Vitamin C, swine flu, media, lawyers

By Grant Jacobs 23/08/2010 136


This article is an opinion piece. I am not lawyer or medic.

If you think my title looks like one of those lists in IQ tests were they get you to pick the odd one out, you’d be right, only this time one the question is what is missing?

If you thought ‘medical experts’, you got it right.

Peter Griffin has said quite a bit on this, so as a practical matter there is little left for me to add, but let me add my voice to express concern over the coverage given to this story in the way a (scientifically-minded) movie critic might.

My introduction to this story was John Campbell’s interview with lawyer Mai Chen, however this media story actually starts with an earlier documentary on 60 minutes which presents the case of a patient seriously ill from pneumonia from H1N1 (aka ’swine ’flu’) where the family urged a medical team to use high-dose intravenous vitamin C to treat their critically-ill relative. The account of events is that the doctors were (understandably) reluctant to carry out the unorthodox procedure, but eventually relented under pressure that included correspondence from lawyer Mai Chen. The patient recovered: the program implies that this unorthodox treatment is the reason.

Whatever the motivations and reasoning in presenting it as they did, the documentary pushes a barrow rather than explores the subject.

I suppose it is a valid option for documentary producers looked at one way (I’ve seen this argument presented elsewhere), but I dislike it. Polarised material makes for good ratings, I guess, but it’s also poor coverage.

In short, where was the balance?

It’s ironic.

Regular readers will know I’m not a fan of the media’s tendency towards ’he said, she said’ balance: it‘s badly flawed for subjects that rest on factual material. But here I am wondering where it was.

They don’t explain that with two or more alternative explanations one cannot plump for one over the others without further evidence. They don’t present independent medical comment. They don’t show what is known (or not) from research.

Mr Smith’s survival is not ’proof’ of efficacy of intravenous vitamin C injection. That this treatment was applied – but not it’s outcome – is certainly proof of the stubbornness of this family, their beliefs, and perhaps the power of letters from lawyers, but research evidence requires more than one case history.

The legal aspect leads us to the follow-on story in the current events show, Campbell Live.

Campbell’s interview of lawyer Mai Chen, who represented the family, wanted to explore (only) the angle of what rights does a family have. I think of it as the distinction between wishes and rights: one might wish for something, but not have a right to demand it. It’s an interesting question and a perfectly valid one to explore. However, I wasn’t happy with Chen’s diversions to speak about medicine and Campbell’s choice to use only her to speak, given her involvement in the events.

I would have preferred to have seen this explored by an independent lawyer, one not involved in the case, and for a medical opinion to be added to the discussion, even if only from a legal/rights perspective. I would have much preferred a longer segment, explaining the what is known about the medical aspects (this would be beyond what the Campbell team seemed to want to cover).

I’m no lawyer, but I struggle with the idea that it is reasonable to demand that a doctor to carry out a procedure against their professional advice. I would like to think any professional would have sympathy. Clients do naïvely ask businesses of all stripes to do unsound things, but reputable businesses don’t acquiesce.

Encouraging the public to place this sort of pressure on medical groups, or any other professional group whose work impacts on other’s lives in a substantial way makes me feel very uncomfortable. It seems to me that it opens up a very nasty can of worms.

I bring this up because Chen presented medical opinion (as opposed to what is known), claiming that intravenous vitamin C was a sound treatment for the particular case (swine flu), citing it being ’well-researched.’ There’s always room for new treatments in medicine, but a sure sign of trouble is when claims made by unregistered practitioners, wishful relatives or spouses, or advocates (lawyers included!) run ahead of what has been tested in a clinical setting.

John Campbell’s stepped in at this point, steering the discussion back to the legal issue.

On having the legal rights question put to her again, Mai Chen replied ’In the end of the day it’s professional judgement […]’, which is what I would have thought, it’s just that where I thought it would have rested too.

(She goes on to make a ’they [the doctors] have nothing to lose’ argument, but I worry that argument this works best, even only, looking back on a successful case.)

There are no two ways that Alan Smith is a lucky man, and it’s always good to hear someone survive being as ill as he was. Like most people, more than one person I’ve been directly acquainted with has come through serious medical issues. Good for all of them, Alan Smith included.

I just hope that for the price of brief period of exposure, a hot story, a splash on the mid-week news, medical staff don’t get to face a lot nonsense for a long time to come.

Footnotes

Purely as a curious aside I ran into while researching this, the journalist of the 60 minutes documentary – Melanie Reid – is a previous winner (or should that be loser?) of the Skeptic’s Society’s Bent Spoon Award, now in it’s eighteenth year, for her

August 22 segment “Back from the Dead” profiling Taranaki medium Jeanette Wilson.


Other articles on Code for life:

All things pooped

A booster falls

Have your say on the development of a Natural Health Products Bill

An horrific case of natural health treatment of cancer

Homeopathic remedies in NZ pharmacies


136 Responses to “Vitamin C, swine flu, media, lawyers”

  • Grant, you make some valid points, and I agree it is clearly not possible to know whether the Vitamin C had a role in Mr Smith’s recovery or not. I’ve thought about this case a lot, and think the “correctness” issue comes down – as is usually the case – to real actions. The doctors chosen action was to stop the ECMO; the family chose massive Vitamin C.

    As it turns out, with the benefit of hindsight, the doctors got it wrong. Can happen, no-one’s perfect.

    Now indeed, the family could also be wrong – perhaps it was something entirely other that fixed him – but it does seem a little churlish to point that out (particularly with the repeated enthusiasm that seems to have been embraced by this community :)

    Wouldn’t it be better to accentuate the unexpectedly pleasant outcome, to see this as an opportunity to investigate why something worked?

    I expect there has been real science done regarding high-dose Vitamin C as a treatment for various things, but I’d expect few trials have been done on real humans suffering from a serious bout of H1N1 (I may be wrong, of course, but then this case would be unremarkable). Besides, isn’t Vitamin C water-soluble, so therefore impossible to OD on? Perhaps we don’t see how it could cure him, but can we see how it would harm him?

    I’d be asking what data was gathered on Mr Smith as he recovered, and afterwards, and wondering what we can learn about H1N1 as a result. Then figuring out a way to test the Vitamin C hypothesis in a as close to a real world scenario as possible….

  • With respect to intravenous (IV) vitamin C treatment — the treatment matter at hand — you cannot write both:

    I agree it is clearly not possible to know whether the Vitamin C had a role in Mr Smith’s recovery or not

    then,

    As it turns out […] the doctors got it wrong.

    Sorry for picking on your logic, but these seem inconsistent.

    Got what wrong?

    If by wrong you mean ‘not trying for a few more days’, that argument (for a patient in a stable coma) has it’s own moral dilemmas that will be familiar to anyone, but that’s a different topic to using IV vitamin C treatment or not.

    If you are referring to the IV vitamin C treatment, you can’t make both statements I’ve quoted above and have them both true at the same time. (Ditto by for moving the patient if your first sentence is reworked to include that.)

    it does seem a little churlish to point that out

    A major point of the article is to point out that the documentary “with the repeated enthusiasm” (your words) pushed a particular line without substantial balance. I can’t not say it without making my point. There is nothing churlish in point out the key points of the issue at hand if it’s done fairly. (Food for thought: you could say the documentary was churlish in it’s treatment of the doctors…)

    The target of my article is the documentaries not the family as your remark implies. Your remark might be trying to engender sympathy, but it unfairly implies an “us v. them” approach that’s not present. You’ll notice I avoid slighting the family to the point that I basically don’t mention them outside the few points I have to and in neutral fashion when I do. (I didn’t really have to be as gentle on them as I did in my opinion. You’ll notice I’m much less charitable the media, for example.)

    (As a more general point while I’m writing: distinguish between attacking a claim someone made, and the person. Around here people rarely attack the people who make claims.)

    Wouldn’t it be better to accentuate the unexpectedly pleasant outcome

    Please see the penultimate paragraph (“There are no two ways that Alan Smith is a lucky man, and it’s always good to hear someone survive being as ill as he was. …”)

    to see this as an opportunity to investigate why something worked

    Well, I didn’t write a lot of other things either.

    The rest of your reply seems to set off from this, which as I haven’t written about it, hasn’t much to do with what I did write! 😉 Quick point: this sort of idealistic thinking looks nice retrospectively and taken simplistically. We’ve all done this, but the reality is usually more pragmatic. The medics’ main goal (at the time) will be to help the patient, they’ll have their hands full with that and other patients.

    Two additional loose thoughts:

    Ideally you’d want to start sampling before the treatment (to establish the base line for comparison). Obviously that’s a contradiction in terms in this case, save for whatever things that they routinely measure.

    Taking (further) samples from a critically-ill patient could be risky for the patient; if so, they couldn’t really do it.

    few trials have been done on real humans suffering from a serious bout of H1N1

    Almost certainly ‘few’ as in none. (I haven’t time to verify this – did you?) Aside from the fact that H1N1 has been only with us a very short time (esp. w.r.t. that studies take time to prepare) and, speaking of prospective studies, there are good ethical reasons testing has a slow build-up procedure and doesn’t jump straight to testing critically ill people in a trial without first showing promise from earlier non-clinical studies, etc.

  • what about the challenge, rechallenge, challenge aspect of this case?

    The Vitamin C was tried. Patient improved. This could be a coincidence. Vitamin C was withdrawn, patient got worse. Vitamin C was restarted, patient got better.

    I find it interesting that this aspect of the case just isn’t mentioned by the supposed supporters of scientific medicine. Why not?

  • Sure, but several points:

    My article present some opinions about how the documentary and media interview presented the story, and in particular about the moral (or legal if you look at it that way) issue of non-specialists “demanding” specialists to do something the specialists consider unprofessional. It wasn’t about if IV vitamin C is a valid treatment or not.

    If you’re referring to us in writing “supposed supporters of scientific medicine”, you’re setting up ‘us v. them’. Tsk, tsk 😉

    I haven’t time to check, but my recollection is that the documentary doesn’t present medical views on the challenge aspect.

    You would want to ask a clinical researcher but a loose thought: it in effect presumes that recovery from serious illness is steady and constant, rather than patients having their setbacks and their good times during the course of their recovery, and that these could be due to many other things that would have to be controlled for. There’s also placebo effects to consider in the second application (the patient was aware of what they were doing then).* I’m just pointing out is that you’d want to be cautious about thinking it’s as simple as the documentary makes out, esp. given they are simplifying (and have to, really) but have also chosen to present this from one point of view. If you’re going to be critical of “supposed supporters of scientific medicine”, don’t forget to apply the same critical thought to the documentary!

    By the way I’m not sure this part you write is correct: “Vitamin C was withdrawn, patient got worse.” My (recollected) impression from the documentary is that the patient improved over this time, just slowly.

    * Single cases can’t control for these things, and therefore are limited, which brings up what is reliable evidence, why controlled, blinded, trials are used, etc.

  • Lost in this discussion, besides the fact that IV C cured the worst of the worst cases of Polio within 72 hours, in 1949,(see Klenner/Polio) is that the treatment the patient was receiving before the IV C was started – WAS KILLING HIM.

    What was the treatment? What was the anti-viral regimen that failed so miserably and does this “drug” have clinical studies to show both safety and efficacy?…of course the drugs weren’t killing him, I know that…it was the flu.

    .

  • “You would want to ask a clinical researcher but a loose thought: it in effect presumes that recovery from serious illness is steady and constant, rather than patients having their setbacks and their good times during the course of their recovery, and that these could be due to many other things that would have to be controlled for.”

    Exactly. Recovery is an organic process. Most patients don’t get better like clockwork: there are good weeks and bad weeks. When you’ve been as sick as Mr Smith evidently was, the road back to health can be rocky with any number of complications to negotiate.

    Mr Smith got unbelievably lucky, and I’m happy for him and his family. The false hope and heartache that other families with critically unwell loved-ones will suffer on hearing the story is very unfortunate, and made worse by the lack of balanced reporting.

  • Rainman said:
    ‘Besides, isn’t Vitamin C water-soluble, so therefore impossible to OD on? Perhaps we don’t see how it could cure him, but can we see how it would harm him?’
    Although vitamin C is in practical terms nontoxic to anyone with normal renal function, someone in severe shock is a different matter, because they often have severely impaired kidney function. There is a lack of information on the safety of IV vitamin C in the presence of renal failure.
    Vitamin C is ascorbic ACID, and many critically ill patients are suffering from metabolic acidosis to begin with. Is it a good idea to load them with more acid? What would the legal situation have been if the patient had promptly died of acidosis?

  • @ Rosalind
    …There is a lack of information on the safety of IV vitamin C in the presence of renal failure…

    Not so, have a look here..
    http://www.fasebj.org/cgi/reprint/01-0880fjev1.pdf
    Vitamin C protects the kidneys.

    In another study the kidneys of rabbits were surgically removed, one group were given Vitamin C, the other none.
    The Vitamin C group survived twice as long on average. (3-4 days (none) compared to 7-8 days (Vitamin C)).

    …Vitamin C is ascorbic ACID, and many critically ill patients are suffering from metabolic acidosis to begin with. Is it a good idea to load them with more acid?…

    Again you do NOT administer Vitamin C in its ascorbic acid form, but as Sodium ascorbate. i.e. buffered to 7.4 Ph which is slightly on the alkaline side.

    @Grant
    ….issue of non-specialists “demanding” specialists to do something the specialists consider unprofessional. It wasn’t about if IV vitamin C is a valid treatment or not….

    My goodness…
    The way you detach your comments from the truth of Life and Death is amazing.
    Referring to the family as “non-specialists” (trying to SAVE a life), and the doctors as “specialists” (wanting to TAKE a life).

    These “specialists” you refer to, I fear were too “specialised”, and therefore under trained for the problem they faced. They would rather let the problem DIE and go away than admit to their lack of knowledge.

    There are tens of thousand of Vitamin C studies in the medical literature going back many decades.
    If you want 1200 studies up front here is a book or two to have a look at:-
    http://www.livonbooks.com/

  • Tim,

    You don’t get to pin your problems with their actions on me, I’m afraid. I didn’t write about that, you said so yourself! There’s nothing special about me choosing not to write about it, I’m just interested in other aspects, and you certainly can’t frame me for something I didn’t write about in straw-man fashion! :-)

    All I meant by specialists are those offering a service who know more than their clients, i.e. what is true of more-or-less all businesses, whatever they are, plumbers, electricians, etc. (It’s why I wrote “businesses of all stripes”.)

    It’s a fairly general moral/legal point about business and applies to most businesses in a very wide range of situations, which is why it struck me.

    There are tens of thousand of Vitamin C studies in the medical literature

    Vitamin C is certainly well studied, but what would be relevant for this case would be studies of the high-dose intravenous vitamin C treatment the family were asking for. Just a thought.

