Supplements for cardiovascular diseases – more evidence that they don’t work

supplements for cardiovascular diseases

I have been skeptical of supplements for a long time – not because I have some predisposition against them. My skepticism results from the relative lack of any robust evidence that supplements have any positive effect on human health other than in unique situations of chronic diseases or malnutrition. In fact, most of the high-quality evidence about supplements show that it does not work. And a recently published review shows that using supplements for cardiovascular diseases are expensive and useless.

Since many readers fail to read what I wrote above, let me repeat myself for clarity. Supplements are not completely useless – of course, they are important for those who have chronic diseases or conditions may require supplements of some or many micronutrients. Someone who has had bariatric surgery or other types of serious gastrointestinal surgery may not be able to consume enough vitamins and minerals from food, and they will require multivitamins.

Also, some individuals may be malnourished, which doesn’t mean just not eating enough, but not eating some foods that have specific nutrients. For example, avoiding certain foods that contain vitamin C could put you at risk for a disease called scurvy, which can be deadly. There are several other diseases that result from missing key nutrients. However, in the modern developed world, these diseases are extremely rare because of the varied diet we have – and the availability of supplements to treat those diseases.

However, several points have got to be made. Just because vitamin C can treat scurvy doesn’t mean that more vitamin C makes your immune system suddenly powerful enough to destroy the common cold or flu or cure cancer. Vitamin D, although there are many cases of deficiency in many countries, is not a miracle supplement. It cannot cure or prevent cancer. It does not impart superpower abilities to your immune system.

The whole supplement industry has an overreliance on logical fallacies (like appeal to popular belief or appeal antiquity) or anecdotes (which aren’t data) to convince customers to buy their nonsense. They do this because they are not required to undergo gold-standard clinical trials to convince the FDA to approve their claims. Real pharmaceuticals, on the other hand, take 10-20 years of research and clinical trials before they are approved for use.

Big Supplement (yeah, it’s a huge industry, over US$100 billion annually, worldwide) also pushes the trope that if a little helps, a lot is better. This is not good science. The millions of years of human evolution (following up a billion years of immune system evolution) has led to a rather powerful immune system that is exceedingly complex and has always been able to do its job without the addition of supplements (unless early Homo sapiens had access to a GNC someplace).

But let’s take a look at supplements for cardiovascular diseases (stroke, heart attacks, and other cardiovascular conditions) – a new review shows us, once again, that there’s nothing there. Continue reading “Supplements for cardiovascular diseases – more evidence that they don’t work”

Omega-3 supplements have little effect on cardiovascular disease and mortality

omega-3 supplements

I have been skeptical of supplements for a long period of time. Supplements are generally of low quality, they don’t prevent or cure cancer, they don’t prevent colds, they can’t boost the immune system, and they don’t prevent heart disease. Now there is a powerful review of omega-3 supplements that shows that it has little effect on cardiovascular disease.

Unless one has a chronic disease or is chronically malnourished, there are precious few instances where supplements are necessary. A couple of cases where supplements may be critical include prenatal folic acid supplements to prevent neurological defects in the developing fetus, vitamin C to prevent scurvy, and vitamin D supplements for individuals who do not produce enough endogenous vitamin D. In each of these cases, however, supplements are necessary to counteract a micronutrient deficiency that results from a chronic deficiency in the diet.

The benefits of omega-3 supplements have always been intriguing to me because it is a supplement that I thought might be useful for improving cardiovascular health. But as I reviewed before, the evidence seemed awfully weak. With this new study, there may be no evidence whatsoever supporting the use of omega-3 supplements, at least for cardiovascular disease. Continue reading “Omega-3 supplements have little effect on cardiovascular disease and mortality”

Andrew Wakefield and Elle Macpherson – woo attracts woo while we laugh

Andrew Wakefield and Elle Macpherson

Celebrity romances rank with soccer, Game of Thrones, and iPhone vs. Android as the things I couldn’t care less about. I wouldn’t know anything about anyone. But, there are exceptions, like when the USA is actually in the World Cup. When I see stories about Andrew Wakefield and Elle Macpherson, I cannot stop myself. I have to read about it, and I have to make fun of it.

