Getting to the Facts by Abram Hoffer, MD

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Getting to the Facts

by Abram Hoffer, MD

 

 

FACTS AND FACTOIDS: An Information Sheet for Patients

by Abram Hoffer MD PhD FRCP©

 

Fact: Something that has really occurred or is the

case: hence a datum of experience, as distinct from

conclusions. Loosely defined, something that is

alleged to be, or might be a " fact. "

 

Factoid: A factoid is a fact that never existed

before it appeared in print, but has been reprinted

ever since. It is truly launched if it first appears

in a reputable medical journal like the Journal of the

American Medical Association and republished in the

New York Times which gives it international stature. A

factoid, using simple Anglo Saxon terminology, is a

lie, and like many lies and misconceptions, once it

has been published develops a life of its own and is

reprinted over and over, from textbook to textbook.

The best example is the lie (factoid) that vitamin C

causes kidney stones.

 

There is a close and intimate relationship between

these definitions and the battle between the former

vitamins-as-prevention and the current

vitamins-as-treatment paradigms. A paradigm consists

of a system of beliefs which are generally accepted by

the supporters of the paradigm, usually a majority of

the scientific establishment if we are considering

medicine and science. It is a combination of facts and

factoids, but the supporters of the paradigm will

support both facts and factoids with equal fervor.

Pirsig wrote, " You are never dedicated to something

you have complete confidence in. No one is fanatically

shouting that the sun is going to rise tomorrow. They

know it's going to rise tomorrow. When people are

fanatically dedicated to political or religious faiths

or any other kind of dogmas or goals, it's always

because these dogmas and goals are

in doubt " .

 

In most cases the facts and factoids comprising the

paradigm are not properly labeled, and factoids will

be accepted as facts. The paradigm is replaced in time

by a new paradigm when enough of the factoids present

in the original paradigm are either destroyed by new

evidence or data or become facts by the accumulation

of new data, new observations. A factoid may become a

fact, but a fact can never revert to a factoid.

 

Factoids about vitamins are rampant on the internet

because there is no editorial control as there are in

the journals. In journals statements are expected to

be derived from previous publications and from data.

On the internet they do not need any basis since they

are merely ideas put forward by the writers. The

internet also contains discussions of facts designed

to explode the factoids. Other public media use either

facts or factoids, depending on the current public

opinion. If the opinion is positive for vitamins,

facts are most often published. If the public opinion

is judged to be negative, factoids receive easy

publication.

 

Evidence Required to Establish Facts in Clinical

Medicine

Clinical facts are based on clinical observations

made by a clinician who can draw careful and honest

conclusions from clinical data. These are one-to-one

observations, patient and doctor. These kind of

observations have fallen into disfavor with the

medical establishment and are labeled anecdotal. These

clinical trials are basic to the whole field of

medicine because no therapeutic trials will ever be

undertaken until one or more physicians find that the

treatment has some value, even even if only for a few

patients.

 

The clinical observations are reinforced by special

ways of collecting the data called controlled clinical

trials.

 

1) Historical controls - A number of patients are

given the treatment and the outcome of treatment over

the follow-up period is compared with the expected

outcome based upon the history of that disease as

established by many observers. Thus if a disease kills

every patient and if a treatment saves half of them

over the same follow-up period, then one will conclude

that the treatment had value. This is the traditional

way of running therapeutic trials. This is the least

expensive way of testing treatments but is no longer

considered scientific.

 

2) Controlled comparison therapeutic trials based on

probability theory and the need for equal samples of

patients from the treatment and the control (no

treatment) group. This is similar to the first method

except that it uses current controls, not historical

controls. The decisions as to whether the patients

will receive the control treatment, i.e. no treatment,

or the research treatment, is based on random

selection to remove bias.

 

3) Prospective single blind controlled therapeutic

trials. With these experiments the investigators and

evaluators of the results of treatment know whether

the patients got the research treatment or the control

treatment but the patients are not told. That, of

course, does not mean that they do not know.

