Divorce court for the doctor-patient relationship?

The doctor-patient relationship has gone sour.

This probably comes as no surprise to most of you, particularly if you've been following conversations here in The Heart Scan Blog:

Who is your doctor? discussing the emergence of the physician-as-hospital-employee phenomenon that causes your doctor to become the de facto portal (seller?) of hospital services to you, a model fraught with conflicts of interest.

Exploitation of trust, my observation that the enormous gap in heart disease prevention between the woefully ignorant (by necessity) level of sophistication of the primary care physician and the procedure-obsessed cardiologist leads to an exploitation of humans-for-heart-procedures because of the failure to institute genuine preventive efforts.

Bait and switch , a description of how a minor test or symptom can reap a bonanza of medical testing; a $20 "screening" test yields $10's of thousands in hospital procedures. If it were entirely due to the imprecision of medical testing and detection of disease, that might be forgivable. But it often is not: It has become utterly distorted by the profit model.



Lest you think that I am a kook ranting off in some backwoods corner (Milwaukee), here are the comments of New York Times' Health Editor Tara Parker-Pope in a series called Doctor and Patient, Now at Odds:

Lately I've been hearing a lot from patients who are frustrated, angry, and distrustful of doctors. Their feelings speak to a growing disconnect between doctors and patients and worries that drug companies, insurance rules, and hospital cost-cutting are influencing the care and advice that doctors provide.

Research shows that even among patients who like their personal physicians, there is a simmering distrust of the medical system and the doctors who work inside it.


(There's also a series of candid video interviews with people who echo these sentiments.)

There are a number of reasons for this increasing "disconnect," some of them articulated by Ms. Parker-Pope, others detailed in my blog posts.

The solutions, however, will not be found by advancing technology: the newest robotic surgery, a better defibrillator, a new statin drug, the next best chemotherapeutic agent. It will not be found by adding a new wing to the hospital. It will not be found by the reorganization of healthcare delivery achieved by converting primary care and specialty practice into an arm of hospital care. It will not be improved by employing "hospitalists." It will not emerge from legislation controlling insurance company practices. It certainly will not come from increasing marketing dollars spent by drug companies (who make $4 for every $1 spent on direct-to-consumer marketing).

The solutions will come from shifting the idea of care from a paternalistic, "I'm the doctor and I'll tell you what to do" approach, to the doctor-as-advocate-and-supporter of the patient. The physician should act as someone with a particular sort of expertise that can advise a patient.

But a caveat: The patient MUST be informed.

Proper information will not originate with the doctor. It will originate with internet-based information portals and tools that help you understand the issues, often with far greater depth than your doctor could ever provide. The physician needs to accept this role, one of advocate, adviser, but not of being in charge, not of viewing the patient as profit-center, not as an opponent in a power struggle.

Sadly, the last few years in online information portals has been dominated by the drug company-dominated websites like WebMD, nothing more than a deliverer of the conventional wisdom with nothing whatsoever aimed towards empowering patients in a self-directed healthcare model.

Some people call the emerging new empowered and information-armed patient Medicine 2.0. Unfortunately, Medicine 2.0 will first benefit the intellectual upper crust of Americans, the web-savvy and motivated to engage in health issues. But, give it 10 years, and we will witness the effects on an unprecedented broad scale. Part of the Information Age is acceleration of information dissemination. Imagine your children, facile with a computer mouse, posting comments on FaceBook, doing homework with Google and Wikipedia, now turning their attentions to health.

It will be a startling change.

In the meantime, be wary. Be empowered. Think increasingly about self-direction in your health.


In a comment to the Bait and switch post, Jennytoo offered an insightful response:

You are getting to the essence of the problem, and it's not just cardiology that is rife with what is, at bottom, malpractice.

There is little incentive for the profession as a whole to know anything about or promote prevention, and many incentives from hospitals, drug and insurance companies to stick with the status quo or to change it in their corporate favor. The formulaic, conventional statements purporting to be guidelines for prevention that are put out by various interest groups and in such publications as hospital-sponsored newsletters ("eat a 'balanced diet', avoid stress, etc.") are useless sops to the concept of prevention.