Now, most of us know all about one of the greatest scientific frauds of the past 100 years – Mr. Andrew Wakefield and his false, and ultimately retracted, claims that somehow the MMR vaccine was linked to autism spectrum disorder. Of course, there is a mountain of affirmative evidence that has refuted the claim of a link between the vaccine and autism. That’s settled science, except, of course, in the minds of Wakefield sycophants who believe otherwise.  Continue reading “Andrew Wakefield and Elle Macpherson – woo attracts woo while we laugh”

“Bad Advice” by Paul Offit – a book review by Dorit Rubinstein Reiss

Bad Advice

A new book, “Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Informationby Dr. Paul Offit, is different from his previous writings in two ways – much of it is autobiographical, with a lot of personal anecdotes, and it is about science communication rather than the actual science.

“Bad Advice” opens with a story of a 1997 TV interview Dr. Offit has, and how he bungled – by his account – a question about which vaccines children get, how many, and when. The story sets the tone for the book – it’s funny, it’s candid about what Dr. Offit did, in his view, wrong, and it offers sound advice for other science communicators.

To a large extent, this book was written for those engaged in science communication, and it is full of tips that can help every current or would-be science communicator.

What gives the book its charms are the anecdotes and the humor sprinkled throughout it, and its accessible and conversational tone, but I don’t think I can mirror that here without spoiling the effect – I think these are best enjoyed in context. So this review describes the content but does not capture what makes “Bad Advice” so much fun.

For full disclosure, I highly admire Dr. Offit, have sought his advice and help on many issues in my writing on and advocacy related to vaccines, and consider him a personal friend. I have also read a draft of the book and provided comments. 

Why Science Communication?

The first three chapters of “Bad Advice” provide important background by explaining why science communication is needed, and some of the obstacles to it. 

The first two chapters of the book set out what science is and what scientists do, and why their training and background make it difficult for them to be effective science communicators. Among the things covered – again, with a lot of humor, humility, and personal anecdotes – are that much of the scientific work is done alone, and much of what it requires makes people less, rather than more, suited to work with people. 

Dr. Offit discusses the fact that the scientific method trains scientists away from using absolute statements, but qualified statements can backfire when communicating about science; the challenge of reducing complex, nuanced reality into sound bites that work in a digital age; and more.

The next chapter analyzes why we need science communication, why people – however smart – may fall for misinformation. It looks at several natural, human features that make us easily wrong on scientific issues. “Bad Advice” also examines our difficulty identifying and assessing risks, the pull of celebrities as authority figures, even though they may not have the background to provide good information, and may, in fact, promote bad information (for example, Robert F. Kennedy Jr.  – revisited later in the book – constantly provides bad information about vaccines  ). The chapter also talks about other limits on the ability of humans to think rationally and the ways we acquire knowledge.

After thus setting the stage for why it’s important to engage in science communication and some of the challenges, Dr. Offit is ready for the next stage.

Good advice vs bad advice

Chapters 4 through 7 offer direct advice on communications through personal anecdotes of things that worked and things that didn’t in Dr. Offit’s over 20 years of doing it.

In chapter 4, Dr. Offit offers “some painful, hard-earned, and occasionally humorous lessons gleaned from personal experience” on communicating with the public. These range from the deeply practical (“be comfortable”) to the content based (“be sympathetic,” in the context of an eleven-year-old diagnosed with AIDS at the time when HIV was a death sentence, and “Don’t panic.

The facts are your safety net.”). But they’re invariably written as amusing anecdotes leading to a useful punchline. In one of the stories, Dr. Offit describes how he arrived at the famous “10,000 vaccines” quote that anti-vaccine activists like to misuse. The punchline? “You are going to say things that, although scientifically accurate, you will regret. It’s unavoidable.”

Chapter five addresses whether it’s appropriate for scientists to debate science deniers, using several examples. Dr. Offit’s recommendation is to avoid it, but he does provide three successful examples of such debates. His conclusion is that he, personally, is too angry and passionate on vaccine issues to successfully participate – because he annually sees children die from preventable diseases, “invariably, .. because parents have chosen not to vaccinate their children. And the reason they had made that choice was that they had read or heard bad information..”

Bad Advice ends with a recommendation that “debating the undebatable is worthwhile,” if, and only if, scientists can see the discussion as a teachable moment, and not focus on the people they are debating or the others in the room.

