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March 27,2007 JOIN: Alliance for Natural Health
Dorking, United Kingdom
ANH responds to EFSA accusation of legal threat over EU food supplement applications
The Alliance for Natural Health (ANH) filed nine applications to Annex I of the EU Food Supplements Directive and a further six to Annex II in late February and early March 2007. The primary subjects of the applications were natural vitamins and minerals which were omitted from the Directive’s Annexes (‘positive list’). On 16 March, the ANH informed the European Commission that it had filed the applications and would scrutinise its and the European Food Safety Authority’s (EFSA) procedures with regard to their evaluation. This scrutiny, ANH indicated, would be in accordance with the process made clear by the European Court of Justice (ECJ), in its ruling on the ANH’s case in July 2005.
Although the EFSA made no comment to the media on 16 March, it responded on 23 March with statements quoted by Nutraingredients.com Europe. Spokesperson for the EFSA, Dr Carola Sondermann, told NutraIngredients.com: "We are surprised that ANH even tries to threaten the European Commission and EFSA with taking them to court if a negative opinion will be issued by EFSA.”
Responding to the EFSA statement, Dr Robert Verkerk, executive and scientific director of the ANH, said:
“We have in no way threatened either the European Commission or the EFSA. We have merely made clear that we are following the process set out by the ECJ in relation to its 2005 ruling on our case, which, I quote, says ‘If the procedure results in a refusal, the refusal must be open to challenge before the courts.’
“Given the ECJ ruling, we would in fact be neglecting the interests of our supporters if we were not to reserve the right to challenge any negative decisions by the EFSA if we believed such decisions were unjustified.
“If the ANH’s role as a watchdog on these matters ends up helping to create a more workable, timely, transparent, proportionate and scientifically credible procedure for applications to the positive list of this Directive, then that will be a big step forward for natural health. This will greatly benefit the tens of thousands of Europeans who use natural forms of vitamins and minerals and who would not expect to see unwarranted restrictions on their use.”
For the public record, ANH legal director, Robert Collins, made the following statement in relation to the EFSA’s comments:
“With regard to the article in Nutraingredients.com on 23 March, the response from the EFSA spokesperson is unwarranted. The ANH has consulted at each stage of the procedure both with the Food Standards Agency in the UK and the relevant European institutions.
Clearly if there is a refusal to accept a particular nutrient for inclusion onto the positive list that we believe is not warranted, then the ANH will not hesitate to exhaust all means at its disposal to challenge the decision. Ultimately this might require our pursuing the matter in the courts, a right clarified by the European Court in its judgment on our case. However we have endeavoured and will continue to endeavour to work cooperatively with the FSA, the EFSA and the European Commission.
We are slightly taken aback that the EFSA’s only response to our communications on the subject of adding nutrients to the Annexes of the Food Supplements Directive has been through the medium of a spokesperson making a comment upon a very small part of the proposals that we have put to them.
We have as yet received no constructive response from the EFSA, the FSA or the European Commission over any of the genuine concerns we have raised in relation to the transparency, proportionality or legal and scientific credence of the application process for vitamins and minerals to the Annexes of the Directive.”
ENDS.
EDITOR’S NOTES
Nutraingredients.com articles
1. ANH pledges scrutiny and pressure over EC positive list, 19 March 2007
http://www.nutraingredients.com/news/ng.asp?id=75066
2. EFSA surprised at legal threat over dossier assessment, 23 March 2007
http://www.nutraingredients.com/news/ng.asp?id=75209
About the Alliance for Natural Health (ANH) - www.anhcampaign.org The ANH is a UK-based, EU-focused, international, legal-scientific, non-governmental organisation that is working on behalf of consumers, medical doctors, complementary health practitioners and food manufacturers and distributors, to protect and promote natural healthcare, using the principles of good science and good law. The ANH’s principal objective is to help develop an appropriate legal-scientific framework and environment for the development of sustainable approaches to healthcare. Within this setting, consumers and health professionals should be able to make informed choices about a wide range of health options, and in particular those that relate to diet, lifestyle and non-drug-based or natural therapies, so that they may experience their benefits to the full while not exposing themselves to unnecessary risks.
March 16,2007 JOIN: Alliance for Natural Health
The ANH mounts today the next phase of its legal activities aimed to stop a ban on thousands of food supplement products in Europe.