  • Kiwis May Die Through Medical Ignorance

    Voxy, New Zealand

    In response to the Auckland DHB 14th September press release, visiting Vitamin C expert, Dr Thomas Levy said today, “to assert that there is ‘no evidence’ that high-dose vitamin C is either safe or effective is to ignore the results of thousands of such IV administrations by doctors around the world, as well as to ignore tens of thousands of articles in the medical literature, in the most esteemed medical institutions in the world, that have been published over the last 70 years.” The DHB decision was made in the wake of mounting demand for high-dose vitamin C after news broke out of Waikato Dairy farmer Alan Smith’s complete recovery from what the hospital classed as a terminal case of Swine flu. Mr Smith is the hospital’s only Swine Flu patient on life support to have survived. He is also the only one to have received the high-dose intravenous vitamin C, which was administered at the family’s request after being advise that life support, and therefore his life, were about to be terminated.

    Introduced by Alan Smith himself, Dr Levy, cardiologist, associate professor, lawyer and author, spoke about Vitamin C, use, myths, safety and efficacy on Friday 17th September, at Auckland Girls Grammar School, New Zealand.

    http://www.vitaminccancure.org

  • Given that Dr Levy has a book called “Curing the Incurable: Vitamin C, Infectious diseases and toxins” I’m not surprised he is an advocate of high dose intravenous vitamin C.
    Most scientists who have studied the scientific literature on vitamin C are not so convinced. While it certainly does have beneficial effects, to suggest that it is a blanket cure for virtually everything seems highly improbable. A search of the Cochrane reviews shows that careful assessment of the use of vitamin C in many areas shows results that are inconclusive. Hopefully some quality research on vitamin C will be carried out in the future to either confirm or reject vitamin C’s efficacy in a range of areas.
    While we need to remain open to the possibility that vitamin C may have some valuable medical applications to assume that it is a cure all based on a history of inclonclusive research and anecdotal evidence (Mr Smith) is, in my opinion, premature.

  • Erwin Alber,

    “tens of thousands of articles in the medical literature”

    See my previous comment. What is relevant is the particular treatment in question. (By way of example using ‘intravenous vitamin C pneumonia’ as a search string, PubMed reports only 7 matches.)

    You have posted the identical comment elsewhere on this forum. Do that too often and I might consider you’re spamming 😉

  • Peter Griffin pointed to this interesting article in yesterday’s Otago Daily Times by Grant Gillett, professor of medical ethics at the University of Otago Bioethics Centre:

    http://www.odt.co.nz/print/126632?page=0%2C0

    The second of these sentences caught my attention as it addresses a point I was concerned about in my article:

    “Right 7 of the code allows patients to make informed choices about treatment and exercise a right to informed refusal. As normally understood, these are choices between treatments offered by doctors (or providers), and patients do not have the right to demand services.” [My emphasis added.]

    Prof. Gillett’s article elaborates further. Those interested in this aspect may find it worthwhile reading.

  • I’ve received the ADHB Vitamin C report prepared by the boards Clinical Practice Committee. The report is devoid of any meaningful scientific analysis… here it is in its entirety.

    Analysis of the Evidence

    The first reviewer noted the following:

    • Two small studies of high dose intravenous Vitamin C in normal volunteers without significant adverse effects
    • Cancer studies with very high doses (up to 100g/day) of intravenous Vitamin C where renal calculi were noted in some patients
    • 3 randomized controlled trials of Vitamin C to prevent pneumonia
    • 2 randomised controlled trials of Vitamin C treatment in patients with established pneumonia – these two were of relevance to the question asked of the CPC

    • Hunt et al (1994):

    o Excluded those considered at risk of death within the next 48 hrs
    o Used only 0.2 g/day of Vitamin C and it was delivered orally
    o 57 cases, no overall differences in outcome
    o Marginal improvement in the sickest subgroup but only in a symptom score, not survival or other measure of morbidity

    • Mochalkin et al (1970):

    o 3 groups of patients with pneumonia
    o Non-randomised, non-blinded study with no patient details
    o Doses of Vitamin C in treatment groups ranged from 0.25 – 1.6 g/day delivered orally
    o Outcome measures were subjective and not well-defined. ‘Recovery’ was said to occur more rapidly with Vitamin C treatment but no mortality or morbidity data is recorded.
    o Poor quality study

    The second reviewer noted the following:

    • Oncology studies have shown no major toxicity
    • A pancreatitis study (as an example of a severe inflammatory illness) showed shorter hospitalisation in those treated with Vitamin C
    • Renal toxicity has been noted with high dose Vitamin C
    • The pertinent studies in pneumonia are Mochalkin et al and Hunt et al

    • Hunt et al (1994):

    o nothing to add to previous reviewer’s comments
    o not really of relevance to CPC question given the dose, route of administration and illness severity
    o Discussion of relatives rights described in “Cole’s Medical Practice” available on the NZMC website

    • Mochalkin et al (1970):

    o n=140
    o Three treatment groups: no Vitamin C, low and high dose Vitamin C (both delivered orally)
    o Control group noted to have low levels of Vitamin C in the blood and that these levels fell during the illness
    o Signs and symptoms were said to improve more rapidly in the treated patients
    o Poor quality study, no mention of mortality or other measures of morbidity

    Cochran reviews undertook a review recently… they concluded differently having undertaken a rational scientific analysis of the literature;
    “Overall, the results of the five identified trials suggested vitamin C is beneficial in both preventing and treating pneumonia. However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. Therefore, more research is needed. In the meantime, supplementing pneumonia patients who have low plasma vitamin C levels may be reasonable because of its safety and low cost.”

    http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005532/pdf_fs.html

    To claim that there is zero evidence of efficacy or safety is scientific clap-trap.

  • Ron,

    I have withdrawn your comment to a ‘waiting for moderation approval’ status.

    You posted the contents of document from another party. I am happy to encourage open discussion, but it is not clear to me from your comment if you have obtained permission to publicly distribute this document (or if it is formally in the public domain). As I am not in a position to be able to make that decision (it’s not my document to approve or not), could you please re-submit your comment heading it with a statement that you accept all responsibility for distributing the document, including obtaining permission to do that.

    Please understand that my decision is not based on the content of the document, but that I don’t wish to carry responsibility for distributing it. The onus of getting permission, etc., should be yours, not mine.

    If you do re-post this, I suggest you make clearer to readers where the quoted document ends in your comment. (It not clear, for example, if the penultimate line are your words or from the document.)

    Finally, given your active involvement in this area, I would encourage you to write under your full name.

  • Grant, any document provided under the official information act is by definition in the public domain… what are you afraid of? People seeing how unscientific the medical establishment is???

    Most posters on here use a pseudonym… so why the double standard with me? At least I use my correct first name. Focus on the evidence… don’t try and impugn the name.

  • I’ve received the ADHB Vitamin C report prepared by the boards Clinical Practice Committee. I received this from the CEO of the ADHB following an Official Information Act request. The report is devoid of any meaningful scientific analysis… here it is in its entirety.

    “Analysis of the Evidence

    The first reviewer noted the following:

    • Two small studies of high dose intravenous Vitamin C in normal volunteers without significant adverse effects
    • Cancer studies with very high doses (up to 100g/day) of intravenous Vitamin C where renal calculi were noted in some patients
    • 3 randomized controlled trials of Vitamin C to prevent pneumonia
    • 2 randomised controlled trials of Vitamin C treatment in patients with established pneumonia – these two were of relevance to the question asked of the CPC

    • Hunt et al (1994):

    o Excluded those considered at risk of death within the next 48 hrs
    o Used only 0.2 g/day of Vitamin C and it was delivered orally
    o 57 cases, no overall differences in outcome
    o Marginal improvement in the sickest subgroup but only in a symptom score, not survival or other measure of morbidity

    • Mochalkin et al (1970):

    o 3 groups of patients with pneumonia
    o Non-randomised, non-blinded study with no patient details
    o Doses of Vitamin C in treatment groups ranged from 0.25 – 1.6 g/day delivered orally
    o Outcome measures were subjective and not well-defined. ‘Recovery’ was said to occur more rapidly with Vitamin C treatment but no mortality or morbidity data is recorded.
    o Poor quality study

    The second reviewer noted the following:

    • Oncology studies have shown no major toxicity
    • A pancreatitis study (as an example of a severe inflammatory illness) showed shorter hospitalisation in those treated with Vitamin C
    • Renal toxicity has been noted with high dose Vitamin C
    • The pertinent studies in pneumonia are Mochalkin et al and Hunt et al

    • Hunt et al (1994):

    o nothing to add to previous reviewer’s comments
    o not really of relevance to CPC question given the dose, route of administration and illness severity
    o Discussion of relatives rights described in “Cole’s Medical Practice” available on the NZMC website

    • Mochalkin et al (1970):

    o n=140
    o Three treatment groups: no Vitamin C, low and high dose Vitamin C (both delivered orally)
    o Control group noted to have low levels of Vitamin C in the blood and that these levels fell during the illness
    o Signs and symptoms were said to improve more rapidly in the treated patients
    o Poor quality study, no mention of mortality or other measures of morbidity”

    Cochran reviews undertook a review recently… they concluded differently having undertaken a rational scientific analysis of the literature;
    “Overall, the results of the five identified trials suggested vitamin C is beneficial in both preventing and treating pneumonia. However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. Therefore, more research is needed. In the meantime, supplementing pneumonia patients who have low plasma vitamin C levels may be reasonable because of its safety and low cost.”

    http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005532/pdf_fs.html

    To claim that there is zero evidence of efficacy or safety is scientific clap-trap.

  • Grant, any document provided under the official information act is by definition in the public domain… what are you afraid of?

    Your comment here implies that I knew this when I moderated your comment. I did not, and could not — I don’t have ESP! You did not indicate how you obtained the material in your original comment. In fact the wording you offered could be read as you having received with without permission. I note you have now edited your comment adding the second sentence that states that you obtained it under the OIA that was not present in the original. (Thank you.)

    People seeing how unscientific the medical establishment is???

    I refer you to my earlier words: Please understand that my decision is not based on the content of the document […]. Following this, what you offer clearly it cannot be my reason. I went on to state explicitly my reason: I don’t wish to carry responsibility for distributing it.

    Please don’t place “alternative reasons” on me, thank you: I can speak for myself and already had in this case.

    Most posters on here use a pseudonym… so why the double standard with me? At least I use my correct first name. Focus on the evidence… don’t try and impugn the name.

    There is no double standard nor am I trying to impugn anyone’s name. Given your public involvement in this arena, I not am not entirely comfortable with you anonymously on my forum. It not a matter of focusing on the evidence or not (the evidence can stand on it’s own), but a matter of potential conflict with your public involvement elsewhere.

    Just while I’m writing here: it’s still not very clear where the quote of the document ends. Are we to take it that the words starting from “Cochrance reviews understood…” are you own and not part of the report? (I’ll approve your comment in a bit, I have a few things to attend to.)

  • Using my first name is not using a pseudonym…. You know my email address and I used my regular one… I could have used a private email that you wouldn’t have been familiar with and I could have used a pseudonym.

    I couldn’t possibly think of any reason why you would want to think that the dribble from the ADHB should be protected… other than the fact that it is an extremely poor document…

    I also note that you are willing to keep my original posts off line while engaging in so-called discussion… I guess that’s the right of gatekeepers.

    As Klenner wrote some time ago, “Some physicians would stand by and see their patient die rather than use ascorbic acid because, in their finite minds, it exists only as a vitamin.” That is happening in New Zealand in 2010… how sad.

  • Using my first name is not using a pseudonym…. You know my email address and I used my regular one… I could have used a private email that you wouldn’t have been familiar with and I could have used a pseudonym.

    I didn’t write ‘pseudonym’, you did 😉 I wrote anonymously. Whether or not I know who you are or your email address is immaterial. Please understand that as moderator I have to consider how my readers perceive things. To them, not me, you are anonymous.

    couldn’t possibly think of any reason why you would want to think that the dribble from the ADHB should be protected… other than the fact that it is an extremely poor document…

    You can think what you like, for yourself. I wrote explicitly making clear why I held it up. There is no need to try place other actions or words on me, I can speak for myself and did.

    I also note that you are willing to keep my original posts off line while engaging in so-called discussion… I guess that’s the right of gatekeepers.

    I told you I had other things to attend to. I am extremely busy and trying to juggle a lot of different things. I am not your servant; I do not run this blog at your beck and call. Be grateful that I give you the privilege of writing here at all. Be grateful I moderate as quickly as I do: some people only moderate once a day. Do note it’s a privilege, not a right. I don’t really “have” to put up with accusations and slights like your’s. (For the record, among other things, the browser I was using to reply to you was slowing to a stand-still, so I had to abandon ship; I anticipated that while waiting to restart under another browser other things would take me away from this — hence my remark in closing my previous comment. Yes, ordinary little things like that happen when you are trying to juggle things.)

  • “Be grateful that I give you the privilege of writing here at all…”

    You are sooo modest…!

    You should stop worrying about perceptions and focus on the evidence… the evidence in this case is unequivocal… the ADHB (and others) would rather patients died than try a treatment that has been used for sixty years or more!

  • I sent you the source documents…. you email me so I hit the reply button and sent you copies of the source documents so you could analyse the evidence for yourself…

  • For clarity:

    The passage quoted by Ron is not the full report, but the first two of three parts of the section “Analysis of the Evidence”.

    The material from “Cochrane reviews undertook” onwards are not part of the report, but are Ron’s words.

    I’ve released both comments, so that readers might see for themselves why it was not clear to me how Ron had obtained the material, and hence if it was available for general distribution.

  • You should stop worrying about perceptions and focus on the evidence […]

    (1) I have already explained that my holding your quote from a portion of the CPC document up is not about “perceptions”. Think we can all see you are/were (quite!) impatient to present your “evidence”, but it was not my document to approve for general distribution and I had every right to satisfy myself that I am acting properly before releasing it.

    (2) It would be good if you focus on the evidence: too much of what you had done thus far has been focused on me personally, IMO.

  • you email me

    I am still trying to resolve this. It may well be innocent on your part, but for clarity – I didn’t email you, nor did I invite you to email me personally.

    Your wording wasn’t quite “so you could analyse the evidence for yourself…” 😉

  • On the Cochrane reviews However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. This is hardly a glowing endorsement. In one of the trials patients were in the age group 64-99 & any benefits appeared to accrue only to those who were most seriously ill. Another was carried out in what used to be the USSR but key data on social status, nutritional background etc were not accessible to the Cochrane system, which limits the value of that study & any conclusions that may be drawn from it. In addition, of 3 prophylactic trials “only one was satisfactorily randomised, double-blind and placebo-controlled”, and similarly for 2 therapeutic trials only one met these conditions, which again limits the value of the studies. The ADHB & the Cochrane authors don’t really seem that far apart in their conclusions, given that the ADHB reviewers seem to have identified the same shortcomings as the Cochrane folks.