 

4) Prospective double blind randomized double blind

therapeutic trials. In these trials the treatment is

allocated by random selection and neither the patients

nor the investigators know from which group each

patient is derived. Under my direction Psychiatric

Services Branch, Department of Public Health,

Saskatchewan, conducted the first psychiatric

controlled trials of this type, completing six between

1952 and 1960. We compared the therapeutic effect of

vitamin B-3 (niacin and niacinamide) against placebo

in schizophrenic patients. In this way I contributed

to the development of a method which is now the gold

standard but which has never been calibrated, i.e.

shown to do what it is supposed to do. It is an

awkward, very costly method best suited for

institutions with a lot of money and little

imagination, and meets the needs of the U.S. FDA and

Health Protection Branch in Canada, medical journals

and granting agencies. It is a treatment trial which

probably is not as valuable as the direct clinical

examination which is so derided today as anecdotal.

However, fewer than one-quarter of the treatments

commonly used in medicine and surgery have been tested

in this way.

 

Evidence Required to Establish Factoids in Clinical

Medicine

No evidence is required. When discussing side effects

and toxicity a whole new set of variables are

introduced. For establishing toxicity no controlled

trials are needed. The originators of the factoids may

develop their factoid on the basis of a theoretical

examination of the literature, or it may arise from

their own bias against a treatment. It often arises

out of faulty experiments which later can not be

confirmed. Thus critics of a new treatment demand that

the proponents provide airtight facts based upon a

large number of double blind controlled experiments,

but they will also attack the use of the treatment

based upon toxicity for which there is no basis. One

of the best examples of this occurred when it was

concluded that folic acid would decrease the incidence

of congenital abnormalities. The publication of this

fact, which it is now, was followed by a series of

irate letters in the medical journals written by

physicians who bemoaned the fact that these tiny

amounts of folic acid would be toxic. We hear no more

of this now. The factoid about toxicity has vanished

and the fact of its efficacy remains.

 

A recent example is the statement by oncologists that

antioxidants (by which they usually mean vitamin C)

will decrease the therapeutic value of chemotherapy

for treating cancer. In fact there are no clinical

series which show that the patients given vitamin C

and chemotherapy fare worse than those not given this

vitamin. On the contrary, all the published series

show just the opposite. I have treated over 1130 cases

with large doses of vitamin C and most of them had

chemotherapy. I have examined the follow-up data and

find that the mean difference on prolongation of life

was heavily in favor of the use of the vitamins.

Recently Prasad KN et al, after reviewing seventy-one

scientific papers found no evidence that antioxidants

interfered with the therapeutic effect of

chemotherapy. Even earlier Simone CB et al, on the

basis of a large number of clinical studies (he also

examined seventy-one scientific papers) came to the

same conclusion. Not one subject reported a worsening

of symptoms. He concluded, " ...cancer patients should

modify their lifestyles using the Ten Point Plan,

which included modifying nutritional factors and

taking certain vitamins and minerals especially if

they are receiving chemotherapy, and/or radiation. "

(The emphasis of this last part of the sentence is

mine).

 

Labriola et al concluded that vitamin C may prevent

the therapeutic effect of chemotherapy if given

concurrently and recommended that antioxidants be

withheld until after the chemotherapy is completed. He

based his conclusion on one case. His report elicited

three rebuttals, Reilly, Gignac, and Lamson and

Brignall. I will not repeat the arguments but it was

evident that Dr. Labriola was not convinced by the

points put forward by Reilly and Gignac. I think the

factoid repeated by Dr. Labriola would have a much

better chance of becoming a fact if he had considered

the following points:

 

(1) What is the therapeutic value of chemotherapy

without any antioxidants? Even within the field of

standard oncology there is a debate whether

chemotherapy has any merit except for a small number

of cancers, Moss15. Before one can claim that a

treatment has been inhibited, surely there must be

pretty good evidence that the treatment has any merit

to begin with. It is possible (we do not know the

probability for this) that chemotherapy interferes

with the therapeutic value of the antioxidants. Almost

all the studies testing large doses of vitamin C

yielded positive results while there is no such

unanimity with respect to chemotherapy.

