Sunday, January 01, 2012

Medical fads - are they cycling faster?

We've always had crazy fads in medicine.

I fell for a few when I had wet ears. Magnesium Sulfate post-MI is the one I remember best. That one even made it to textbooks before it died.

It's typical of medical fads that they infest journals, and now newspapers, but usually die before they get to textbooks. Estrogen for osteoporosis wasn't in that class -- that was a somewhat understandable research problem. Medical fads are less forgivable; they really aren't supported by evidence. They're built on easy money and bored specialists.

It feels like the fads are cycling faster. Emily and I thought the Vitamin D craze had another year or two, but it died fast.

Our local minor neurotrauma ("acute mild head injury") craze reeks of fadism. In Minnesota recommendations are being written into law, with little basis in science. As of today, PubMed has precious few studies.

Maybe it will be real. Some cults become established religions, some fads become science.

I don't think this one will make it to science, I do think it will cause significant harm along the way. Labels are powerful.

Hope this cycles as fast as Vitamin D, but putting minor traumatic brain injury into law may stretch its lifespan. Medical fadism is a crime against the vulnerable...

Update: More on the Vitamin D fad.

A few readers asked me for more detail on the vitamin D fad.

Briefly, for a year or two, I couldn't avoid popular articles claiming that Americans suffered from an epidemic of Vitamin D deficiency causing a wide range of disorders, and that recommended daily allowances were inadequate. Then, at the end of 2010, the Institute of Medicine published a report declaring that the science wasn't there, and that overdosing was more harmful than expected ... (emphases mine)

... The committee provided an exhaustive review of studies on potential health outcomes and found that the evidence supported a role for these nutrients in bone health but not in other health conditions. Overall, the committee concludes that the majority of Americans and Canadians are receiving adequate amounts of both calcium and vitamin D. Further, there is emerging evidence that too much of these nutrients may be harmful...

In retrospect, within a few months of the IOM report, the media attention ended. The fad moved on.

There's still science to be done of course. Ever since medical school I've wondered about the relationship of latitude to multiple sclerosis, and whether there was some kind of cutaneous immunity/solar radiation component. Today there are many interesting articles on the relationship between vitamin D and MS. That's research though, the fad is over.


chrismealy said...

wait, what's wrong with vitamin d?

bfh said...


I, like chrismealy, would like a little more detail on the vitamin D craze you refer to. Google led me to a summary on vitamin D supplements and their usefulness. Is this what you were referring to?

My reason for asking is that here in Australia there has been a debate about how we should get our vitamin D as many of us have low levels. For many years the sun was not regarded as a good option because of the risk of skin cancer (most adult Australians know someone who has died as a result of skin cancer), so supplements have been pushed. Food does not seem to be highly regarded as an option. This debate - if supplements don't work, how are vitamin D levels raised without increasing the risk of skin cancer - has been interesting to this casual observer.

Thanks for the stimulating posts over the year.

All the best


John Gordon said...

Thanks for the comments Chris and Bernard. I added a postscript to my post with the Vit D story.

The Vit D fad resembles the Vitamin E fad. Great enthusiasm, negative results, then a suspicion of harm due to large doses.

Still good science to be done, but the fad is past.