Please circulate this release widely to those who might be interested.
By making 15 applications to the positive list according to the clarified and simplified procedures set out by the European Court of Justice in 2005, we aim to force the European Commission and other EU institutions to use proper, transparent and proportionate procedures for adding new ingredients to the EU Food Supplements Directive's 'positive lists' while not over-stepping their legal powers.
This entire strategy is based on the gains offered by the European Court in 2005 - which, up until now, appear to have been ignored by the EU institutions.
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Read the full press release and Editor's Notes below to find out more about this crucial next stage of the ANH's legal strategy on European food supplements.
ANH PRESS RELEASE: ANH puts spotlight on European Commission over food supplement procedures
Press Release – for immediate release 16 March 2007, Dorking, United Kingdom
ANH PUTS SPOTLIGHT ON EU PROCEDURES FOR FOOD SUPPLEMENTS FOLLOWING EUROPEAN COURT JUDGMENT
The Alliance for Natural Health has today informed the European Commission that it will scrutinise its procedures and those of the European Food Safety Authority on food supplements, in accordance with a European Court of Justice (ECJ) judgment.
On 12 July 2005 the European Court of Justice (ECJ) in Luxembourg delivered its judgment on a case brought by the EU-wide Alliance for Natural Health (ANH), along with two UK health food associations. The case challenged the EU Food Supplements Directive potential ban on thousands of food supplement products on the EU market that contain nutrient forms not listed on the ‘positive list’ of the Directive.
ANH files applications to create legal precedent
The ANH has filed 15 applications to the Directive’s positive list as a means of testing the European Commission and European Food Safety Authority’s procedures, which were referred to as having the “transparency of a black box” by the ECJ’s Advocate General Geelhoed in April 2005. This flaw was regarded as being of such a profound nature that the Advocate General made a recommendation to the ECJ that the Directive be invalidated.
When the ECJ delivered its ruling some three months later, the Directive was upheld – but on the condition that the procedures for adding vitamin and mineral ingredients to the Directive’s limited positive lists were made fully transparent and carried out within a reasonable time frame.
The ANH has been engaged in correspondence with the relevant authorities, including the UK Food Standards Agency, the European Commission and the European Food Safety Authority, on all aspects of the procedure and time lines for applications to the positive list and has yet to receive adequate, clear responses.
“The European Commission and European Food Safety Authority appear to be ignoring the ECJ’s ruling and continue to be operating within their black box,” says Dr Robert Verkerk, Executive & Scientific Director of the ANH. “It’s critically important now that we establish proper procedures for permanently adding vitamins and minerals to the Directive’s positive list, using the clarified procedures set up by the European Court, especially as derogation dossiers, some of which were very brief, could be rejected at any stage.”
The Directive only lists 15 minerals, when scientific research has shown that many more are needed for optimum health, at dosages greater than those found in most contemporary diets. Among the ANH’s 15 applications, nine are applications to have additional minerals, including sulphur, strontium, vanadium, boron and lithium added to Annex I of the positive list.
The European Court clarifies the criteria required for positive list applications
The ECJ also spelled out the criteria required for applications to the positive list. The ECJ made it clear that the only criterion required to have a vitamin or mineral added to the positive list (Annex I) was that it be normally found in and consumed as part of the diet. In its nine test applications to Annex I of the Directive, the ANH has demonstrated, using peer reviewed, published scientific research or government nutrient intake statistics, that all these substances are normally found in the diet. However, scientific research shows that their concentration is often insufficient for optimum health, hence the value of supplements containing these substances.
The ECJ also stipulated that two criteria were required for applications to Annex II of the positive list, which contains the vitamin and mineral forms which may be used in the manufacture of food supplements. The current list contains only 114 forms, while more than 400 forms have been used safely for decades. A ban has yet to occur since the fate of the additional 400 or so vitamin and mineral forms has yet to be decided following the submission of derogation dossiers to the European Food Safety Authority prior to 12 July 2005. In fact, only two of these submissions have been evaluated and approved since this time. The fate of the vast majority may not be known until closer to the end of the derogation phase in December 2009. Any dossier that is rejected will immediately make illegal any sale of products containing the relevant ingredient.