 

(2) The difference between possibility and

probability. Most people do not distinguish between

these two. Theoretically anything is possible, and it

is certainly possible that taking vitamin C might

prevent the toxic beneficial effect of chemotherapy.

In the same way when one buys a lottery ticket it is

possible they may win. People confuse these two terms,

which is why lotteries are so popular. The relevant

statistic is the probability. What is the probability

that patients receiving vitamin C during their

chemotherapy will not fare as well? The lottery ticket

may give one a probability of winning of one in a

million and the possibility that vitamin C may prevent

the therapeutic effect of chemotherapy may be equally

low. We can only assume from the literature reviewed

by Simone, by Prasad, by Lamson and Brignall, and more

recently by Moss, that the real probability must be

extremely low. As I have pointed out earlier, I have

seen no evidence that adding vitamin C inhibited the

therapeutic effect of chemotherapy. Just the opposite.

Patients on my orthomolecular program live

substantially longer and about 40 percent achieved

over four year cure rates.

 

(3) If he had not tried to bolster his argument by

referring so frequently to the peer reviewed journal

in which his paper appeared. This is certainly no

guarantee of fact. The first factoid that vitamin C

caused kidney stones appeared in eminently

peer-reviewed journals. All the factoids regarding

vitamins appeared first in peer reviewed journals. I

can assure you that articles attacking the use of

vitamins have very ready access to peer-reviewed

journals. But they would not have accepted the report

had they tried to conclude from one patient that

vitamin C taken during chemotherapy was therapeutic.

This would not even be sent to the peer review

committee because they do not accept anecdotes -

unless of course they consider them scientific because

they contain something adverse against vitamins.

 

(4) Moss points out that oncologists have no objection

to using xenobiotic antioxidants during chemotherapy.

This includes Amifostine which decreases the toxicity

of radiation but is too toxic on its own and is not

used; Mesna, a drug used around the world to protect

against the toxic side effects of ifosfamide which

damages the urinary system; and Cardiozane, which

counters Adriamycin's toxicity. There are over 500

papers showing the safety of Cardiozane. In one

clinical trial using a drug similar to Adriamycin

one-quarter of the patients suffered damage to their

hearts. When given Cardiozane concurrently only 7%

did. Thus it appears that only orthomolecular or

natural antioxidants are potentially dangerous.

Synthetic antioxidants protect against the toxic

effect of drugs but do not increase their therapeutic

value. In sharp contrast, natural antioxidants not

only protect against the toxic effect of drugs but

also increase their efficacy in destroying cancer

cells.

 

(5) Dr. Labroila emphasizes that long term studies

must be used. I agree and for this reason I have

followed up my patients since 1977. In my series,

hardly any patients receiving chemotherapy but no

antioxidants survived very long. But chemotherapy is

used by many oncologists who know it will not extend

life because there is nothing else that they can do

and they feel they have to do something.

 

In conclusion, as the proponents of the old paradigm

see it, facts are facts only after double blind

controlled experiments conducted by the right

investigators from the correct school and published in

the correct medical journals. Factoids can be thought

up by anyone and immediately become facts in the

profession if the factoid attacks the evidence against

the new paradigm.

 

Current Factoids:

About Megadose Vitamin C

These factoids are based upon hypotheses. There is no

clinical data to support any of them and almost all

studies show that they are not true or real. They are

not supported by any studies.

 

- causes kidney stones,

- causes kidney damage,

- causes pernicious anemia,

- decreases fertility in women,

- causes liver damage,

- causes iron overload and toxicity,

- is dangerous for diabetics by interfering with

glucose tests,

- causes cancer,

- inhibits chemotherapy,

- prevents radiation from being effective

- prevented Linus Pauling from living longer

- prevents surgical scars from healing.