  • Grant, I sent you the ADHB document in good faith… you will know that what I posted is the entire analysis… the third part you refer to is the committee’s deliberation… The extracts from the cochran review are verbatim… don’t defend the indefensible… this report is a shocker and is not good science at all… especially when the alternative in this case is certain death…

  • Alison, I totally agree…. “On the Cochrane reviews However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. This is hardly a glowing endorsement. In one of the trials patients were in the age group 64-99 & any benefits appeared to accrue only to those who were most seriously ill. ”

    No one is proposing that vitamin C be given to the general populace and the group of patients the ADHB is considering are the most seriously ill…. so the comments are totally pertinent…

    The ADHB analysis and conclusions is nothing like the cochran reviewer’s…

  • Ron,

    Don’t play word games, please.

    I wrote those points for clarity for other readers, not as some personal attack. Your implying I am not telling the truth is silly, incorrect, and (again) focusing on slighting me, not the science. Enough of that already, as they say.

    You claimed you wanted to focus on the science, please do.

    Bear in mind if I am to write about the science, I am more likely to do it when I have time to read and think, and if it is more than a stray point or two am more likely to present it as a blog post.

    Bear in mind also that I am a little skeptical that you went to the effort of obtaining this document under the OIA just to pester me and this blog 😉

    I would have thought the omitted discussion portion of the Analysis of the Evidence is important as this subsection is where they state the final conclusions they drew (as a committee, not just the reviewers) and what they intended to present in reply. I would have thought it meaningful to also present the question their analysis is to address.

    Regards your claim I am “defending” their report, I suggest leaving finger-pointing until I have actually said something for or against it! 😉

  • Imagine if the ADHB searched for something like penicillin being used for pneumoncoccal pneumonia… they’d be left empty handed, as there are no trials…. However, the treatment in question is widely used as a ‘proven’ treatment… even though there is no evidence-based-medicine trials showing that it works… Strange how politics and double standards work in medicine.

  • Ron

    A quick search of both Cochrane and other databases shows there are plenty of evidence based studies supporting the use of penicillins in the treatment of pneumonia as well as many other infectious diseases. Furthermore penicillin also has a well understood mechanism of action based of scientific studies.

    Smug comments such as “Strange how politics and double standards work in medicine” suggest to me that now that your arguments have been countered with facts and logic you have nothing left but insults and emotive comments. If so perhaps you should move on.

    Also you do not seem to have understood Alisons comment
    “On the Cochrane reviews However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. This is hardly a glowing endorsement. In one of the trials patients were in the age group 64-99 & any benefits appeared to accrue only to those who were most seriously ill. ”

    You seem to be interpreting this as meaning if there is a possibility that vitamin C worked under one set of extreme/specific conditions it should work under all extreme/specific conditions.
    This is a bit like saying if a fire extinguisher is useful under one set of extreme conditions (a fire) it will also be useful under other extreme conditions (e.g. floods, earthquakes, tsunamis).
    Personally I think there is merit in having vitamin C treatments investigating more scientifically in order to see what benefits it might have. However, having people running around making extravagant claims based on anecdotal evidence and small trials as well as flinging insults everywhere is hardly helpful.

  • “Also you do not seem to have understood Alisons comment
    “On the Cochrane reviews However, these trials were carried out in such extraordinary conditions that the results may not apply to the general population. This is hardly a glowing endorsement. In one of the trials patients were in the age group 64-99 & any benefits appeared to accrue only to those who were most seriously ill. ””

    Michael, I fully understand the quote from Cochran and fully agree with it… surely people committed to death by doctors with their fingers itching to turn the life support system off is an exceptional circumstance? Given the conclusion that, “any benefits appeared to accrue only to those who were most seriously ill” one would think that these would fit the ‘most seriously ill’ criteria, wouldn’t you?

    Show me any studies that provide evidence for ECMO being of benefit in treating severe pneumonia in the cases. There aren’t any that I can see… I will be interested in reading any that you might be able to provide.

    As for studies using penicillin for the treatment of pneumoncoccal pneumonia please can you provide a link to one?

    The Cochran reviews could not find a single study of community-acquired pneumonia in children younger than 18 years of age in both hospital and ambulatory (outpatient) settings where placebo controls were used… based on the criteria used by the ADHB this means antibiotics in general would score a zero for efficacy as the ADHB ignored all other evidence… Double standards indeed…

  • I’d help out with this, but I’m overwhelmed with other things. One small point though, Ron: you seem to be asking things of others, but not really providing any argument for your position. I emphasis ‘argument’, as that is more than holding something up (quoting bits) and saying “so there” then ask others to “disprove” it. You want to showing some substance for it.

    I would encourage you to present the omitted portion of the Analysis of the Evidence section. Really more than this is needed, but this would go a long way to putting what you have presented into the context it’s being used. Without it, you’re leaving out the committees final analysis and reasoning. I would present it myself, but — aside from being busy! — it’s yours to present, really. (It’s your case you’re presenting, not mine!)

    I like the first extinguisher analogy Michael. I’d have compared different types of fires: electrical (don’t use water), chemical (what you use depends on the chemical), etc.

  • Grant, do you mean the following? It is not analysis… it is discussion…

    General discussion ensued and the following was agreed:

    • There is no published data specific to the situation described in the question to the CPC (i.e. very ill patients with severe influenza or other similar life-threatening conditions treated with high dose intravenous Vitamin C)
    • There is some data related to adverse effects of the treatment, which appears more common in patients with renal impairment (see package insert for ASCOR L 500®)
    • Given this situation and applying the CPC scoring tool, the score would be zero, the lowest score ever given to a health technology submitted to the CPC for analysis.
    • A letter would be drafted to the Chief Medical Officer of ADHB to outline this score and to state the view that use of high dose intravenous Vitamin C in such patients would only be reasonable in the context of a properly authorised clinical trial”

    Their very first statement is blatantly false…

    There is published data specific to the situation described in the question to the CPC (i.e. very ill patients with severe influenza or other similar life-threatening conditions treated with high dose intravenous Vitamin C)… for them to condemn patients to death with such blatantly false statements is scandalous…

  • Yeah Ron, just post the report here in full and we can all have a read and digest it – its in the public domain anyway if it was released under OIA. [Peter Griffin, Sciblogs editor]

  • Grant, do you mean the following?

    You know it is, you said so yourself earlier 😉

    A brief outline of the overall procedure might assist readers.

    My own recollected impression from a quick skim of the full report (what’s been given is one section) yesterday was that a letter is drafted and sent to the committee, who read it, charged two of their members to review the literature; they present what they found back to the group (presumably at a later date), which is then reviewed by the group, i.e. the final analysis/findings/decisions are from this discussion by the group, not resting solely on the two reviewers’ findings. They also determine as a group what the nature of the reply should be, as indicated in the section you’ve just quoted. You’re welcome to verify this (I haven’t time to re-read the full report).

    The report opens with question asked, includes the analysis procedure used to extract the literature reviewed, and closes with the reply letter. (Again, I’m writing from recollection.)

    Their very first statement is blatantly false…

    You might want to back this assertion with an argument.

  • Report: Vitamin C
    September 2010

    Contents

    The Brief and Question 2
    CPC Methodology 3
    Search Strategy 4
    CPC Members 5
    References 6
    Analysis of the Evidence 10
    Letter from CPC to Chief Medical Officer 12

    The Brief and Question

    On August 23rd 2010 Margaret Wilsher, Chief Medical Officer made the following request of the Clinical Practice Committee (CPC):

    Please could the CPC consider reviewing the evidence of efficacy (or otherwise) of high dose vitamin C in the treatment of influenza and other critical illness. Clinicians at ADHB are being asked to administer IV Vit C as a consequence of the 60 minutes document screened last Wednesday. It is difficult for our clinicians to refuse such when the profile of Vit C in relation to HN1N has been so publicly elevated. We would like to have a DHB position on whether or not it is good clinical practice to prescribe or withhold such treatment.

    CPC Methodology

    The Clinical Practice Committee (CPC) Manager uses a Checklist when undertaking a literature search and uses this to document search terms and databases used, namely Medline OvidSP (or PubMed), Cochrane, NICE Evidence, INAHTA, HealthPACT etc… Google is also used.

    The actual search strategy from Medline OvidSP is documented in full (see below) along with a selection of the resulting references.

    The CPC Reviewers are encouraged to use a similar method in order to ensure a systematic process.

    For the purpose of this particular search, the following search strategy was used with Medline OvidSP:

    1. vitamin c.mp.
    2. (ascorbic or ascorbate).mp.
    3. (safe or safety).mp.
    4. high dose.mp.
    5. (intravenous or iv).mp.
    6. (renal or kidney).mp.
    7. efficacy.mp.
    8. 1 or 2
    9. 3 or 7
    10. 8 and 9
    11. 4 and 5 and 10
    12. limit 11 to english language
    13. 6 and 10
    14. 5 and 13
    15. 6 and 8
    16. 4 and 15

    [mp=title, original title, abstract, name of substance word, subject heading word, unique identifier]

    CPC Members
    CPC Members:

    Name
    Present at Meeting Primary Reviewer
    Stephen Munn (Chair) Yes
    Stephen Streat (Deputy Chair) Yes
    Emma Parry Yes Yes
    Lucille Wilkinson Yes Yes
    Rhondda Paice Yes
    John Beca Yes
    George Laking Yes
    Nigel Robertson
    Louise Webster
    Sarah Fitt
    Barry Snow
    Lochie Teague

    Management:

    Name Present at Meeting

    Caroline McAleese (Manager)
    Yes
    Margaret Wilsher (CMO)
    Yes

    References

    The following list of references was provided by the CPC manager to the CPC reviewers:

    1. AHRQ: Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cancer (2003) Evidence Report/Technology Assessment Number 75, AHRQ Publication No. 04-E003. Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Prepared by: Southern California − RAND Evidence-based Practice Center, Santa Monica, California;

    2. AHRQ: Effect of Supplemental Antioxidants Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cardiovascular Disease (2003) Evidence Report/Technology Assessment Number 83, AHRQ Publication No. 03-E043. Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Prepared by: Southern California − RAND Evidence-based Practice Center, Santa Monica, California;

    3. Bjelakovic et al, Antioxidant supplements for preventing gastrointestinal cancers (2008) Cochrane Database of Systematic Reviews, Issue 3;

    4. Bjelakovic et al, Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention: Systematic Review and Meta-analysis (2007) JAMA 297:842-857;

    5. Bjelakovic et al, Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases (2008) Cochrane Database of Systematic Reviews, Issue 2;

    6. Berger, M. Vitamin C Requirements in Parenteral Nutrition (2009) Gastroenterology 137:S70–S78;

    7. Berger et al, Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid haemorrhage patients (2008) Critical Care 12:R101;

    8. Coulter et al Antioxidants vitamin C and vitamin E for the prevention and treatment of cancer (2006) Journal of General Internal Medicine 21(7):735-744;

    9. Du et al, Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms (2003) World Journal of Gastroenterology, 9(11): 2565-256.

    10. Ely, JT. Ascorbic Acid Role in Containment of the World Avian Flu Pandemic (2007) Experimental Biology and Medicine Jul;232(7):847-51;

    11. Giordan et al, Impact of Trace Elements and Vitamin Supplementation on Immunity and Infections in Institutionalized Elderly Patients A Randomized Controlled Trial (1999) ARCH INTERN MED/VOL 159, APR 12, 1999 748-754;

    12. Hemilä H and Louhiala P, Vitamin C for preventing and treating pneumonia (2009) Cochrane Review;

    13. Hemilä et al, Vitamin C for preventing and treating the common cold (2010) Cochrane Database of Systematic Reviews 2007, Issue 3;

    14. Heyland et al Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient (2005) Intensive Care Med 31:327–337;

    15. Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections (1994) International Journal for Vitamin and Nutrition Research, 64:212–9;

    16. Kaur et al Vitamin C supplementation for asthma (2009) Cochrane Database of Systematic Reviews, Issue 1;

    17. Klein F. Juhl B. Christiansen JS. Unchanged renal haemodynamics following high dose ascorbic acid administration in normoalbuminuric IDDM patients. Scandinavian Journal of Clinical & Laboratory Investigation. 55(1):53-9, 1995 Feb. [Clinical Trial. Journal Article. Randomized Controlled Trial] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=med3&AN=7624737

    18. Lawton JM. Conway LT. Crosson JT. Smith CL. Abraham PA. Acute oxalate nephropathy after massive ascorbic acid administration. Archives of Internal Medicine. 145(5):950-1, 1985 May. [Case Reports. Journal Article] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=med2&AN=3994472

    19. McGregor & Biesalski, Rationale and impact of vitamin C in clinical nutrition (2006) Current Opinion in Clinical Nutrition and Metabolic Care 9:697–703;

    20. McHugh GJ. Graber ML. Freebairn RC. Fatal vitamin C-associated acute renal failure. Anaesthesia & Intensive Care. 36(4):585-8, 2008 Jul. [Case Reports. Journal Article] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=medl&AN=18714631

    21. Mikirova et al, Anti-angiogenic effect of high doses of ascorbic acid (2008) Journal of Translational Medicine 6:50;

    22. Molchalkin Mochalkin NI. Ascorbic acid in the complex therapy of acute pneumonia (1970) Voenno-Meditsinskii Zhurnal 9:17-21

    23. Mulhofer, A et al, High-dose intravenous vitamin C is not associated with an increase of pro-oxidative biomarkers, European Journal of Clinical Nutrition (2004) 58, 1151–1158;

    24. Ohtake T. Kobayashi S. Negishi K. Moriya H. Supplement nephropathy due to long-term, high-dose ingestion of ascorbic acid, calcium lactate, vitamin D and laxatives. Clinical Nephrology. 64(3):236-40, 2005 Sep. [Case Reports. Journal Article] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=med4&AN=16175950

    25. Padayatty, SJ et al, Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use (2004) Annals of Internal Medicine, Volume 140, Number 7, p. 533- 538;

    26. Padayatty SJ. Sun AY. Chen Q. Espey MG. Drisko J. Levine M. Vitamin C: intravenous use by complementary and alternative medicine practitioners and adverse effects. PLoS ONE [Electronic Resource]. 5(7):e11414, 2010. [Journal Article. Research Support, N.I.H., Intramural] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=prem&AN=20628650

