Alternative Nutrition bingo: we predict industry responses to the JAMA trial of vitamin C and E

The Journal of the American Medical Association has recently published a good quality, placebo-controlled, randomised, double-blind trial looking at whether vitamin C and E supplementation can reduce cardiovascular events. It ran for 10 years, and included “14 641 US male physicians enrolled, who were initially aged 50 years or older, including 754 men (5.1%) with prevalent cardiovascular disease at randomization.” The trial concluded that “[t]hese data provide no support for the use of these supplements for the prevention of cardiovascular disease in middle-aged and older men.”

I was surprised to see that the alternative nutrition industry has not yet responded to this – I was waiting with bated breath for Sir Cliff Richard’s definitive critique of the science – so I thought that I would respond on their behalf: frankly, the alternative nutrition industry’s response to such trials has become tediously predictable so there seems to be little point in waiting.

I will list a number of likely industry responses below; I will then enjoy the small satisfaction of ticking them off when they appear in industry press releases:
– Wrong type of vitamin pills (e.g. not ‘natural’ or organic vitamin C and E pills)
– Not high enough doses.
– Excessive doses.
– Treatment needs to be individualised.
– Participants were too young to reveal the effects of the pills.
– Participants were too old to reveal the effects of the pills.
– Supplements don’t work unless taken with loads of other pills.
– Pills need to be taken several times a day, in order to maintain levels of the vitamins.
– Subjects may have been using pharma drugs alongside the vitamins: this is why the antioxidants did not provide the ultimate protection.
– Subjects were eating bad diets: this is why the pills did not work.
– Subjects were eating good diets: this is why the pills did not work.
– Measuring the wrong things. Who cares about stroke when Vitamin C will protect you from something really nasty that wasn’t measured…
– Participants were too ill to reveal the effects of the pills.
– Participants didn’t have health problems so couldn’t reveal the effects of the pills.
– How much did big pharma pay the researchers?
– We have mounds of in vitro and observational studies, research in animals, anecdotes etc. that PROVE this is wrong.
– We need more research to PROVE that the pills we sell work. Don’t be silly, of course we won’t fund good quality research from our own profits…
– Meanies.

So, did I miss any?

BPSDB

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20 Comments

Filed under antioxidants, supplements, vitamin c, vitamins

20 responses to “Alternative Nutrition bingo: we predict industry responses to the JAMA trial of vitamin C and E

  1. Anne Nick-Dote spokeswoman for the Northern College of Phytonutrients ( not to be confused with National Car Parks – they clamp your car, but we clamp your diet!) had this to say:

    “This study had doctors participating. They are always SOOOO far behind. Moreover, they have a bias against supplements which may have induced a rather harsh nocebo effect. We need more studies with people who have an open mind such as therapists trained by the Northern College of Phytronutrients. Not to be confused with … ” [That’s enough – Editor]

  2. I’ve taken vitamin C all my life and never had a heart attack.

    (said by celebrity of your choice)

  3. There are probably some bingo points that may be adapted from the College of Natural Nutrition discussion about the BBC Inside Out South West programme.

    SOMEONE FEELS VERY THREATENED ! :) We know what the truth is, and have to make it known…………………..or: is ignoring it better?
    So: keep smiling………..it does not really affect us personally – it depends on US how we play our own cards – Barbara only passed on her knowledge………it is up to us what we make of it…………………..which leads me to PERCEPTION once again : WE DO NOT KNOW THE TRUTH ONLY THE WAY WE PERCEIVE IT……………………right?

    – People running the trial felt threatened.
    – Scientists don’t smile enough.
    – There is no truth, only perception, so that *proves* that trial results do not have any greater intrinsic value than studies with mice or my grandmother’s opinion.
    – Scientists are only passing on what they believe to be knowledge – it is up to everyone how they choose to interpret it.

  4. Ooh – thanks. I also forgot one: “vitamin C cured my horse/dog/gerbil, so it must work”.

  5. Vitamins are so 20thC. What you need now are phytonutrients.

  6. How about… “Previous trials demonstrated heart health benefits associated with vitamin C and E. Therefore the results of the new trial *must* be wrong. Stands to reason.”

