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Sell America on Vitamin D – and reap the profits



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Dr. Michael Holick's enthusiasm for vitamin D can be described as extreme.

Boston University's endocrinologist, perhaps more than anyone else responsible for creating a million dollar vitamin D sales and test juggernaut, is increasing its own levels of supplements and fortified milk. When driving outdoors, he does not put sunscreen on his limbs. He has written long book books on vitamin D, and has warned in several scientific articles about a "vitamin D deficiency pandemic" that explains the disease and suboptimal health around the world.

His fixation is so intense that it extends to the dinosaurs. What if the real problem created by this asteroid 65 million years ago was not a lack of food, but the weak bones that followed a lack of sunlight? "I sometimes wonder," Holick wrote, "did the dinosaurs die of rickets and osteomalacia?"

Holick's role in drafting national vitamin D guidelines and embracing his message through mainstream physicians and wellness gurus alike have helped boost sales to $ 936 million in 201

7. That's a ninefold increase over the last decade. Laboratory tests for vitamin D deficiency have also increased: physicians ordered more than $ 10 million for Medicare patients in 2016, 547 percent since 2007, at a cost of $ 365 million. About 1 in 4 adults 60 and older are now taking vitamin D supplements.

But probably, few of the Americans who are swept up in vitamin D enthusiasm are aware that the industry has sent Holicks a lot of money away. A survey by Kaiser Health News has revealed that he has used his outstanding position in medicine to promote practices that benefit companies that have given him hundreds of thousands of dollars – including drug manufacturers, the tanning industry and one of the largest commercial ones Laboratories of the country. 19659008] In an interview, Holick confirmed that he has worked since 1979 as a consultant for Quest Diagnostics, which conducts vitamin D testing. Holick, 72, said that industry funding does not affect me when it comes to the health benefits of vitamin D. "

There is no question that the hormone is important, without enough, bones can become thin, brittle and The question is how much vitamin D is healthy and what is the level of deficiency.

Holick's pivotal role in shaping this debate was played out in late 2011. At the end of last year, the respected National Academy of Medicine (then known as the Institute of Medicine), a group of independent scientific experts, published a comprehensive, 1,132-page report on vitamin D deficiency Concluded that the vast majority of Americans receive much of the hormone from diet and sunlight, and advised physicians, only patients with one high risk of vitamin D-related diseases such as osteoporosis testing

A few months later, in June 2011, Holick oversaw the publication of a report that took a very different view. The study was conducted in the Journal of Clinical Endocrinology and Metabolism on behalf of the Endocrine Society, the industry's leading profession, whose guidelines are widely used by hospitals, doctors and commercial laboratories across the country, including Quest. The company took Holick's position that "vitamin D deficiency is very prevalent in all ages" and advocated a huge expansion of vitamin D testing that affects more than half of the US population, including those who are black, Hispanic or obese are to have a lower vitamin D level than others.

The recommendations were a financial stroke of luck for the vitamin D industry. By endorsing such extensive tests, the Endocrine Society did more business with Quest and other commercial labs. Vitamin D testing is now the fifth most common lab test covered by Medicare.

The guidelines benefited the vitamin D industry in another important way. Unlike the National Academy, which concluded that patients have enough vitamin D when they have 20 or more nanograms per milliliter in their blood, the Endocrine Society said the vitamin D level must be much higher – at least 30 Nanograms per milliliter. Many commercial laboratories, including Quest and LabCorp, adopted the higher standard.

Yet, there is no evidence that higher-level people are healthier than lower-level people Clifford Rosen, a senior scientist at the Maine Medical Center Research Institute and co-author of the National Academy Report. Using the higher standards of the Endocrine Society creates the appearance of an epidemic, he said, because 80 percent of Americans have insufficient vitamin D.

"We see people who are constantly being tested and treated on the basis of many wishful thinking Englisch: bio-pro.de/en/region/stern/magazine/…1/index.html […] Patients with low vitamin D levels are often prescribed supplements and instructed to have them reexamined in a matter of months, said Dr. Alex Krist, family doctor and vice chairman of the US Preventive Services Task Force, a panel of experts who provide health advice repeat the test once a year For laboratories, "it's in their financial interests" to mark patients with low vitamin D levels, said Krist.

In a 2010 book, "The Vitamin D Solution," Holick stated Readers' tips to encourage them to test their blood For readers worried about potential outlay costs for vitamin D testing – ranging from $ 40 to $ 225 – Holick called the exact reimbursement scodes that physicians should use when applying for insurance coverage. "If they use the wrong coding when they submit the claim to the insurance company, they will not be reimbursed and you will have to pay for the test," Holick wrote.

Holick confirmed financial ties with Quest and other companies in the Financial Disclosure Statement published with the Endocrine Society guidelines. In an interview, he said that working for Quest for four decades – he's currently paying $ 1,000 a month – has not affected his medical advice. "I do not get any extra money when they sell a test or a billion," Holick said.

