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Subject: Vitamins Attacked in Article on AMA Website: Victor Herbert's Mindless Dribble Quoted Positive Conversation Between Me and Dr.Costello at NIH Office of Dietary Supplements Prompted By Her Quote
IAHF LIST: Please read the enclosed attack from the AMA website against dietary supplements which quotes the massively discredited Victor Herbert.
When will they ever learn that Victor has been massively discredited and can't be trusted on anything?
Also quoted herein is Rebecca Costello, PhD, deputy director of the NIH Office of Dietary Supplements who erroneously stated that

"We can embrace some dietary and nutritional supplements," said Rebecca
Costello, PhD, deputy director of the NIH Office of Dietary Supplements,
 which was established by Congress to foster supplement research. "But the
 herbals are very questionable, and the science base on many of them is
scant."

I didn't like that statement, so I just called Dr.Costello at ODS at 301-435-2920 and had a very positive conversation with her about a number of issues which are of concern to me,and I asked if she'd seen the English translation of Commission E. She said she has a copy of it, but hadn't had time to read it, so I suggested that she familiarize her self with it, but that it wasn't the ultimate authority by any means. I told her that herbs were so effective that pharmaceutical companies were sending ethnopirates to places like South Africa for the purpose of stealing the indigenous knowledge of the African healers in order to create patented analogs of the various herbs that seemed most efficacious to them. I related how RAFI Rural Advancement Foundation International was blowing the whistle on this life patenting, and that they'd had some life patents overturned. I informed her that we don't need controlled clinical trials on many herbs because they've been in use for thousands of years and we know what they can do from trial and error.

I also told her that Chinese 5 Element theory is completely different than the western allopathic approach and that under Chinese medicine, herbs are seldom given in isolation, but are prescribed in combo with other herbs to suit a given individuals specific needs as determined under 5 Element theory and pulse diagnosis, a system of medicine that in many ways is more effective than western allopathy. I also explained that standardization wrecks the natural synergy of the whole herb, and that it is nothing more than a marketing ploy and a way to turn an herb into a "drug" which herbs are NOT!

I definitly gave her some things to ponder, but was impressed by her openmindedness. I told her of Dr.Rath's ad in USA today, discussed the Codex vitamin situation in depth, told her about participating in Rath's counter meeting and demonstration, and told her that Rath had an ad in JAMA calling for Dr.s to submit research proposals to him re vitamins which he would consider funding. She carefully took down all of this information and I told her how to get to Rath's website. I told her of Rath's patent on a nutritional protocol to prevent heart disease which she'd never heard of before and she seemed genuinely glad to learn of it. So, the impression I have is that ODS is indeed an honest place that will listen to our input. I offered to get her a copy of APA Task Force Report #7 and Hoffer and Osmond's Reply to that mine of misinformation, and recounted my own orthomolecular recovery from schizophrenia. Its good to know when any public servant is actually really trying hard to do her job properly, and I have nothing but praise for Dr.Costello, despite what she said to the AMA about herbs.



http://www.ama-assn.org/sci-pubs/amnews/pick_00/hlsa0821.htm
The herbal hype of dietary supplements

                 Physicians need to educate themselves about supplements
                 used by the elderly, who are taking them in record
                 numbers.

                 By Deborah L. Shelton, AMNews staff. Aug. 21, 2000. Additional
                 information


                 Their names are exotic. Their pitches are enticing. And to the elderly, dietary
                 and nutritional supplements seem like just what the doctor ordered.

                 Some studies have reported the benefits of using certain supplements, but
                 not all doctors are convinced of the safety and effectiveness of most of them,
                 or the validity of the promises. "These people are snake oil salesmen, and
                 what they're selling is magic," said nutritional researcher Victor Herbert,
                 MD, professor of medicine at Mt. Sinai-New York University Health
                 System, New York City.

                 Supplements include vitamins, minerals, amino acids and herbs.
                 Manufacturers promise older people that the remedies will improve
                 digestion, aid sleep, enhance memory, strengthen bones and joints, shrink
                 the prostate, relieve symptoms of menopause and promote "healthier brain
                 function and well-being." The products have mushroomed into a
                 $15-billion-a-year pharmaceutical industry.

                 "A lot of people are still very skeptical and consider [supplements] fluff,"
                 said geriatrician-internist Mary O'Brien, MD, associate professor of
                 medicine at University of North Carolina at Chapel Hill. "But I think more
                 and more physicians are realizing that we need to take a more proactive
                 approach in taking care of the elderly and preventing problems. For the most
                 part these are simple, safe things, if taken as directed."

                 More than one a day

                 A 1994 federal government health survey, the most recent available, found
                 that a third of those interviewed had taken at least one vitamin or mineral
                 supplement during the previous year. The numbers were even higher among
                 older people, and experts believe use is continuing to climb. Some 42% of
                 men between age 50 and 80, and 53% of women in that age group, had
                 taken at least one supplement. Adult non-Hispanic white females were the
                 most likely users. People with higher incomes tended to be major
                 consumers.