    27. Padayatty SJ. Riordan HD. Hewitt SM. Katz A. Hoffer LJ. Levine M. Intravenously administered vitamin C as cancer therapy: three cases. CMAJ Canadian Medical Association Journal. 174(7):937-42, 2006 Mar 28. [Case Reports. Journal Article. Research Support, N.I.H., Intramural] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=medl&AN=16567755

    28. Puthak et al, Chemotherapy Alone vs. Chemotherapy Plus High Dose Multiple Antioxidants in Patients with Advanced Non Small Cell Lung Cancer (2005) Journal of the American College of Nutrition, Vol. 24, No. 1, 16–21

    29. Rathi S. Kern W. Lau K. Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report. Journal of Medical Case Reports [Electronic Resource]. 1:155, 2007. [Journal Article] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=prem&AN=18042297

    30. Reznik VM. Griswold WR. Brams MR. Mendoza SA. Does high-dose ascorbic acid accelerate renal failure? New England Journal of Medicine. 302(25):1418-9, 1980 Jun 19. [Case Reports. Letter] Search Strategy 16 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=med2&AN=7374700

    31. Qazilbash et al, Arsenic Trioxide with Ascorbic Acid and High-Dose Melphalan: Results of a Phase II Randomized Trial (2008) Biol Blood Marrow Transplant 14: 1401-1407;

    32. Tanaka et al, Reduction of Resuscitation Fluid Volumes in Severely Burned Patients Using Ascorbic Acid Administration A Randomized, Prospective Study (2000) ARCH SURG/VOL 135, MAR p.326-331;

    33. Yeum et al, Changes of Terminal Cancer Patients’ Health-related Quality of Life after High Dose Vitamin C Administration (2007) J Korean Med Sci; 22: 7-11;

    The following list of references was provided by the CPC Deputy Chair to the CPC reviewers:

    34. McHugh et al, Fatal, Vitamin C-associated acute renal failure (2008) Anaesthesia and Intensive Care; Jul 2008; 36, 4; pg. 585 (NB. G J McHugh; M L Graber; R C Freebairn, from Palmerston North, NZ);

    35. Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand New England Journal of Medicine 2009; 361;

    36. The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators: Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1) Acute Respiratory Distress Syndrome, Journal of American Medical Association (JAMA) published online Oct 12, 2009;

    37. Alkhunaizi & Chan, Secondary Oxalosis: A Cause of Delayed Recovery of Renal Function in the Setting of Acute Renal Failure (1996) Journal of the American society of Nephrology 7:11 p. 2320-2326;

    Analysis of the Evidence

    The first reviewer noted the following:

    • Two small studies of high dose intravenous Vitamin C in normal volunteers without significant adverse effects
    • Cancer studies with very high doses (up to 100g/day) of intravenous Vitamin C where renal calculi were noted in some patients
    • 3 randomized controlled trials of Vitamin C to prevent pneumonia
    • 2 randomised controlled trials of Vitamin C treatment in patients with established pneumonia – these two were of relevance to the question asked of the CPC

    • Hunt et al (1994):

    o Excluded those considered at risk of death within the next 48 hrs
    o Used only 0.2 g/day of Vitamin C and it was delivered orally
    o 57 cases, no overall differences in outcome
    o Marginal improvement in the sickest subgroup but only in a symptom score, not survival or other measure of morbidity

    • Mochalkin et al (1970):

    o 3 groups of patients with pneumonia
    o Non-randomised, non-blinded study with no patient details
    o Doses of Vitamin C in treatment groups ranged from 0.25 – 1.6 g/day delivered orally
    o Outcome measures were subjective and not well-defined. ‘Recovery’ was said to occur more rapidly with Vitamin C treatment but no mortality or morbidity data is recorded.
    o Poor quality study

    The second reviewer noted the following:

    • Oncology studies have shown no major toxicity
    • A pancreatitis study (as an example of a severe inflammatory illness) showed shorter hospitalisation in those treated with Vitamin C
    • Renal toxicity has been noted with high dose Vitamin C
    • The pertinent studies in pneumonia are Mochalkin et al and Hunt et al

    • Hunt et al (1994):

    o nothing to add to previous reviewer’s comments
    o not really of relevance to CPC question given the dose, route of administration and illness severity
    o Discussion of relatives rights described in “Cole’s Medical Practice” available on the NZMC website

    • Mochalkin et al (1970):

    o n=140
    o Three treatment groups: no Vitamin C, low and high dose Vitamin C (both delivered orally)
    o Control group noted to have low levels of Vitamin C in the blood and that these levels fell during the illness
    o Signs and symptoms were said to improve more rapidly in the treated patients
    o Poor quality study, no mention of mortality or other measures of morbidity

    General discussion ensued and the following was agreed:

    • There is no published data specific to the situation described in the question to the CPC (i.e. very ill patients with severe influenza or other similar life-threatening conditions treated with high dose intravenous Vitamin C)
    • There is some data related to adverse effects of the treatment, which appears more common in patients with renal impairment (see package insert for ASCOR L 500®)
    • Given this situation and applying the CPC scoring tool, the score would be zero, the lowest score ever given to a health technology submitted to the CPC for analysis.
    • A letter would be drafted to the Chief Medical Officer of ADHB to outline this score and to state the view that use of high dose intravenous Vitamin C in such patients would only be reasonable in the context of a properly authorised clinical trial

    • A letter was issued on September 13th 2010 (see copy below)

    Letter from CPC to Chief Medical Officer

    13th September 2010

    Dear Margaret

    “Could the CPC consider reviewing the evidence of efficacy (or otherwise) of high dose vitamin C in the treatment of influenza and other critical illness”

    The above question that you asked the Clinical Practice Committee (CPC) to review was considered by the members of the CPC at a specially convened meeting held on Tuesday 7th September, 2010.

    A literature review had been conducted using a number of pertinent search terms and that evidence was presented by two primary reviewers. Details concerning the index case made public by the New Zealand media (‘60 Minutes’, TV3 – August 18th, 2010) were also reviewed in terms of Vitamin C dose and route of administration. Discussion ensued after the review about both the quality of evidence (there were two randomised trials, one of which was of poor quality and the other of which showed minor symptomatic improvement in one subgroup of patients given only 200 mg of oral Vitamin C per day) and the applicability of this evidence to the specific request noted above.

    The CPC members also noted from the published literature that high cumulative oral doses or high intravenous doses of Vitamin C had been associated with renal toxicity. It is not currently known whether such toxicity occurs in patients with severe influenza given high dose intravenous Vitamin C but it was of concern to CPC members that a high proportion of influenza patients with very severe disease (for example, needing extracorporeal membrane oxygenation therapy) treated at ADHB also had renal impairment or failure.

    As you know, it is usual for the CPC to provide a score that is a composite of safety, effectiveness, cost-utility and the level of evidence supporting such utility. In this instance we concluded that there was no evidence to confidently say that, at the kind of doses used in the index patient (25-50 g/day, intravenously), high dose Vitamin C therapy was either safe or effective (in terms of reducing mortality or morbidity). Translated into an actual score, this would mean the therapy would score zero, the lowest score ever given to a health technology assessed by the CPC. We would not, therefore, recommend that ADHB implement this therapy in patients presenting with “influenza or other critical illness”. This does not mean, however, that the therapy could not be the subject of a suitably constructed and approved clinical trial. Indeed, such a trial would be the only means we know of that would resolve the issues of safety and efficacy of high dose Vitamin C therapy in this patient group.

    Given the possibility of additional renal toxicity from Vitamin C therapy, it seemed reasonable to CPC members that, until further is known about the safety profile of high dose intravenous therapy, such therapy only be delivered within the context of a clinical trial.

    Yours sincerely

    Stephen Munn, Chair
    Clinical Practice Committee

  • Note only two references were analysed in the report… compasre to refs 12 and 26… two refs that debunk the ADHB reports findings/conclusions.

  • Note they didn’t include this ref… there’s a free access link to the full study here… read it then post a comment as to whether you think there is zero evidence of efficacy and safety…

    Ann Surg. 2002 Dec;236(6):814-22.

    Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients.

    Nathens AB, Neff MJ, Jurkovich GJ, Klotz P, Farver K, Ruzinski JT, Radella F, Garcia I, Maier RV.

    Division of Trauma and General Surgery, Harborview Medical Center and the Department of Surgery, University of Washington, Seattle, Washington, USA. anathens@u.washington.edu

    Abstract

    OBJECTIVE: To determine the effectiveness of early, routine antioxidant supplementation using alpha-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients.

    SUMMARY BACKGROUND DATA: Oxidative stress has been associated with the development of the acute respiratory distress syndrome (ARDS) and organ failure through direct tissue injury and activation of genes integral to the inflammatory response. In addition, depletion of endogenous antioxidants has been associated with an increased risk of nosocomial infections. The authors postulated that antioxidant supplementation in critically ill surgical patients may reduce the incidence of ARDS, pneumonia, and organ dysfunction.

    METHODS: This randomized, prospective study was conducted to compare outcomes in patients receiving antioxidant supplementation (alpha-tocopherol and ascorbate) versus those receiving standard care. The primary endpoint for analysis was pulmonary morbidity (a composite measure of ARDS and nosocomial pneumonia). Secondary endpoints included the development of multiple organ failure, duration of mechanical ventilation, length of ICU stay, and mortality.

    RESULTS: Five hundred ninety-five patients were enrolled and analyzed, 91% of whom were victims of trauma. The relative risk of pulmonary morbidity was 0.81 (95% confidence interval 0.60-1.1) in patients receiving antioxidant supplementation. Multiple organ failure was significantly less likely to occur in patients receiving antioxidants than in patients receiving standard care, with a relative risk of 0.43 (95% confidence interval 0.19-0.96). Patients randomized to antioxidant supplementation also had a shorter duration of mechanical ventilation and length of ICU stay.

    CONCLUSIONS: The early administration of antioxidant supplementation using alpha-tocopherol and ascorbic acid reduces the incidence of organ failure and shortens ICU length of stay in this cohort of critically ill surgical patients.

    PMID: 12454520 [PubMed – indexed for MEDLINE]PMCID: PMC1422648Free PMC Article

    http://www.ncbi.nlm.nih.gov/pubmed/12454520

  • Ron,

    If you believe you have a case, you’d be more convincing if you present an argument for your case, rather than holding things up with no explanation and asking that others address them. What stuff in these papers is — in your view — supporting your position? How do they do that, etc.

  • Grant, that’s the problem with modern day so-called scientists… they want evidence digested and spoon fed… people have forgotten the art of looking at evidence and analysing it for themselves (even though that’s supposed to be the point of university degrees.) My point is that people like yourself side with positions that suit their beliefs without engaging the evidence. The ADHB have stated publicly that there is zero evidence to support the use and safety of IV vitamin C… their support champion their conclusion and yet the evidence, even the evidence they use, states the exact opposite…

    I find it interesting that you are always too busy to read the detail… the devil is always in the detail…

  • “If you believe you have a case, you’d be more convincing if you present an argument for your case,”

    I don’t operate in a belief system… I prefer the evidence to do the talking… engage the evidence… then express n opinion…

  • Ron,

    If it has escaped your attention I am just facilitating the discussion, not getting involved in it. (This discussion is away from the topic my article, FWIW: I wrote about the media presentation, not the science.)

    I noted no-one replied to you. It occurred to me that’s because you haven’t presented an argument, and so pointed it out.

    No-one presents a scientific talk by thumping down a paper, demanding that the audience read it, and that the audience “must” tell the speaker if it says one thing or other. The speaker presents their argument. The audience responds to that.

    I don’t operate in a belief system…

    Don’t waste time with word games, eh? (In any event, ‘belief’ here isn’t applied to the substance of the case, but that you have a case.)

    they want evidence digested and spoon fed… etc, etc.

    Straw man arguments aren’t worth replying to.

    I find it interesting that you are always too busy to read the detail… the devil is always in the detail…

    I’m busy. Deal with it. Trying to make others to do things for you by trying to slight them is silly. (Not to say rude and arrogant.)

  • Here are two takes on the same evidence… how can they be so different?

    Ascorbic Acid Infusion – Human Studies
    A randomized, prospective study by Tanaka et al. evaluated the use of continuous ascorbic acid infusion
    in burn patients using a group of 37 patients with greater than 30% TBSA burns. Investigators compared
    resuscitation fluid volume requirements and overall edema formation. A significant reduction in fluid
    volume requirements, weight gain, and wound edema was noted, along with an overall improvement in
    pulmonary function, demonstrated by a significant reduction in mechanical ventilation days (4).

    Department of Surgical Education, Orlando Regional Medical Center
    http://www.surgicalcriticalcare.net/Guidelines/ascorbic%20acid.pdf

    “One paper was found that detailed a trial in burns patients given one (high) dose of intravenous vitamin C in the first 24 hours of their admission as an infusion. This trial was not blinded and showed no mortality benefit (Tanaka et al. Arch. Surg. Mar 2000;135; 326-321).”
    http://cicm.org.au/cmsfiles/Press%20Release.pdf

    How could they be so different?

    It should be noted that the CPC paper did not anlalyse Tanaka’s study.

  • Grant, there are no clinical studies demonstrating the ECMO is effective in treating patients with influenza with pneumonia and yet is routinely used. The European Centre for Disease Prevention and Control says this… “Data on the effectiveness of ECMO treatment are difficult to obtain as it would be unethical to study a control group of patients with similar clinical severity not receiving ECMO. However the positive outcome of the
    majority of patients requiring ECMO suggests that the treatment is likely to have reduced mortality.”

    Why could not a similar argument be made for pneumonia patients suffering from terminal illness… they’ve been condemned to death… the choice is; a) switch off life support now, or b) wait a day or two and give IV vitamin C and see if they improve…

    If they didn’t improve then at least their loved ones would be able to let them rest in peace knowing they had given them every chance to survive… Why would that be unethical?

    (EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL Pandemic H1N1 2009 Risk Assessment Update – 6 November 2009)

  • Ron,

    I was about to reply with a list of studies that show scientifically that penicillin is appropriate for treating pneumonia, when I read your subsequent post;
    “The Cochran(e) reviews could not find a single study of community-acquired pneumonia in children younger than 18 years of age in both hospital and ambulatory (outpatient) settings where placebo controls were used… based on the criteria used by the ADHB this means antibiotics in general would score a zero for efficacy as the ADHB ignored all other evidence… Double standards indeed”

    The Cochrane review you quote is all about attempting to determine whether one antibiotic treatment is better than another. Implicit in this review is the fact that ALL of the antibiotics work.
    Evidence based medicine does not only include double blind, placebo trials – in fact in some cases they are impossible to run because of ethics considerations. Penicillin is a prime example – since it’s introduction towards the end of World War II penicillin has amply demonstrated it’s effectiveness through vast numbers of observational studies. To suggest “testing” such a treatment using placebo trials would be akin to the Tuskegee experiment.

