Vitamin D acceptance delayed by Big Pharma following the Disinformation Playbook
Commentary by William B. Grant, Ph.D.
(OMNS Oct 1 2018) A "Disinformation Playbook" has been used for decades by corporations to delay government action on matters of public interest that would adversely affect their income and profit. Some well-known examples include the big tobacco companies, the coal and oil industries, the sugar industry, and the National Football League. The Union of Concerned Scientists has outlined five "pillars" of the Playbook [Disinformation Playbook], [Alvord 2017]. Big Pharma may be using the Playbook to slow the adoption of strong support for vitamin D. This article is the product of my further analysis.
The Disinformation Playbook
1. The Fake
Conduct counterfeit science and try to pass it off as legitimate research.
2. The Blitz
Harass scientists who speak out with results or views inconvenient for industry.
3. The Diversion
Manufacture uncertainty about science where little or none exists.
4. The Screen
Buy credibility through alliances with academia or professional societies.
5. The Fix
Manipulate government officials or processes to influence policy inappropriately.
Background and evidence that vitamin D improves health outcomes
Big Pharma and its allies in the U.S. and perhaps also in Europe are opposing major recommendations for increases in vitamin D intakes and higher serum 25-hydroxyvitamin D [25(OH)D] levels [above 30 or 40 ng/ml (75-100 nmol/l)], apparently because such measures can significantly reduce the burden of human disease and, therefore, would reduce income and profit from treating disease. Healthcare in the U.S. now consumes almost 20% of the gross domestic product.
Historically, vitamin D was associated with prevention and cure of rickets and osteomalacia, and later with calcium absorption and bone health. In the past two decades, evidence has accrued showing that higher 25(OH)D serum levels from diet, supplements, and/or solar UVB exposure, are associated and mechanistically linked to better health and longer life expectancy.
In 2009-2010, the Institute of Medicine (IOM) reviewed the evidence regarding vitamin D, and was instructed by the study sponsors, the Food and Drug Agency, the National Institutes of Health, and Health Canada, to use only the evidence from published high-quality vitamin D randomized controlled trials (RCTs). However, by that time, such trials had only found benefits for bone health. From these studies it was known that bone health 'normalizes' above 25(OH)D levels of~20 ng/ml (50 nmol/l). However, they also used evidence from purely observational studies to suggest that there were risks associated with vitamin D supplementation that raised serum 25(OH)D levels above 30 ng/ml [Ross, 2011a]. This was the basis for their hypothesis of a U-shaped serum 25(OH)D level vs. health outcome relationship (higher risk for both low and high levels). However, this concern was later shown to be largely unfounded since most of the studies reporting U-shaped risk vs. serum level had no data for subject vitamin D supplementation, or for when it had started, thereby confounding subject stratification [Grant, 2016].
Over the last two decades, evidence has accumulated that UVB exposure and vitamin D have many non-skeletal health benefits, mainly from ecological and observational studies and from mechanistic evidence. Recent evidence has accumulated from vitamin D supplementation studies, especially those showing a correction of deficiency [Martineau, 2016]. Such evidence is now strong for cancer [Moukayed, 2013], [Grant, 2017], [Grant, 2018], [McDonnell, 2018], cardiovascular disease [Zhang, 2017], [Wimalawansa, 2018], respiratory tract infections [Martineau, 2017], all-cause mortality rates [Grant, 2011], [Garland, 2014], [Grant, 2016], [Lindqvist, 2016], and pregnancy and birth outcomes such as preterm birth [McDonnell, 2017], [Wagner, 2018] and as now widely reviewed [e.g. Holick, 2007; Pludowski, 2013; Baggerly, 2015; Grant, 2018; Page, 2018; Sorenson and Grant, 2018].
Recommended vitamin D intakes and optimal 'target' serum 25(OH)D levels have increased since the IOM report. For example, The Endocrine Society subsequently recommended 1000-4000 IU/d (25-100 mcg/d) vitamin D supplement intakes and serum 25(OH)D levels >30 ng/ml (75 nmol/l) for patients with baseline insufficiency [Holick, 2011]. A more recent review of vitamin D supplementation guidelines also recommended >30 ng/ml [Pludowski, 2018]. However, such recommendations may be replaced in the near future by those recommending >40 ng/ml based on studies such as those reported recently for preterm birth [McDonnell, 2017] and breast cancer [McDonnell, 2018]. One reason for the low earlier recommendations was the large underestimate made by the IOM in calculating intakes for the average population, (i.e. in 50% of the population) rather than for 97.5% of the population for whom the recommendations were presumed to be aimed [Veugelers & Ekwaru, 2014].
Of course, Big Pharma and its allies must follow current research findings on vitamin D with trepidation since they also realize that the general public also follows the research and has increased its rates of self-supplementation with > 1000 IU/d vitamin D from 0.2% of the population in 2001-2002 to 18.2% in 2013-2014, and that supplementation with >4000 IU/d has also increased from 0.2% in 2007-2008 to 3.2% in 2013-2014 [Rooney, 2017].
interesting the resistance ................
https://www.orthomolecular.org/resources/omns/v14n22.shtml
FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, Oct 1, 2018
Vitamin D acceptance delayed by Big Pharma following the Disinformation Playbook
Commentary by William B. Grant, Ph.D.