It is, and I fear is going to remain, up to motivated individuals, both physicians and patients, to reshape the system, and it's going to be a long frustrating struggle.

It's my personal conviction that if just 4 things were promoted to the public, and people actually practiced them, we could change the health profiles of the majority of people in this country for the better within two years or less. They are:

(1) education on and promotion of a true low-carbohydrate, whole foods, diet,
(2) measurement and supplementation of Vitamin D3,
(3) supplementation with DHA/EPA (found in Fish Oils), and
(4) measurement and supplementation of intracellular magnesium.

I am not a health professional, and others may want to add to this list, but I don't think any strong case can be made against any of the items. The wonderful and hopeful thing is that each of us can implement them ON OUR OWN, and thereby take charge of our own well-being. (The Life Extension Foundation is one organization which provides access to lab tests you can request on your own.)

If you have a physician who is willing and capable of being your partner, you are richly blessed, and that is the ideal we all should hope for. But in the more likely event that you do not have such a physician, and if your physician demonstrates little potential for becoming one, think about firing the one you have and finding another.

Sometimes we are forced by circumstances, particularly urgent ones, to deal with physicians who are not ideal, but the main impetus for change will come from us, the patients, and the expectations we communicate to our individual doctors. In the meantime, we can be self-reliant in our own prevention practices.


Wow. A woman after my own heart.

Comments (4) -

  • Anonymous

    8/12/2008 5:44:00 AM |

    It's Tara Parker-Pope.

  • Dr. William Davis

    8/12/2008 11:43:00 AM |

    Oops!

    Thanks. Corrected.

  • Anonymous

    8/13/2008 3:39:00 AM |

    can somebody expand on the thought of supplementation of intracellular magnesium ?
    Thank you

  • Jenny

    8/14/2008 4:13:00 PM |

    Hopefully, Dr. Davis will correct any misinfo in this reply when he moderates. By "intracellular" I was referring in my comment to MEASUREMENT of Magnesium levels, rather than supplementation.  It's my understanding that serum measurement (a blood draw) may not accurately reflect absolute levels of Magnesium in the body.  That is, if a blood test shows low serum Magnesium levels, you can be assured that Intracellular levels are low--but that Intracellular levels may be low without having it reflected in blood testing.  There are other methods of testing available--one is called ExaTest, and is done by testing a smear of buccal cells.  (Can also reveal intracellular levels of other minerals/electrolytes.)  Supplementation can be accomplished in various ways, and ideally would be done with the help of a physician. Magnesium can be delivered by IV,(obviously must be done in a medical setting), by oral supplementation, which can best be done through supplements such as Magnesium Citrate, Taurate,or Maleate or by making and drinking Magnesium Bicarbonate Water (made by combining proper proportions of Milk of Magnesia and Seltzer--google for details, or see
    Mgwater.com)  Some supplementation can also be accomplished by absorption through the skin, which is best done by soaking in Epsom Salts.  I don't know the relative effectiveness of this method, but it certainly is relaxing and soothing to muscles.  Magnesium taken in the evening is said to help some people sleep better, and it seems from personal experience to be true for me.  There is lots of good, reliable  info about Magnesium at mgwater.com, and also on the TrackYourPlaque site if you are a member.  Hope this clarifies my meaning.  It seems to me that  supplementation, no matter how it is done, should affect all reservoirs of Magnesium in the body, if it is in adequate amounts, but IV supplementation would be the most intensive and quickest form.  I believe it can take a few weeks to months to correct deficiencies orally.  People with normal kidney function can  safely supplement Magnesium, but those with abnormal kidney function should consult their physicians.

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Watch your fish oil labels

Watch your fish oil labels

A quick quiz:

How much omega-3 fatty acids, EPA + DHA, are in each capsule of fish oil with the composition shown on the label below:





If you said 1340 mg (894 mg + 446 mg), sorry, but you're wrong. There are 670 mg EPA + DHA per capsule.

