage, Roi Mandel as saying “So many things are exactly the same, even 102 years later, even after science has made such huge progress.”

Even after all this scientific progress and all the advances in health care, people are still fascinated by over the counter magic drugs, things that seem easy, and are often cheap (although usually very profitable), and somehow better than the treatments being offered by the medical community. This is, of course, even more so when that medical community does not have a whole lot to offer in terms of treatment, a particular issue for virus infection, and mostly talks about prevention, about such things as isolation and physical distancing. Wouldn’t it be better if you could just take something that would cure it or make it better or at least decrease the seriousness of an infection? And, you know, there are ‘studies’ that show it works (although of course I haven’t actually read them and would have no idea how to understand if the research was legit) and, you know, there are doctors who recommend it!  Like ‘Dr. Pierce’s Pleasant Pellets promised that the pills — made from “May-apple, leaves of aloe, jalap” — offered protection “against the deadly attack of the Spanish Influenza.”’ Oh, wait, that was from 1918 – but we have Dr. Oz!

This is not to say that some popular treatments do not have benefit, and this is especially good if they do not harm you, and if they are cheap. One such could be Vitamin D, which has been advocated (most recently for COVID-19, but for a lot of things) by many people, some of whom are actually experts. As with many “natural” remedies, most of the basis for this is in syllogism. You extrapolate from something that is known about a substance (commonly, as in the case of Vitamin D, that it “promotes immunity” – a pretty general, non-specific claim), but such claims are uncommonly backed up by rigorous testing to see if it actually does work. (Freeman’s Second Law: Something that makes sense is properly called a “research question”. You wouldn’t want to study something that didn’t make sense. However, to know whether it is actually true, you have to actually do the studies!)

Recently, The Guardian had an article titled “Does Vitamin D Combat COVID?”. It is very positive about the vitamin, citing many important people (unsurprisingly, being The Guardian, many from England), but does stop short of claiming that it will definitely work. The claims for benefit vary: it makes it less likely that you will get infected, that if you get infected you will get less sick, that if you get sick you are less likely to die. Not really quantified though. The reason is that there are studies that show both benefit and not, and none of them are definitive. There is also concern that people with more melanin in their skin, presumably a genetic adaptation to being from areas with more sunshine (and thus more vitamin D) can become vitamin D deficient when they live in areas in northern latitudes with less sun. Obviously, this is confounded by the existence of a variety of other social and medical health risks accruing to dark-skinned people in northern latitudes. Maybe it is an additional one, but it is unlikely that just taking Vitamin D will solve the problem of inequity.

The actual evidence is summarized in a recent piece in JAMA, “Sorting out whether vitamin D deficiency raises COVID-19 risk”. The first thing that you note here is that it is answering quite a different question – whether people who have low vitamin D levels have greater risk (and, thus, presumably, should take vitamin D supplementation), not whether everyone should be taking vitamin D. ‘Research findings about vitamin D and COVID-19 have been mixed and sparse,’ is the key finding, and the ‘Upshot’ of the pieceis a quote from Dr. Catherine Ross, a nutritionist at Penn State: ‘“Avoiding vitamin D deficiency is always a goal.”

So you should take vitamin D supplements if you are deficient (Dr. Fauci says this also), although knowing if you are deficient would require both your having your level measured, something which is not recommended by the most reliable source, the US Preventive Services Task Force (USPSTF) for asymptomatic adults (although it is by many who are consultants to vitamin D advocating groups), as well as to know what the level below which you are deficient is: 20? 30? 50? You can find all of these in the “literature”. And it is concerning when advocates have industry ties. Nonetheless, vitamin D is available cheaply and generically, is safe if you don’t take too much (as a fat-soluble vitamin you CAN overdose on it), and Dr. Fauci takes it (same article). I took one this morning.

But the really big question is not vitamin D, even if the evidence is not absolutely clear. Overall, it is pretty safe and pretty cheap and has a conceptual justification and at least some studies show some benefit. The really big issue, as put forth early in this piece, is why do people continue to search for magic treatments that are not mainstream? Why do they often trust their friends and neighbors and strangers on the Internet more than doctors? I don’t know for sure, but in Hsu’s article comparing today to 1918 he quotes Jason P. Chambers, associate professor of advertising at the University of Illinois: “Human beings haven’t changed all that much. We’d like to believe we’re smarter, that we’d be able to spot the lies, but the ability of advertising to maintain its veneer of believability has only become more sophisticated over time.” Unfortunately, we’re probably not. That is why advertising is so successful.

This fear is related to not only mistrust of science (it is hard to understand) but to conspiracy theories in general; recently the “political” belief in a “deep state”, that “they” are lying to us and trying to keep important information and benefits from us. Of course, “they” may be; I certainly do not trust the leadership of our country (or any country) to necessarily work in the best interests of the people, except of the richest, most powerful and well-connected people. I absolutely believe that Big Pharma is only interested in making as much money as possible and selling us drugs which may not be any better than cheaper ones, or none at all. But the suspicion that science and medicine are working to harm us often segues into pretty odd stuff (I was recently sent this nonsense about the COVID vaccine being a plan to engender female sterilization!) (On the subject of conspiracy theories, Andy Borowitz’ recent satire – QAnon merging with the Elvis-is-Alive groups -- is, as usual, not far off the mark.)

I am sure that some of this is the fault of the arrogance of scientists and doctors. A good friend was recently diagnosed with breast cancer and was told by her doctors to “not go on the Internet, to not talk to anyone who has had it, because everyone’s cancer is different”. This is ridiculous, although I understand that they probably get frustrated by people coming up with silly or, worse, dangerous treatment ideas that they have heard from someone, or stories from their sister-in-law’s neighbor. This can of course be much better addressed, with something like “You’ll hear a lot from people who have had breast cancer; it is a common disease. You will certainly look things up on the Internet. Listen to them, but remember you are you, and your experience is not likely to be exactly the same as theirs. Please don’t take any treatments without discussing it with us, so we can make sure there is no danger. Welcome the support.” And, I would be wrong to omit, the big reason that doctors feel so pressured and don’t have enough time to talk to and discuss things with folks is in large part because the big corporations they work for (for-profit or “non-profit”) are about maximizing income, not health.

Still, people seem to find themselves drawn to “alternatives”. They like “natural”. OK, keep your mind open, but remember than “natural” is not necessarily better. Any substance that has any effect, positive, negative, or neutral is because of chemicals in it. That they occur naturally does not make them safer than those that are manufactured.

And watch the conspiracy theories and think about what is important. Life on earth could be extinguished by climate change. That is real. War which leads to nuclear war could do it first. People all over the world are starving, are without housing, without basic health care, subjected to natural disasters and man-made ones. They are being killed, often in genocides. In all countries, including ours, there is structural oppression of people based on race, religion, gender. Wealth is being transferred from regular and even poor folks to the richest at an astounding rate. Authoritarian leaders, and even fascists, are proliferating.

These are real problems, that need real concerted efforts to combat. Work on these. Don’t be distracted by non-issues.

1 comment:

Paul Mermin said...

I set out to give this a plethora of thumbs up, but found I could only manage two. And all my life I've been told I'm all thumbs... ... whatever the tally, this is a superior blog, Dr. F.

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