Paul Alper points us to this scary news article by Susan Perry:
Calcium and vitamin D supplements have been shown repeatedly to have no beneficial effect on preventing or treating osteoporosis . . . In fact, the evidence has not only demonstrated that calcium and vitamin D supplements do not reduce the risk of bone fractures, it has also found that they may cause harm in some cases. This harm includes a greater risk of developing kidney stones, gastrointestinal symptoms that require hospitalization, heart attacks, stroke and even (paradoxically) hip fractures.
OK, fair enough. Lots of ideas seem good until you try them out and gather lots of real-world data; calcium supplements could be one such idea.
So what’s the problem?
Yet doctors continue to recommend the supplements to their patients. And people keep taking them. Indeed, studies have revealed that more than half of older Americans (70 percent of older women) take either prescription or over-the-counter calcium and/or vitamin D supplements — mostly because they’ve been told the products will strengthen their bones.
Why has the evidence about the ineffectiveness of these supplements in preventing broken bones and about their potential for harm — evidence that has been around since 2002 — failed to dampen people’s belief in them?
I guess doctors are as clueless as the rest of us. It’s hard to keep up with the news.
But maybe there’s more going on. Perry points to an article in the British Medical Journal by Andrew Grey and Mark Bolland, who write:
Industry gains scientific credibility, which protects or enhances the sales of its products, and indirect marketing through advocacy groups. Advocacy organisations and specialist societies gain funds to support their existence. Academics gain by maintenance of their status and by obtaining access to research funds and career enhancing publications and presentations.
– Here are just a few of the reasons Grey and Bolland cite for why medical specialty societies, advocacy groups and academia continue to discount the science and promote supplements for preventing and treating osteoporosis:
Calcium and vitamin D supplements are enormously profitable — and not just for the companies that make and sell them.
– Health-advocacy groups, such as the National Osteoporosis Foundation (NOF) in the United States and the International Osteoporosis Foundation (IOF) in Europe, rely heavily on money from commercial sponsors.
– Some academic researchers also rely heavily on the support of the nutrition and supplement industry, although they have often failed to disclose that financial connection.
This all seems like bad news, and it’s good for this particular rock to be picked up so we can see the worms crawling underneath.
I have one question
In her news article, Perry contrasts calcium and vitamin D supplements with “other therapies once recommended for the prevention and treatment of osteoporosis — estrogen, calcitonin and fluoride [which] were essentially abandoned once they were shown to be ineffectual or harmful.”
So here’s my question. If there’s money to be made in calcium and vitamin D, why isn’t there money to be made in estrogen, calcitonin, and fluoride. What happened so there isn’t a web of vested interest for these other discredited treatments?
I posed this question to Alper and he responded as follows:
Susan Perry is the expert on this subject. My guess is that estrogen, calcitonin and flouride are far harder and more costly to obtain compared to nipping down to the nearest pharmacy for calcium and vitamin D. Perry appears to be the author of a book on menopause where you can see her comments on estrogen, calcitonin and fluoride.
The “web of vested interest” is more tenuous when there is an expensive intermediary such as a doctor’s visit. Besides, Americans are enamored with pill taking and fish oil swallowing. I have observed friends drinking a large glass of orange juice followed by a vitamin C pill.
I’m reminded of my Linus Pauling theory.
Alper posed my question to Perry who told us some more:
Estrogen has fallen out of favor for the treatment of osteoporosis because of the findings from the Women’s Health Initiative regarding serious adverse risks. That’s not to say that some sectors within the medical community do not continue to try to revive the use of the drug for osteoporosis prevention, but most women have wisely resisted that recommendation. As for calcitonin, the FDA ruled a couple of years ago that it shouldn’t be marketed for the treatment of osteoporosis, again because of research showing links to potentially serious adverse effects, so that would explain it going out of favor. Doctors would be unwilling to recommend a product to their patients that the FDA has explicitly said shouldn’t be used for that purpose. I suspect that fluoride supplements were found to be ineffective, although that is an older story (and one I’d have to research for the details). Also, fluoride is very out of favor with people who practice alternative medicine, so that may also have contributed to it being abandoned.
Estrogen is certainly more expensive and more difficult to obtain than vitamin D and calcium supplements. I’m not sure about calcitonin and fluoride. But I think the reasons I cite above may be stronger explanations for why estrogen, calcitonin and fluoride have been (essentially) abandoned for the treatment of osteoporosis. I don’t know for sure, though.
“I don’t know for sure” . . . that’s not something you’ll be hearing from David Brooks any time soon! I guess we can forget Susan Perry ever getting a column in the New York Times.