Did you notice that the composition, or "Supplement Facts," lists the contents of two capsules? Rather than the usual one capsule contents, this product label lists two capsules.

I don't know why some manufacturers or distributors do this. However, I have seen many people tripped up by this kind of labeling, taking half the omega-3 fatty acids they thought they were taking. This can be important when you are trying to obtain a specific dose of EPA + DHA to reduce triglycerides, reduce Lp(a), control abnormal heart rhythms, reduce bipolar mood swings, or other important effects.

I liken this to pulling up to a gas station where the sign says gasoline for $1.25. Wow! Can't beat that! You then find out that it's really $1.25 for a half-gallon, or $2.50 a gallon.

In truth, the labeling is accurate; it's just very easy to not notice the two capsule composition.

Comments (36) -

  • Jenny

    12/17/2009 2:43:18 PM |

    The supplement business, completely unregulated, is a magnet for scoundrels. The label is nothing compared to the deceptions they practice in what they put into the capsule and pill. Over and over again lab testing shows the pills either don't contain what you are paying for or contain dangerous contaminants.

    This probably explains why so many studies find that taking vitamin supplements increases mortality in large populations. The toxic load of the pills is probably to blame.

  • jtkeith

    12/17/2009 4:27:25 PM |

    This is a good point, and one I've certainly seen.  

    On a side note, 670mg of EPA/DHA  per capsule is higher than pretty much anything I can find.  500 is more like the upper limit.  Can anyone provide brand guidance about where to find these super potent versions?  

    And another thing I've long wondered is if there are any significant differences between one fish oil and another?  For example, some tout that the fish oil comes from wild salmon, which is better because... ?

  • Dennis

    12/17/2009 6:26:10 PM |

    Interesting article. I have some articles that I've written on fish oil too on my website http://myherbalsupplement.com - I'd love if you checked it out.

  • sdkidsbooks

    12/17/2009 7:27:40 PM |

    Dr. D,

    A bit off this topic, but I was wondering what your thoughts are on the latest research posted yesterday on Crestor.  They are now recommending Crestor for those with normal lipids who have "other" factors for potential heart disease.  It was shown to prevent heart attacks and strokes for those participants. Is this another BIG PHARMA scam?

  • gsbuck

    12/17/2009 8:25:17 PM |

    what would be an eqivilant dose of Flax seed oil if one is currently taking fish oil (2,600IU's of EPA+DEA )

  • Kamila

    12/17/2009 11:11:37 PM |

    I've noticed this too, Dr Davis.  There is some justification with regard to splitting doses in order to make the capsule size more palatable.  But, oftentimes there does appear to be deliberate obfuscation in order to make the purchase price appear more attractive.

  • Dr. William Davis

    12/17/2009 11:30:47 PM |

    Gsbuck--

    3 gallons.

    Just kidding. So little of the linolenic acid in flaxseed oil is converted to DHA that it's impossible to raise your blood level of EPA + DHA using flaxseed oil.

    The claims made by some marketers of flaxseed oil as an omega-3 fatty acid source are simply untrue.

    Nonetheless, flaxseed oil is a wonderful oil with benefits all of its own, just not EPA or DHA blood levels.

  • preserve

    12/18/2009 12:59:14 AM |

    "I don't know why some manufacturers or distributors do this."

    Profit optimization / discriminatory pricing.  Charge illiterates a higher price than literates.

  • Hans Schrauwen

    12/18/2009 10:15:14 AM |

    And what about the claims that     Omega3 from algae is just as good ? They claim fish have DHA because they get it from algae anyway, so why not go direct? If nothing else it has less environmental impact, and if cold-subtracted potentially less oxidized :
    http://www.v-pure.com/

    I take it myself and I never have those "fish burps" from it although it tastes exactly like all other fish-oils.

  • Rob

    12/18/2009 3:47:57 PM |

    I've only recently started following your blog and I dunno if this is the most appropriate place to ask, but what (generally speaking) would be a recommended daily EPA/DHA (or total Omega-3) dosage?