                 "As a physician I have learned how to guide patients through this process
                 and not to encourage or discourage their use," said Bernd Wollschlaeger,
                 MD, clinical associate professor of medicine and family practice at
                 University of Miami (Fla.) School of Medicine. "After all, they will use them
                 whether I want them to or not."

                 Ginkgo biloba -- believed to be an aid in maintaining and improving memory
                 and cognitive function, and possibly in preventing Alzheimer's disease -- is
                 the No. 1 herbal remedy used by older people. St. John's wort is a popular
                 treatment used by elderly women for mood disorders, including minor
                 depression. Glucosamine and chondroitin sulfate are popular treatments for
                 arthritis.

                 "Vitamin supplementation is very popular because of the notion that they
                 maintain quality of life and healthy living," Dr. Wollschlaeger said.

                 Herbal supplements come in every imaginable form: teas, powders, tablets
                 and capsules. Some 24,000 to 30,000 products are currently on the market,
                 according to the National Institutes of Health. They are sold in pharmacies,
                 health food stores and grocery stores; over the Internet; and in physicians'
                 offices.
                "We can embrace some dietary and nutritional supplements," said Rebecca
                 Costello, PhD, deputy director of the NIH Office of Dietary Supplements,
                 which was established by Congress to foster supplement research. "But the
                 herbals are very questionable, and the science base on many of them is
                 scant."

                 When a patient asks for advice, "the average physician just shrugs his
                 shoulders," said George Lustig, MD, who chairs the Broward County (Fla.)
                 Medical Society's complementary and alternative medicine committee. "They
                 don't know enough to tell their patients, and until that paradigm is changed,
                 the patient will be shortchanged," he said.

                 A major concern is product purity. "All of these people are coming in with
                 herbs and dietary supplements," said Texas family physician Robert P.
                 Carroll Jr., MD, who last year called on the AMA to seek tighter regulation.
                 "You don't know what crap you're getting with these things."

                 Under the 1994 Dietary and Nutritional Supplement Health and Education
                 Act, supplements are considered food, not drugs, and are not regulated by
                 the Food and Drug Administration. Manufacturers are restricted from
                 marketing them as remedies to treat, prevent or cure disease. But many skirt
                 that rule by promoting them as aids to "improve joints" and "restore
                 well-being," rather than saying they treat arthritis or depression.

                 There are no standards governing concentrations of key ingredients, which
                 can vary widely, "which doesn't allow the physician to prescribe the product
                 in an analytical fashion," said Dr. Wollschlaeger, who trained in Germany,
                 where the government requires standardization of ingredients.

                 "Physicians are caught in between," he said. "They hear about all these
                 studies -- often contradictory -- on various products, that say there's a place
                 to utilize, for example, St. John's wort in the treatment of minor depression
                 or ginkgo biloba in the treatment of early dementia. Then physicians have to
                 determine which product is safe and efficacious for their patients.

                 "A ginkgo biloba product on a store shelf is not necessarily the same ginkgo
                 biloba used in the study. Physicians, actually, are lost. Good guidelines do
                 not exist."

                 There are other concerns about side effects and possible drug interactions
                 between supplements and prescription medications, especially in elderly
                 patients, a group taking larger quantities of medicines.

                 "It's a potentially devastating problem," Dr. O'Brien said. "Physicians are
                 very good at asking patients about the prescription medications they take,
                 but we need to do a better job asking specifically about over-the-counter
                 preparations -- and, even more specifically, about the vitamins, minerals and
                 herbs they're taking -- and document that in the medical record."

                 A common problem involves patients facing surgery who use ginkgo biloba,
                 which can cause excessive bleeding during surgical procedures. Vitamin E
                 also can cause bleeding in high doses.

                 "The physician may have told the patient to stop taking aspirin, but nobody
                 has told the patient to stop taking ginkgo biloba," Dr. Wollschlaeger said. "If
                 the patient is on antidepressant medication and takes St. John's wort, it can
                 intensify the effects of the antidepressant and cause severe side effects. It's
                 crucial that we educate and develop guidelines for the health care
                 professional. And we have to proactively educate patients to avoid potential
                 side effects, because herbs and vitamins are pharmacologically active
                 substances."

                 Other dangerous combinations include St. John's wort and Zoloft or Prozac
                 -- and even St. John's wort and cough syrup. An ingredient in cough syrup,
                 dextromethorphan, combined with St. John's wort can cause serotonin
                 syndrome, a condition of high fever, confusion, muscle rigidity, profuse
                 swelling and diarrhea. St. John's wort also has been found to decrease the
                 effectiveness of oral contraceptives, a protease inhibitor used to treat
                 HIV/AIDS and the heart medication digoxin. Some supplements, including
                 chaparral, thought to prevent cancer, have been linked to liver damage.

                 Some studies suggest St. John's wort, valerian root and kava-kava may
                 prolong the effects of certain anesthetics and impair awakening from
                 anesthesia.

                 "A lot of physicians don't think supplements are effective so they don't worry
                 about it," said Lisa Colodny, PharmD, clinical coordinator of pharmacy
                 services at Broward General Medical Center in Fort Lauderdale, Fla. But
                 some of them, including St. John's wort and valerian root, have to be
                 tapered off slowly before they're stopped.