ANH applications prioritise natural forms of vitamins and minerals
The ANH has filed six applications to Annex II including generic and proprietary forms of mixed carotenoids, wheatgerm oil containing natural forms of vitamin E (mixed tocopherols and tocotrienols) and palm fruit vitamin E tocotrienols. These sorts of natural complexes are conspicuously absent from the Directive’s positive lists and, at the proposed dosages, are considered to be free of harmful effects sometimes associated with isolated, synthetic vitamin forms. Scientific studies also suggest that these natural forms of vitamins are of greater benefit to health.
ANH intends to challenge any refused applications in the courts
Robert Collins, Legal Director of the ANH said, “With so much uncertainty about, it is essential that clear, workable and transparent procedures are established – and of course the European Court has made this abundantly clear. The European Food Safety Authority can only reject applications if the criteria they have given are not met or they can prove that the proposed use is unsafe. Moreover, the Court has indicated that if the procedure results in a refusal, the refusal must be open to challenge through the courts. Since, in our test applications, we believe we have met the required criteria and have demonstrated the safety of the proposed uses, we will be taking any refusals to the courts so that proper precedents can be developed according to the procedure made law by the European Court.”
The ANH will continue to maintain very close scrutiny over the European Commission and European Food Safety Authority procedures. It is hoped, assuming the ECJ’s ruling is taken into account, that this will pave the way towards a more rational and transparent approach towards regulation of all categories of food supplements over the coming years.
ENDS.
CONTACTS
Dr Robert Verkerk, Executive & Scientific Director
Robert Collins, Legal Director
Alliance for Natural Health The Atrium, Dorking, Surrey RH4 1XA, United Kingdom
Phone: +44 (0)1306 646 550 Fax: + 44 (0)1306 646 552 E-mail: info@anhcampaign.org Web: www.anhcampaign.org
EDITOR’S NOTES
About the Alliance for Natural Health (ANH) - www.anhcampaign.org
The ANH is a UK-based, EU-focused, international, legal-scientific, non-governmental organisation that is working on behalf of consumers, medical doctors, complementary health practitioners and food manufacturers and distributors, to protect and promote natural healthcare, using the principles of good science and good law.
The ANH’s principal objective is to help develop an appropriate legal-scientific framework and environment for the development of sustainable approaches to healthcare. Within this setting, consumers and health professionals should be able to make informed choices about a wide range of health options, and in particular those that relate to diet, lifestyle and non-drug-based or natural therapies, so that they may experience their benefits to the full while not exposing themselves to unnecessary risks.
About the Press Release
Judgment of the ECJ on the ANH case (12 July 2005) can be downloaded from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:62004J0154:EN:HTML
The ANH’s key grievance
The ANH’s greatest concern over the EU Food Supplements Directive (2002/46/EC), which affects millions in Europe who consume food supplements containing vitamins and minerals, as well as other nutrients to support their diets, is the absence from the positive list of many key natural forms and complexes of vitamins and minerals. None of this would be a problem if it was reasonably easy to have a nutrient added to the list – but, unfortunately, the data requirements set by the European Commission are so onerous that only the largest companies have the capacity to conduct the studies required.
The Advocate General’s ‘black box’
Worse than this, the exact procedure, data requirements and time lines required to gain access have not been clearly set out. This was in fact the major stimulus for the opinion of the Advocate General, Leendert Geelhoed, handed down on 5 April 2005, which recommended that the Directive be invalidated. He rather famously pronounced the procedure as ‘transparent as a black box’. Extracts from the Advocate General’s opinion are given below:
“In short, this procedure, in so far as it may exist and in so far as it may deserve this title, has the transparency of a black box: no provision is made for parties to be heard, no time-limits apply in respect of decision-making; nor, indeed, is there any certainty that a final decision will be taken. The procedure therefore lacks essential guarantees for the protection of the interests of private applicants….. Thus, lacking appropriate and transparent procedures for its application, the Directive infringes the principle of proportionality. It is, therefore, invalid.”
Directive upheld by the ECJ, but….
Three months later, when the ECJ delivered its judgment, many were surprised to find that the 13 judges in the case did not follow the Advocate General’s recommendation to invalidate the Directive. Rather, the judges decided to uphold the Directive, yet at the same time, through the 25-pages of their ruling, they provided key clarification that went a very long way to remove the black veil from Advocate General Geelhoed’s box.