A Quest spokeswoman, Wendy Bost, said the company is seeking the advice of a number of expert advisors. "We firmly believe that working with the best experts in the field, be it Vitamin D or any other area, means better quality and better information for our patients as well as for our doctors," said Bost.

Holick's attorney was taken over by the wellness industry complex. Gwyneth Paltrow's website, Goop, cites his writing. Dr. Mehmet Oz described vitamin D as "the # 1 you need more" and told his listeners that it can help prevent heart disease, depression, weight gain, memory loss, and cancer. And the Oprah Winfrey website tells readers that "knowing your vitamin D levels could save your life." Mainstream doctors have pushed the hormone, including Dr. Walter Willett, a widely respected professor at Harvard Medical School.

Today, seven years after the head of the report of the National Academy fighting for the call for more sunshine pills.

"There is no pandemic," A. Catharine Ross, a professor at Penn State and chairwoman of the committee that wrote the report, said in an interview. "There is no widespread problem."

Links to druggists and tanning salons

In "The Vitamin D Solution" Holick describes his promotion of vitamin D as a lonely crusade. "Pharmaceutical companies can sell fear," he writes, "but they can not sell sunlight, so there's no promotion of sunshine."

But Holick also has extensive financial ties to the pharmaceutical industry. From 2013 to 2017, he received nearly $ 163,000 from pharmaceutical companies, according to Medicare's Open Payments database, which tracks payments from drug and device manufacturers. The paying companies included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes anti-hormonal drugs that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corp., both conducting vitamin D testing

The database contains only payments made since 2013, but Holick's review of compensation by pharmaceutical companies. In his book of 2010, he describes the visit to South Africa as "giving lectures to a pharmaceutical company" whose president and CEO were in the audience.

Holick's ties to the tannery have also attracted attention. Although Holick said he does not support tanning, he has described tanning beds as a "recommended source" for vitamin D when used in moderation. "

Holick has accepted funding from the UV Foundation – a non-profit arm of the now-defunct Indoor Tanning Association – which provided $ 150,000 to the University of Boston from 2004 to 2006 for Holick's research. The International Agency for Research on Cancer classified tanning beds as carcinogenic in 2009.

In 2004, the associations of the tanning industry Barbara Gilchrest, then director of the Department of Dermatology, Boston University, was moving Holick to step down from the department. He did so, but remains professor at the medical faculty of the Department of Endocrinology, Diabetes and Nutrition and Weight Management.

In "The Vitamin D Solution", Holick wrote that he was "forced" to give up his position because of his "Consistent support for sensible sun exposure." He added, "Shame on me for contesting one of the dermatology dogmas."

Although Holick's website lists him as a member of the American Academy of Dermatology, an Academy Member, Amanda Jacobs, is not a current member.

Dr. Christopher McCartney, chair of the Endocrine Society's Clinical Guidelines Subcommittee, said the company had introduced stricter conflict of interest policies since the Vitamin D Guidelines were released. The current policy of the Society would not allow the Chairman of the Policy Writing Committee any financial conflicts.

A miracle pill loses its luster

Enthusiasm for vitamin D among medical professionals has diminished in recent years, as rigorous clinical studies have shown, to corroborate the benefits suggested by early, preliminary studies. A number of studies have found no evidence that vitamin D reduces the risk of cancer, heart disease or falls in the elderly. And most scientists say that there is not enough evidence to know if vitamin D can prevent non-bone-related chronic diseases.

Although the amount of vitamin D in a typical daily supplement is generally considered safe, it is possible to take too much. In 2015, an article in the American Journal of Medicine linked blood levels as low as 50 nanograms per milliliter with an increased risk of death.

Some researchers say vitamin D may never have been the miracle pill it seemed to be. Sick people who stay indoors tend to have low vitamin D levels; Her poor health is probably the cause of her low vitamin D level, not the other way around, Dr. JoAnn Manson, Chief of Preventive Medicine at Brigham and Women's Hospital in Boston. Only truly rigorous studies that randomly engage some patients with vitamin D and others with placebo can provide definitive answers to vitamin D and health. Manson leads such a study of 26,000 adults, which is expected to be published in November.

A number of insurers and health professionals have begun to see widespread vitamin D testing as unnecessary and expensive. In 2014, the US Preventive Services Task Force announced that there is not enough evidence for or against routine vitamin D screening. In April, the Task Force explicitly recommended that older adults outside nursing homes should avoid taking vitamin D supplements to prevent falls.

In 2015, Excellus BlueCross BlueShield released an analysis demonstrating the overuse of vitamin D testing. In 2014, the insurer spent $ 33 million on 641,000 vitamin D tests. "That's an astronomical amount of money," Dr. Richard Lockwood, Vice President and Chief Medical Officer of Excellus for Usage Management. More than 40 percent of the tested Excellus patients had no medical reason to be screened.

Despite efforts by Excellus to curb the tests, the use of vitamin D has remained high, Lockwood said. "It's very hard to change habits," he said. "The medical community is not much different from the rest of the world, and we're getting into fads."

Kaiser Health News is a national health news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not associated with Kaiser Permanente.


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