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Lack of evidence for benefit of multivitamins
Editorial
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Lack of evidence for benefit of multivitamins
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
For the draft statement on multivitamin/mineral use released by NIH panel see http://consensus.nih.gov.
A panel convened by the US National Institutes of Health concluded last week that there is insufficient evidence to either support or advise against the use of multivitamin and mineral supplements in the general population to prevent chronic diseases. After review of studies of supplements containing three or more vitamins and minerals (without herbs, hormones, or drugs), the panel emphasised the need for rigorous randomised trials to test the efficacy and safety of individual supplements in the prevention of chronic diseases such as cancer; age-related sensory loss; and cardiovascular, endocrine, neurological, musculoskeletal, gastroenterological, renal, and pulmonary diseases. Given the potential risks of multivitamin and mineral consumption, and the limited efficacy data, the panel called for increased regulation of these supplements by the Food and Drug Administration. More than half of American adults take a dietary supplement, mostly multivitamins and minerals, at a cost
of US$23 billion a year. In addition, 65% of Americans take foods or drinks fortified by vitamins and minerals, in a market worth $36 billion. Meanwhile, the European Parliament has agreed to harmonise divergent national rules on which vitamins and minerals can be added to foods, and has also approved tougher legislation on food labelling so that consumers are better informed about the nutritional value of foods. Consumers need to know about the supplements and foods they choose to buy. But there is a clear role for informed medical advice to patients here too. Doctors can do more to advise their patients on nutrition, including providing evidence-based information on multivitamin and mineral supplements. First, though, nutrition needs to take a more prominent place in medical school curricula. With the obesity epidemic escalating, and its resultant impact on chronic diseases, doctors must tackle their patients not only about how much they eat, but also what they eat. Q The Lancet
Remembering Dr Lee
See also Online/Obituary DOI:10.1016/S01406736(06)68741-2
1704
Editors at The Lancet this week mourn the unexpected death of Dr Lee Jong-wook, Director-General of WHO. He passed away peacefully on May 22, having suffered a subdural haematoma only 2 days before. Dr Lee brought change and challenge to WHO during his all too brief tenure as its leader (he was elected Director-General in 2003). His predecessor, Gro Harlem Brundtland, successfully upgraded WHO’s strategic mission by aligning its work with broader global political commitments to human development—specifically, the Millennium Development Goals. Dr Lee energetically set about creating a tactical plan to deliver tangible results on these pledges. He took risks. His signature initiative was “3 by 5”: providing 3 million people living with HIV/AIDS with antiretroviral drugs by the end of 2005. The target was missed. But the weight of WHO’s advocacy, the personal commitment of Dr Lee, made access to medicines a serious political objective, not merely an idealistic clarion call from activists. He also listened. Early on in his tenure, he met with a group of publichealth scientists at the London School of Hygiene and Tropical Medicine. What he heard there, and what he
took from many similar meetings around the world, was woven into a series of science-driven public-health initiatives that have done much to sharpen the agency’s focus and to renew its public-health origins. In particular, we pay tribute to his emphasis on child and newborn survival, maternal health, chronic diseases, the social determinants of health, health-systems strengthening, clinical trials registration, surveillance of emerging infections, rebuilding the world’s response to malaria and tuberculosis, and the standards of scientific evidence that should be applied by WHO. But what The Lancet will remember is the man. Dr Lee opened WHO to partnerships and collaborations based on trust, respect, and common purpose. He embraced all those who supported the broad goals of WHO with a warm smile and a welcome hand. He was quick to offer support to those projects that he knew instinctively to be right. He did not hide behind policy advisors or press officers. He was a moral man. He even replied, occasionally, to emails. The Lancet will miss Dr Lee. We celebrate his life and his commitment to improving the health of the world’s least advantaged peoples. Q The Lancet www.thelancet.com Vol 367 May 27, 2006
Getty Images
Lack of evidence for benefit of multivitamins
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
For the draft statement on multivitamin/mineral use released by NIH panel see http://consensus.nih.gov.
A panel convened by the US National Institutes of Health concluded last week that there is insufficient evidence to either support or advise against the use of multivitamin and mineral supplements in the general population to prevent chronic diseases. After review of studies of supplements containing three or more vitamins and minerals (without herbs, hormones, or drugs), the panel emphasised the need for rigorous randomised trials to test the efficacy and safety of individual supplements in the prevention of chronic diseases such as cancer; age-related sensory loss; and cardiovascular, endocrine, neurological, musculoskeletal, gastroenterological, renal, and pulmonary diseases. Given the potential risks of multivitamin and mineral consumption, and the limited efficacy data, the panel called for increased regulation of these supplements by the Food and Drug Administration. More than half of American adults take a dietary supplement, mostly multivitamins and minerals, at a cost
of US$23 billion a year. In addition, 65% of Americans take foods or drinks fortified by vitamins and minerals, in a market worth $36 billion. Meanwhile, the European Parliament has agreed to harmonise divergent national rules on which vitamins and minerals can be added to foods, and has also approved tougher legislation on food labelling so that consumers are better informed about the nutritional value of foods. Consumers need to know about the supplements and foods they choose to buy. But there is a clear role for informed medical advice to patients here too. Doctors can do more to advise their patients on nutrition, including providing evidence-based information on multivitamin and mineral supplements. First, though, nutrition needs to take a more prominent place in medical school curricula. With the obesity epidemic escalating, and its resultant impact on chronic diseases, doctors must tackle their patients not only about how much they eat, but also what they eat. Q The Lancet
Remembering Dr Lee
See also Online/Obituary DOI:10.1016/S01406736(06)68741-2
1704
Editors at The Lancet this week mourn the unexpected death of Dr Lee Jong-wook, Director-General of WHO. He passed away peacefully on May 22, having suffered a subdural haematoma only 2 days before. Dr Lee brought change and challenge to WHO during his all too brief tenure as its leader (he was elected Director-General in 2003). His predecessor, Gro Harlem Brundtland, successfully upgraded WHO’s strategic mission by aligning its work with broader global political commitments to human development—specifically, the Millennium Development Goals. Dr Lee energetically set about creating a tactical plan to deliver tangible results on these pledges. He took risks. His signature initiative was “3 by 5”: providing 3 million people living with HIV/AIDS with antiretroviral drugs by the end of 2005. The target was missed. But the weight of WHO’s advocacy, the personal commitment of Dr Lee, made access to medicines a serious political objective, not merely an idealistic clarion call from activists. He also listened. Early on in his tenure, he met with a group of publichealth scientists at the London School of Hygiene and Tropical Medicine. What he heard there, and what he
took from many similar meetings around the world, was woven into a series of science-driven public-health initiatives that have done much to sharpen the agency’s focus and to renew its public-health origins. In particular, we pay tribute to his emphasis on child and newborn survival, maternal health, chronic diseases, the social determinants of health, health-systems strengthening, clinical trials registration, surveillance of emerging infections, rebuilding the world’s response to malaria and tuberculosis, and the standards of scientific evidence that should be applied by WHO. But what The Lancet will remember is the man. Dr Lee opened WHO to partnerships and collaborations based on trust, respect, and common purpose. He embraced all those who supported the broad goals of WHO with a warm smile and a welcome hand. He was quick to offer support to those projects that he knew instinctively to be right. He did not hide behind policy advisors or press officers. He was a moral man. He even replied, occasionally, to emails. The Lancet will miss Dr Lee. We celebrate his life and his commitment to improving the health of the world’s least advantaged peoples. Q The Lancet www.thelancet.com Vol 367 May 27, 2006