    “the problem with modern day so-called scientists… they want evidence digested and spoon fed…”
    Stop with the insults already. You are rude and obviously have little experience with scientists. Also your constant challenges to others on this blog, while not responding to their challenges but instead just dumping screeds of cut and pasted material suggests that you are the one who wants to be spoon feed. Or perhaps a more appropriate analogy would be that you are like a child who receives a nutritious mouthful of food and spits it out then whines for ice cream.

    Having said that, within all the chaff you have flooded your postings with, there do appear to be a few pieces of grain.
    The Tanaka paper sounds quite interesting as does the following:
    http://www.ncbi.nlm.nih.gov/pubmed/12454520
    As I have stated before, I would have no problems with a scientific study of vitamin C/antioxidants in the severely ill so long as it was done ethically and scientifically.
    It would have taken me a lot less time to find these potentially valuable ideas if you hadn’t includes so much irrelevant, emotive, and insulting information in your posts. Getting peoples backs up is a good way for your views to be discounted even when you finally produce some worthy evidence.

  • Michael, you have supported my argument that the ADHB’s review of vitamin C is fatally flawed.

    “Evidence based medicine does not only include double blind, placebo trials – in fact in some cases they are impossible to run because of ethics considerations. Penicillin is a prime example – since it’s introduction towards the end of World War II penicillin has amply demonstrated it’s effectiveness through vast numbers of observational studies. To suggest “testing” such a treatment using placebo trials would be akin to the Tuskegee experiment.”

    Totally agree… the same applies to many aspects of medicine… so why has the ADHB ONLY considered RDBPC studies?

    “Having said that, within all the chaff you have flooded your postings with, there do appear to be a few pieces of grain.
    The Tanaka paper sounds quite interesting as does the following:
    http://www.ncbi.nlm.nih.gov/pubmed/12454520

    I posted both of these studies… the ADHB ignored them… why????

    “As I have stated before, I would have no problems with a scientific study of vitamin C/antioxidants in the severely ill so long as it was done ethically and scientifically.”

    Agree… but I consider it totally unethical to ignore prime evidence, and then condemn people to death rather than trying a cheap, safe and effective substance that has been used millions of times over more than 60 years..

    Thanks for supporting my view that there is evidence available regarding the potential benefits of IV vitamin C use meaning that the ADHB could not possibly have obtained a zero score other than through ignoring the evidence. Death is their preference to the alternative.

  • Ron,

    I suspect you may be oversimplifying the ADHB’s reasons for rejecting high dose vitamin C. I don’t know what some of the specific statements that were made by the ADHB around their opposition of high dosage vitamin C.
    However, if you want to convince them (or anyone else) about the benefits of vitamin C treatments then might I suggest the following tactics:
    1) Don’t go around insulting everyone the moment they appear to disagree with you. Your previous comments insulting ALL scientists by making generalisations almost made me ignore anything else you said. In fact it is only the scientist in me that made me read further. Most people once you insult them switch off completely.
    2) Pull out the pieces of evidence which most effectively and reliably support your position. But you also have to consider the meaning of any evidence that doesn’t support your point of view. And if there is a much greater amount of evidence opposing you view than supporting it, then scientifiically you have to reconsider your position.
    3) Avoid using any evidence with obvious flaws or limitations, it just clouds the debate.
    4) For evidence that you do think is helpful, read it carefully and not any limitations. For example one of the references you quoted uses a mix of vitamin C and E so one must ask if the positive effects are due to vit C or E or both? Perhaps a trial would be required to test vitamin C separately? In this case where the evidence is only slight (compared to penicillin) one needs to ask if a placebo study would be valid. If not life becomes more difficult, because while I have pointed out that placebo studies are not the only way to study a treatment, they are often the most conclusive.
    From the evidence that I have seen there is a reasonable chance that vitamin C/antioxidants could have benefits. I suspect they may not be as wonderful as some people think they will be but I would love to see some studies done. But just be aware that science is slow and it is cautious. The ADHB is being both, possibily because they fear potential legal complications.
    Try not to knock scientists too much. Sometimes it feels like we can’t win. We can be attacked for being too cautious but when things are perceived to go wrong we are accused of not being cautious enough. We are asked to provide certainty and avoid risk when a certain level of uncertainty and risk is a part of everyday live. It’s not the easiest job in the world and is done mainly by people who have a strong interest in making the world a better place. Also while we have a strong respect for rational thought that doesn’t make us impervious to insults and getting angry about them.

  • Ron,

    As I was saying earlier, and Michael has elaborated, you really need to present an argument for your claim(s). Your claims may be want you wish to be true, but without substantiating them they’re not much use either for or against.

  • Grant, I presented my evidence… the fact that some people choose not to read it, for whatever reason, is not my fault… as they say, you can lead a horse to drink, but you can’t make it water.

    Michael did read some of what I posted and has agreed with me that there is evidence that vitamin C is a therapy worthy of consideration… he has confirmed my argument that the ADHB got it totally wrong and couldn’t possibly have given a score of zero had they looked at the evidence objectively.

    QED

    Ciao

  • Trying to slight me on the way out, saying I didn’t read anything, eh? How would you know? The world would be really interested to learn of the first confirmed case of ESP 😉

    You’ve picked the wrong R 😉

    Because I didn’t write anything doesn’t mean I hadn’t read anything.

    In practice I skimmed quite a few research papers, including most of those you have been showing, before I wrote my article – well before you turned up.

    (I would hardly write without first checking the general state of the subject – even when writing on a different aspect of it, like media coverage as I had here. It’s the same as for when I wrote using XMRV and CFS as an example of a media issue a while back.)

    I imagine most people obtaining documents via the OIA usually want them to write a publication or submission of some sort.

    Are you now are going to write a “media release” that repeats lines like “condemn patients to death” to fan the flames of “natural health” supporters?

  • Grant, I said, “Grant, I presented my evidence… the fact that some people choose not to read it, for whatever reason, is not my fault… as they say, you can lead a horse to drink, but you can’t make it water.” Never said you personlly hadn’t read the info posted… if you read your earlier postings, you said that.

    As for the comment about “condemn[ing] patients to death” that’s exactly what they have done… apparently six people died having been refused iv vitamin C.

    I have no interest in promoting ‘natural health.’ there is nothing natural about IV vitamin C… it is a therapy with a history of safe use on millions of patients for as long as penicillin has been around… it’s not new, it’s not experimental, it’s not natural…

  • Never said you personlly hadn’t read the info posted… if you read your earlier postings, you said that.

    Don’t be disingenuous, please. (As I wrote early on, I am not interested in these sort of word games. You’ve also shifted the tone by the way: my remarks on this were written light-heartedly — note the winks, etc.)

    I have no interest in promoting ‘natural health.’

    It’s not really relevant here (see next paragraph), but I’m curious as to why you’d write this given you have (to my judgement) supported “alternative” or “natural health” remedies elsewhere, and that seems an underlying theme of what you write.

    More relevantly, I did not write “promoting natural health” in my reply to you. Feel free to correct me, but I have not said anything about IV Vit C. treatment being natural or not anywhere in my article or the discussion.

    Returning to media issues for a moment – the focus of my article – one problem in media reports on polarised health issues are unsubstantiated claims. A key claim here is if IV Vit. C would be a sound treatment for someone in Mr. Smith’s condition. A concern was that it is unsound to present a claim like that without substantiating it (or properly verifying it). The documentary, to my judgement, focused on ‘emotive noise’ rather than substance. I believe there are better stories on the topic without that focus.

    with a history of safe use on millions of patients

    Safety is not efficaciousness. It would be like saying we should use homeopathy to treat Mr. Smith because it would be ‘safe’. (It also leaves out the indirect harm that can be caused by promoting the use of a non-efficacious treatment, but that’s another [albeit related] issue that has been dealt with elsewhere on this forum.)

    Juxtaposing IV Vit C. treatment with penicillin looks like trying to imply efficaciousness through word association with a product that is known to be efficacious.

    In referring to “millions of patients” you’ve broadened the claim to general use, to a different claim. As you know Mr. Smith’s condition has different safety issues than the general population and the ADHB’s consideration is for someone in Mr. Smith’s condition, not general use, nor use earlier in a treatment program.

    (FWIW: one of the papers you offer as ‘support’ rests on the latter point. It would seem on the face of it to argue against your claim, but you have not presented an argument as to how you resolved that in offering the paper as supporting your position.)

    The reason I suggested several times that you present an argument supporting your claim that IV Vit. C was an effective treatment for someone with Mr. Smith’s condition was it seemed the key claim of the several you have presented, the one that would seem to want to be demonstrated if this is to be offered as a treatment in these situations, which, in turn, seemed to be the central point you (not me) wanted to establish. (Remember I was trying to facilitate the discussion.)

  • Grant said, “Returning to media issues for a moment – the focus of my article – one problem in media reports on polarised health issues are unsubstantiated claims. A key claim here is if IV Vit. C would be a sound treatment for someone in Mr. Smith’s condition. A concern was that it is unsound to present a claim like that without substantiating it (or properly verifying it). The documentary, to my judgement, focused on ‘emotive noise’ rather than substance. I believe there are better stories on the topic without that focus.”

    Your judgement is wrong… the story focussed on the fact that the doctors were adamant he was going to die… that there was zero hope… the family was adamant that so that they could sleep in peace if he died that the doctors at least try iv vitamin C. The rest is history… the doctors were 100 percent wrong… Mr Smith was given IV vitamin C and survived… in fact his lung xrays/cat scan were well on the mend the third day of treatment.

    The Doctors were wrong on an other aspect of the 60 minute story…. they said there was zero evidence of efficacy re iv Vit C use as a therapy in such cases…. there is a realm of evidence… they even identified some of it and for some unexplained reason they chose to ignore it.

    I have presented evidence showing that vitamin C has produced positive outcomes in severe pneumonia… an argument is much lower level than actual meta-analysis of the evidence… even expert opinion is a very low level of evidence. Grant… forget the packaging…. forget the experts…. read and analyse the evidence for yourself…. tht’s what you are trined to do… do it! Then you will be able to make a truly informed comment.

    Ron

  • Ron,

    Repeating your assertions won’t make them right. Anyone with common-sense knows that persistently being rude is asking for trouble. Certainly trying to tell the writer what they should to do, & trying troll them into doing things for you is stupid.

    This is my blog. I would like to encourage good discussion. You seem unable to discuss matters or attempt to engage others other than to slight or attack them, or play disingenuous games, which creates an unpleasant atmosphere. (For me, if no-one else.) No further contributions from you on this thread, please.

  • Just to set the recovery straight in regards to allan smith , for 3 weeks he was on ecmo keeping him alive,then when the doctors found out he had hairy cell leukimia and that none of the antibiotics or tamiflu was doing any progress for his recovery it was decided that his life support should be turned off. The family being told about and shown literture of the antioxidant vitamin c which had been used for over 60 years having cured people with polio ,pneumonia etc in the right required doses realised it was worth a try as the alternative was death. As you have read within 3 days his lungs were functioning so well the ecmo machine had to be turned down and was running at 25% . The hospitals feed back said it was more than likely it was the proning of allan that made the difference, no mention of the 100grs of vitamin c he was getting per day. The family wondered why this proning wasnt tryed before the doctors wanted to turn off life support. A clinical trial number 1 of sorts was then commenced on allan with out the hospital realising that they were doing one, as allan was taken off the vitamin c. As soon as this happened allans recovery stopped and his lungs deteriated again, the family realising this had a disscusion with the doctor that stopped the vitamin c stateing that they wanted it reinstated as he was still being proned and given antibiotics but this treatment as before was failing him . To give credit where credit is due this doctor did put allan back on the vitamin c but at 1gr twice a day . Allans lungs then started to recover again but not the same speed as before because the dose was to low however recover they did enough to get allan off ecmo and leave him on a ventilator. He then was shifted to hamilton hospital ,closer to his home where clinical trial no2 started.Again the vitamin c was stopped and again he began to deteriorate .The family now having proof that the vitamin c addministration was the difference between his recovery or death decided that enough was enough and called in the lawyers to get it reinstated. The hospital explained to the family that allan was still in renal failure and wanted to stop all medications to see what was causing this and as the family wished if the vitamin c wasnt the cause then they would put allan back on it . The hospital deciding the vitamin c was not the cause of allans renal failure recommenced iv vitamin c at the same low dose as before 1gr twice a day and his recovery then continued but at a slow pace, until he was bought out of his drug induced coma. Once he was awake the family started giving him lypospheric vitamin c, which speed up his recovery and got him back home in no time at all .The auckland and hamilton hospitals as i stated before by there own hand did do 2 trials on allan showing the safety and efficacy in a person such as allan and his condition, and proved that it was the vitamin c that turned him around as three times orthadox methods were failing. Had allans blood levels been tested i suggest it would be found that his vitamin c levels would have been close to if not 0 and to correct this deficiency it may take hundreds of grams iv vc. If a person is ill , checking of antioxidant levels such as vitamin c and vitamin d also, should be done and corrected to get back to heathy levels to help the bodys own immune system fight off infection. I am not wanting to hospital bash at all but for them to say there is no proof that iv vitamin c does any good is contradictory to what they acomplished with allan. There is 2 main points that should be looked at 1 check and correct any antioxidant deficiency in conjuction with orthadox methods . 2 when all else fails what does the hospital have to lose when a patients family asks for vitamin c to be tryed as it has worked before and the only alternative is death. Also in regards to the hairy cell leukimia in allan, at this point in time there is no sign of it , another area for the hospitals to look at , iv vc for leukimia.

  • Jim, would you care to provide at least one reference for your claim about vitamin C CURING polio?
    “antioxidant vitamin c which had been used for over 60 years having cured people with polio ,pneumonia etc in the right required doses”
    and just some technical points – the varying of Allan’s vitamin C dosages is not a TRIAL, it is a very interesting observation, which in my opinion needs to be followed up with some careful scientific study.
    I think your point about monitoring the antioxidant levels in someone very ill would be an important part of any study, though making unverifiable claims such as “Had allans blood levels been tested i suggest it would be found that his vitamin c levels would have been close to if not 0 and to correct this deficiency it may take hundreds of grams iv vc” are pointless. If such tests weren’t don’t there is no value in guessing what might have been found.
    The other challenge of closely monitoring antioxidant levels in blood, is that the repeated taking of blood might be considered detrimental to the patient. How do any MD’s reading this stand on such testing?
    Doctors are often cautious about new treatments, as they are charged with saving lives and causing no harm. In spite of what some people claim, the use of high concentration vitamin C treatments is a relatively new idea with limited scientific evidence supporting it’s use and it is only fair that the medical profession is cautious. However, in my opinion there is probably enough research as well as anecdotal observations, as you have described with Allan, to merit some research in this area.

