More MS news articles for July 2002

For better or worse, we'll keep on paying those vitamin bills

http://www.portal.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2002/07/07/do0702.xml&sSheet=/opinion/2002/07/07/ixopinion.html

7th July 2002
By Alasdair Palmer

When, a decade ago, I was diagnosed with multiple sclerosis, a chronic disease which still baffles medical science, the doctor who broke the news said: "I have to warn you that you will be offered all kinds of cures. People will tell you to take vitamin supplements, to change your diet, to go into oxygen tents, to have the fillings in your teeth removed. My honest advice is: don't bother with any of it. Nothing has been shown to make the slightest difference. The only treatment you should take notice of is one which does better than a placebo in a properly controlled trial. None of the 'unorthodox' treatments now being peddled has done so. So ignore them."

It was good advice, and I have tried to follow it - but I haven't always succeeded. Avoiding oxygen tents and dentists who wanted to pull my teeth has been easy. Ducking out of vitamins and dietary supplements has been a lot harder. As friends and relations who have kindly bought packets of vitamin supplements for me have all earnestly insisted: they won't do you any harm, and they might really help you. So obviously you'll take them, won't you?

It is not easy to answer "No" to that question, even if you don't have anything obviously wrong with you - which may help explain why half of the households in the UK buy vitamin supplements, and why we, collectively, spend more than £345 million every year on vitamin and mineral pills. The hope that vitamins may prove to have magical life-giving qualities springs eternal.

Last week, the results of the biggest-ever investigation into the effects of large daily doses of vitamins C and E on heart disease and cancer were published. The study concluded that neither had any beneficial effect at all on the progress of those diseases: in fact, the people on the placebos did slightly better than the ones taking the high doses of vitamins. What did significantly reduce the risk of heart attack was a group of synthesised chemicals called statins. The study showed that statins - which are about as "unnatural" as it is possible to get - had the power to prevent between 70 to 100 people in every 1,000 from having at least one major "vascular event", such as a heart attack or a stroke. That is an enormous benefit, one with the potential, not just to diminish the amount of misery, but to save the NHS millions of pounds every year.

Professor Rory Collins, who led the team responsible for the £21 million study, explained to me that he "did not expect that result. In fact, when we began the research, we expected to find exactly the opposite. So, of course, did Roche, one of the companies which produces vitamins C and E. [The company makes more than £250 million a year on the sale of its vitamin products, although it is also a major producer of medical drugs.] Roche was so convinced of the benefits of vitamins that the company helped to fund our research. The manufacturers of statins, on the other hand, were extremely nervous. They thought their product would be beaten by vitamins."

Prof Collins's investigation is the latest in a long line of studies - one in Finland, involved 22,000 people; one in the United States looked at 20,000 people; another in China examined 30,000 individuals - which have looked for, but failed to find, any evidence that taking vitamins reduces the incidence of strokes, heart disease or cancer. It adds up to compelling scientific evidence that many of the claims that have been made in favour of the miraculous curative powers of vitamins are - not to put too fine a point on it - completely bogus.

Do not, however, expect the news to make any dent in the colossal sales of vitamins. The manufacturers are already giving their own reasons for why the study's results ought to be ignored. I was told by a spokesman for the Pharmaceutical Association of Great Britain, which represents the companies which make vitamins that "the results are not very surprising. We would not expect the benefits of vitamin supplements to show up over five years: we are talking about lifetime benefits." This move-the-goalposts approach has the advantage of ensuring that it is impossible ever to demonstrate that vitamins don't work: every study which shows they don't can be dismissed on the grounds that it didn't last long enough, or it didn't look at vitamins' real health benefits.

The science, however, is actually beside the point: most people who buy vitamins are not doing it because they are convinced that the weight of biological evidence is firmly on the side of vitamins' efficacy in preventing cancer, heart disease, or any of the other thousand diseases that they are supposed to arrest. We buy them not to prevent any particular ailment, but rather because we believe the generalised promise that, somehow, vitamins will make us feel better.

Pascal argued that it was rational to believe in God because if God turned out not to exist and you believed in him, you were no worse off. But if he did exist, and you didn't believe in him, you would spend eternity burning in hell: the worst possible outcome. So in a situation of uncertainty about God's existence, the rational thing to do is to believe in him. Precisely the same kind of reasoning leads people to take vitamins: if you take them, those who do argue, then the worst that can happen to you is that you are no worse off (except financially) than the people who don't; but if you don't take them, and they turn out to have miraculous powers, you will have damaged your own health irreparably.

"Actually," says Prof Collins, "that's not right: vitamins might do you some harm, if you take enough of them, over a long enough period. Our study showed they were inert over a five year period, but we really don't know much about their long-term effects. If they could do good, they could also certainly do harm."

No one who buys vitamin supplements will be convinced by that, however, because when you buy vitamins, you are buying hope: the hope that you are doing something which will improve your health in a general kind of way. The advertising feeds off that hope mercilessly, depicting the people who take vitamins as wonderfully fit and energetic, perpetually full of the joys of spring. The manufacturers make a fortune out of our willingness to pay over the odds for it: in the 1990s, a price-fixing cartel involving Roche, Aventis and other vitamin manufacturers, was uncovered by the US Justice Department. The companies agreed to pay fines of several hundred million pounds as a result.

The news that drug companies had been systematically over-charging customers had no effect on the willingness to buy vitamins either. Hope - which, as a philosopher once said, is the confusion of a desire for something with its probability - is very resistant to mere facts which seem to destroy it. It may be why, despite all the evidence, I have to admit that I occasionally take the odd vitamin supplement myself, and not only to placate those friends and relatives who buy them for me. At one level, I know it can't have any more effect on the illness I have than a placebo - but at another, I hope that it just might. And as any doctor will tell you, when you believe that what you are taking can do you good, the placebo effect becomes one of the most powerful known to medicine. But it won't cure a disease.
 

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