    I've been taking a krill oil supplement for several months, but the dosage is a fraction of that offered by the capsule you used for an example in this post.  So that makes me wonder if I'm taking enough of the supplement to even make a real difference.

  • Carolyn Thomas

    12/18/2009 5:47:20 PM |

    This helps to explain my pet peeves about the supplement industry - as Jenny says, it's a completely unregulated industry.

    In fact, there is no legal requirement for what's listed on the label to even match what's actually inside the capsule.  As long as manufacturers don't claim to 'cure disease', they can pretty well say what they like, at least until proposed industry regulation hits in the next two years - unless the industry's very powerful lobby groups are successful in squashing regulation, as they are of course trying to do.

  • Anonymous

    12/19/2009 1:25:49 AM |

    How can one enjoy raw Almonds and Hazelnuts (my fave) without overdosing on Omega 6?

    Also, any thoughts on whether monocytes reflect too much Omega 6?  I read something on this by Dr. Glen Aukerman regarding lipomas.  He claims lipomas and uterine fibroids are caused by excessive Omega 6 and recommends no nuts at all, no flaxseed, no poultry.  My monocytes tested at 10 which was not flagged as abnormal -- he claims 3.5 is ideal.  I have lipomas and fibroids. My CRP is so low it does not register and ESR was zero. I've never heard this monocyte theory before.

  • Dr. William Davis

    12/19/2009 1:32:47 AM |

    The key with nutritional supplements is to be an informed consumer.

    The WRONG response is: Because I can't always trust the supplement manufacturers, I'll turn to prescription agents (like prescription fish oil).

    I'd personally only turn in the direction of prescription fish oil if I were interested in STICKING IT TO MY FELLOW HEALTHCARE CONSUMERS! I am not, so I prefer that we all educate ourselves on what preparations are reliable and safe.

  • Anonymous

    12/19/2009 2:57:36 AM |

    Dear Author heartscanblog.blogspot.com !
    Clearly, I thank for the help in this question.

  • Healthy Oil Planet.com

    12/19/2009 5:26:49 PM |

    It's really important to look closely at the labels to determine exactly how much ingredient you're getting per dose.  The same applies to food labels as these can be misleading if one doesn't analyze the label closely.

  • homertobias

    12/20/2009 7:44:57 PM |

    Dr Davis

    It is worse than that.  Alot of brands, (Costco is the worst), not only trip you up on serving size but also do the following: Total omega 3: (including DHA/EPA) 375mg.
    So how much DHA/EPA here?  Who knows!  When you look down at the ingredients you will find anchovies, Vit E, and SOY.  Which is cheaper, anchovies or ALA from soy.  And who knows how much Omega 6.

  • Anonymous

    12/20/2009 9:23:45 PM |

    Also be on the lookout for labels that don't mention the EPA/DHA ratios. I've seen some cheaper brands just list 'Omega 3s', with no breakdown.  And if interested in form used (ethyl ester vs triglyceride) you'll have to read the label closely too -- but quite often this isn't even mentioned.

    Although that leads to another point: what is the optimal EPA/DHA ratio as far as reducing heart disease risks?  I don't think this has really been studied that closely.

  • Mindscaper

    12/21/2009 6:00:22 PM |

    I read so much on nutritional interventions for CHD and atherosclerosis that I sometimes lose the source of my information. Sorry if this is the wrong attribution but I think it was Art Ayers (might have been Stephen Guyenet) who blogged about the dangers of using fish oil as a source of Omega 3s. One caveat is that  fish oil oxidizes very easily on the shelf and is likely to also do so in the warm temperatures within the body--therefore it could contribute to inflammation rather than prevent it. If this is true, it is a serious consideration for those who already have atherosclerosis and are attempting to reverse it by using anti-inflammatory foods and supplements. What do you think about this? Should we be getting our omega 3s and 6s from other sources? If so, which?