 

I should have used weasel terms - instead of " causes "

by writing " may cause. " Because using the word may

allows the proponent of the factoid to leave the

suggestion that these factoids are true but leaves an

escape path in case they turn out not to be true. The

author can then claim, " well I did not say that these

factors were true. I merely suggested that they might

be true. " There is the usual confusion of probability

and possibility. If a phenomenon occurs once out of a

million tries the probability is one out of a million,

but there is no value attached to the possibility. It

is indeed possible. Again, the enormous sale of

lottery tickets depends upon confusing the public in

this way. Or looked at in another way, if the

probability of winning a lottery is one in ten million

if one buys one ticket, and the probability is zero if

one does not buy the ticket, then one can say that

dividing the ratio one in ten million by zero yields

the enormous probability of infinity that one will win

the lottery. Any number divided by zero yields

infinitesimal large values. Critics of megavitamin

therapy never give any probability values since they

know they are close to zero.

 

About Megadose Niacin

The factoid niacin causes liver damage is analyzed

thoroughly by William Parsons Jr, who shows that

niacin will often increase liver function tests but

that these increases do not arise from liver

pathology. Since I began using megadoses of this

vitamin in 1952 I have seen a few cases of

obstructive-type jaundice which cleared when niacin

was stopped, and in one case I had to resume the use

of niacin because the patient's schizophrenia

recurred. He recovered and the jaundice did not recur.

I have seen so few cases of jaundice that there is

little evidence that the jaundice arose from the use

of the niacin. Jaundice has a natural occurrence rate

and from any series of patients a few will get

jaundice from other factors. In rare cases too much

niacin causes nausea and vomiting, and if this

persists because the niacin is not decreased or

stopped the dehydration might be a factor. I have seen

no cases in the past fifteen years. The main danger

from taking niacin is not jaundice, it is that people

will live longer.

 

Factoids in the Making

It is very interesting, even if frustrating, to

witness the manufacture of factoids. A new one may

soon be born. It is that niacin is dangerous because

it increases the plasma homocysteine levels. Garg et

al reported that niacin increased homocysteine levels.

Apparently no other B vitamins were given. After a

tough battle for acceptance the homocysteine findings

are recognized as playing a role in atherosclerotic

heart disease. But the reduction in the abnormal

cholesterol levels and the increase in HDL decreases

the risk if heart disease. The Coronary Drug Study,

Canner et al, showed that over a fifteen year follow

up mortality was decreased by 11% by niacin and

longevity increased by two years. In this study niacin

was used as a drug which lowered elevated cholesterol

levels. No other vitamins were used. Garg et al are

aware of this. They referred to the report by Basu et

al that the niacin induced increase in homocysteine

levels did not interfere with its normalizing effect

on blood lipids. And they pose the question whether it

would be beneficial for patients on long term niacin

treatment to take other B vitamins such as folic acid.

My answer is that of course it would be beneficial,

and since 1965 I have routinely given my patients one

of the B-complex formulations such as B-complex 50's

or 100's. These provide pyridoxine, folic acid and

vitamin B-12 as well as other vitamins. Adding these

vitamins inevitably will be beneficial since the other

vitamins have therapeutic properties of their own in

addition to keeping homocysteine levels from going too

high. But even niacin alone was beneficial, not

harmful. And this confirms what I have seen since 1952

when Ibegan to used megadoses of niacin and

niacinamide for schizophrenia and for other

conditions, including elevated cholesterol levels and

arthritis. The authors did not invent any factoid but

it is highly probable that some of the readers of that

report will ignore almost the whole report except that

niacin elevates homocysteine and therefore will

increase the risk of heart disease. You will soon see

this factoid repeated endlessly.

 

Niacin is a methyl acceptor and this may be the

mechanism which leads to the elevation of homocysteine

levels. Niacinamide is also a methyl acceptor but it

has no effect on blood lipid levels. Its effect on

homocysteine levels is not known but there is no

evidence that it reduces life expectancy. On the

contrary, it has great value in the treatment of

senile states, both physical and mental, and in my

series, if anything, tended to prolong life.

 

Kaufman had studied the use of this vitamin for the

arthritides before 1950 and had published two books

describing his remarkable results. Since that time

this vitamin has been a very important component of

the orthomolecular regimen for treating arthritis. Dr

William Kaufman, my long term friend, died a few days

ago (August 2000) at age 89. His very important work

remains mostly ignored even after a double blind study

showed him to be correct.