The unveiling of the Advocate General’s ‘black box’ by the ECJ
The ECJ makes very clear in paragraph 82 of its ruling that transparency must be maintained, as well as clarifying the European Commission’s responsibilities to interested parties, viz:
“The absence of any such provisions cannot, however, be regarded as such as to jeopardise the proper functioning of the procedure for modifying the positive lists within a reasonable time. It is none the less the responsibility of the Commission, by virtue of the implementing powers conferred on it by Directive 2002/46 concerning, inter alia, the way the procedure is operated, to adopt and make accessible to interested parties, in accordance with the principle of sound administration, the measures necessary to ensure generally that the consultation stage with the European Food Safety Authority is carried out transparently and within a reasonable time.”
The European Court clarifies the criteria required for applications to the positive list
Many companies have understandably feared that they cannot afford to make applications to the positive lists because of onerous data requirements stipulated by the European Commission. Others have been given the impression that they cannot make an application for a specific vitamin or mineral form (Annex II) because the group to which the form belongs is not listed in Annex I of the positive list. However, the ECJ made clear in its judgment the criteria required to gain access to both Annexes of the Directive’s positive list, as well as indicating that the procedure needs to be fully transparent and must be carried out “within a reasonable time”.
Criterion required for applications to Annex I of the positive list
The Court specifies only one criterion required for applications to Annex 1, which presently contains 13 vitamins, and only 15 minerals. The criterion is as follows, as demonstrated in paragraph 85 of the judgment:
“….the criterion that the vitamin or mineral be normally found in, and consumed as part of, the diet is the only relevant criterion for the purposes of the list in Annex I to the directive.”
Criteria required for applications to Annex II of the positive list
Also in paragraph 85, the Court clarifies the two criteria required for applications to Annex II:
“As regards the list in Annex II to the directive, it is apparent……that the only relevant criteria are those relating to the safety and bioavailability of the chemical substance in question.”
ECJ clarifies basis for refusals
Paragraph 73 of the ruling re-states that the procedure for applications to the positive list must be completed in a “reasonable time” and applies the burden of proof for lack of safety on the competent authorities in cases where applications are refused:
“Such a procedure must be accessible in the sense that it must be expressly mentioned in a measure of general application which is binding on the authorities concerned. It must be capable of being completed within a reasonable time. An application to have a substance included on a list of authorised substances may be refused by the competent authorities only on the basis of a full assessment of the risk posed to public health by the substance, established on the basis of the most reliable scientific data available and the most recent results of international research. If the procedure results in a refusal, the refusal must be open to challenge before the courts (see, by analogy, Case C‑24/00 Commission v France [2004] ECR I‑1277, paragraphs 26, 27 and 36, and Case C‑95/01 Greenham and Abel [2004] ECR I‑1333, paragraphs 35, 36 and 50).“
Conclusion
The European Court, in its ruling of July 2005, appeared to go a very long way towards addressing the claimants’ main concerns, while at the same time avoiding the severe option of invalidating the Directive. This approach may have been developed to provide as much of a win-win situation to all parties as could be mustered, while at the same time saving the European institutions the embarrassment of an over-turned Directive.
The difficulty for many leading-edge, innovative manufacturers has been that since the ruling, almost two years ago, the European Commission appears to be ignoring the ECJ’s ruling. Geelhoed, who has now retired, may be surprised to find that his ‘black box’ has yet to be made transparent.
The ANH’s strategy to test the ECJ ruling will, it is hoped, apply the pressure needed to ensure transparent, clear and proportionate procedures for applications to the Directive’s positive list. It will likely set a precedent which will then be applied to other groups of nutrients such as botanicals, essential fatty acids, amino acids and probiotics.
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Dr.Steve Hickey's Reply to the AMA article. Original article at Alliance for Natural Health:
Poor methodology in meta-analysis of vitamins
Dr Steve Hickey i,ii, Dr Len Noriegai and Dr Hilary Roberts
i Faculty of Computing, Engineering and Technology, Staffordshire University;
ii School of Biology, Chemistry and Health Science, Manchester Metropolitan
University.
