MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The newest recruit to the (by now quite crowed) coronavirus bandwagon is orthomolecular medicine. In case you are unsure what hides beind this pseudoscientific name, here is a (slightly abbreviated) explanation from my book:

Orthomolecular medicine is the term for a mega-vitamin therapy coined in the 1960s by Linus Pauling (1901-1994). Pauling had two Nobel prizes to his name and was once called one of the 20 greatest scientists of all time. In 1968, he published a paper stating that the functioning of the brain is affected by the molecular concentrations of many substances that are normally present in the brain. The optimum concentrations of these substances for a person may differ greatly from the concentrations provided by his normal diet and genetic machinery. Biochemical and genetic arguments support the idea that orthomolecular therapy, the provision for the individual person of the optimum concentrations of important normal constituents of the brain, may be the preferred treatment for many mentally ill patients. It was the start of his (and the world’s) obsession with mega-doses of vitamins.

Orthomolecular medicine assumes that an optimum nutritional environment in the body is a precondition for good health and suggests that diseases reflect nutritional deficiencies. Treatment for disease, according to this view, involves the correction of imbalances or deficiencies based on individual biochemistry by use of high doses of vitamins, minerals, amino acids, trace elements and fatty acids. The assumptions of orthomolecular medicine lack biological plausibility. Although there are some encouraging reviews, no compelling evidence exists that orthomolecular treatments are clinically effective for patients who do not suffer from nutritional deficiencies. (references: see original book)

But perhaps I was too harsh in my judgement?

Perhaps there is something to orthomolecular medicine after all?

Perhaps Linus Pauling (photo) was right?

Perhaps it even helps against the coronavirus infection?

Dr. Andrew W. Saul, an international expert on vitamin therapy, says, “The coronavirus can be dramatically slowed or stopped completely with the immediate widespread use of high doses of vitamin C.” Yes, this is what proponents of orthomolecular medicine are trying to tell us. They go on to persuade the unexpecting public that:

Physicians have demonstrated the powerful antiviral action of vitamin C for decades. There has been a lack of media coverage of this effective and successful approach against viruses in general, and coronavirus in particular.

It is very important to maximize the body’s anti-oxidative capacity and natural immunity to prevent and minimize symptoms when a virus attacks the human body. The host environment is crucial. Preventing is obviously easier than treating severe illness. But treat serious illness seriously. Do not hesitate to seek medical attention. It is not an either-or choice. Vitamin C can be used right along with medicines when they are indicated.

“I have not seen any flu yet that was not cured or markedly ameliorated by massive doses of vitamin C.”
(Robert F. Cathcart, MD)

The physicians of the Orthomolecular Medicine News Service and the International Society for Orthomolecular Medicine urge a nutrient-based method to prevent or minimize symptoms for future viral infection. The following inexpensive supplemental levels are recommended for adults; for children reduce these in proportion to body weight:

  • Vitamin C: 3,000 milligrams (or more) daily, in divided doses.
  • Vitamin D3: 2,000 International Units daily. (Start with 5,000 IU/day for two weeks, then reduce to 2,000)
  • Magnesium: 400 mg daily (in citrate, malate, chelate, or chloride form)
  • Zinc: 20 mg daily
  • Selenium: 100 mcg (micrograms) daily
  • Vitamin C [1], Vitamin D [2], magnesium [3], zinc [4], and selenium [5] have been shown to strengthen the immune system against viruses.

The basis for using high doses of vitamin C to prevent and combat virus-caused illness may be traced back to vitamin C’s early success against polio, first reported in the late 1940s.[6] Many people are unaware, even surprised, to learn this. Further clinical evidence built up over the decades, leading to an anti-virus protocol published in 1980.[7]

It is important to remember that preventing and treating respiratory infections with large amounts of vitamin C is well established. Those who believe that vitamin C generally has merit, but massive doses are ineffective or somehow harmful, will do well to read the original papers for themselves. To dismiss the work of these doctors simply because they had success so long ago sidesteps a more important question: Why has the benefit of their clinical experience not been presented to the public by responsible governmental authorities, especially in the face of a viral pandemic?

