Monday, September 01, 2008

The Fear Mongers

By James J. Gormley

On March 4th, 1933, in his first inaugural address, Franklin Delano Roosevelt delivered the following inspiring words: “So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself […]”
Now while FDR was, at the time, addressing a nation in the depths of the Great Depression that had recently been rocked by bank runs and was experiencing crushing unemployment and epidemic business debt, if uttered now these same words could just as well apply to the irrational, yet no less viral, fear of dietary supplements on the part of certain scientists, legislators and public health officials today.

Today, we are experiencing a new Great Depression of unhealth and chronic disease, marked by conditions which modern medicine, with its drugs and invasive procedures, is often ill-equipped to safely and effectively handle.

Instead of bank runs, we are witness to countless “pharmacy runs” and visits to mainstream physicians.
In point of fact, Americans reportedly spent $287 billion dollars on prescription drugs in 20071 and $16.1 billion on over-the-counter drugs.2

In August 2008, the U.S. Centers for Disease Control and Prevention (CDC) noted that, in 2006, Americans paid 1.1 billion visits to doctors and clinics.3

With epidemic levels of obesity, insulin resistance and type 2 diabetes, our most critical national debt is the good health to which our country’s citizens are entitled.

With this backdrop of America’s tragic overuse of drugs coupled with nutritional bankruptcy, a group of researchers recently published a paper entitled, “Dietary supplement use among elderly, long-term cancer survivors” (Journal of Cancer Survivorship, Paige Miller, et al.).4

Since chemotherapy is known to be either ineffective or marginally effective but laden with toxic side-effects, I had hoped that this study (based on two phone surveys with cancer survivors) would add another rock to the foundation of research supportive of dietary supplements in supporting immunity, fending off cancer and reducing the side effects of cancer drugs.

Instead, the researchers (from Penn State University, UT-MD Anderson Cancer Center, Duke University and a VA Medical Center) chose to highlight supplement use among elderly cancer survivors while, at the same, time raising the specter of largely theoretical supplement dangers while soft-soaping their well-supported benefits.

For example, the authors’ main support for the argument that supplements could be “risky” are several articles by supplement critic Golan Bjelakovic who, in 2007, co-authored an article with the cynical title, “Surviving Antioxidant Supplements.” 5

The rest of the study by Miller and colleagues does not seem to really offer a coherent message. The paper, for example, indicates that the survey participants who used the most supplements were better educated, ate more fruits and vegetables, ate more grains and, in general, had better nutrient profiles than did their less healthy co-participants. Problems of equal access to nutritional supplements notwithstanding, how is this a problem?

Other parts of the paper suggest that older Americans do not get enough of certain nutrients (e.g., magnesium, calcium and vitamin D) but elsewhere the researchers warn that people should be careful to not get too much. The study also cautions older Americans against getting too much zinc while later bemoaning the fact that many cancer survivors need more of this mineral.

In addition to the lack of a clear, practical value to this Journal of Cancer Survivorship paper (aside from adding to usage data re supplement use in older Americans who are cancer survivors) and the mixed, in some cases contradictory, messages that are communicated relating to supplementation, there is a rich body of established research—largely ignored here by Miller and colleagues—which strongly supports the use of dietary supplements to: reduce cancer risk6-11, treat cancer patients after diagnosis or surgery12-16, and improve health markers or reduce side effects in patients undergoing chemotherapy17-21.

Why then do fear-mongering papers continue to get published (time and again) and attract undue media attention while the majority of studies that are supportive of dietary supplements and cancer are rarely cited by researchers or noted by reporters?

I think there are, perhaps, several reasons. One is that skepticism and cynicism are often mistaken for intellectual probity—people seem smarter when knocking something.

Another potential reason is misplaced paternalistic protectiveness: researchers may feel that they are serving a public good by alerting doctors and the world to the putative, albeit ephemeral and largely baseless, “dangers” of dietary supplements.

The fact that universities and their medical centers regularly receive endowments from pharmaceutical corporations may also have an insidious effect that trickles down to researchers who are on the bench, working with patients or punching data into their biostatistical calculators.

