Stacking the deck

No doubt you’ve been reading the devastating press about vitamins being useless in the treatment of heart disease. Before you throw your bottles in the bin (or before the EU does that for you), it is worth sifting through the details, the players involved and the careful stacking of this particular deck.

Professor Rory Collins, who led the five-year Heart Protection Study, took 20,536 Britons with coronary disease, arterial disease and diabetes, and gave them either simvastatin (the best-known ‘statin’ drug) or a placebo. He then took an identical 20,536 patients with the same health problems and gave them either a cocktail of antioxidants (vitamins C and E, and beta-carotene) or a placebo. Then, for five years, he sat back and observed what happened (Lancet, 2002; 360: 7-33).

For the high-risk individuals in the antioxidant group, the vitamins did not do any significant good in terms of preventing deaths of any sort.

The results of the statin group were a different story, with a significant reduction in deaths from coronary/vascular events, heart attacks and strokes.

These results are virtually a licence for Merck, who makes simvastatin, to print money. An accompanying editorial waxed lyrical: ‘Practically all patients with vascular disease today in western countries will benefit from statins.’ Statins will be prescribed for anyone with the merest hint of a heart condition.

The first stacking of the deck was by the dosages used. Simvastatin was given as 40 mg/day, a rather healthy dosage as recommended by doctors.

The vitamin dosages, except for vitamin E, were appallingly low: 600 mg of vitamin E, 250 mg of vitamin C and 20 mg of beta-carotene.

Nutritional doctors like Patrick Kingsley and Melvyn Werbach routinely prescribe 1-3 g, or up to 12 times this dose of vitamin C for well patients. For ill patients, they are known to administer 25 g or more intravenously, two or three times a week, and to recommend an additional daily oral dose of up to 10 g if tolerated. The same goes for beta-carotene and vitamin E. There is absolutely no question that when you are ill, your nutritional needs skyrocket.

Once again, a research team utterly ignorant of nutritional medicine tested vitamins as if they were a magic bullet – a drug – used in isolation. Besides higher dosages, they needed to include selenium, chromium, magnesium and the B-complex vitamins, particularly folic acid, to have a meaningful test.

Conspicuously absent from the study were any controls over diet. Or details of drug side-effects other than muscle weakness. We know that one-sixth of patients in the drug group dropped out, but we don’t know why.

The studies were sponsored by Merck, but also by Roche, which produces vitamins as well as other heart drugs. There is major-league money to be made from a study that endorses a wider use of drugs.

The Lancet editorial claimed that up to three-quarters of all vascular events could be prevented by a cocktail of aspirin, beta-blockers, ACE inhibitors and statins. Even the idea of a combination pill was mooted. The editorial, I should add, was written by Salim Yusuf, who receives his research grants from pharmaceutical companies, including the Canadian subsidiary of Merck. Merck, by the way, manufactures beta-blockers, ACE inhibitors and statins.

I bet you didn’t hear about another study, published just two weeks earlier in the Journal of the American Medical Association. The study carried out a scientific review of all studies over a 30-year period examining the effects of vitamins on human health (JAMA, 2002; 287: 3116-26).

The two doctors from Harvard University concluded that the evidence overwhelmingly showed that vitamins can indeed prevent cancer, heart disease and osteoporosis. As a result of their research, the American Medical Association is reversing a long-standing antivitamin policy, and having the Harvard researchers write new guidelines for all doctors in America to advise every adult patient to take at least one multivitamin pill a day.

The only vitamins that work for ill patients are megadoses – the ones being phased out by the EU. Call me a consipiracy theorist, but it’s impossible not to view the Heart Study as a well-timed blow on the brink of the EU legislation.