    A couple they won’t use:
    “The study was in males. Only females benefit from Vits C&E for CVD” [could lose about half their market].
    “The study only looked at Americans. The pills still work in Britain” [too ludicrous / solidarity with US pill salesmen]
    “The study only looked at physicians. Doctors’ bodies were designed differently by God and metabolise vitamins differently”. [surely this one is just too cranky?]
    “Compliance: we don’t know if the physicians actually took the pills and we are not satisfied with annual self-reporting of compliance” [not cranky enough]

    Sorry about the quality – but all the best ones were already taken!

  7. On a more serious note it is strange how ex-professor Holford always claims everyone else is so far behind with their research. What with the Cochrane Collaboration’s systematic review of the data on anti-oxidant supplements and now this study, it looks like Patrick Holford is the one who is really far behind.

  8. Wulfstan

    Doctors’ bodies were designed differently by God and metabolise vitamins differently.

    I would pay good money to hear Dara O’Briain or someone similar incorporate some of these into a routine. Along with the imps from the broccoli (?) that mine the fat off you (I’m mostly sure that that was in one of his tours, probably involving Gillian McKeith).

  9. Smart Bombs

    I think you forgot “lalalalala I’m not listening”

  10. *red faces* So we did. Hand – forehead.

  11. This article was on AP yesterday, and has now been picked up by lots of media – I wonder if there will be a response soon, or if Big CAM will take the lalalala approach ;)

  12. And now the Alliance for Natural Health have put out their response [PDF]. We got most of them – though the complaints that the placebo might have been a beneficial nutritional supplement caught me by surprise…

  13. Oh, that is glorious. Exactly what I’d expect from the ANH, but it’s good to have my prejudices confirmed.

  14. Interesting, in a way – there are infinite ways in which one can get these things wrong, but ANH focuses on a relatively predictable subset of these…

  15. It’s uncanny. Actually, we’re just advertising our abilities in such matters should they decide to offer us a retainer.

    Ticks for: synthetic; low-dose; synergy; diet; not enough pills; Big Pharma shills; paranoia.

    The placebo that is not truly inert is a good one. But, how could we have omitted, “The research was conducted by the wrong sort of scientist” – you know, ones that rely on more than a “fluid concept of evidence”.

    We will learn.

  16. Wulfstan

    It seems that they give a very personal interpretation of Michael Pollan, one that the man Pollan would not recognise. New York Times has this:

    Be as vitamin-conscious as the person who takes supplements, but don’t actually take them. And in the soon to be exhaustively quoted words on the book’s cover: “Eat food. Not too much. Mostly plants.”

    I don’t take supplements so I lack the micro-nutrients that would give me the ninja reading comprehension to turn that into the ANH version:

    As Michael Pollan asserted in his book “In Defense of Food: An Eater’s Manifesto” (Penguin, 2008), be a supplement user, as they do most things better, including eating healthier diets, taking more exercise and generally living healthier lifestyles.

  17. Courtesy of the American Chronicle, we learn that

    A number of landmark epidemiological studies have, in fact, established that vitamin E supplementation reduces cardiovascular disease progression and reduces mortality.

    Then again, we also learn about a Prophet Yahweh prediction re UFOs. You don’t get that from CNN.

  18. A bit late to the table, but step forward Jonny Bowden:

    Number one, we have no idea what kind of vitamin E was given. From past experience, doctors- who know absolutely nothing about this stuff- tend to give alpha-tocopherol, the least effective of the 8 components of vitamin E. Number two, look at the dose. Four hundred IUs taken every other day. And if previous experience is any guide, they probably used an synthetic source, which is about half as effective as a natural source. On what planet do you dismiss any possible benefit from vitamin E based on a low dose of an ineffective form of the vitamin given to a population that wasn’t at risk in the first place?

    And while vitamin C at 500mg is a nice basic dose, no one seriously thinks that’s enough to make a therapeutic difference…

    Never mind that just last year multivitamin and vitamin E use was found to be associated with lower mortality from cerebrovascular disease (CVD)

  19. Re “Not high enough doses”; “too high doses” –
    I think that Pamela Mason of HSIS may have used these in her response to a similar paper in JAMA (on antioxidants and cancer).

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