____________________________________________________________________

Yes, exactly: Why has the benefit of their clinical experience not been presented to the public by responsible governmental authorities, especially in the face of a viral pandemic?

Does anyone know the answer to this question?

I suspect it goes something like this:

Their clinical experience is misleading and orthomolecular medicine is bogus.

15 Responses to ‘Orthomolecular medicine’: more quacks jump on the CORONAVIRUS bandwaggon

  • The linked article’s headline:

    People are dying needlessly of coronavirus

    This closely resembles the recent Samoan measles crisis, where quacks had the gall to blame doctors and healthcare workers for the death of dozens of children, claiming that these children were deprived of ‘lifesaving’ vitamins, and instead received only Evil vaccines. (And they even blamed the actual outbreak on those vaccines, but I digress.) These were lies packed in lies – as a) extra vitamins were distributed by health officials, and b) these vitamins hardly have any effect on the course of the disease, except in malnourished people.

    Physicians have demonstrated the powerful antiviral action of vitamin C for decades

    I very much would like to see some evidence of this. As far as I can recall, studies do show that vitamin C deficiency has all sorts of detrimental effects, including impaired immune function, but also that daily dosage in excess of 500 mg is quite useless, and does not significantly contribute to preventing viral infections. At best, taking an increased daily dose (200 mg) of vitamin C reduces the duration of a cold with perhaps one day. This is rather less impressive than the claime “powerful antiviral action”.

    Unfortunately, it still appears to be fully legal to spread myths, nonsense and lies about serious health threats, making people spend money and time on useless treatments at best, and at worst causing unnecessary sickness and death.

  • > Why has the benefit of their clinical experience not been presented to the public by responsible governmental authorities, especially in the face of a viral pandemic?

    I don’t want to take sides here… but this is the argument? What about the mentioned studies? On the one hand I see hundreds of studies about vitamin C with the earliest from 1933, on the other I see two arguments: “There is no evidence.” and “Not approved by authorities.” That’s not really how scientific arguing works. The principle of falsification means, “that for something to be scientific it must be be able to be proven false. If things are falsifiable (able to possibly be proven false) then they can be used in scientific studies and inquiry.”

    Would you be so kind and point to a study that falsifies the claims of the proponents of orthomolecular medicine, i.e. proves the uselessness of higher doses of vitamin C?

    Thank you.

    (For reference: https://www.seanet.com/~alexs/ascorbate/)

    • that’s not how science works.
      I do not make the claim that vit C cures/prevents viral infections.
      the burden of proof is with the one who makes the therapeutic claim.

      • I must agree with you. The one who makes the claim must bring proof. But are the studies about vitamin C that show successful treatment not proof, until otherwise falsified? Doesn’t that (just logically) bring the burden of proof to the other side, to bring proof that it’s not working what was initially claimed?

        At which point is a study accepted as “proof”? What’s the definition of proof in regards to scientific studies and what are these studies lacking that they are not regarded as valid scientific studies?

        Apart from that, there seem to be numerous studies made by researchers not affiliated with the proponents of orthomolecular medicine regarding viral infections, e.g. https://www.tandfonline.com/doi/full/10.1080/14787210.2020.1706483. As an example, would this study be valid?

        I’m not trying to say that one or the other group is right or wrong. Right now it’s about analyzing the discourse about these topics I find it quite interesting to see by which not quite obvious standards studies are accepted or disregarded.

        Thank you very much.

        • ” are the studies about vitamin C that show successful treatment not proof”?
          can you provide the links to some of those that, in your view, show efficacy, please?

