The always interesting Eric Topol recently conducted an enlightening interview (linked here) with Dr. Paul Offit. Offit is head of the Infectious Diseases Division at the Children’s Hospital of Philadelphia and author of the new book Do You Believe in Magic? The book discusses the subject of supplements, vitamins, and alternative/complementary medicine.
He credits Linus Pauling with giving birth to the idea that megavitamins — large quantities of vitamins greatly in excess of the recommended daily allowance — have a vast array of beneficial activities. Pauling’s take on this matter had credibility because
he was a brilliant man. He is the only person ever to win 2 unshared Nobel prizes. In many ways he launched the fields of molecular biology and evolutionary biology. He received a Nobel Prize in chemistry as a very young man because he was able to formulate these secondary structures for proteins. He was amazing.
Nonetheless, Offit presents evidence that Pauling’s brilliance did not extend to his opinions on the health benefits of megavitamins. He postulates that after a breathtaking career,
something happened to (Pauling) in his mid-60s. Maybe it was just the sin of hubris because he had been so right for so long, where he believed that his notions about megavitamins were correct even when study after study showed that they weren’t correct.
Indeed, as Offit states in his interview, recent studies show that excessive doses of certain vitamins, such as A and E, can be harmful.
Another problem with the vitamin and supplement industry is its limited regulation by the FDA. For this reason, consumers sometimes cannot have confidence about what they are taking. For instance, Topol notes that
a number of years ago in The Lancet, there was a very nice randomized trial of glucosamine for knee osteoarthritis. But the problem, of course, is that the preparation that was used in the trial — the one positive trial — you would have a hard time finding that particular preparation and dose because, as you say, it is an unregulated industry.
Offit believes that
people have this sort of false notion that there is big pharma on one side and then on this other side, there are just a group of people who want to make natural products, and that they are being made by elves and old hippies on mountainsides.
In reality, the vitamin and supplement and field is a 34 billion a year industry, so that
there are a lot of people making a lot of money, including big pharmaceutical companies. Pfizer bought Alacer recently, which is probably the biggest maker of megavitamins in the United States. Hoffmann-La Roche has been a player in the megavitamin and supplement game since the 1930s.
Offit also comments on the credibility celebrities like Jenny McCarthy and Suzanne Somers carry with the public despite their absence of scientific or medical training. Since we know these figures from television and the movies, many people feel they can trust what these famous folks say.
I have not yet read the book, but it seems that Offit is open to the idea that valuable contributions can come from the areas of alternative and complementary medicine. He just wants to see a rigorous, scientific approach applied so that we can know what really helps people.