Thursday, January 2, 2014

Vitamin E Surprises Me

Most of the articles written here are meant to be free-standing, so that anyone who happens across them will be able to benefit, but regular readers of my blog will benefit from their experience in reading my blog post today.

To set the scene: Three weeks ago, I made an off-hand comment about the rise and fall of vitamins, mentioning specifically vitamin E. Vitamin E was the focus of a lot of attention many years ago, when it was believed that use of high doses of the antioxidant vitamin might prevent cardiovascular disease. Since then, however, it has fallen out of favor, and is now believed by many to have been over-hyped. Further studies of vitamin E have failed to verify the benefit, and so I tend not to recommend it much, or at least not to patients with cardiovascular disease. In my most cynical moments, I dismiss vitamin E as a fad of a prior time.

Then, two weeks ago, an editorial in the Annals of Internal Medicine came out slamming vitamins in general and vitamin E in particular. I deconstructed that article and argued that it was riddled with problems, but as it relates to today's posting, the editorial suggested that vitamin E was ineffective for, just about anything, and was also probably unsafe.

It turns out that I was wrong to dismiss vitamin E, and so was the Annals of Internal Medicine. Just two days ago, an article was published in the Journal of the American Medical Association that found that vitamin E may provide benefit as an adjunct treatment in Alzheimer's disease. Further confirmation is necessary, but the findings were significant and worthy of attention because of their clinical utility - researchers posited that vitamin E delayed progression of symptoms by about 19% per year in Alzheimer's patients. Additionally, no ill effects were noted over a mean follow-up time of about two years.

I'm not going to discuss the results of the study here, however. Rather, I'm going to make an important point about research. The editorial published in the Annals of Internal Medicine was rash in its suggestion that physicians stop recommending supplements, consumers stop buying supplements, and researchers stop investigating supplements. I argued that broad, blanket statements like this one rarely, if ever, hold up to scientific scrutiny, and less than two weeks after publication, we've already started chipping away at the editorial by way of a peer-reviewed study published in a major medical journal. Broad statements that do not take into account nuances, or indeed evidence, are bound to fail, though they may be partnered with major media campaigns.

The second point is this - clearly I was wrong too. Medicine, despite its attempts to pursue neutrality and evidence, is subject to fads - treatments of all kinds come in and out of favor, and it's not uncommon for clinicians to discount older therapies in favor of newer ones. And lo, I was guilty as charged. Though the evidence for vitamin E in cardiovascular disease remains weak, I was wrong to dismiss the supplement altogether as a fad that lost favor. Vitamin E may indeed hold promise as an effective treatment for other conditions, and I'll now continue to keep an eye out for research.

The point is this: It does no one any favors to close doors in medicine. When we do so, we're inevitably proven wrong. While evidence may lead us away from going to a certain treatment for a certain condition, we should never discount that treatment entirely. I hope we've all learned our lesson today.