 

But Garg's report does raise very interesting

questions which will have to be studied. The first is

whether the elevation of homocysteine is an important

factor but only in subjects who are not taking

adequate levels of the other B vitamins, i.e. are not

well nourished in orthomolecular terms. It is possible

that in the presence of good nutrition the increase in

homocysteine levels is not pathological at all and may

even be beneficial.

 

Another potential factoid was trumped up by the press

and received wide attention in all the media. The

press reported that Dr. James Dwyer, University of San

Diego Medical School, had found that the carotid

arterial walls had been thickened by 500 milligrams of

vitamin C daily. The press report cautioned against

the use of vitamin C because this showed that the

arteries were depositing plaque. But Professor Dwyer

told Owen R. Fonorow they had used only one measure

and had not used two other measures which would have

shown the degree of focal plaque called the plaque

index, nor the velocity ratio to determine whether or

not plaque interfered with blood flow. He did not say

that plaque had developed. Dr. Robert Cathcart with

experience on over 25,000 patients since 1969 has seen

no cases of heart disease developing in patients who

did not have any when first seen. He added that the

thickening of the vessel walls, if true, indicates

that the thinning that occurs with age is reversed. I

have used vitamin C in megadoses since 1952 and have

not seen any cases of heart disease develop even after

decades of use.

 

Recently Gokce, Keaney, Frei et al gave patients

either a single dose of 2000 milligrams of vitamin C

and 500 milligrams daily for thirty days and measured

blood flow through the arteries. Blood flow increased

nearly fifty percent after the single dose and this

was sustained after the monthly treatment. They

concluded that ascorbic acid treatment may benefit

patients with coronary artery disease. This certainly

effectively does not support the conclusion of Dwyer

who did not measure blood flow.

 

The Good News

The opposite of a factoid is a fact. The good news is

that as none of these factoids are true, the opposite

is true. This summary statement is based upon

literally thousands of published papers in medical

literature and hundreds of books that have been

published in the past twenty years. I can not provide

references to these numerous clinical studies, but

readers of the Journal of Orthomolecular Medicine have

ready access to the facts and also to the book reviews

of over one hundred of these books. The internet

contains a large number of excellent discussions of

vitamins and, of course, the facts and factoids which

are current.

 

Vitamin C

Alleged Toxicity Factoid (Lies) Fact

Kidney Stones Decreases frequency Kidney Damage No

Pernicious anemia Yes No

Fertility Impaired No

Liver damage Yes No

Iron overload Theoretical No clinical evidence

Glucose blood tests Interferes Not with modern

tests

Cancer Causes cancer Therapeutic for cancer

Atherosclerosis Increases Prevents

Chemotherapy Decreases efficacy Increases efficacy

Radiation Decreases effect More effective

Surgery Prevents healing Increases

healing rate

 

and decreases

scaring

Linus Pauling Shortened his life A ridiculous

claim. He died age

 

94, fully mentally

 

alert.

 

Conclusion

The factoids about vitamins, used in optimum doses

when needed, are not true, are not based upon clinical

evidence, do not have any studies including double

blind controlled clinical data to support them, and

are used primarily to attack the new paradigm, the

vitamins-as-treatment paradigm. Be wary of factoids

whether they are in print, on the internet, in the

news media, on radio or on television. If you hear of

any new factoids, please let me know so I can add to

my collection.

 

The unfortunate result of these lies is that patients

are made fearful, some will stop taking their

vitamins, medical costs will increases since patients

want to see their doctor again to discuss these

matters, and more patients will relapse. The harm done

by these factoids is immeasurable, but fortunately is

slowly decreasing as the population becomes more

knowledgeable and sophisticated about nutrition and

nutrients. In the same way that drug companies are not

allowed to make false therapeutic claims about their

products, we need a system which will neutralize the

factoids as they are proposed. And above all we need

the public media to become much more intelligent and

less subservient to major papers like the New York

Times.