Scientific papers often reveal more than is apparent from the reported results. A recent
review of clinical trials by Bjelakovic et al. claimed to show that certain antioxidant
vitamins increased the risk of death. 1 Superficially, this study appears to have a
degree of scientific rigour because of a detailed and extensive use of statistics.
However, the statistics were inappropriately applied to poorly selected data, thus the
conclusions are invalid. Researchers need to remember the fundamentals of the
scientific method to avoid introducing experimenter bias. In this case, experimenter
bias was compounded by a basic misuse of statistical testing.
Selecting your data
Bjelakovic’s review was a meta-analysis of 16,111 scientific papers. Meta-analysis is
a statistical technique which summarizes the results of several studies, giving a
greater weighting to higher quality studies. The problem with Bjelakovic’s review
relates to how the studies were chosen for inclusion in the analysis. Of the initial
studies, 14,910 (93%) were discarded, with only a brief explanation of the exclusion
criteria. Studies were dismissed because they were cancer studies, duplicates, or
because they were deemed ‘not relevant’. However, studies of precancerous lesions 2
and skin cancer 3 were included in the group designated as having a low risk of bias.
Following the initial selection, 1201 research papers, covering 815 clinical trials, were
described as being “reviewed.” It might be more accurate to say these papers were
subjected to additional selection procedures: 747 (92%) of the 815 were rejected, for
example, because no subject died during the experiment. The remaining 68 studies
were included in the analysis.
Bjelakovic’s review states that this decision, to exclude 9 out of 10 studies (i.e. 747
from 815), depended on the judgement of three of the authors. This is a clear
indication of potential selection bias, as the reviewers had access to the experimental
results in addition to the experimental procedures.
Selection of trials for meta-analysis should be almost mechanical, based on rigorous
objective criteria with critical justification. The large number of studies by Bjelakovic
himself raises concerns in respect of objectivity, as the probability of trials being
selected for inclusion in a meta-analysis can be influenced by knowledge of their
results, leading to inclusion bias. 4
Two of the researchers in the Bjelakovic meta-analysis further segmented the data
into two groups, according to the perceived quality of the experimental procedures.
However, once again the selection method did not exclude experimenter bias, as the
researchers may have been influenced by the results of the studies. The complete
selected data set of 68 trials reportedly showed no effect of vitamins on mortality.
Notably, the group selected for low risk of bias showed an increased risk of mortality
with supplements (RR 1.05). A reduced risk of mortality was found in the other group
(RR 0.91). These results are consistent with experimenter bias, based on knowledge
of outcomes in the selection.
Selection of data is a powerful technique. To take an analogy, imagine we were to
survey passenger-carrying vehicles in central London. Unwanted traffic includes
bicycles, milk floats and delivery vans, so we exclude vehicles with less than four
wheels, without side windows, and quiet ones. Small vehicles have a high risk of bias,
since they can be hidden behind other traffic, so we reject any vehicle less than 20
feet long. Dark vehicles are hard to see at dawn or dusk, light coloured ones do not
show up well against the local stone, and blue, green or yellow ones are hard to see
against the panels of a nearby building site, so all are eliminated from the study. After
excluding the groups with a high risk of bias, we count the vehicles and register their
type. The survey concludes that all road passengers in London travel by red bus!
Repeated testing
A critical failing of the Bjelakovic paper is the absence of detail on the number of
statistical tests performed on the data. For example, at least two groups of tests
reported concerned vitamin A. Vitamin A was tested singly and in combination with
other supplements. Both sets of tests showed no significant effects. Then it was
multiply retested: as a single or combined supplement, or taken with selenium, and
again after exclusion of high bias risk. In this second group of tests, vitamin A
reportedly increased mortality.
The fact that this many tests were carried out on just one of the supplements
investigated suggests the results of the study are unreliable. Conventionally, a single
statistical test has a 1 in 20 probability of being significant by chance alone. With 100
such tests, we would therefore expect five ‘significant’ results, just by chance. The
equation for computing the probability of a positive result, p, at significance level α,
in n tests is:
p= (1-(1- α)n)
With a large data set and repeated testing of factors and subsets, several significant
results could be attributable to chance alone. 5 In this case, the paper gives no
indication of the number of statistical tests employed, or justification for the
probability values provided.
Nutrition or Pharmacology?