I’m not sure I agree, at least in terms of a televised debate. I think Dr. David Gorski said it well when he wrote:

…debating cranks doesn’t sway anyone, sharing the stage with a real scientist does unduly elevate the crank in the eyes of the public. Besides, whatever the seeming outcome of the debate, you can count on the crank to declare victory and his believers to agree. In any event, science isn’t decided by the metrics used to judge who “wins” a public debate, which rely more on rhetoric and cleverness rather than science to decide the outcome. Finally, such debates are not without risks. Although Julian Whitaker, for example, was terrible at it, other cranks are adept at the Gish Gallop, and an unprepared skeptic or scientist can be made to appear clueless in front of a crowd that is almost always packed with supporters of the crank, not the skeptic.

I think I agree with Dr. Offit’s initial position that agreeing to a debate is a bad idea.

Chapter six looks at the role of comedians in combating misinformation about science, focusing on vaccines – covering the Penn and Teller episode, Jimmy Kimmel, the Daily Show and the Colbert Report. And I’m really going to let you read that by yourselves. It’s fun.

Chapter seven looks at the ways the cinema helps or harms science communication. It opens by comparing two films about outbreaks – “Contagion,” that got the science right, and “Outbreak,” that did not. To give a flavor, when talking about “Outbreak,” Dr. Offit describes how a monkey carrying the harmful virus was caught, and the movie scientists had to “determine which antibodies are neutralizing the mutant virus, synthesize those antibodies, and make several liters of life-saving antisera. Assuming everything goes well, Hoffman’s task should take about a year. Cuba Gooding Jr. does it in a little less than a minute. (Now I understand why people are angry that we still don’t have an AIDS vaccine.).”

Nonetheless, Dr. Offit sees an important role for movies in science communications, and urge scientists to work with filmmakers to get it right.

Science communication in action – confronting the anti-vaccine movement:

The last part of the book uses the anti-vaccine movement as a story of the pitfalls and successes of science communication.

Chapter 8 of “Bad Advice” looks at how charismatic figures can promote anti-science misinformation. Although it covers several examples, the heart of the chapter is the case of Andrew Wakefield, the British doctor who promoted misinformation about MMR. Dr. Offit tells the dramatic story of Wakefield’s rise, the scientific literature that showed him wrong, and the discovery of his misdeeds, that led to his fall. He describes Wakefield’s situation today – thoroughly discredited, on par with other conspiracy theorists – through his participation in the infamous Conspirasea Cruise.  The end of the chapter examines different explanations for why Wakefield sticks to his original claims, years after they’ve been thoroughly disproven. I’ll let you find out yourselves. It’s not exactly flattering to Wakefield, though. 

Chapter 9 looks at the role of politicians in promoting anti-science misinformation, focusing on Dan Burton’s hearings that tried to make a case that vaccines cause autism (YouTube snippets of the hearings, out of context, are still used by anti-vaccine activists. Dr. Offit will give you a more comprehensive view). Dr. Offit also tells of his own experience in the hearing, and what he sees as errors committed because of his naiveté and inexperience. It’s half sad and half comical to read through both his preparation for the hearing, and the actual experience of Mr. Burton, who came into the hearing with a set conclusion and a set role he wanted Dr. Offit to play, trying to delegitimize him. 

Chapter 10 warns science communicators to expect a campaign of personal delegitimization and attacks, drawing on Dr. Offit’s own extensive experiences with anti-vaccine efforts to attack him. It goes from hateful emails, through lawsuits, to death threats. It’s painful but incredibly important for people who go into these areas to be prepared for the ugly reaction from misguided but passionate people on the other side, in all its extreme forms. 

Chapter 11 goes more deeply into Dr. Offit’s own reasons for entering the fray. It is very autobiographical (some of the events in it were described in some of Dr. Offit’s other books, but many will be new to readers), telling his career story – again, with lots of humor, more than a few lumps. This is to explain what motivates him to speak up, and to some degree, to counter the claims accusing him of having a conflict of interests because of his involvement in the creation of the rotavirus vaccine. It’s a powerful chapter.

Chapter 12 ends on an optimistic note, pointing out things that have improved in the war for science – the rise of science bloggers, the better attitude of the media. And in the epilogue, Dr. Offit ends with the March of Science, as an embodiment of the willingness of science supporters to fight back.