(OMNS Oct 1 2018) A "Disinformation Playbook" has been used for decades by corporations to delay government action on matters of public interest that would adversely affect their income and profit. Some well-known examples include the big tobacco companies, the coal and oil industries, the sugar industry, and the National Football League. The Union of Concerned Scientists has outlined five "pillars" of the Playbook [Disinformation Playbook], [Alvord 2017]. Big Pharma may be using the Playbook to slow the adoption of strong support for vitamin D. This article is the product of my further analysis.
The Disinformation Playbook
1. The Fake
Conduct counterfeit science and try to pass it off as legitimate research.
2. The Blitz
Harass scientists who speak out with results or views inconvenient for industry.
3. The Diversion
Manufacture uncertainty about science where little or none exists.
4. The Screen
Buy credibility through alliances with academia or professional societies.
5. The Fix
Manipulate government officials or processes to influence policy inappropriately.
Background and evidence that vitamin D improves health outcomes
Big Pharma and its allies in the U.S. and perhaps also in Europe are opposing major recommendations for increases in vitamin D intakes and higher serum 25-hydroxyvitamin D [25(OH)D] levels [above 30 or 40 ng/ml (75-100 nmol/l)], apparently because such measures can significantly reduce the burden of human disease and, therefore, would reduce income and profit from treating disease. Healthcare in the U.S. now consumes almost 20% of the gross domestic product.
Historically, vitamin D was associated with prevention and cure of rickets and osteomalacia, and later with calcium absorption and bone health. In the past two decades, evidence has accrued showing that higher 25(OH)D serum levels from diet, supplements, and/or solar UVB exposure, are associated and mechanistically linked to better health and longer life expectancy.
In 2009-2010, the Institute of Medicine (IOM) reviewed the evidence regarding vitamin D, and was instructed by the study sponsors, the Food and Drug Agency, the National Institutes of Health, and Health Canada, to use only the evidence from published high-quality vitamin D randomized controlled trials (RCTs). However, by that time, such trials had only found benefits for bone health. From these studies it was known that bone health 'normalizes' above 25(OH)D levels of~20 ng/ml (50 nmol/l). However, they also used evidence from purely observational studies to suggest that there were risks associated with vitamin D supplementation that raised serum 25(OH)D levels above 30 ng/ml [Ross, 2011a]. This was the basis for their hypothesis of a U-shaped serum 25(OH)D level vs. health outcome relationship (higher risk for both low and high levels). However, this concern was later shown to be largely unfounded since most of the studies reporting U-shaped risk vs. serum level had no data for subject vitamin D supplementation, or for when it had started, thereby confounding subject stratification [Grant, 2016].
Over the last two decades, evidence has accumulated that UVB exposure and vitamin D have many non-skeletal health benefits, mainly from ecological and observational studies and from mechanistic evidence. Recent evidence has accumulated from vitamin D supplementation studies, especially those showing a correction of deficiency [Martineau, 2016]. Such evidence is now strong for cancer [Moukayed, 2013], [Grant, 2017], [Grant, 2018], [McDonnell, 2018], cardiovascular disease [Zhang, 2017], [Wimalawansa, 2018], respiratory tract infections [Martineau, 2017], all-cause mortality rates [Grant, 2011], [Garland, 2014], [Grant, 2016], [Lindqvist, 2016], and pregnancy and birth outcomes such as preterm birth [McDonnell, 2017], [Wagner, 2018] and as now widely reviewed [e.g. Holick, 2007; Pludowski, 2013; Baggerly, 2015; Grant, 2018; Page, 2018; Sorenson and Grant, 2018].
Recommended vitamin D intakes and optimal 'target' serum 25(OH)D levels have increased since the IOM report. For example, The Endocrine Society subsequently recommended 1000-4000 IU/d (25-100 mcg/d) vitamin D supplement intakes and serum 25(OH)D levels >30 ng/ml (75 nmol/l) for patients with baseline insufficiency [Holick, 2011]. A more recent review of vitamin D supplementation guidelines also recommended >30 ng/ml [Pludowski, 2018]. However, such recommendations may be replaced in the near future by those recommending >40 ng/ml based on studies such as those reported recently for preterm birth [McDonnell, 2017] and breast cancer [McDonnell, 2018]. One reason for the low earlier recommendations was the large underestimate made by the IOM in calculating intakes for the average population, (i.e. in 50% of the population) rather than for 97.5% of the population for whom the recommendations were presumed to be aimed [Veugelers & Ekwaru, 2014].
Of course, Big Pharma and its allies must follow current research findings on vitamin D with trepidation since they also realize that the general public also follows the research and has increased its rates of self-supplementation with > 1000 IU/d vitamin D from 0.2% of the population in 2001-2002 to 18.2% in 2013-2014, and that supplementation with >4000 IU/d has also increased from 0.2% in 2007-2008 to 3.2% in 2013-2014 [Rooney, 2017].