                 The hospital recently documented two cases within two days involving
                 adverse medication reactions, she said. One involved ginkgo biloba and
                 Coumadin.

                 "A potentially dangerous assumption is that supplements 'may not help me
                 but they won't hurt me,' " she added. "The problem is that we don't have a
                 lot of information that's science-based that says that they're helpful or
                 harmful."

                 Doctors can't always persuade their patients to discontinue them, either.
                 "You may not convince that little old lady to stop taking that ginkgo with her
                 Coumadin," said Dr. Colodny. "Instead, ask her to have her blood tested
                 more frequently. Educate patients about what could happen so you're
                 proactive about preventing the adverse effects."

                 Diet vs. supplements

                 Isn't maintaining a healthy, balanced diet enough? Ideally, yes, Dr. O'Brien
                 said.

                 "But the truth is, most people don't," she said. "A shocking percentage of
                 older people have nutritional deficiencies. By taking a
                 multivitamin-multimineral supplement, they're just covering all the nutritional
                 bases."

                 Scurvy, a vitamin C deficiency once identified with sailors hundreds of years
                 ago, is now being seen among several population groups, including the
                 homeless and elderly men living alone. For that reason, Dr. O'Brien
                 recommends older people consume children's chewable supplements twice a
                 day with meals.

                 Dr. Herbert, on the other hand, argues that only a few supplements are
                 generally desirable, including the following:

                      Calcium and vitamin D for women starting at age 35 and for men
                      starting at age 50, to prevent bone loss associated with aging.
                      Folic acid for women in their reproductive years to prevent neural
                      tube defects in offspring.
                      Vitamin B-12 for black women at age 25 and for all others at age 50
                      due to the body's declining ability to absorb the vitamin from food.

                 "The rest are a waste of money and often harmful," he said.

                 People with serious medical conditions, including cancer, diabetes,
                 hypertension, thyroid disorders and heart disease should avoid taking
                 supplements without physician supervision, Dr. O'Brien said.

                 "For others, the best approach is for doctors to be open-minded and
                 approachable," she said. "Folks don't want to tell you about the Benadryl
                 they're taking over the counter, much less the echinacea. In most cases, they
                 don't want to confide because they're afraid of reproach, criticism and
                 feeling foolish. Unless our patients trust us, we're going to be operating
                 without complete information."

                 When Dr. Carroll senses that a patient is using supplements, he tells them to
                 bring them in. "If I get a bag filled with herbal medicine, four or five laxatives,
                 two or three dietary supplements and a whole lot of stuff that's not given by
                 a doctor, it's time for a lecture."

                 But Dr. Costello said doctors also should ask themselves if the treatments
                 they're prescribing are themselves causing problems that could lead patients
                 to seek relief elsewhere.

                 And despite the concerns, doctors shouldn't reject supplements out-of-hand,
                 Dr. O'Brien said. "What a smart physician does is be open-minded and take
                 the best of both worlds and combine that in a manner that fits the needs of
                 the individual patient."

                 Back to top.


                 Supplemental advice

                 What should doctors tell their patients about dietary and nutritional
                 supplements?

                      If you're going to use them, stick with well-known manufacturers.
                      Supplements imported from Germany have undergone that country's
                      rigorous quality assurance review.
                      If it doesn't say "standardized extract" on the bottle, stay away from it.
                      That's not a guarantee of safety or effectiveness, but the absence of
                      ingredient standardization is a red flag.
                      Look for the insignia or label "USP" or "NF." USP indicates the
                      product has been formulated to purity, strength, disintegration and
                      dissolution standards of the U.S. Pharmacopoeia, an independent,
                      nonprofit testing laboratory. NF is a uniformity standard for herbs and
                      botanicals that is still evolving.
                      Stop taking supplements immediately if you experience side effects
                      such as skin rashes, stomach upset or headache.
                      Don't take them if you're being treated for cancer, heart disease,
                      diabetes, hypertension or thyroid disease.
                      In general, lactating mothers, infants and young children should avoid
                      herbal remedies altogether.

                 Back to top.


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                 American Herbal Products Assn. (http://www.ahpa.org/) A member
                 organization of manufacturers of herbal products that are promoted as
                 remedies to enhance health and quality of life

                 American Nutraceutical Assn. (http://www.americanutra.com/) A group that
                 provides educational materials, continuing education programs for health
                 professionals and a comprehensive online database on supplements

                 ConsumerLab (http://www.consumerlab.com/) A nonprofit organization that
                 provides independent test results and information to help consumers and
                 health care professionals evaluate health, wellness and nutrition products

                 Food and Drug Administration (http://www.cfsan.fda.gov/) Information
                 about supplements from the FDA Center for Food Safety and Applied
                 Nutrition

                 National Institutes of Health International Bibliographic Information on
                 Dietary Supplements (http://odp.od.nih.gov/ods/databases/ibids.html) A
                 database of published, international, scientific literature on dietary
                 supplements

                 PDR.net Information on products, uses and dosing(http://physician.pdr.net/)