          • Yes, here are some links to studies […] that seem to show the efficiency of high dosages of vitamin C:

            The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections, https://www.ncbi.nlm.nih.gov/pubmed/7814237

            Efficacy of Vitamin C in Reducing Duration of Severe Pneumonia in Children, https://www.journalrmc.com/volumes/1405749894.pdf

            The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections, https://www.ncbi.nlm.nih.gov/pubmed/10543583

            Vitamin C and Immune Function, https://www.ncbi.nlm.nih.gov/pubmed/29099763

            And here’s an interesting one to watch, just started:

            Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia, https://www.journalrmc.com/volumes/1405749894.pdf

            Thank you for your attention.

          • the studies you linked to are either not showing that vit C prevents or cures infections, or are not related to viral infections, or are not clinical trials at all.

          • Wilhelm,

            That’s not really how scientific arguing works. The principle of falsification means, “that for something to be scientific it must be be able to be proven false. If things are falsifiable (able to possibly be proven false) then they can be used in scientific studies and inquiry.”

            A hypothesis such as “Vitamin C is useful in the treatment of coronavirus” isn’t strictly falsifiable in the way that “swans are white” can be falsified by a trip to Australia where there are black swans with red bills.

            Unfortunately biological systems, such as the response of an infected patient, are subject to a huge range of random influences, genetic and environmental, which makes it difficult to tease out real effects from random noise. We have to resort to statistical tools to do this, though unfortunately they aren’t always applied at the design stage of a trial, which can lead to invalid results, and often the analysis of the data is carried out by people who don’t have a clear idea of what they are doing.

            Many studies looking at questions of this sort (vitamin C and coronavirus) start their analysis by assuming the null hypothesis, which is that the intervention has no effect and any differences found are due to chance. Stanadard statistical methods then give a probability of getting the results that have been found, and it that probability is low (less than 5% is a commonly used value) then the results are said to be statistically significant (though a significant effect may not be large enough to be clinically useful). Note that this is very different from saying that the results have a 95% probability of being true – the probability of this is usually much lower, requires additional information to calculate which may well not be available, and is not normally given in medical reports of this nature.

            Now let’s look at some of your links:

            The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections, https://www.ncbi.nlm.nih.gov/pubmed/7814237

            Unfortunately this only links to the abstract, and the full paper is hidden behind a paywall, so we have very little information about how the study was conducted and analysed. Even so, the authors state that the greatest effect of vitamin C was seen in subjects who had very low serum and white blood cell vitamin C levels. This suggests that what they were treating was vitamin C deficiency in these patients, which is quite a common problem in elderly individuals who don’t eat enough fresh fruit and vegetables. From this it might seem a reasonable idea to administer supplemental doses of vitamin C to elderly hospitalised patients, but it doesn’t really tell anything about the effects of vitamin C in well-nourished individuals with respiratory tract infections.

            Efficacy of Vitamin C in Reducing Duration of Severe Pneumonia in Children, https://www.journalrmc.com/volumes/1405749894.pdf

            Here we have the full paper, and it is apparent that the study population comes from a deprived area of Pakistan with widespread malnutrition. Unfortunately the treatment and placebo groups are not well balanced, with a higher proportion of children under 1 in the latter, and also a higher proportion of those who are very underweight (and therefore presumably the worst-nourished). This alone is enough to skew the results and invalidate any conclusion other than that vitamin C treats vitamin C deficiency.

            Vitamin C and Immune Function, https://www.ncbi.nlm.nih.gov/pubmed/29099763

            This is a review discussing the mechanisms of action of vitamin C, which we already know is essential for normal metabolic function (or it wouldn’t be a vitamin), so while it is interesting and infromative, it isn’t really relevant here as it does not address the question we are investigating.

            Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia, https://www.journalrmc.com/volumes/1405749894.pdf

            This links to the paediatric paper from Pakistan that we have already discussed, which presumably wasn’t your intention. OldBob provides the following link:
            https://clinicaltrials.gov/ct2/show/NCT04264533

            which I think was the one you meant to put in.