    I also wonder about disturbing the appropriate balance of omega 3s and 6s by eating either walnuts, almonds, or sunflower seeds daily to help eliminate excessive plaque. So many conflicting ideas--what is one to believe and do?

    Thanks for all the information you generously provide.

  • Judy B

    12/22/2009 2:00:31 AM |

    Is there a search function on this site?

  • Mindscaper

    12/23/2009 3:05:39 AM |

    Ted, Thanks very much for your detailed and informative post. I intend to follow-up by reading your suggested list. Your post is very helpful in clearing up some confusion I was experiencing.Just rereading Stephan's posts go a long way to solidify my understanding of inflammatory processes resulting from chronic overindulgence in excess omega 6s, refined carbs,etc. Ironically, I have been conscientiously attempting to follow the best advice and practices concerning CVD since my father died in the 1970s at the age of 48 after 2 heart attacks and a series of strokes.

    Unfortunately, it turns out that the "best advice" was almost all certainly wrong and in some cases fraudulent. I succumbed to the very disease I thought I was avoiding by my "healthy" lifestyle. The best thing I had going for me had been a  complete  avoidance of doctors until my totally unexpected heart attack last year. At that point my life was saved by Western medicine but I was literally hijacked by the medical system. Because I had insurance I was given an unnecessary $17,000 helicopter ride, two angioplasty procedures, a week's confinement in a hospital and 4 stents--(one of them to replace a botched procedure that caused a vessel dissection). Subsequently, I was placed on statins,plavix, ace inhibitors, and beta blockers for at least a year.

    My intent is to get off of these as soon as possible and to that end I'm seeing an integrative medicine D.O. at the University of Maryland in addition to my cardiologist. She is supportive of my anti-inflammatory diet, antioxidents, vitamin D3  and amino acids, Q-10, and  NO enhancers. I've made her my primary care doctor so she can help me communicate with my cardiologist who I overheard saying (while I was being wheeled in on a gurney "here's a person who should never eat another egg for the rest of her life". How can these MD's be so indoctrinated and misinformed? It is mind-boggling to me. However, once a captive within the system it is extremely difficult to extracate oneself. I was told before I left the hospital that if I missed one dose of Plavix I could cause a clot to form and could die. I was not told that there are other natural platelet anticoagulants that work very well. I was also told that it is virtually impossible to reverse atherosclerosis by nutracueticals and lifestyle changes. It has been an eye opening process to learn differently from doing my own research.
    Again. . . thanks for the information. It will keep me busy for the next little while. Cee

  • Adolfo David

    12/23/2009 6:40:02 AM |

    Dear Dr Davis, I have seen some people criticize your TC scan program because of this might increase cancer risk. So I believe you may be interested in an opposite view, since low dose radiation can be healthy and good based on the phenomenon of hormesis – "a dose response phenomenon whereby a substance that in a high dose inhibits, or is toxic to, a biological process will, in a much smaller dose, stimulate (or protect) that same process."

    CT Scans May Reduce Rather than
    Increase the Risk of Cancer
    http://www.jpands.org/vol13no1/scott.pdf

  • TedHutchinson

    12/25/2009 1:47:43 PM |

    @ Judy B
    If you go to the Heartscanblog home page you will find on the left hand side of the black bar at the very top of the page, a searchbox.

    But that only searches Dr Davis blogs.
    It doesn't search the comments.
    Some of the readers here are very informed and often there are interesting points raised in the comments that add to the valuable information in the blog.
    So to search the blog and the comments I use
    Google advanced search and enter the Heartscanblog URL
    http://heartscanblog.blogspot.com/
    in the search filter box
    Search within a site or domain:

    If you are searching for a post or comment that was recent then select an option from the
    Date, usage rights, numeric range, and more filter menu.

    To speed up searching through the results for the information you want then using you keyboard keys
    Ctrl F brings up a new searchbox, enter the word/phrase you are looking for in this box and then you can quickly skim through each of the occasions that word/phrase appears here.

