Medical Bias and Supplements, Part I: Multiple Vitamins

In 1998, eyebrows were raised when the New England Journal of Medicine ran an editorial¹ that advocated the use of multivitamins for the general population. I wondered why some of the world's best and brightest practitioners took so long to recognize what appeared so obvious to so many.

A few months later, I read a commentary piece in the Archives of Internal Medicine.² Drs. James Goodwin and Michael Tangum did an outstanding job to articulate what many so-called alternative practitioners have personal experience with: American academic medicine's bias against micronutrient supplementation.²

The authors based their article on three themes, each supported by interesting examples. They state:

1. "By uncritical acceptance of bad news about micronutrient supplements, reports of toxic effects were rarely questioned and widely quoted.

    

2. "By the scornful, dismissive tone of the discussion about micronutrient supplementation in principles of medicine, a tone avoided in most medical controversies.

    

3. "By the skeptical reaction greeting any claim of efficacy of a micronutrient, relative to other therapies; indeed, most claims were simply ignored."

This month, our focus will be on the questions posed in the second statement, because the example used by Goodwin and Tangum involved multivitamins. The authors reviewed multiple additions of Harrison's Principles of Internal Medicine (arguably one of the most important texts used to educate American MDs since World War II).

Beginning in 1950, Harrison's text stated that massive use of vitamins by the American public could lead to careless food selection and increase the risk of amino acid and mineral deficiencies. They further stated that most supplementation was useless; this theme was repeated in the 1952, 1958 and 1962 editions.² The 1962 edition also called routine supplementation indefensible and poor medical practice.² The 1970 edition was harsher: "Multivitamin use is wasteful, unnecessary, and unjustified." Even breakfast cereal manufacturers received a scolding for adding vitamins to their products.

The 1987 and 1991 editions reported that problems of vitamin excess were now more common than those of deficiency. What was most interesting was that none of the statements in any of the editions were referenced. Nevertheless, this is the type of education many MDs received. When you couple this with very few or no courses on nutrition, it is not surprising that many allopaths are less than enthralled with supplements.

Goodwin and Tangum then reviewed some terms used in the vitamin sections of various editions of Harrison's: "massive; carelessness; useless; indiscriminate; false; indefensible; wasteful; insidious; unnecessary; deplored." Goodwin and Tangum pointed out that when other controversial subjects were covered, like hysterectomies or tonsillectomies, the discussions lacked the contemptuous tones observed in sections on multiple vitamins.

I believe the vast majority of health care professionals in all disciplines simply want to know the truth. When one reviews the literature on the use of multiple vitamins, it appears that for the vast majority of the population, routine use will certainly do no harm and will likely be beneficial.

Next month, in part II, we will look at the vitamin C kidney stone story, an example of the uncritical acceptance of bad news about supplements that Goodwin and Tangum highlighted in their article.

References

1. Oakley GP. Eat right and taking multiple vitamins. New England Journal of Medicine 1998;338(15):1060-61.

    

2. Goodwin JS, Tangum MR. Battling quackery. Archives of Internal Medicine November 9, 1998, pp. 2187-91.