Bjelakovic’s meta-analysis has little biological meaning, because of the large number
of ill-defined substances that have been grouped together. The meta-analysis includes
a diverse range of doses of the individual supplements, with no concern for the
expected physiological effects. In one of the included trials, a single dose of vitamin
A was followed up over a period of three months. 6
Bjelakovic also analysed studies of ‘vitamin E,’ an almost meaningless term in terms
of nutrition or pharmacology. Vitamin E refers to a number of fat-soluble
antioxidants, including four natural forms each of tocopherols and tocotrienols.
Additional synthetic forms of tocopherol are widely used for vitamin E studies. Thus,
it is not clear to which actual nutrient Bjelakovic’s ‘vitamin E’ results would apply.
Moreover, one of the vitamin E studies selected by Bjelakovic, as having a ‘low risk
of bias’, has previously been cited by Hickey and Roberts as a prime example of bias
in vitamin studies. 7
Only studies with recorded deaths were included by Bjelakovic: this was presumably
considered necessary in a study of death rates. However, this selection has the
potential to increase bias, as it clearly excludes studies where supplements could not
be associated with increased mortality. A secondary effect of this selection technique
is that the included population tended to be sick, rather than healthy. Although most
included studies were on the sick, they used nutritional rather than pharmacological
doses. For example, doses of vitamin C ranged from 60 to 2000 mg; these are too
small to be helpful against serious illnesses. 7 Furthermore, trials on nutritional
supplements in disease do not necessarily apply to healthy members of the population.
Conclusions
The paper by Bjelakovic was reported widely by the media but was not subjected to
scientific criticism. Media reports gave the impression that scientific evidence
suggests vitamins may be harmful. In fact, no evidence has been provided to this
effect. The statistics provided were insufficient to support a claim that vitamin
supplements will increase mortality. Moreover, the results cannot validly be
generalised to a relatively healthy general population.
The design of the study was not consistent with general principles of pharmacology
and nutrition. The authors, by not controlling for experimenter bias, have produced a
paper that might simply reflect their own personal bias. This bias is scientifically
controversial and is, perhaps, in resonance with a similar bias in the media.
1 Bjelakovic G., Nikolova D., Gluud L.L., Simonetti R.G. Gluud C. (2007) Mortality in randomized
trials of antioxidant supplements for primary and secondary prevention: systematic review and metaanalysis,
JAMA, 297, 842-857.
2
Correa P. Fontham E.T. Bravo J.C. et al. (2000) Chemoprevention of gastric dysplasia: randomized
trial of antioxidant supplements and anti-helicobacter pylori therapy, J Natl Cancer Inst, 92, 1881-1888.
3
Green A. Williams G. Neale R. et al. (1999) Daily sunscreen application and beta-carotene
supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised
controlled trial, Lancet, 354, 723-729.
4
Egger M. Smith G.D. (1998) Bias in location and selection of studies, BMJ, 316(7124), 61-66.
5 Davies O.L. Goldsmith P.L. (1972) Statistical methods in research and production, 4th Edition, John
Wiley, New York.
6
Murphy S, West KP Jr, Greenough WB III, Cherot E, Katz J, Clement L. (1992) Impact of vitamin A
supplementation on the incidence of infection in elderly nursing home residents: a randomized
controlled trial, Age Ageing, 21, 435-439.
7
Hickey and Roberts (2004) Ascorbate: the science of vitamin C, Lulu press.
From ANH:
By the ANH team
5 March 2007
On 28th February we saw headlines around the world once again condemning vitamin supplements. The stimulus? A Serbian doctor, Goran Bjelakovic, who was involved in an earlier canning job on vitamins – in 2004 on vitamin supplements for reducing risk of gastrointestinal cancers (Lancet 2004; 364: 1219–28) – somehow found himself doing it all over again. This time he published in the US-based Journal of the American Medical Association (JAMA). On both occasions, his papers triggered headlines around the world which appeared to have just one purpose: getting people to stop taking vitamin supplements.
Interestingly, in a bout of apparent schizophrenia for JAMA, Bjelakovic and colleagues’ views are fundamentally opposed to those of Fairfield and Fletcher published in the same journal some two years earlier (JAMA 2002; 287:3116-3126). Fairfield and Fletcher broke the long-standing anti-supplement agenda of the JAMA by supporting supplementation as a means of reducing risk of key chronic diseases. But it seems it’s now back to business as usual for JAMA.
