Vitamin D.

This is exactly the sort of thing I write about regularly that drives me crazy. Physicians and patients never seem to appreciate when they are being manipulated and used by others for financial gain.

This excellent new exposé in the New York Times details the conflicts of interest, behind-the-scenes payments, and denial-of-science behind the $1 billion Vitamin D industry. It is alarming how one man (Dr. Hollick) can do so much damage.

I have stated for years that the Vitamin D thing is a scam. How did I know? Because there was simply no science to support any of the claims made about it. Here’s what happened:

• Dr. Hollick was paid by one the largest companies that perform the lab test for Vitamin D levels and also by one of the companies that sell Vitamin D supplements to help them sell more products (that’s why companies pay people).
• He managed to get the Endocrine Society to adopt the position that normal Vitamin D levels should be between 30-100 ng/ml in 2011 despite there not being any evidence to support this range.
• This new guideline automatically made about 60-80% of the US population Vitamin D “deficient” and Hollick promoted widespread testing and supplementation (still with no evidence that this made people healthier).
• Hollick promoted the narrative that there was a Vitamin D deficiency “epidemic” (after creating it by changing the normal values) and he promoted his 2010 Vitamin D book which made wild and unsubstantiated claims about Vitamin D.
• The industry and Hollick cashed in. Vitamin D sales last year were around $1 billion dollars and Vitamin D tests for Medicare patients alone were $365 million dollars. The total cost of tests for Vitamin D for all populations was likely in the many billions of dollars plus the cost of unnecessary doctors’ visits. These numbers are about 10 times higher than a decade before and Hollick was paid by both the lab company and the pill makers for these results.
• Hollick also received payments from the indoor tanning industry and he started to promote tanning as a way of boosting Vitamin D while telling people to wear heavy sunscreen if they go outside. He was asked to resign from the dermatology division at Boston University by his chairwoman for this obvious shameful act. He immediately cried persecution, as con-men typically do.
• Meanwhile, the real doctors over at the National Academy of Health released a report telling doctors that there was no Vitamin D deficiency epidemic and that all the extra testing and supplementation wasn’t based on science and was unwarranted (unless bone health was the concern). But, as usual, doctors ignored science-based guidelines and went instead with the recommendations of Dr. Oz, Oprah Winfrey, Gwyneth Paltrow, and other shameless merchants.
• Thousands of studies meanwhile have been done linking low Vitamin D levels to hundreds of different medical disorders, but these studies have failed to show that adding back Vitamin D changes the course of this diseases (except for osteoporosis, osteomalacia, and rickets – which we already knew). Vitamin D checks have become the panacea for primary care doctors, who conveniently blame almost any problem a patient might have on Vitamin D deficiency.

There really isn’t much more to add. The article is excellent and worth the read. Patients don’t need (and never have needed) to be tested for Vitamin D deficiency except in a few rare cases. Actual Vitamin D deficiency is likely only when levels are below 15-20 ng/ml. Levels above 50 ng/ml (which are now seen commonly due to so much supplementation) are associated with an increased risk of mortality. If your Vitamin D is truly deficient, go outside for about 15 minutes per day and it will become normal.

Why are Vitamin D levels lower in people who have so many medical problems? Well, first, remember that correlation rarely equals causation. But in this case the reason is simple: young, active, healthy people tend to do things outside (work, exercise, play, etc.). Obese, elderly, depressed people tend not to go outside as much. Predictably, then, the Vitamin D levels of the latter group are lower.

Sunshine is good.

This pattern has been repeated countless times. Someone makes a wild and unsubstantiated claim about a product. They become an advocate and guru for it (sometimes out of real belief but often too make money). He (or she) is promoted by the industries that stand to profit from the bogus claim. The public, eager to find that “one neat trick” or “breakthrough” accept the claim at face value. The medical community is not immune to this problem.

History repeats itself. How about hydrogen peroxide? Or maybe Vitamin C? Or hundreds of other nonsense remedies.