Tuesday, August 12, 2008

Media's Medicines

August 12, 2008, 8:10 a.m.

[Note: The "Sexual Assault Update," July 19-August 8, 2008, blog entry remains at its former location; however, any updates to it following August 8, 2008, will be found, along with the blog entry as of August 8, at a new Web site, Nicholas Johnson, "University of Iowa Sexual Assault Controversy -- 2007-08."]

Practicing Medicine with an FCC Broadcasting License

Are broadcasters practicing medicine -- or at least undercutting our family physicians ability to do so?

I found a report on last evening's [August 11] "ABC World News with Charles Gibson" a little troubling.

Unfortunately, I cannot now find a link to a transcript or video of what ABC's Dr. Tim Johnson said. But in some ways that helps to make my point. [I subsequently (Aug. 14 9:00 p.m.) found this ABC Audio feed interview with Dr. Tim Johnson that is comparable. He repeats that he's now added a 1000 IU dose to his former 400 IU of vitamin D; he goes on to say that there's no evidence doses in that range and higher cause any harm; and he says nothing about the adverse effects of doses of 2000 IU and above reported by the Mayo site, referenced below.]

Unless we TiVo or tape the TV news, days or even minutes later we have little but faintly recalled impressions to draw upon regarding what we learned; impressions created from moving images (more than the voice over) and however much attention we were paying at the time.

TV news may not be a very efficient, or safe, way of communicating information that matters. In fact a Pew study revealed that the more TV news viewers watched the more likely it was they would be misinformed regarding such things as whether the 9/11 terrorists had come from Iraq, and whether we'd actually found weapons of mass destruction there.

Dr. Johnson was reporting on new studies revealing that some of us, some of the time, have inadequate levels of vitamin D. The more shocking and attention-grabbing suggestion was that, as a result, we were more likely to die.

So what was he, personally, doing with this information? Although he was formerly taking a multi-vitamin with the standard 400 IU of vitamin D he was now, as a result of these studies, adding an additional 1000 IU to his daily intake.

So what's wrong with that?

What's wrong with it is an application of my late friend, Molly Ivins', insight that her fellow Texans are a people who believe "that more is better, and too much is not enough."

While that observation related to conspicuous consumption generally, especially of hard goods, it is applicable beyond the borders of Texas, automobiles, houses and jewelry.

How many Americans are today buying up vitamin D capsules, hoping that if 1400 IU will keep Dr. Tim Johnson from dying, just to be safe they're going to start taking 5000-25000 IU a day?

To the best of my recollection, during the TV news broadcast there was no effort to explain the many limitations on the studies' findings, or even more significantly the very serious harms that can come from taking excessive dosages of vitamin D.

And yet, as the Mayo Clinic's online resource points out,

"Vitamin D is an essential nutrient for your entire body. Still, it's possible to have too much of a good thing. . . . You're unlikely to get too much vitamin D from the food you eat, and prolonged sun exposure doesn't seem to cause vitamin D toxicity. Over time, however, megadoses of vitamin D supplements can cause nausea, vomiting, poor appetite, constipation, weakness and weight loss. More seriously, excessive doses of vitamin D can raise the level of calcium in your blood — which can cause confusion and changes in heart rhythm. Generally, the upper limit for vitamin D is 2,000 IU a day."

Katherine Zeratsky, "Vitamin D: How much is too much? Is it possible to take too much vitamin D? I know vitamin D is important, but I wonder if too much is dangerous?" MayoClinic.com, July 25, 2008.

It's true that sunscreen reduces your skin's ability to make vitamin D from sunlight. But sunscreen also reduces the likelihood of your getting the skin cancer called melanoma -- which, if you're interested in long life, has the possibility of shortening rather than lengthening it. Some may react to Dr. Johnson's comments by risking sunburn (not to mention skin cancer) in their rush to grab as many unscreened rays as possible before school starts -- convinced that tans are now good for you because they are a source of vitamin D.

The power of the Internet is such that it has turned all other media -- radio, television, newspapers, magazines, billboards -- into advertisements for itself, efforts to direct readers and viewers to Web sites. That's where you are sent to see the company's full catalog, T. Boone Pickens' energy plan, the continuing conversation in the ABC "This Week" green room, the online store from which you can order and pay for the advertised product.

And so it is with ABC News. And in fairness, its full-length, online report on the vitamin D studies is relatively full and balanced, complete with scientists' skepticism and warnings. Joseph Brownstein, "'Sunshine Vitamin' May Cut Death Risk; Vitamin D Appears to Cut Risk of Dying Early; Exact Mechanism Remains Unclear," ABC News Medical Unit, abcnews.com, August 12, 2008.

[T]he study's researchers and others were quick to say that the study provides absolutely no evidence for now that taking vitamin D can reduce the risk of heart disease.

"Before we tell all Americans out there that this will definitely prevent heart attack, we need some clinical trials," Michos said.

Some took it a step further and questioned whether low vitamin D levels can even be considered a risk factor at all at this point.

"A relative increase in risk of death of 26 percent is not trivial, but not huge, either," said Dr. David Katz, director of the prevention research center at Yale University School of Medicine.

"Consider that being physically active, not smoking, and eating well could reduce the risk of premature death by as much as 80 percent," said Katz. "We would not want people to get the impression that a vitamin D supplement is a panacea. The findings are by no means that significant."

Others strongly agreed.

"It can't be considered a risk factor with the strength of cholesterol and hypertension until further studies are done," said Dr. Melvyn Rubenfire, the director of preventive cardiology at the University of Michigan. . . .

Dr. James O'Keefe, a cardiologist at the Mid America Heart Institute in Kansas City, Mo., . . . noted that the latest study's findings were unclear because many of the risk factors for heart disease, like obesity, can actually cause a deficiency in vitamin D. So, it may be a marker rather than an agent.
Of course, however much harm can be done by inaccurate, or inadequate, journalistic reports of medical studies, they pale by comparison with the potential harm from the broadcast of pharmaceutical companies advertising of "illegal drugs."

Why do I call them illegal drugs? Because it is against the law for TV viewers to buy the product being advertised. They are not over-the-counter medicines. They are medicines that, by law, can only be authorized for purchase by physicians. So what it the purpose of the commercials? To encourage us to put pressure on our doctors to give us prescriptions for the advertised drugs. And the commercials work.

Moreover, to the extent the effect of this aspect of broadcasting is that we are taking medicines that may be at best unnecessary for our conditions, and at worst actually harmful, it is the result of deliberately manipulative presentations, drawing on all that is known about the psychological and emotional promotion of sales, as applied by America's most professionally skillful advertising agencies. Journalists may be simply not fully informed, or not given sufficient time (or space) to tell the full story. Pharmaceutical companies' presentations are focused on one goal only: an increase in sales. "Broadcast and print advertisements accounted for some 94 percent of the $4.2 billion spent in 2005 on direct-to-consumer drug ads, according to a recent report by the federal Government Accountability Office. It said that such ads are increasing each year by about 20 percent a year, and officials say the spots are working, increasing profits of drug companies . . .." Bill Hendrick, "Self diagnosis from TV drug ads can be dangerous," Atlanta Journal-Constitution, January 8, 2007.

As a former FCC commissioner I can assure you, whatever Congress originally authorized the Commission's broadcast licenses to permit broadcasters to do, it never intended them to be a license to practice medicine.

Taking excessive quantities of most vitamins only results in a waste of your money as you transfer most of them directly into your local sewer system.

Not so with vitamins A and D.

Before you are swept away with enthusiasm for excessive doses of vitamin D in your quest for life everlasting I'd recommend you see your doctor.

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