On the top of the Serbian’s hit list were the favourites: vitamin E and beta-carotene. Dr Bjelakovic, given his previous work, appears to have a bit of thing for antioxidant supplements which he considers to be beta-carotene, vitamin A, vitamin C, vitamin E and selenium. From the point of view of any informed scientist, this is a peculiarly narrow perspective on what is meant by ‘antioxidant supplements’. First of all the vitamins in question are not automatically antioxidants. In certain forms (especially as synthetic, isolated forms) and dosages, they can actually have the reverse effect – and act as pro-oxidants. Secondly, the dose and form of the vitamin are critical to determining how the vitamin will behave in the body, as are the other nutrients which are consumed at the same time.
To give an example, high doses of vitamin E (the very forms that have swayed Bjelakovic’s analysis) actually reduce the body’s absorption of the more important antioxidant form of vitamin E, gamma-tocopherol, the predominant form in foods and high quality vitamin E supplements.
It was seriously remiss of Bjelakovic and his team to not emphasise that; a) the studies they used to condemn these vitamins were nearly all performed using synthetic forms of the vitamins that behave in the body in remarkably different ways to the natural forms and b) to not make clear the effects their study selection approach would have on the final results.
Looking further at this second, crucially important point, Bjelakovic’s team found 815 trials that were potentially relevant. But they culled out a massive 747 (yes – a jumbo jet load!) of these trials, leaving just 8% of the total number for the number crunching! The most important reason given by the authors themselves for the exclusion of studies (responsible for 50% of the exclusions – a total of 405 trials) was “mortality was 0 in both study groups.”
Consider what effect this might have on bias. If you remove 50 % of the studies because they didn’t cause any increased risk of death – how can you say that vitamin supplements overall cause a 5% increase in risk of death….it simply beggars belief that the JAMA can tolerate this type of science.
This is just one of the stunning problems with Bjelakovic’s study. Dr Steve Hickey (of the ANH Expert Committee) and colleagues reveal more reasons for the flawed nature of the Bjelakovic’s meta-analysis – click here to view their rebuttal submitted and approved for publication in the Journal of Orthomolecular Medicine.
Bjelakovic’s specialty appears to be meta-analyses (statistical study of studies). The application of a lot of statistics to a given data set does not change the quality of the data set. In fact it can often magnify inherent problems in the data. Bjelakovic’s data set is poorly selected and severely compromised – and the results of his analyses do not provide any reflection on the risk of supplementing with vitamin A, beta-carotene, vitamin C, vitamin E or selenium, the targets of the meta-analysis. In fact, the results tell you absolutely nothing about taking, either the natural forms of these supplements, or the effects of taking all these nutrients together, the common way they are taken by most people – as multivitamin/mineral supplements.
Newspaper headlines on 28 February were as dire as “Supplements ‘raise death rate by 5%’” (The Times, UK), “Vitamins ‘could shorten lifespan’” (BBC News, UK), “Des vitamines dangereuses pour la santé?” (Le Soir, France) and “Another knock on antioxidants” (Los Angeles Times, USA). But they may not have had the impact that was hoped for by certain interest groups. Judging by the vehement and often irrational hatred for vitamin supplements shown by elements of the orthodox medical profession closely aligned with the pharmaceutical industry, it seems likely that the main objective both of Bjelakovic’s meta-analysis and the resultant articles was to stimulate a turn-around in the increasing numbers of people who are side-stepping pharmaceutical medicine in their quest for health.
Just like all the other factors Bjelakovic and his colleagues failed to consider, clarify or include in their meta-analysis, it seems that another important factor has been ignored. And that’s the millions of people who have derived benefits from taking supplements, combined with other aspects of a healthy lifestyle. These people will need a little more than a computer-generated, reductionist, flawed analysis of past studies of pharmaceutical forms of vitamins to put them off.
So will we.
Links:
Journal of the American Medical Association, Bjelakovic et al
Times online article, 28 Feb 2007, Supplements 'raise dealth rates by 5%'"
BBC News, Vitamins 'could shorten lifespan', 28 Feb 2007
Rebuttal by Dr Steve Hickey, ANH Scientific Expert Committee
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