In this very autobiographical, often humorous, extremely candid and full of good advice book, Dr. Offit does a service to science communicators by telling them what worked, what didn’t, and some thoughts on what comes next. You may not always agree with his advice, but you are very likely to agree with large parts of it, think about much of it, and enjoy the way it’s delivered. It’s a very fast read, and worth reading and probably rereading. And rereading.

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Celiac disease is not caused by modern wheat, despite internet claims

celiac disease

Although this blog focuses on vaccines, there are really so many myths and tropes on the internet that are based on the misunderstanding of science, on pseudoscience, or just plain ignorance. One of those myths is that human meddling in plant genetics, which led to modern wheat, is the root cause of all gluten sensitivity, including celiac disease.

Of course, the quack medicine world has vastly overrated the “dangers” of gluten – those with real gluten issues, with properly diagnosed celiac disease and wheat allergies, represent less than 1% of the population. The internet quacks also have no understanding of real gluten sensitivity – it’s an on/off switch. With some relatively rare exceptions, gluten causes significant symptoms in those with gluten sensitivity, not vague feelings. And there’s no dose-response curve – a tiny amount has almost the same effect as a large amount of gluten.

Although I doubt it will have any effect on these anti-gluten food fads, a new peer-reviewed paper in a respected journal clear shows that that modern wheat is not responsible for celiac disease. Gluten from 2018 probably is the same as the gluten in wheat when it was first domesticated 12,000 years ago.

Let’s take a look at celiac disease, wheat, gluten, and the paper. I hope it makes sense. Continue reading “Celiac disease is not caused by modern wheat, despite internet claims”

Dietary supplements make costly urine – not helpful for CVD

dietary supplements

I have never been a fan of dietary supplements pushed by Big Supplement, the less regulated, less evidence-based, more pseudoscientific mirror image of Big Pharma. Recently, a meta-review published in a respected journal examined whether there were any causal links between various dietary supplements and cardiovascular disease (CVD). They only found one, folic acid, that might have an effect on CVD, but, in that case, causality might not be so clear.

Just to be perfectly clear, no one on the side of real science-based medicine would dismiss using dietary supplements to treat chronic medical conditions. Many people have had surgeries, illnesses, and other medical conditions where certain supplements are necessary for the patient to survive. But these are highly specific requirements, not general quack claims that taking supplements will somehow miraculously treat colds and flues, prevent cancer, or some other nonsense.

Essentially, if you’re taking dietary supplements for no medical reason other than you believe it makes you healthier, let’s stick to facts – all that you are doing is having your kidneys create some very costly urine. Human physiology, based on a couple of billion years of evolution, automatically regulates its needs for micronutrients – excess amounts do not stick around to make you healthier, it just becomes a component of your pee.

It’s time to take a look at this article about dietary supplements and cardiovascular disease. Maybe I’ll convince you to save some money each month, and spend it on something like investing in a better diet. Continue reading “Dietary supplements make costly urine – not helpful for CVD”

How to prevent cancer in 12 easy steps – vaccines are critically important

how to prevent cancer

I have railed against pseudoscientific charlatans who claim that they have the easy way to prevent or cure cancer. Generally, these snake oil salesmen try to convince you that they have some miraculous food, supplement, spiritual energy, and on and on, that can either kill cancer in its tracks or keep them from even growing in your body. Of course, none of their claims are actually supported by robust science. On the other hand, real science has 12 evidence-based methods to actually prevent cancer.

But what about those memes that say that supplements prevent cancer? Nope, they don’t. And that’s been shown in study after study after study after study (yeah, I could go on for awhile).

What about avoiding GMO foods because they cause cancer? Again, studies show that GMO foods have no effect on cancers. Oh, one more thing – bananas don’t have tumor necrosis factor, and the yellow fruit can’t prevent or cure cancer (but that doesn’t mean that they aren’t delicious).

Despite the absolute lack of evidence that supplements, kale, bananas, or drinking the pure waters of a glacial fed stream (which may not be an option with climate change), there are only a few things that can be done to manage your overall risk of cancer.

How to prevent cancer has been codified by the World Health Organization’s  (WHO) International Agency for Research on Cancer (IARC) into 12 steps (no, not that debunked one) that are called the European Code Against Cancer.

Let’s look at cancer and how to prevent cancer.