            This is a proposal for a clinical trial. It will be interesting to see where it leads but it would be wrong to pre-empt the results.

            Real-world clinicians have to make all kinds of decisions concerning the management of the patient in front of them. In this they are guided by their own training and experience, their knowledge of the totality of the medical literature as it applies to their area of specialisation, the opinions of their colleagues, local policies etc. In Britain we have NICE, which provides guidance based on cost-effectiveness, and Cochrane reviews are also very helpful since they present a summary of the data in one place making it easily accessible to busy practitioners.

            [Note that I have taken the trouble of replying to you at length since you maintain that you hold a neutral position. I wrote a similarly long reply yesterday and accidentally deleted it just before it was ready to post – I spent the rest of the day in hospital having cancer treatment so I wasn’t able to start again until this morning, with interruptions from phone calls and the grandchildren accidentally smashing a glass jar in the kitchen while the dog was drinking water leaking through the ceiling… Anyway, I hope you find this useful.]

        • the link you provided is not to a ‘study’!

        • At which point is a study accepted as “proof”? What’s the definition of proof in regards to scientific studies and what are these studies lacking that they are not regarded as valid scientific studies?

          My response to this would be the current state of the scientific consensus on a topic. “Proof” isn’t really the right word. To me, it implies a single thing to demonstrate a claim. Science doesn’t really work like that.

          This feels like the situation that homeopathy finds itself in. There’s a mountain or literature on the topic, but most of it is crap. When the crap is filtered out what’s left is collated and, hopefully, it shows a common trend falls out at the end of the process. In the case of homeopathy, it is, in layman’s terms, quite conclusive in showing it doesn’t work.

          My understanding of the state of the art on Vit C mega dosing was that it has a similar outcome. Not really useful for any of the things it is typically claimed to be useful for.

          This is also why it isn’t worth presenting a single, or even a handful of studies to demonstrate a point like this. When there is enough research on a topic you can find studies to fit any agenda. Individual studies aren’t worth presenting unless you are intentionally trying to manipulate a discussion with people that don’t know better.

          Is this a reasonable understanding of how things should work?

  • Your mention of Linus Pauling’s cause of death is really bad form. And certainly, although he named it, he was not the father of orthomolecular medicine.

    The orthomolecular medicine approach generates falsifiable hypothesis as Wilhelm points out. Drs. Hoffer, Klenner and (if we include minerals) Abraham could be considered the orthomolecular medicine fathers and their hypothesis are falsifiable: benefit of megadoses of niacin on Schizophrenia is mostly falsified (new acute cases too?) but benefit of megadoses of either vitamin C on bacterial or viral infections, or megadoses of iodine on cancer are certainly not. For example, research on sepsis (now I see vitamin C benefit —without hydrocortisone—, now I don’t —with hydrocortisone) and breast cancer (iodine RCTpreliminar results) is ongoing nowadays; now that of vitamin C on viral infections too.

    My claim? Orthomolecular medicine is NOT pseudocientific. You should correct your book.

    Moreover, since a risk/benefit analysis on using oral saturation doses of vitamin C is positive (very low risk, highly probable benefit), there are lots of us that will proceed to try it for the coronavirus too if the time comes, even if the intravenous route RCT is not yet completed by then.

  • Andrés on Monday 17 February 2020 at 14:36 said:

    “…there are lots of us that will proceed to try it for the coronavirus too if the time comes, even if the intravenous route RCT is not yet completed by then.”

    How about 50 tons of it?

    From here:
    https://twitter.com/dsm?lang=en

    this:
    “ Yesterday, we shipped 50 tons of immunity boosting Vitamin C from our DSM Jiangshan plant to the Province of Hubei, of which Wuhan is the capital city. The banner text on the truck reads: ‘In the fight against N-CoV the people of DSM Jiangshan and Wuhan are heart to heart’ ”

    (DSM is the Dutch State Mining company.)

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