  • Vitamin C used to treat polio:
    5: BOINES GJ. A rationale for the use of hesperidin and ascorbic acid in the management of poliomyelitis. Ann N Y Acad Sci. 1955 Jul 8;61(3):721-5; discussion, 725-8. PubMed PMID: 13249308.
    6: GREER E. Vitamin C in acute poliomyelitis. Med Times. 1955 Nov;83(11):1160-1. PubMed PMID: 13279345.
    Ascorbic acid as a chemotherapeutic agent.
    McCORMICK WJ.
    Arch Pediatr. 1952 Apr;69(4):151-5. No abstract available. PMID: 14924799 [PubMed – indexed for MEDLINE]Related citations
    full-text available here: http://www.seanet.com/~alexs/ascorbate/195x/mccormick-wj-arch_pediatrics-1952-v69-n4-p151.htm
    Vitamin C in the prophylaxis and therapy of infectious diseases.
    McCORMICK WJ.
    Arch Pediatr. 1951 Jan;68(1):1-9. No abstract available. PMID: 14800557 [PubMed – indexed for MEDLINE]Related citations
    full text: http://www.seanet.com/~alexs/ascorbate/195x/mccormick-wj-arch_pediatrics-1951-v68-n1-p1.htm
    5: Jungeblut CW. A FURTHER CONTRIBUTION TO VITAMIN C THERAPY IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1939 Aug 31;70(3):315-32. PubMed PMID: 19870912; PubMed Central PMCID: PMC2133810.
    6: Jungeblut CW, Feiner RR. VITAMIN C CONTENT OF MONKEY TISSUES IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):479-91. PubMed PMID: 19870678; PubMed Central PMCID: PMC2133579.
    7: Jungeblut CW. FURTHER OBSERVATIONS ON VITAMIN C THERAPY IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):459-77. PubMed PMID: 19870677; PubMed Central PMCID: PMC2133575.
    8: Jungeblut CW. VITAMIN C THERAPY AND PROPHYLAXIS IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Jan 1;65(1):127-46. PubMed PMID: 19870585; PubMed Central PMCID: PMC2133474.
    9: Jungeblut CW. INACTIVATION OF POLIOMYELITIS VIRUS IN VITRO BY CRYSTALLINE VITAMIN C (ASCORBIC ACID). J Exp Med. 1935 Sep 30;62(4):517-21. PubMed PMID: 19870431; PubMed Central PMCID: PMC2133291.
    some of these may be duplicates of what I’ve already listed:
    These ones are free: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2133810/

    •Jungeblut Claus W. INACTIVATION OF POLIOMYELITIS VIRUS IN VITRO BY CRYSTALLINE VITAMIN C (ASCORBIC ACID) J Exp Med. 1935 Sep 30;62(4):517–521. [PMC free article] [PubMed]
    •Jungeblut CW. INACTIVATION OF POLIOMYELITIS VIRUS IN VITRO BY CRYSTALLINE VITAMIN C (ASCORBIC ACID). J Exp Med. 1935 Sep 30;62(4):517–521. [PMC free article] [PubMed]
    •Jungeblut CW. VITAMIN C THERAPY AND PROPHYLAXIS IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Jan 1;65(1):127–146. [PMC free article] [PubMed]
    •Jungeblut Claus W. VITAMIN C THERAPY AND PROPHYLAXIS IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Jan 1;65(1):127–146. [PMC free article] [PubMed]
    •Jungeblut Claus W. FURTHER OBSERVATIONS ON VITAMIN C THERAPY IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):459–477. [PMC free article] [PubMed]
    •Jungeblut CW. FURTHER OBSERVATIONS ON VITAMIN C THERAPY IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):459–477. [PMC free article] [PubMed]
    •Jungeblut CW, Feiner RR. VITAMIN C CONTENT OF MONKEY TISSUES IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):479–491. [PMC free article] [PubMed]
    •Jungeblut Claus W, Feiner Rose R. VITAMIN C CONTENT OF MONKEY TISSUES IN EXPERIMENTAL POLIOMYELITIS. J Exp Med. 1937 Sep 30;66(4):479–491. [PMC free article] [PubMed]
    •Sabin Albert B. VITAMIN C IN RELATION TO EXPERIMENTAL POLIOMYELITIS : WITH INCIDENTAL OBSERVATIONS ON CERTAIN MANIFESTATIONS IN MACACUS RHESUS MONKEYS ON A SCORBUTIC DIET. J Exp Med. 1939 Mar 31;69(4):507–516. [PMC free article] [PubMed]
    •Sabin AB. VITAMIN C IN RELATION TO EXPERIMENTAL POLIOMYELITIS : WITH INCIDENTAL OBSERVATIONS ON CERTAIN MANIFESTATIONS IN MACACUS RHESUS MONKEYS ON A SCORBUTIC DIET. J Exp Med. 1939 Mar 31;69(4):507–516. [PMC free article] [PubMed]
    •McCormick WJ. POLIOMYELITIS: VITAMIN B DEFICIENCY A POSSIBLE FACTOR IN SUSCEPTIBILITY . Can Med Assoc J. 1938 Mar;38(3):260–265. [PMC free article] [PubMed]
    •McCormick WJ. POLIOMYELITIS: VITAMIN B DEFICIENCY A POSSIBLE FACTOR IN SUSCEPTIBILITY. Can Med Assoc J. 1938 Mar;38(3):260–265. [PMC free article] [PubMed]
    ————————————

    as it happens I was researching this exact topic for another reason and then I saw a request for the citations on Vitamin C and polio.

    Apologies in advance if I dropped in a couple of duplicates or irrelevant articles, I don’t have much time tonight.

  • Thanks MinorityReview, I was hoping for any papers that showed that vitamin C could cure polio. You have provided papers that only mention vitamin C and polio which is a different thing altogether. Still it’s a useful starting point, cheers.
    Looking through the papers one can’t help but observe how old they are. A lot of the analytical chemistry used in the 1930s – 1950’s was fairly primitive so I do wonder about the accuracy of the results. The underlying methodologies of several of the papers is questionable, which is not surprising as we have a much better understanding of infectious disease these days. Furthermore, assuming we don’t fall into conspiracy theories one would expect that if any of the positive results were confirmed as useful they would developed further and used in medical treatments..
    I’ve been able to access a few of them and haven’t found much evidence of a cure:

    J Exp Med. 1939 Mar 31;69(4):507–516. “In the experiments reported in the present communication it was found that vitamin C, both natural and synthetic preparations, had no effect on the course of experimental poliomyelitis induced by nasal instillation of the virus.”

    J Exp Med. 1937 Sep 30;66(4):479–491 – not much useful information, does suggest that there is a slight drop in vitamin C levels at the height of paralysis or during the early stages of convalescence

    J Exp Med. 1937 September 30; 66(4): 459–477.”The figures, taken as a whole, show that among 181 monkeys treated with natural vitamin C 58 (32 per cent) survived without paralysis, and among 101 monkeys treated with synthetic vitamin C 11 (10.8 per cent) survived without paralysis. In comparing the percentage of non-paralytic survivors of the two treated groups with that of the untreated controls (5.1 per cent)” This appears to be an interesting result although the suggestion that there would be a difference between “natural” vitamin C and synthetic vitamin C seems very strange. I wonder at the sources and purities of these compounds.

    Can’t access many of the others at the moment, and it’s such a nice day I feel the need to sit outside in the sun.

  • Michael it is good to see that in your opinion the evidence so far at least in regards to allan and the last 60 years or so of the treatment of vitamin c should be further researched. There now is a time line involved as to getting this done so that by may or june next year the next wave of swine flu complications wont have the chance to take lives. What do you suggest to do to get this research done before this time frame as waiting 2 to 5 years or more is going to result in more deaths. For allan the difference between him living and dieing was the vitamin c as well as the young girl in austrialia who was also put on iv vc and recovered to the stage of takeing her off acmo , unfortunately vitamin c was stopped and she died of complications .I must add that the care and professionalism of the medical team looking after allan was outstanding and without that allan would not be here today however it was the vitamin c that made the difference to his recovery. The clinical trials i was refering to with allan was not the doses but the fact that when the vitamin c was stopped his recovery stopped and declined all be it with the utmost care from the hospital team. With the adhb wanting to have nothing to do with iv vc at all even with at least the evidence regarding allan more people will die next year. I realise you cant save every one but iv vc should be given a try especially if the other out come is to turn off life support. So there is the situation how do we work around it before next year . Suggestions ?

  • Thanks, Jim. A couple of comments.
    1. This paper dates to 1949, a time when polio still wasn’t completely understood. This is obvious from comments throughout the paper, where apparently similar responses to treatment are assumed to reflect relatedness on the part of the viruses.
    2. In the first case study series (because that’s all that’s described here – these are not clinical trials) many of the patients were never positively diagnosed with polio due to the lack of a lumbar puncture.
    3 There’s also an ethical issue here, incidentally, which the author is quite up-front about but which would have been frowned on then & even more so now – had there been a positive diagnosis he would have had to send the patients to a higher-level hospital.

  • Hi Alison I agree the papers are old however from what i have read there were 15 confirmed cases that did have lumbar puncture with cell counts ranging from 33 to 125 . There were 60 cases but yes not all confirmed .

  • In the latest twist on media representation of this topic, an article has appeared in the December 2010 issue of Uncensored magazine.

    I’m not about to waste the $NZ10 price tag of purchasing a copy to verify this, but eye-balling a copy in the store made me wonder if most of the material had been lifted from vitaminccancure.org (I didn’t spot any authorship credits for the article in my brief skim of it).

    Personally this strikes me as not helping advocates of this treatment, as the article stands alongside the likes of stories about the “Holocaust Debate” and one titled “Ice Age Imminent?” Likewise, the on-line website is still touting “Read the truth about the MMR-autism connection.” (!)

    I also couldn’t help noticing the final citation in the article was to mercola.com, a (very) well-known repository quackery. So much so that even despite that one shouldn’t confuse the messenger for the message, it is generally regarded that citing mercola.com is cause enough to dismiss an article citing it.

  • It seams that Linus Pauling was right all along ,here is a article in pubmed about vitamin c and colds and flu http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&orig_db=PubMed&term=The%20effectiveness%20of%20vitamin%20C%20in%20preventing%20and%20relieving%20the%20symptoms%20of%20virus-induced%20respiratory%20infection&cmd=search&cmd_current= Unfortunately the full article cant be accessed but what you can read at this site shows The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections

  • It seems to me a little unusual for a paper on vitamin C to be publised in the “Journal of Manipulative and Physiological Therapeutics”. I would have thought a more mainstream medical journal would have been more appropriate. Although the fact it was written by two private practice chiropractors probably means they have a preference for chiropractic related journals
    The paper states that the study was neither randomised or double blinded, though at first glance the research methods themselves seem quite rigorous. Though I’ve just noticed the control group uses a cohort of students in 1990, while the test group is uses a cohort of students in 1991? Hmmm, I think this needs closer reading.

  • This song was posted by Fred Hoy on November 6th @10:37 am 2011 to the tune: clementine

    THE HAPPY FLU SONG
    Alan Smith is on his death bed, he has Swine
    Flu in his blood.
    Mainstream doctors have no cure, Swine Flu’s
    going to kill him dead.
    He’s hardly breathing, tubes all round him, life
    support is fading fast.
    Doctor’s want to pull the plug, cause there’s no
    way that he can last.
    But wait a minute, there’s a slim chance, Intravenous
    vitamin C.
    50 grams into his bloodstream, can make a difference,
    lets just see.
    Daily doses, slowly dripping, oh look his eye’s are
    open wide!
    He can see us, he can hear us, Grim Reaper’s going to
    slide right by.
    Happy family, joyous family, welcome back him from
    the dead.
    There’s a moral to my story, dont give up, just use
    your head.

  • Aside from the poor scansion, this ‘poem’/lyric is horribly flawed. Among the flaws are :-

    It swaps ‘slim chance’ later for ‘can’. Aside from the conflicted statements (i.e. shifting stances), you can’t write “can make a difference” unless it has been demonstrated to “make a difference”.

    It assumes that the vitamin C offered was what made the difference. There’s no real way to determine that off a single case, as you can’t rule out other things being at play. (This is a key reason for needing controlled, blinded, trials.)

  • Everyone is happy
    Alan Smith recovered from the flu
    But how are we to know Vitamin C
    Was what pulled him through?

    Should doctors acquiesce
    to every patient’s families demands?
    Whether it be vitamins, or exorcisms
    or the laying on of hands?

    Of any treatment doctors must consider
    the possibility of abuse.
    Any thing can be dangerous
    If too high a dose is used

    If vitamin C could have helped
    Further studies should be done
    But let us not form conclusions
    On a sample size of one

  • The reason I said, it can make a difference, is because I personally became well, from both angina and bladder cancer because of using vitamin c intravenously, and orally. Furthermore I dont need a double blind study to prove I survived .Imagine using a double blind study to prove that a parachute really works, what could you use for a plocebo ?

  • Fred, I’m very glad to hear that you’ve recovered from angina & bladder cancer. However, I do need to ask – what other treatments were you on at the time? How can you know that it was the vit.C, & not those other treatments, that put paid to your symptoms?

  • Fred,

    Good to hear you overcame angina and bladder cancer.

    A double blind study would be inappropriate for testing parachutes because:
    1) a parachute very obviously works
    2) death would definitely occur without using one, therefore a double blind placebo assessment would be unethical.

    Thus attempting to use parachutes as an analogy to vitamin treatments being tested by double blind experiments is a false analogy. It was a false analogy when Smith and Pell first published their “research” in the BMJ and it remains a false analogy now.

    The notes section from the article demonstrate the seriousness of the “research”

    “Contributors: GCSS had the original idea. JPP tried to talk him out of it. JPP did the first literature search but GCSS lost it. GCSS drafted the manuscript but JPP deleted all the best jokes. GCSS is the guarantor, and JPP says it serves him right.”

  • Fred,

    Please post your comments via the web interface. How are you trying to send them? If you are “replying” to email notifications of comments, please note that this is not an email chat forum.

