Be Not Afraid (October 20, 2015)
It happens occasionally that my otherwise-overactive mind slams into a brick wall and finds itself dazed and unable to conceive of a newsletter topic. When this happens, I begin trolling the internet for health-related articles that might start up the mental engine, so to speak. Perhaps I shouldn’t do this, because all too often what I encounter is a piece of nonsense which gets me lathered up to what surely must be an unhealthy extent.
Anyway, this past week I collided head-on with a Reuters report that is a particularly nasty example of misleading journalism. This writeup referenced a study recently published in the New England Journal of Medicine which estimated that approximately 23,000 emergency room visits yearly are caused by nutritional supplements. The Reuters' rendition of said article was liberally sprinkled with sneers referencing “health” and “all natural” products that are apparently carving a bloody swath through our hapless citizenry, “many of them children”, and informed us that these dangerous products are “hawked” for a wide range of uses with little or no testing to back up their claims.Just in case we didn't want to take Reuters' word for it, it included some warnings from a -- wait for it -- pharmacist about how risky natural products are.
This choice bit of yellow journalism is being echoed by a number of different outlets, all of them dutifully heading their articles with a photograph of a glass of water and a few pitiful-looking vitamin pills that YOU thought were GOOD for you, and all of them cautioning us that just because something is “natural” doesn’t mean that it’s safe. Why did this little sucker catch my eye? Because vitamins and minerals ARE safe.
Now, by “safe” I don’t mean entirely without risk. I mean “safe” like if you are walking from your house to your car, you are safe from being hit by a meteorite. In other words, nutritional supplements are something you can take according to the rules for without worrying. Unless you make a practice out of worrying about those one-in-a-billion events that theoretically keep even getting out of bed from being a risk-free proposition.
But aren't 23,000 emergency room visits per year a lot? Um, no. Let’s start by addressing that number specifically. First of all, only about 10% of those 23,000 visits were serious enough to require hospitalization. Additionally, about a third of the visits were due to children under five and adults over sixty choking on pills they couldn’t swallow. People who worry about taking supplements are usually worried about some kind of toxicity or effect of the nutrient itself, so let’s just assume that that is the reason for the other 16,000 ER visits a year.
Of those visits, about half were adults 20-34 for cardiac symptoms specifically due to energy-boosting and weight-loss combination products if you were a woman, and body-building and sexual enhancement products if you were a man. (Insert your own joke here.) Those products are notorious not just for being abused against label instructions, but (especially if they are of foreign manufacture) are often contaminated with pharmaceuticals. So your bottle of Shaklees is starting to look pretty safe here.
Some people believe (because it is something that the pharmaceutical industry keeps repeating) that the FDA does not regulate nutritional supplements. It does, though. The FDA regulates nutritional supplements by instituting compulsory standards in manufacturing, by inspecting manufacturing sites, and by monitoring AERs (Adverse Event Reports) for signs of anything untoward going on. It does not regulate them to the same standards that are demanded of pharmaceuticals, and no one except pharmaceutical manufacturers think that they should.
In 2013 the GAO did an analysis of the period from 2008 to 2010 and found about 3,827 AERs associated with dietary supplements (again, most of them the aforementioned combination products).
That's not very many, especially when you understand that the simple existence of an AER does NOT mean that the adverse event was the fault of the supplement. The wiggle word here is “associated”. If you drop a vitamin E capsule on the floor, slip on it and fracture your skull and have to go to the hospital, the vitamin E capsule is “associated” with your problem and, if your doctor is a big enough dick, will wind up the subject of a nutritional AER.
Events, reports, incidents, blah blah blah – how many people DIE? Well, in the period from 2008 to 2011, the GAO found that there were 92 deaths from taking nutritional supplements. 92 deaths over three years, that’s about 31 deaths a year. In any given year, about half the American adult population is taking nutritional supplements, so we’re talking about 150 million people. Your chance of dying from a nutritional supplement, then, is about 1 in 5 million, or a 0.00002% chance of death in any year in which you take a vitamin pill. You are ten times more likely to be STRUCK BY LIGHTNING.
Now let's put those numbers up against prescription medications. In that 2008-2010 period wherein 3,827 AERs and 92 deaths from nutritional supplements occurred, about 1500 people died just from taking acetaminophen. 100,000 people per year died from PROPERLY PRESCRIBED prescription medications. In 2009 alone, there were over two million visits to the ER from adverse events related to prescription medications.
That's why are drugs regulated differently from nutritional supplements. Because they are far far FAR more dangerous, and the federal government isn't exactly awash in extra cash these days to go regulating things that don't need regulation. Vioxx is somewhat conservatively estimated to have killed over 27,000 people before it was pulled from the market, and it was fully evaluated by the FDA as SAFE. So if you want to be scared of something, I wouldn’t pick your Happy Sunshine multivitamin.
Are you still worried about what might be in your supplements? Then do this. Invest in a subscription to ConsumerLab, a fabulous website that not only is up-to-date on what supplements are good for which conditions, but evaluates brand names as to quality and cost, and don't buy something unless they recommend it. See how easy? Now you can spend your time worrying about something that is actually going to happen, like the Northwest earthquake.
--dr. diane holmes
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