Continue reading “How to prevent cancer in 12 easy steps – vaccines are critically important”

20th anniversary of the Andrew Wakefield vaccine fraud – no celebrations

andrew wakefield

I’m a couple of months late with this article because of life and reasons, but a bit over 20 years ago, in February 1998, Andrew Wakefield published his infamous article in Lancet, which was eventually retracted in 2010. He stated that “onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella (MMR) vaccination in eight of the 12 children.” Because Wakefield claimed that most of the behavioral problems were autism, that became the rallying cry of the anti-vaccine religion for the past 20 years – the MMR vaccine, if not all vaccines, cause autism.

I actually remember getting that particular issue of Lancet 20 years ago, and I ran across that article. My first thought was, “why in hell would Lancet publish such a troublesome article with just 12 freaking (not the word I used) data points.” Then I wondered who that Wakefield character was – was he an expert on vaccines and childhood behavioral issues? Well, the internet in 1998 didn’t have search engines like we do today, so finding out anything about Andrew Wakefield was difficult at best. I just assumed that if the Lancet, one of the top medical journals in the world, published it, Wakefield must have some level of respect.

Even though the internet was as much a bastion of pseudoscience and conspiracists as it is now, you would never “do your research” on the internet. But our local newspaper had a blurb about the Wakefield study in a Sunday health section, and my wife read the article. She got panicked that our two young daughters, who were having upcoming MMR vaccines, would become autistic. That was my first experience in having to defend vaccines against nonsense (don’t tell my wife I called her worries were nonsense).

My daughters eventually got that vaccine (and received all subsequent vaccines up to and including the HPV vaccine), although even I monitored my children for a few weeks for any behavioral changes. Knowing what I know now, I should have just a fun dad, but I admit to worrying.

Let’s remind everyone about the frauds and lies of Andrew Wakefield because it has led to the return of vaccine-preventable diseases. Continue reading “20th anniversary of the Andrew Wakefield vaccine fraud – no celebrations”

Once more about Andrew Wakefield fraud extraordinaire

For the handful of you who don’t know him, MrAndrew Wakefield fraudulently alleged a connection between the MMR vaccine, for measles, mumps and rubella) and autism – this has had the effect of suppressing vaccination rates in many countries. His claims were published in a now retracted paper published in the Lancet, a mostly respected medical journal who seemed to have forgotten how to do proper peer review back in the late 1990’s. This is a quick review of the Andrew Wakefield fraud.

Dorit Rubinstein Reiss – Professor of Law at the University of California Hastings College of the Law (San Francisco, CA) – is a frequent contributor to this blog. She had posted an article that debunks the myth that Andrew Wakefield is probably innocent of all charges made against him by the UK’s General Medical Council (GMC). Basically, some of the antivaccination crowd believes that because Wakefield’s partner in the fraud, Professor John Walker-Smith, had his own decision by the GMC overturned, it is considered evidence that Andrew Wakefield was wronged when the GMC found Wakefield, too, guilty of serious ethical violations. But that would be an incorrect interpretation of the facts. Continue reading “Once more about Andrew Wakefield fraud extraordinaire”

Why do I call it the “anti-vaccine religion”? Let me explain

anti-vaccine religion

A few months ago, I started characterizing the anti-vaxxer fanatics as being members of the “anti-vaccine religion.” It wasn’t an important point to me, because as I constantly stress, the only thing that matters is scientific evidence – the vast bulk of which supports the safety and effectiveness of vaccines.

In fact, I know a lot of pro-vaccine people, many of whom are leaders in pointing out the flaws of the anti-vaccine religion, are themselves religious. I am an atheist, but I do not decide who are my friends on social media or real life, based on their religious beliefs. Since almost every major religion in the world supports vaccination, and in almost every case, strongly so,  it’s clear that organized religion and vaccines are not in conflict.

For me, “anti-vaccine religion” was a throwaway line almost tongue-in-cheek, because, from my standpoint, the group acts as if it were a religious cult. In fact, some people I know, who loathe the anti-vaccine zealots, do classify them as a cult. Anyway, of all the things I represent, my obvious pejorative use of religion ranked near the bottom of my “care” list.

Then, this:

Now that Daniel Goldman has thrown down the gauntlet, I guess I’m going to have to fully explain my impeccable (or not) logic. Because from any perspective, the anti-vaccine religion functions like a religion, in some ways, an organized one. Let me explain. Continue reading “Why do I call it the “anti-vaccine religion”? Let me explain”