    “hi alison; good question, i was prescribed the standard allopathic treatment for angina,which is lipitor. beta blocker,bisphorol, etc. after taking a few, it did not make me feel very good, so i studied the side effects and quit taking them at all. i did a little research and found linus pauling protocol under patent #5278189. I began taking vitamin c and the amino acid lysine immediately as these were the 2 main ingrediants in the protocol. later on for the sake of convenience i ordered a case lot of the protocol from the vitamin c foundation “cardio C” . my symptoms of chest pain and shortness of breath were no longer an issue. i went back to my cardio. and he told me ” i no longer had angina “. since i no longer had angina i asked, how much blockage did i have in my arteries, so to answer this question in march of 2009 i had a calcium score cat scan done at the vancouver general hospital. my calcium score was “0” , this meant my arteries were completely unblocked. as for my bladder cancer, i already new about intravenous vitamin c as i researched it already, so upon recieving my diagnoses of bladder cancer i immediately went to a naturalpath for intravenous vitamin c. according to my scan i had a solid mass of high grade carcinoma measuring 3.2 by 2 centimetres on the upper wall of my bladder. by the time i had the operation to remove it, my surgeon told me, his exact words ” its less than a size of a penny “. my last medical report said it weighed 1.8 grams. a complete report can be found @thrive alive foundation. this is a charitable foundation set up to help those who cannot afford alternative treatment such as intravenous c, to help pay for treatment. I hope this answers your question. for further info my website is healthyheartfredhoy.com.”

  • Below is from fred hoy. (Fred: you should be taking your website to the post and comment thread, i.e. here, and entering comments in the text box at the bottom of the page. While I don’t mind manually posting these once or twice, I don’t want to keep doing it if this turns into an extended discussion!)

    “Hi michael: I have something better than a double blind study that anyone can try. As you probably know, most men over the age of 60 have some degree of arteriosclerosis. One way you can find out is to have a calcium score scan done at your local hospital. Only 3% of men over 70 have a score of 10 or less according to Dr. Grossman. (author of the book “live long enough to live forever”) If say, your calcium score is 190, then you cross reference the agagston score table and you will know that your arteries are 45-50% blocked by plaque. According to Dr. williams, plaque grows @20-35% annually if it is not treated. Start doing the Linus Pauling Protocol and check your score in 6 months, if it is descending, then you will know that the protcocol works, if it descends all the way to “0” as it did in my case, then you are truly free. The reason I can say that is because the National Institute of Health, has a arterial age calculator that shows that anyone who has a score of  “0” has a arterial age of 39, if your score is 10 your arterial age is 56. Tim Russert the famous journalist had a score of 218 when he was 45, his arterial age was 78. Off course you know he died of a massive heart attack at age 55. Dr. Grossman in his 10 rules for longevity, rule #6 says “know your calcium score”. Considering that heart disease is the number one killer,would you not agree with Dr. Grossman ? ”

  • Fred,
    The whole calcium score story sounds intriguing though I’m trying to work out what happens after 3 years if one’s plaque grows at 35% per annum.
    Medical research is a very challenging area in that the body is incredibly complex and to find causations of diseases (and also cures) one has to try and and control many variables and look for statistical patterns across a large group of people.
    Thus, while your health turnaround is a wonderful thing, without being able to compare it to the experiences of many other people within a trial which contols some of these variables it is hard to draw any scientific conclusions.
    I hope your good health continues

  • i am not asking to draw any scientific conclusion. allopathic med. does not seem to have a scientific solution to the #1 killer. So, if someone like Russert, who was no doubt receiving medical care at the time of his sudden demise , was following dr. william davis’s track your plaque program , medical intervention could have saved him. In other word’s if his score was growing at a slower rate than 35% because of allopathic care, (it could go as high as 3000 on the agatston score table). then, just by being aware of how much blockage he had. by knowing his score, perhaps he could have avoided his attack. The point that I am making is anyone suffering from heart disease could empower themselves by doing a little research and in doing so save himself a lot of pain suffering and expence, not to mention invasive immune suppressing surgery. Linus pauling’s protocol, is cheap, convenient and easy to do and the likelehood of lowering ones score is probablly very high, as there are many testimonials like mine. As you said medical research is a very challenging, not to mention expensive as well, and the more complex it is the more capital is needed, if I am not mistaken, fund raising for the cure has become an industry. Something simple, like having a descending calcium score, can save our health care system countless millions of $, and the beauty of it is individuals can do it for themselves.

  • i am not asking to draw any scientific conclusion.

    That was a key point I was making. You can’t correctly write definitive things like “can make a difference” unless it has been demonstrated to “make a difference” – otherwise you’d be over-stating your position.

    You need controlled trials to resolve these type of things as whenever there are more than one reason something might have happened, you have to ‘control’ against the other possible reasons whilst testing one of the possible reasons, hence controlled trials. Anecdotal cases or accounts leave that unresolved.

  • In at least one study (of post-menopausal women), there was no evidence that vitamin supplements provided any cardiovascular benefit & some potential for harm… This was a randomised, double-blind trial of 423 women, so a reasonable sample size.

  • Fred,

    what is your involvement with Tower Laboratories Corporation whose website yours is linked to, and who sell these various vitamin based treatments for aging and heart disease?

    It seems quite curious to me that as Tower have been selling these vitamin mixes for 15 years that they themselves have not done any scientifically validated studies to show the effectiveness of their vitamin mixes. If they did so they would not only increase their customers they would likely be lined up for a Nobel prize.

  • Michael To do a scientific validated study requires a financial outlay of 5-6 million $. Big pharma has a monopoly on doing these kinds of studies. The latest drug, Plavix is the subject of a class action lawsuit. Anyone who has been harmed by the drug can call 1800 bad drug, and join the lawsuit. I am sure Plavix did a “scientific validated study” , so there is no guarantee that a drug like Plavix is a panacea for cardio vascular disease, just because it went through a double blind-placebo process. As for Nobel Prize, Linus Pauling won 2 of which 1 was for chemistry. His patent for the “cure” for heart disease was filed under patent # 5278189 and he recieved the approved patent in 1994. In order to recieve an approved patent, the patent office would need “proof” that the claims made under the application are scientifically valid. As for my involvement with Tower, I set up my website, so my friends and relatives could have access to the therapy. My website is dormant as my tech savvy friend who help me set it up, is no longer available. I also found a canadian source for the protocol, so I no longer order from Tower. However because of the link that is connected to Dr. Jeffrey Dach, who is a board certified doctor, my website can impart a lot of research, which Dr Dach has already done on the L.P. protocol.

  • Fred,

    Big pharma does not have a monopoly on these types of studies for several reasons.
    1) Drugs have to undergo a whole series of clinical trials before they can be sold.There are far fewer restrictions around running trials with supplements, therefore a simple trial could be done for much much less than millions of dollars (perhaps $50,000)
    2) Supplement companies should have plenty of funding available given the mark up on their products. And a scientifically verifiable result would provide the opportunityto increase their business exponentially. So I don’t think it is the money that holds back supplement companies from doing research.
    Linus Pauling was indeed a great man but no one is perfect.
    In fact Pauling accused the 2011 winner of the Nobel prize in chemistry of being a “quasi-scientist” and not knowing what he was talking about.
    Tests of vitamin C and other supplements carried out by other researchers shows it has limited applications and that Paulings ideas were overhyped.
    The bottom line is that if there is no scientific evidence to support it’s use (and I mean research trials/papers not anecdotes) it is difficult to take such claims as reasonable.
    However, if you think it works for you and your health is good, good luck to you. One assumes that the doses you are using aren’t potentially harmful so at least that is fine.
    I maintain good health through a good diet (apart from the occasional treat) and exercise and my doctor tells me my blood pressure etc is excellent, which is good for someone with a family history of heart disease. I have yet to be convinced that supplements have as much value as the many companies which sell them have claimed.

  • Alison
    It often depends on the dosage, of the vitamin supplements used in the randomized study, which determine it’s effectiveness. If big Pharma financed the study, then it’s likely they used synthetic low dosage supplements. As to doing harm, allopathic approved drugs, such as Plavix is the subject of class action lawsuit, and ” Iatrogenic disease ” is the 3rd. leading cause of death. There has been no deaths from vitamins in the last 28 yr.

  • Michael.
    Did you have a look at patent # 5278189 ? The claims made were validated, otherwise he would not have a #. As for the dosage that I used, it was the same dosage Alan Smith used for his swine flu, there has been no deaths caused by vitamins in the last 28 yrs. I am glad you have excellent blood pressure and I wish you continued good health.

  • Michael, $50,000…??????? Where did you get that figure from?

    How much did SELECT cost? [The study on selenium and vitamin E…] Who else funded the study, and why?
    NCI is the primary funding agency for SELECT and has provided $129,687,000 to SWOG from 1999 through 2011, with an additional $4.5 million contributed by the National Center for Complementary and Alternative Medicine (NCCAM), also an agency of the National Institutes of Health (NIH). NCI has also separately funded a substudy to see if the supplements affect the growth of colon polyps. Participants who report having had a colorectal screening procedure while participating in SELECT were asked to sign a consent and release agreement for their medical records. Once all screening procedure reports are collected and reviewed, the researchers will study and report the findings.

    In addition, ancillary studies were funded by three other NIH institutes:
    The National Institute on Aging (NIA) provided almost $7 million for the Prevention of Alzheimer’s Disease with Vitamin E and Selenium (PREADVISE) trial. This trial is evaluating whether these supplements can help prevent memory loss and dementia, such as that found in Alzheimer’s disease. This study closed to accrual in 2009 but PREADVISE participants continuing in centralized follow-up are still being followed.
    The National Eye Institute (NEI) provided almost $2 million for the SELECT Eye Endpoints Study (SEE). Age-related macular degeneration (AMD) and cataracts are two leading causes of visual impairment in older Americans. AMD is a disease that affects the central vision, and is the leading cause of visual problems and blindness, with about 25 percent of people over 65 showing some AMD. Cataracts cloud the eye’s lens that causes loss of vision. More than 50 percent of adults in the U.S. age 75 and older suffer from visually significant cataracts.
    The National Heart, Lung and Blood Institute (NHLBI) has provided more than $3 million for the Respiratory Ancillary Study (RAS). The overall objective of RAS is to understand whether supplements being studied in SELECT have an impact upon the loss of lung function experienced with aging, which is higher in persons who smoke cigarettes. This study closed to accrual in 2007. Sites that were invited to participate had a higher percentage of current and former smokers than the overall SELECT study. (19-20)”

    $50,000???? Really???

  • To do a scientific validated study requires a financial outlay of 5-6 million $. Big pharma has a monopoly on doing these kinds of studies.

    With all respect, that’s too simple. $10 million isn’t that big an outlay in the biotech sector—you’d find outlays of that size even in NZ—and there is more to the industry that the later stage trials.

    In practice a lot of the ground work is done in smaller biotech companies, who aim to be bought out or sold on. Initial trials (not full clinical ones) to draw attention to the value of a product, and hence draw attention from investors or companies with more cash, can be done on smaller budgets, too.

    A key reason the bigger players have an advantage overall is the number of steps and the length of time involved in getting full approval. This doesn’t mean that smaller players are not involved – see my earlier paragraph.

    As for Nobel Prize, Linus Pauling won 2 of which 1 was for chemistry.

    It’s unwise to hang something on a ‘name’. Pauling’s overstatements on vitamin C are widely criticised – and rightly. It’s not the only thing he got wrong either. In the height of his research career (the vitamin C work was done when he was quite old) he published a suggested for a model for the structure of DNA that was immediately criticised. My way of looking at this is that his biologically-oriented work (that I am aware of) was mostly extrapolation based on modelling and whatnot, and with that had mixed success as you expect extrapolative work like that to have, with some more-or-less right (his model for the alpha helix is a good example) and some simply wrong (e.g. his DNA model).

    This isn’t saying that he was a bad scientist (he was an excellent chemist), but that the nature of that particular portion of his work meant it was tentative.

    The ‘natural remedy’ / supplement industry actually pulls in a lot more money that many realise. (I’ve been trying to find it again so I can write about it, but I read somewhere that in NZ it earns more that the wool industry.)

    I’m surprised you think patents require “proof” that they work – at least in the strict sense of ‘proof’. My understanding (now a little rusty) is that patent doesn’t declare ‘this works’, it declares a protection of a design and an application of the design.

    (In a way I know from personal experience. Something I suggested was in an earlier patent for ‘designer’ zinc finger proteins, now a big deal. (Stupid of me for talking openly, I was fresh out from a Ph.D. then.) I’ll bore you, so let’s not go there. Suffice to say that I still would like to work on zinc finger proteins; that’s a long boring story for non-scientists, too!)

    there has been no deaths caused by vitamins in the last 28 yrs

    And, outside of cases of deficiency, not a lot of good done either. Similar to homeopathy, if it does nothing it is unlikely to do direct harm either, but that’s not saying much.

    You should read recent posts here about vitamins; I’ll link them later – you’ll find that supplements can actually cause harm and that this has been identified in research studies.

    Another problem is that by putting off sound treatment a condition can get worse, with the upshot that when the patient turns to sound treatment it will struggle. An example (of sorts) in New Zealand was this rather startling case.

  • Ron,

    $50,000???? Really???

    You know that I ask that readers treat others with respect, as per the comments section of my ‘About’ page. This could easily have been written other ways, e.g. “I’m surprised that a study could be done for $50,000.” (Owing to his past behaviour here, I feel obliged to give Ron prompt reminders.)

  • What costs would be involved in testing such a supplement mixture?

    a) the cost of the materials (vitamin mix plus a suitable placebo)
    b) the cost of the researchers time + a statistician to interpret the data.
    c) Costs associated with the testing
    d) Recruiting participants

    SELECT utilised $35000 people and was multinational. Surely a significant study could be done with a smaller cohort. It was also carried out over 4 years. Fred’s description of his own health suggests the supplements produce an effect that could be detected within months so a shorter period would also be cheaper.

    My $50,000 guestimate overlooked the cost of the researcher(s). Because I work in academia I’m too used to researcher time not being costed (internally anyway). Also the total cost would depend on the cost and number of the tests required and the number of participants.
    So $50,000 was too low but I can’t see how it would need to be in the millions of dollars.

    The point I was trying to make is that the costs borne by most pharmaceutical companies who create new drugs are
    1) Studies to find suitable drug molecules
    2) syntheising the drug molecule
    3) Preliminary testing and refining of the drug molecule
    4) Phase 1 trials – testing of safety
    5) phase 2 trials – testing of efficacy
    6) phase 3 trials – randomised controlled testing on those with the disease

    Because the law is “looser” with regards to supplements, I thought supplement testing could go straight to step 6 (so long as the protocol wasn’t too extreme). Perhaps that is not correct and someone can correct me, but supplements certainly do not involve steps 1 to 3 above.

  • A couple of additional thoughts about therapeutic trials.

    If one assumes that calcium levels are an acceptable indicator of heart health and that the Pauling therapy affords significant changes in calcium levels then even a small study could be used to indicate its effectiveness.
    Large studies are needed to get statistically significant information when changes are likely to be small. If one was anticipating that the therapy would drop calcium levels by say 100 points then a sample size of 100 would surely suffice.
    If those people on the therapy had their calcium level drop by an average of 50 points and those on a placebo had it drop by say 0 then even a small sample size would suffice.
    If the results are generally as striking as Fred’s case suggests then a sample size of 100 would be more than adequate.