Ultimately, however, what matters most is that, armed with science and evidence-based facts (the results behind what actually works, and what doesn’t), we continue to be open to the benefits of dietary supplements in virtually all areas of health and wellness and not immediately, or uncritically, buy into the anti-supplement brigade’s usual messages designed to sow unreasoning doubt and inspire baseless fear.

  1. Colihan K. Shop around if you pay for pills. WebMD Health News. Website: Accessed August 31, 2008.
  2. Consumer Healthcare Products Association (CHPA). OTC Retail Sales—1964-2007 [chart]. Website: Accessed August 31, 2008.
  3. CDC. Americans made over 1 billion hospital and doctor visits in 2006. August 6, 2008. [press release] Website: Accessed September 1, 2008.
  4. Miller P et al. Dietary supplement use among elderly, long-term cancer survivors. Journal of Cancer Survivorship. Published online July 11, 2008.
  5. Gormley J. Antioxidant supplements won’t hurt us, but misinformation might. Blog: The Gormley Files Posted online May 4, 2008.
  6. Reid ME et al. The nutritional prevention of cancer: 400 mcg per day selenium treatment. Nutrition and Cancer. 60(2):155-163, 2008.
  7. Weingarten MA et al. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database of Systematic Reviews. 23(1):CD003548, 2008.
  8. Lappe JM et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. American Journal of Clinical Nutrition. 85(6):1586-1591, 2007.
  9. Kirsh VA et al. Supplemental and dietary vitamin E, beta-carotene and vitamin C intakes and prostate cancer risk. Journal of the National Cancer Institute. 98(4):245-254, 2006.
  10. Galan P et al. Antioxidant status and risk of cancer in the SU.VI.MAX study: is the effect of supplementation dependent on baseline values? British Journal of Nutrition. 94(1):125-132, 2005.
  11. Duffield-Lillico AJ et al. Selenium supplementation, baseline plasma selenium status and incidence of prostate cancer: an analysis of the complete treatment period of the Nutritional Prevention of Cancer Trial. BJU International. 91(7):608-612, 2003.
  12. Li Z et al. Feasibility of a low-fat/high-fiber diet intervention with soy supplementation in prostate cancer patients after prostatectomy. European Journal of Clinical Nutrition. 62(4):526-536, 2008.
  13. Gold EB et al. Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL Study. Menopause. 13(3):423-433.
  14. Ishikawa H et al. Aged garlic extract prevents a decline of NK cell number and activity in patients with advanced cancer. The Journal of Nutrition. 136(3 Suppl):816S-820S, 2006.
  15. Stratton MS et al. Selenium and inhibition of disease progression in men diagnosed with prostate carcinoma: study design and baseline characteristics of the ‘Watchful Waiting’ Study. Anticancer Drugs. 14(8):595-600, 2003.
  16. Jatoi A et al. A cross-sectional study of vitamin intake in postoperative non-small lung cancer patients. Journal of Surgical Oncology. 68(4):231-236, 1998.
  17. Block KI et al. Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials. International Journal of Cancer. 123(6):1227-1239, 2008.
  18. Read JA et al. Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Supportive Care in Cancer. 15(3):301-307, 2007.
  19. Mantovani G et al. A phase II study with antioxidants, both in the diet and supplemented, pharmaconutritional support, progestagen, anti-cyclooxygenase-2 showing efficacy and safety in patients with cancer-related anorexiz/cachexia and oxidative stress. Cancer Epidemiology, Biomarkers & Prevention. 15(5):1030-1034, 2006.
  20. Gramignano G et al. Efficacy of L-carnitine administration on fatigue, nutritional status, oxidative stress, and related quality of life in 12 advanced cancer patients undergoing anticancer therapy. Nutrition. 22(2):136-145, 2006.
  21. Altundag K et al. Selenium supplementation may increase the efficacy of cetuximab in metastatic colorectal cancer patients. Medical Hypotheses. 64(6):1162-1165, 2005.
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