“I have been making the claim that MSers should keep themselves vD replete and have recommended the Vitamin D Council’s guidelines. The rationale for my advice is not because vD is a disease-modifying treatment – definitive evidence for the this is lacking – but to optimise bone health. The latter is not evidence-based, but comes from extrapolating results from studies that have been done in older women with osteopenia and osteoporosis. I am aware that there is a lack of evidence on this issue from the field of MS, which why Dr Ruth is currently preparing a post-doctoral fellowship application to address this issue.”
“I am not a bone expert, which is why I defer to my esteemed colleagues in the field of vD biology and endocrinology for advice. This is why I was astounded when I read the following analysis over the weekend from last week’s British Medical Journal that calls all the advice on vD and calcium supplementation in relation to bone health into question. Please note I have never recommended calcium supplements to MSers; there is no scientific rationale for this. Importantly, the authors’ finger the influence of Industry in the setting of national and international guidelines in relation to vD and calcium supplements for the prevention of fractures. The esteemed Vitamin D Council is not exempt from the list (see table below)?”
“What should we do? I don’t think I will change my advice just yet. I still think there is a strong argument from an evolutionary medicine perspective to be vD replete. However, to make the claim that this is for bone health reasons seems to be at odds with the evidence presented in this paper and recent meta-analyses. More importantly there is no evidence from studies done in MSers to support the bone health position. I will need to seek expert advice from my metabolic bone disease colleagues before coming back to you.”
Grey & Bolland. Web of industry, advocacy, and academia in the management of osteoporosis. BMJ 2015;351:h3170
….. Other industries benefit from enthusiasm for use of supplements for osteoporosis. Measurement of serum 25-hydroxyvitamin D has become widely used, benefiting both the manufacturers of assay kits and the laboratories that perform the tests. The commercial rewards are substantial— annual costs of vitamin D testing in Australia increased from $A1m (£500 000; €700 000; $800 000) in 2001 to $A96m in 2010…..
…. The US National Osteoporosis Foundation (NOF) and the Europe based International Osteoporosis Foundation (IOF) are highly influential advocacy organisations. Both state their aim as improving patient outcomes, but their objectivity may be compromised by the influence of a range of commercial sponsors, including companies that market supplements, dairy products, and nutrition related laboratory tests. In their drive to attract corporate sponsorship, the IOF and NOF emphasise their academic and scientific strengths and global influence, and offer the opportunity for corporate members to influence the strategic direction of the organisation at both formal and informal levels….
…. Other industry sponsored advocacy organisations have failed to acknowledge the unfavourable evidence. The news section of the website of the Vitamin D Council does not mention the recent meta-analyses of randomised trials that reported no health benefits of vitamin D supplements, while less rigorous research findings that encourage vitamin D testing and use are enthusiastically endorsed….
…. Setting aside finances, academic leaders may also have academic conflicts of interest. For example, their career development may be enhanced by the persistence of beliefs that nutritional supplements benefit the skeleton. Such conflicts of interest may have influenced the Endocrine Society’s endorsement of widespread moderate dose vitamin D supplementation in contrast with the Institute of Medicine (IOM), which recommended low level supplementation for older adults, and the Preventive Services Task Force, which advised against vitamin D supplementation……
…… The interactions among the nutrition industry, advocacy organisations, and academia are complex. Each party benefits. Industry gains scientific credibility, which protects or enhances sales of its products, and indirect marketing through advocacy groups. Advocacy organisations and specialist societies gain funds to support their existence. Academics gain by maintenance of their status and by obtaining access to research funds and career enhancing publications and presentations. The party that may lose, and be harmed, is the public. Failure to reverse inappropriate practice leads to overtreatment, systematic waste of healthcare resources, unnecessary costs for patients, and missed opportunities for application of interventions with proved efficacy. Ultimately, the cost is erosion of trust in the medical system……