    Fred, it is impressive that your calcium levels is now at 0. Do you know what it was at before you started the therapy?
    And how long did it take for you to notice an improvement?

  • Grant, it is no secret… and has been widely achnowledged as being in the region of $700-$800 million per annum…

    Where did I say it was it was secret – I didn’t and obviously I knew that and the general amount involved. Thanks for the source, but stop this type of gamemanship or you’ll be out again.

  • Michael
    I do not have a document to show my calcium score prior to being treated with L.P.P. My cardiologist confirms my diagnosis of Angina, in that a stress test was positive for “ischemia” in that I experienced chest pain and my ECG was not normal as there was 2 mil of segmented depression. I have another document that says if a patient fails a stress test the amount of blockage is in the 50-70% range. Thus if I used the Agagston score table and crossed referenced it with my blockage using the lower figure of 50% my calcium score would be in the 200 range. I was on the procol for about a year. By the way there was a program on c.n.n. in Aug. 2011, where Sanjay Gupta did a documentary and he “heart attack proofed himself” with the help of Dr. Agagston and Dr. Essylsten, using the coronary calcium score scan as the basis for his treatment. Dr. Esselstyn is Bill Clinton’s dr. who put him on a extreme vegetarian diet to cure his heart condition. He also has a book out on his diet. As for when did my symptom’s go away, I would say about a month and a half, I no longer had chest pain and I could chug up a hill easily. Of course I had no idea that the therapy worked so well until I recieved my calcium score results in March of 2009. If it were possible to do a double blind study as you outlined, I am confident that Steven Carter of the Orthomolecular org. in canada would be interested in supporting, and participating in such a study.

  • michael I like your idea of a therapeutic trial, I am sure that owen Fonorow of the vitamin c foundation as well as Steven Carter of tha Orthomolecular society of canada woul support and participate in such a trial.

  • Grant Jacobs
    On your comment 10 days ago re; my poem/song. Thanks for your critique, I have changed 2 words, to make it better.

    Flu in his blood.
    Mainstream doctors have no cure, Swine Flu’s
    going to kill him dead.
    He’s hardly breathing, tubes all round him, life
    support is fading fast.
    Doctor’s want to pull the plug, cause there’s no
    way that he can last.
    But wait a minute, there’s a good chance, Intravenous
    vitamin C.
    50 grams into his bloodstream, will make a difference,
    lets just see.
    Daily doses, slowly dripping, oh look his eye’s are
    open wide!
    He can see us, he can hear us, Grim Reaper’s going to
    slide right by.
    Happy family, joyous family, welcome back him from
    the dead.
    There’s a moral to my story, dont give up, just use
    your head.

  • Grant, the last comment was incomplete
    This song was posted by Fred Hoy on November 6th @10:37 am 2011 to the tune: clementine

    THE HAPPY FLU SONG
    Alan Smith is on his death bed, he has Swine
    Flu in his blood.
    Mainstream doctors have no cure, Swine Flu’s
    going to kill him dead.
    He’s hardly breathing, tubes all round him, life
    support is fading fast.
    Doctor’s want to pull the plug, cause there’s no
    way that he can last.
    But wait a minute, there’s a good chance, Intravenous
    vitamin C.
    50 grams into his bloodstream, will make a difference
    lets just see.
    Daily doses, slowly dripping, look his eyes are
    open wide!
    He can see us, he can hear us, Grim Reaper’s going to
    slide right by.
    Happy family, joyous family, welcome him back from
    the dead
    There’s a moral to my story, dont give up, just use
    your head.

  • fred,

    I see that you’ve chosen to exaggerate your claims; this makes your piece less accurate, not better.*

    Remember my key point was that:

    […] you can’t write “can make a difference” unless it has been demonstrated to “make a difference”.

    It assumes that the vitamin C offered was what made the difference. There’s no real way to determine that off a single case, as you can’t rule out other things being at play. (This is a key reason for needing controlled, blinded, trials.)

    (I’ve shifted the emphasis to bold for clarity and it’s now in a blockquote.)

    You changed:

    “there’s a slim chance” -> “there’s a good chance”

    and:

    “can make a difference” -> “will make a difference”

    Assertions without substantive backing ring hollow, right? In your discussion with Michael you acknowledged a need for trials (i.e. recognised a lack of evidence). Why are you now doing the opposite by making even stronger assertions in the absence of trials?

  • Grant
    In my discussion with Michael, it’s true I agree a therapuetic trial using the Linus Pauling Protocol, as outlined by him to prove it’s effectivness in lowering ones calcium score would be scientifically acceptable by the Academic community such as sciblog. Bear in mind we are talking about oral intake of a vitamin c formula along with amino acid’s etc. and thats not quite the same as intravenous c. In Alan Smith’s case in using the power of deduction one can come to the conclusion that its “demonstrated”, that it can only be I.V.C. that revived him. However the power of deduction is not the same as a therapuetic trial, and we do need a one to prove it conclusively. I am still waiting for a response from my comment 6 and 7 days ago to Michael. Lets get the ball rolling, because as Michael said, the vitamin co’s would deserve a Nobel prize if the results of such a trial were positive. Just to re-enforce my previous comment c.n.n.was on last nite with a documentary with Sanjay Gupta, Dr. Agagston, and Dr, Esselstyn on the subject ” the Last Heart Attack” using the calcium score test as the basis of treatment. It demonstrated that heart disease is curable and reversible and former president Bill Clinton is on the road to recovery as we blog.

  • Fred,

    You seem to be missing the point that several people have made that the recovery of someone who is using a particular therapy does not automatically mean that that therapy is responsible.
    Also, my comments around how a trial might be done do not mean I have the time or inclination to be involved. It sounds like you have some experts in mind who could do it anyway.
    If a trial is run, and done scientifically, I will be most interested in the results.

  • In Alan Smith’s case in using the power of deduction one can come to the conclusion that its “demonstrated”,

    See my previous comment (and earlier ones).

    Diseases and their treatment aren’t simple in a way that simple deduction of a single case would work, they have a lot of factors at play. Consider the video I put up last night: from just a single case you’d have no way of determining what of several possibilities was the cause of cholera deaths. In fact what most thought was the ‘obvious’ reason was completely wrong. Similarly, your comment gives several confounders (alternative things that might contribute), which you’d have to control (cover in testing the treatment).

    Lets get the ball rolling

    The people to roll that ball are those selling it, or intending to sell it, surely. Why should people sell an untested product claiming it to ‘work’? That’s unethical, false advertising if you will.

    On a practical note, you’d want people who already understand the background to check it’s plausible first (or have the time to do this) and, of course, the time to run a trial. Randomly chosen scientists won’t have the background needed. (In fact a trial would involve several different areas of expertise.) I sometimes think most non-scientists don’t appreciate just how much background is involved. Think of that saying that it takes 10,000 hours to become good at something.

    My research interests lie elsewhere and I certainly haven’t the time to spare!

    It demonstrated that heart disease

    With all respect I can’t see what that might have to do with Smith’s case. If anything, treatments that claim to treat too wide a range of things are ones to be wary of, as I believe I mentioned a while back.

  • Grant says, “Why should people sell an untested product claiming it to ‘work’? That’s unethical, false advertising if you will.”

    Grant, over 50 percent of pharmaceutical drugs are sold/used off label… I agree with you; that is billion$ of dollar$ of fraud.

  • Ron,

    I wrote about advertising; off label use is about prescriptions. (I’m advocating the latter, just pointing out it’s different thing.)

    You would be better to stop this thing of rushing in to nitpick & troll, etc., please.

  • Grant, are you suggesting that the Fair Trading Act is impotent and not enforced? How do doctors find out about using prescription medicines off label???

  • So are you suggesting that Pharma reps visiting doctors and marketing / advertising via the back door is ok?

  • Michael
    with flu season approaching, both Jim and Alison, seem to agree, that a thearpeutic study is a good idea. The makers of Lipospheric vitamin c, would be interested in considering such a study. The question is how much would a study cost, and how and who would they pay to do it? Instead of doing it just for swine flu, it would probably easier to do it for Flu in general.

  • “both Jim and Alison, seem to agree, that a thearpeutic study is a good idea.”

    I didn’t reject studies, btw: I was pointing out that ‘formal’ studies should be completed and the results known before making definitive claims that a product works, e.g. before using statements advocating something to ‘work’ in advertising.

    Commercial ventures should really make their own efforts to sort out product standards – it’s just part of business. I don’t really see why it should be different for the ‘natural remedy’ or supplement crowd.

  • Grant, the big problem is that generic ingredients/products have not patent protection… patent medicines have legal protection to make lots of money… especially when the bulk of sales is off-label… ie, fraudluent…

  • Grant Jacobs 22days ago
    Albert Einsteins good friend and colleage Hans Reichenbach is the author of ” Reichenbach’s common cause principle says if 2 rare events might reflect cause and effect, they probably do”. You can think of it like this; Lightning does not strike twice in one place for 2 different reasons. Thus in analyzing the cause of Alan Smith’s recovery, one can only conclude that it was intravenous c that was the effect.

  • fred,

    Sorry, but no. I’ve tried to explain this to you earlier. Your analogy doesn’t work here (i.e. for biology/medicine) and citing famous names doesn’t make it stronger. (In logical fallacy terms, it called “the appeal to authority” fallacy.)

    Single case histories can be interesting but are considered not a lot more than ‘interesting’ for reasons. They can throw up an idea at a pinch (you really want more than a single case) or highlight something, but they cannot ‘show’ or ‘prove’ something. I believe I’ve pointed this out to you earlier.

    I also believe I’ve already pointed out that recovery is rarely a nice straight line. It’s easy to then ‘fit’ pre-conceived ideas onto the rises and falls of the patient’s recovery. It’s another reason why formal testing is needed and another example of where human wishing gets in the way of determining what is really happening.

  • “The combination of phenomena is beyond the grasp of the human intellect. But the impulse to seek causes is innate in the soul of man. And the human intellect, with no inkling of the immense variety and complexity of circumstances conditioning a phenomenon, any one of which may be separately conceived of as the cause of it, snatches at the first and most easily understood approximation, and says here is the cause.”

    Count Leo Tolstoy, “War and Peace”

  • I know this is an old article, but just wanted to add my 2 cents….
    I’d like to bring up your comment – “run ahead of what has been tested in a clinical setting.” (and I hear you, I totally agree)
    Herein lies the problem. Many alternative methods of treatment have not and will not be tested in a clinical setting for the reason that they will not make money for doctors or drug companies. Setting up and financing clinical trials is costly, and only undertaken if the drug or treatment will end up being profitable to offset the costs.
    This has happened with many of the nutritional cancer treatments like Gerson Therapy (I was trained as a Gerson assistant and can vouch for its success in many cases….not all, but many)….also, Hoxey, Burzynski, Rife, etc etc….There are many more.
    Not only will the Pharmaceutical Industry not put any of these treatments through sound clinical trials….but they will actively pursue them and try to shut them down for being unethical and unorthodox. The Gerson Therapy is banned in the US and have to practice in Mexico.
    I don’t think they will put mega dose Vitamin C through a sound clinical trial….its not worth their while.
    And in their arrogance, the medical establishment refuses to account for its effectiveness. (I have met many doctors who think this way). It’s a tragedy, really.
    These treatments should be given their fair place in medicine.

  • Just a heads-up for regular readers, the Alison immediately above is not the resident Alison who writes bioblog. But then I’d hope the views expressed would make that clear anyway 😉

    (In hindsight I ought to have taken the liberty of appending something to your name to distinguish the two of you in case she wants to comment here – it might get rather confusing otherwise.)

    You’re welcome to make additions to old threads, that’s fine.

    I’ll try get back to later. Brief loose thoughts in the meantime: –

    Testing products should be done before making claims about them or using them as ‘remedies’. The excuse “not in a clinical setting” is an excuse – my impression is that it’s offered to duck responsibility (and/or cut corners).

    Things aren’t ‘put down’ because they are unorthodox per se – but because of a lack of evidence for them or because they fly in the face of evidence.

    I’d like to think that unethical things shouldn’t be done – are you suggesting unethical things should be allowed? (!)

  • The Gonzalez protocol – an ‘updated’ version of the Gerson ‘therapy’ – was the subject of a trial with pancreatic cancer patients that compared it with gemcitabine (the ‘gold standard’ for chemo for this type of cancer). The results were clear-cut & not in favour of the ‘natural’ therapy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860407/

    Mind you, I have never been able to see why coffee enemas & handfuls of vitamin supplements every day should be regarded as ‘natural’. Also, the quantities of supplements involved in alt.med. are such that someone is doing very well out of it – there is considerable money to be made there. In other words, no excuse really not to put such ‘treatments’ through proper clinical trials.

  • Gerson Therapy […] Hoxey, Burzynski, Rife, etc etc….There are many more.

    Exactly. All these alternative cancer therapies, based on completely different and indeed mutually-incompatible theories of cancer causation. If one of those theories is correct, the others are wrong; if one of the therapies works, the others should not. Anyone who claims that they all work — and that the chemotherapy pursued in hospitals is the only treatment that doesn’t work — really needs to stop breathing, because at the moment they are a waste of perfectly-good oxygen.

  • The one you really should go after is ‘cancer is a fungus. Whoever came up with that can never have looked at a fly agaric toadstool.

  • The same person linked to a ‘cancer is a fungus’ post 😉 Same woman who suggested homeopathic remedies for treatment of the consequences of nuclear fallout.

    I have to return to that, but I have my work cut out in part because her writing is fairly confusing and in part because I’m getting short on time… you’ll know a bit about that.

    Either way, from my reading thus far she seems to think you should use anti-fungals to treat cancers because in her mind cancers are a consequence of “interactions” with fungi – whatever she means by that.

    Getting further of topic, as undergrad students we would go for mycology field trips up near Arthur’s Pass on the east side of the Main Divide. It’s fun poking around in the bush and seeing what you can find.

    Now I’ve got to get back to the work stuff…

  • lilady – thanks for the heads-up. You mean the first comment there, by ‘FastBuckArtist’ (ha) on 24 May 2013 at 7:38 am – ?

    I’ll see if I can find time to look at this later – I’m a bit overwhelmed with work at the moment (hence the sorry lack of blog posts of late, too).

    For some reason I haven’t linked it in this article, but I later wrote a brief of review of what papers had been published on IV vitamin C as treatment for severe pneumonia. Seems appropriate to the SBM article you link to (which I’ve barely skimmed the top portion of).

    [Edited to correct typo.]

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