  • bestrate

    1/4/2010 6:53:02 PM |

    Regarding Rob's question (way up at the top) about fish oil dosages, I too have been wondering about that.  I did find a very fascinating compilation summarizing the opinions of experts on proper dosages which I have bookmarked at (see http://www.buy-fish-oil.com/how-much-fish-oil-dosage-per-day-should-i-take/ )  It was particularly instructive to learn how fish oil has been used in extreme cases of brain failure, heart failure, kidney failure and liver failure such as the treatment and remarkable recovery of the coal miner who survived the Sago mine disaster.  Fascinating.

  • Health Test Dummy

    1/13/2010 7:41:20 PM |

    I recently bought one out of necessity. It has Caramel Coloring added!!!! CARAMEL COLORING???!!!!

    I am indeed perturbed.

  • Anonymous

    1/26/2010 1:36:39 PM |

    "The supplement business, completely unregulated, is a magnet for scoundrels. The label is nothing compared to the deceptions they practice in what they put into the capsule and pill. Over and over again lab testing shows the pills either don't contain what you are paying for or contain dangerous contaminants."

    As a recent subscriber to http://www.consumerlab.com/ I find that for the most part supplements have in them what they claim...and are free of contaminants.  You COULD generally buy supplements from certain dependable sources and be safe doing so.  I don't work in the industry.

  • Term papers

    1/26/2010 3:42:22 PM |

    I notice that the composition, or "Supplement Facts," lists the contents of two capsules Rather than the usual one capsule contents, this product label lists two capsules.

  • Marek Doyle

    2/6/2010 9:23:22 PM |

    Definitely worth buying a good quality fish oil supplement from a manufacturer you trust - and, ate least, taste the oil thats in your capsule before gobbling them down.

    Reference gsbuck's question above, it is difficult to create an exact equivalent between fish oils and flaxseed oils because of the way they are handled in the body. Flaxseed provides a lot of ALA, a plant omega-3s, which needs to be converted in the body into EPA/DHA, the 'active' omega 3s. In healthy people, around 16% of ALA is converted into EPA/DHA. So if you take 10g flaxseed oil, thats 8000mg of ALA, converts to 1280mg EPA/DHA. This is what you would find in around 4 grams of normal fish oil. But... older people, those with chronic disease, those with nutritional deficiency, etc, will never convert very effectively and require fish oils.

    I have discussed the benefits of fish oils vs flaxseed oil here.

  • Anonymous

    2/10/2010 6:04:09 AM |

    nice post. thanks.

  • Anonymous

    6/5/2010 2:57:33 PM |

    Hi im new on here, I stumbled upon this forum I find It absolutely useful & it has helped me alot. I hope to give something back and guide other users like its helped me.

    Thank You, See Ya Around.

  • Anonymous

    6/7/2010 6:28:07 AM |

    Hi-ya i am fresh on here, I hit upon this forum I have found It very accessible and it has helped me out a lot. I should be able to give something back & assist other users like it has helped me.

    Thanks, See Ya Later

  • Anonymous

    6/13/2010 7:50:15 AM |

    What's Happening i am new here. I came accross this forum I have found It positively accommodating and it's helped me out a great deal. I hope to contribute & help others like its helped me.

    Thank You, See You Around

  • Anonymous

    6/15/2010 10:56:17 AM |

    Howdy i am fresh on here, I came accross this board I find It very accessible and it's helped me out so much. I hope to give something back and help other users like its helped me.

    Thank You, Catch You Around.

  • buy jeans

    11/3/2010 7:33:52 PM |

    I don't know why some manufacturers or distributors do this. However, I have seen many people tripped up by this kind of labeling, taking half the omega-3 fatty acids they thought they were taking. This can be important when you are trying to obtain a specific dose of EPA + DHA to reduce triglycerides, reduce Lp(a), control abnormal heart rhythms, reduce bipolar mood swings, or other important effects.

  • Serdna

    2/14/2011 10:01:50 AM |

    Well, it seems to me that this is the label of the fish oil I consume. Maybe I am a little naive, but I just interpreted this label as a strong recommendation to take 2 softgels a day at a minimum and that they would have done a twice greater softgel if it could still be swallowed.

