For many years now I’ve been shouting myself hoarse about the way the medical profession — aided and abetted by pharmaceutic multinationals — is recklessly promoting vitamin D supplements. What have I achieved thus far? Just ruffled the feathers of a few. Beyond that, well, it has been like so much water rolling off a duck’s back.
A recent Kaiser Health News investigation done for The New York Times, at last, proves me right. It is an exhaustive piece that must be read and pondered over by every medical practitioner. The scoop brings to light the abhorrent fact that doctors using their prominent positions unabashedly promote practices that give them hundreds of thousands of dollars by way of kickbacks. Dr Michael Holick, a Boston University endocrinologist, reportedly, is one doctor whose excessive enthusiasm helped push Vitamin D supplement sales to $936 million dollars in 2017 — a nine-fold increase over that of the previous decade. Simultaneously, lab tests for Vitamin D deficiency also spiked. That doctors ordered more than 10 million such tests for Medicare patients at a humungous cost of $365 million makes for sad reading! What do we see in a small state like Goa? The trend here too is abysmal and it is saddening that our own medical practitioners swept up in the Vitamin D craze order tests and unwarrantedly prescribe expensive Vitamin D supplements…left and right.
Dr Holick himself oversaw the publication of a report in the peer-reviewed Journal of Clinical Endocrinology and Metabolism. The report was done on behalf of the Endocrine Society, the field’s foremost professional group, whose prescribed guidelines are widely used by hospitals, physicians and commercial labs nationwide. Dr Holick adopted the position that “Vitamin D deficiency is very common in all age groups” and went on to advocate a huge expansion of Vitamin D testing, targeting more than half of the United States population.
The recommendations proved to be a financial windfall for the Vitamin D industry. The guidelines also benefited the Vitamin D industry in another important way. Unlike the National Academy (which concluded that most patients have sufficient vitamin D levels in their blood), the Endocrine Society proposed that Vitamin D levels needed to be higher than earlier prescribed. Dr Holick has now admitted that he had extensive financial ties with the pharmaceutical industry. He allegedly received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug manufacturers.
The Vitamin D hype is not backed by scientific trials. In fact, there’s absolutely no evidence that people with higher levels of Vitamin D are any healthier than those with lower levels. Using the Endocrine Society’s higher standard created the appearance of an “epidemic” because it labeled 80 percent of Americans as having an inadequate amount of Vitamin D. Dr Rosen, a leading endocrinologist, piquantly remarked, “We see people being tested all the time and being treated unnecessarily based on a lot of wishful thinking that erringly recommends a supplement to make one healthier.”
In the majority of people, there’s no reason to order Vitamin D tests like it is being done. They may not have osteoporosis, their bones are not cracking; they do not have diseases that interfere with Vitamin D absorption. Yet, in a recent sample of 800,000 patients in Maine, US, nearly one in five had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests to hilariously evaluate such ill-defined complaints as weakness or fatigue. The result is that millions of people started popping supplements in the belief that Vitamin D could help turn back even depression, fatigue, muscle weakness, heart disease or cancer.
Regrettably, the Vitamin D bandwagon is still running at full speed despite the jolts. It is almost as though there is nothing else serious in clinical practice. Reports compiled by the respected Institute of Medicine in the US are extremely critical of the Vitamin D craze and doctors are being told that there’s absolutely no reason to start telling healthy patients to get tested and treated.
It is an unfortunate reality that we live in a time where traditional medicine is driven by pharmaceutical companies. The current model is a “drug for every symptom” and the idea that one can do something to improve a symptom without a drug is far from mainstream. Dr Holick’s enthusiasm for Vitamin D was indeed fairly extreme. He even did his level best to elevate his own levels of the stuff with supplements and fortified milk. His fixation was so intense that he was found attributing the mysterious extinction of dinosaurs million years ago to vitamin D deficiency.
So, what can we say in conclusion? Dr Holick’s over enthusiasm is well-nigh the height of absurdity. But when this absurdity leads others into the trap it is all the more deplorable.
(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa.)
