If you watched the 60 Minutes item Living Proof on Wednesday night, you’ll no doubt agree that King Country farmer Alan Smith is lucky to be alive.

60 minutesAcutely affected by the H1N1 virus, Smith lay in intensive care close to death, an ECMO machine battling to keep his fluid-filled lungs functioning.  As Mike McRoberts says in the introduction to the 60 Minutes piece by veteran reporter Melanie Reid, Smith came back from the dead.

But what saved his life?

Well, if the 60 Minutes piece is to be believed, large doses of vitamin C administered to Smith intravenously at the behest of his desperate family pulled him back from the brink of death. The family had to battle doctors to allow the treatment to proceed and even had to enlist top-flight constitutional lawyer Mai Chen to apply the legal blowtorch to the hospital treating Smith to allow the treatment to continue.

Smith’s lungs began to clear as the vitamin C was administered though his family admits this may have had something to do with the fact that at the same time, Smith was put in the prone position – that is, he was rolled onto his stomach in the hope that this would help clear his lungs.

Where did the family come across the idea of administering vitamin C intravenously? What does the peer-reviewed literature say about this sort of treatment for pneumonia-like symptoms? Could Smith’s family have actually risked harming him by giving him large doses of vitamin C? None of that is clear from the piece, because 60 Minutes didn’t  interview anyone with a medical or scientific background equipped to answer these questions. No one from the two hospitals that treated Smith would comment on how he was treated but it is clear from the case notes flashed across the screen that the doctors treating his thought intravenous shots of vitamin C was a wacky idea and would do him no good.

The upshot is that we have an apparent “miracle”  on our hands – that’s definitely  how 60 Minutes promoted the piece:

So was it a one-off miracle? Or has the family stumbled on a miracle cure?

Or how about option three – no one knows what led to Smith’s recovery and there’s certainly no evidence it was vitamin C. Not that you’d get that sort of equivocation from 60 Minutes, who obviously didn’t want to let pesky experts get in the way of a powerful story about a good kiwi family standing up to a cold medical bureaucracy. At the Science Media Centre, we asked experts to watch the piece and provide feedback on it.

Professor John Fraser, Head of School of Medical Sciences, University of Auckland told the SMC:

It is disappointing that the journalist did not attempt to seek expert advice on the reasons why the consultants were unwilling to administer high dose vitamin C. There is certainly no evidence from the medical literature that this treatment works particularly in severe cases of pneumonia. The consultants were quite right to resist the use of an unproven treatment, and to their credit they did acquiesce to accommodate the family’s wishes because they felt it would do no harm. In this remarkable case the patient did survive but there is no evidence that this was due to the vitamin C. This is a wonderful story of personal survival and it is sad that it has been used to discredit those professionals who were just trying to provide their best for a very sick patient. If the vitamin C had killed him, then the story would have been different. That is the risk of using an unproven treatment.

None of this point of view was reflected in the 60 Minutes piece, though any number of independent experts like Professor Fraser would have happily provided it if asked.

The evidence on intravenous vitamin C

At the very least, 60 Minutes could have added a bit of background about intravenous vitamin C treatments and the lack of empirical research suggesting such treatment is effective. I haven’t been able to find a single study looking at intravenous use of vitamin C to treat people in Smith’s condition. There are instead assorted case studies of patients treated in this way – but almost always for types of cancer and there have been some studies looking at vitamin C administered to mice and rats. This paper published in the Journal of Orthomolecular Medicine ten years ago suggests: “Some cancer patients have had complete remissions after highdose intravenous vitamin C infusions”.

A study by the US National Institutes of Health (NIH) published in the Proceedings of the National Academy of Sciences in 2008  showed “high-dose injections of vitamin C reduced tumour weight and growth rate by about 50 percent in mouse models of brain, ovarian, and pancreatic cancers”. The paper caused some heated debate among scientists as this letter from molecular biologist Professor Piet Borst to PNAS illustrates:

It is possible that ’the promise of ascorbic acid in the treatment of advanced cancer may lie in combination with cytotoxic agents’. As long as this has not been tested, we should try to avoid a new hype of vitamin C as cancer treatment by pointing out, especially in PNAS, the limitations of the available data.

There simply isn’t enough peer-reviewed literature to see this treatment endorsed by the medical profession other than those offering alternative therapies yet isolated cases of cancer sufferers going into remission following treatment with intravenous vitamin C keep the media spotlight on this supposed miracle cure. Check out another such story that screened in the US on ABC:

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The reality is that Smith’s being placed in the prone position is just as likely to have been responsible for his recovery than the administering of large doses of vitamin C or anything else for that matter. We simply don’t know and the 60 Minutes piece suggests you should be willing to defy the advice of medical experts and demand alternative therapies for yourself or loved-ones who are seriously ill. How irresponsible is that?

Campbell Live does no better

Campbell Live followed up the 60 Minutes piece this evening, not with a medical expert adding clarity and context, but with Mai Chen, the lawyer who came to Smith’s rescue. Chen had no qualms about veering well out of her area of expertise telling John Campbell:

The intravenous vitamin C is a well-researched treatment. At the point we intervened John, his family had been advised three times to turn off the machine… intravenous vitamin C has actually been administered by doctors for ten years, low-level doses not intravenous for 25 years. Its a well-researched medication form of treatment.

Then she says…

Its so difficult to get doctors to administer treatments that they don’t consider to be conventional or not research-based.

Note the “not research-based” bit. She then goes on to contradict herself, expressing her concern that “New Zealanders all could potentially face this issue” but admitting that medical specialists using “professional judgement and the Hippocratic oath” ultimately decided what was best for their patients.

TV’s Aversion to experts

Here then are another couple of examples of TV current affairs shows avoiding watering down a sensationalist story by actually interviewing people who know what they are talking about.

We know that the TV networks have been advised that experts are a turn-off to audiences, that people relate to human stories, the victim, the patient, the family, not the academic giving a dispassionate view.

In this case the sins of omission are potentially dangerous by sending a message that it is acceptable to take treatment into your own hands when you or a member of your family has “nothing left to lose” defying experts and evidence in favour of treatments that haven’t been proven effective. Nice one TV3…