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Dr. Cannell on vitamin D and cancer

Dr. Cannell on vitamin D and cancer

Here is Dr. John Cannell's Vitamin D Council Newsletter reprinted in its entirety. It answers some of the questions that came up on The Heart Scan Blog about the recent release of a study of vitamin D and cancer



The Vitamin D Newsletter

December, 2007

Does vitamin D prevent cancer? If it does, will doctors who ignore the research end up with blood on their hands? The press makes it easy for doctors to believe what they want to believe. Below are six stories about the same scientific study; read the six different headlines. According to your a priori beliefs, you can choose the story you want to believe and read that one. Don't feel bad, we all do it. As Walter Lippman once said, "We do not see and then believe, we believe and then we see."


Vitamin D cuts colon cancer death risk



Study Finds No Connection Between Vitamin D And Overall Cancer Deaths



Vitamin D protects against colorectal cancer



Vitamin D May Not Cut Cancer Deaths



Vitamin D protects against colorectal cancer



Scientists advise a vitamin D downgrade as there is no real proof ...




Another option is to read the study yourself.


Freedman DM, et al. Prospective Study of Serum Vitamin D and Cancer Mortality in the United States. J Natl Cancer Inst. 2007 Oct 30; [Epub ahead of print]




What Dr. Freedman actually discovered is that when you take a very large group of people (16,818), some as young as seventeen, measure their vitamin D levels, and then wait about ten years to see who dies from cancer, you find 536 die and that a vitamin D level from ten years earlier is not a good predictor of who will die from cancer. However, even a level drawn ten years earlier predicted that those with the lowest level were four times more likely to die from colon cancer, suggesting, as Ed Giovannucci has, that colon cancer may be exquisitely sensitive to vitamin D. Furthermore, 28 women got breast cancer, 20 in the group with the lowest vitamin D level but only 8 in the highest. The breast cancer findings were not statistically significant - even during a very long breast cancer awareness month - but can you imagine what critics at the American Cancer Society would be telling women if the numbers were reversed, if the 20 women who got breast cancer were in the high vitamin D group?



Another large epidemiological study appeared about breast cancer the very next day. This time, the press passed on the story and the American Cancer Society was mum, no editorials by Dr. Lichtenfeld, their spokesman, in spite of breast cancer awareness month.



Abbas S, et al. Serum 25-hydroxyvitamin D and risk of postmenopausal breast cancer - results of a large case-control study. Carcinogenesis. 2007 Oct 31; [Epub ahead of print]



In the above study, 1,394 women with breast cancer were case-controlled with a similar number of women without breast cancer. The women with breast cancer were three times more likely to have low vitamin D levels. That is a lot of women who may be dying during next year's breast cancer awareness month.



Both of the above studies were epidemiological, not randomized controlled trials. Of course a randomized controlled trial has already shown a 60% reduction in internal cancers in women taking even a modest 1,100 IU per day of vitamin D.



Lappe JM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.



What is interesting is the difference in the response of the Canadian Cancer Society and the American Cancer Society. The Canadian Cancer Society has advised all Canadians to take 1,000 IU per day - not enough but a good first step - and for immediate additional large scale clinical trials. The Canadians simply performed a risk/benefit analysis. What is the risk of treating vitamin D deficiency versus what are the potential benefits? They quote the American Food and Nutrition Board, which says 2,000 IU/day is safe for anyone over the age on one to take, on their own, without being under the care of a physician. If there is little or no risk, then the next question is what are the potential benefits of treating vitamin D deficiency? This is not quantum mechanics.



Cancer society calls for major vitamin D trial



The Canadians acted because the Canadian government knows it could save billions of dollars by treating vitamin D deficiency.



Vitamin D Deficiency Drains $9 billion From Canadian Health Care ...



If wide spread treatment of vitamin D deficiency became the rule, ask yourself, "Who would be helped and who would be hurt." First ask yourself that question about Canada and then about the USA. Remember, in Canada, the government directly pays for its citizen's health insurance; in the USA, private insurance is the norm. In Canada, the government is realizing they could save billions if vitamin D deficiencies were treated. In the USA, a large segment of the medical industry would be hurt, some anti-cancer drug manufacturers would have to close their doors, thousands of patents would become worthless, lucrative consulting contracts between industry and cancer researchers would dry up.

Both Canadians and Americans are shocked to think their doctors care about money, are in the illness business. In some ways people think of their doctors like they do their local public schools. They know medicine is a business and know doctors do things for money but they don't think their own doctors do. Likewise they think public schools are in bad shape but think their local schools are above average. They think their doctor is above average, like their "Lake Woebegone" kids.

Lake Woebegone Effect

The fact is that doctors, hospitals, regional cancer centers, and the cancer drug manufacturers are all in business to make money and all of these businesses make money off the sick, not off the well. Just a fact, but, as Aldous Huxley once observed, "Facts do not cease to exist because they are ignored."



Vitamin D will save the Canadian government enormous amounts of money but will cause widespread economic disruption in the USA. Do the physicians leading the American Cancer Society have strong economic ties to the cancer industry in the form of patents, stock options, and consulting fees? If so, what do you expect them to do? What would you do? It's simple. You would believe what you have to believe, what you need to believe, that is, anything with the word "vitamin" in it is simply the latest Laetrile. Look to Canada, not the USA, to lead the way.



Vitamin D may fight cancer


What about American physicians? They are apparently waiting for the American trial lawyers to smell a tort. After all, the case is quite simple. Doctor, did you advise Mrs. Jones to avoid the sun? Doctor, did you tell her the sun is the source of 90% of circulating stores of vitamin D? Doctor, did you prescribe vitamin D to make up for what the sun would not be making? Doctor, did you measure her vitamin D levels? So you had no way of knowing if your sun-avoidance advice resulted in vitamin D deficiency? Doctor, do you know our expert tested her vitamin D level and it was less than 20? Doctor, did you tell her about any of the studies indicating vitamin D deficiency causes cancer? Doctor, did you know Mrs. Jones has terminal breast cancer and will be leaving behind a loving husband and two young children?

And what about the American Cancer Society? Dr. Lichtenfeld, their spokesman, quickly gave his opinion; from what I can tell the first time he ever commented on a vitamin D study. That is, he has ignored the hundreds of positive epidemiological studies, ignored the incredible randomized controlled trial, but he jumped on this one:

Maybe Vitamin D Isn't The Answer After All

Dr. Lichtenfeld, implied the Canadian Cancer Society has acted precipitously in recommending that all Canadians take 1,000 IU of vitamin D daily. He implied that Americans should placidly wait until more randomized controlled trials, such as Lappe JM, et al (above), accumulate before they address their vitamin D deficiency. That is, nothing should be done until more randomized controlled trials prove vitamin D prevents cancer, one randomized controlled trial is not enough; epidemiological studies are not enough, animal studies are not enough, multiple anti-cancer mechanisms of action are not enough? If that is his position, I challenge him to point to one human randomized controlled trial that proves smoking is dangerous?

If he cannot, then he must admit that the American Cancer Society's position on smoking is entirely derived from epidemiological studies, animal studies, and a demonstrable mechanism of action, not on human randomized controlled trials? Vitamin D not only has hundreds of epidemiological studies, thousand of animal studies, and at least four anti-cancer mechanisms of action, vitamin D deficiency has something smoking does not have, it has a high quality randomized controlled trial. If future randomized controlled trials fail to show vitamin D prevents cancer - and Dr. Lichtenfeld better hope they do - he can have the satisfaction of saying "I told you so." If future randomized controlled trials confirm vitamin D prevents cancer, then he needs to look at his hands, the red he sees is the blood of needless cancer deaths.

John Cannell, MD

The Vitamin D Council

9100 San Gregorio Road

Atascadero, CA 93422



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The Vitamin D Council

9100 San Gregorio Road

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