 

REFERENCES

1. The Oxford International Dictionary of the English

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Toronto, 1957.

 

2. Mailer Norman: New York Times, January 9, 2000.

 

3. Pirsig R: Zen and the Art of Motorcyle

Maintenance. Quoted in Globe and Mail, Toronto, June

16, 2000, in Social Studies by M. Kesterton.

 

4. Hoffer A: A theoretical examination of

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5. Hoffer A & Pauling L: Hardin Jones biostatistical

analysis of mortality data for cohorts of cancer

patients with a large fraction surviving at the

termination of the study and a comparison of survival

times of cancer patients receiving large regular oral

doses of vitamin C and other nutrients with similar

patients not receiving those doses. J Orthomolecular

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Vitamin C, E. Cameron and L. Pauling, Camino Books,

Inc. P.O. Box 59026, Phil. PA, 19102, 1993.

 

6. Hoffer A & Pauling L: Hardin Jones biostatistical

analysis of mortality data for a second set of cohorts

of cancer patients with a large fraction surviving at

the termination of the study and a comparison of

survival times of cancer patients receiving large

regular oral doses of vitamin C and other nutrients

with similar patients not receiving these doses. J of

Orthomolecular Medicine, 8:157-167,1993.

 

7. Hoffer A: Orthomolecular Oncology. In, Adjuvant

Nutrition in Cancer Treatment, Ed. P Quillin & RM

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College of Nutrition. Cancer Treatment Research

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Heights, IL 60005-1090, 331-362, 1994.

 

8. Hoffer A: One Patient's Recovery From Lymphoma.

Townsend Letter for Doctors and Patients #160, 50-51,

1996.

 

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18:13-25, 1999.

 

10. Simone CB, Simone NL & Simone CB: Nutrients and

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Medicine 1:20-24, 1999.

 

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Letter for Doctors and Patients, November 1999.

 

12. Reilly P: Dr. Labriola's Editorial on Antioxidants

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Patients Feb/Mar 2000, 90-91.

 

13. Gignac MA: Antioxidants and Chemotherapy. What You

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2000, 88-89.

 

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Brooklyn, New York.

 

16. Moss RW: Antioxidants Against Cancer. Equinox

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17. Hoffer A: Vitamin C and Cancer. Quarry Press,

Kingston ON, 2000.

 

18. Herbert V, Canadian Broadcasting Corporation,

National TV News. Shortly after Dr Pauling died. He

also said that if God wanted us to take vitamin C

tablets they would be growing on trees.

 

19. Parsons WB Jr: Cholesterol Control Without Diet:

The Niacin Solution. Lilac Press, Scotsdale, Arizona

1998. Reviewed in Journal of Orthomolecular Medicine,

Volume 14, 1999, 3rd quarter.

 

20. Garg R, Malinow MR, Pettinger M, Upson B &

Hunninghake D: Niacin Treatment Increases Plasma

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21. Canner PL, Berge KG, Wenger NK, Stamler J,

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mortality in coronary drug project patients: Long term

benefit with niacin. J. Amer College of Cardiology

8:1245-1255, 1986.

 

22. Basu TK & Mann S: Vitamin B-6 Normalizes the

Altered Sulfur Acid Status of Rats Fed Diets

Containing Pharmacological Levels of Niacin Without

Reducing Niacin's Hypolipidemic

Effects. J Nutrition 127:117-121, 1997.

 

23. Kaufman W: Common Forms of Niacinamide Deficiency

Disease: Aniacin Amidosis. Yale University Press, New

Haven CT, 1943.

 

24. Kaufman W: The Common Form of Joint Dysfunction:

Its Incidence and Treatment. E.L. Hildreth and Co.

Brattelboro, VT, 1949.

 

25. Hoffer A: Orthomolecular Medicine For Physicians,

Keats Publishing, New Canaan CT, 1989.

 

26 Fonorow, O.R. www.vitamin C foundation.org

 

27. Cathart, R. Report to Fonorow www.

vitaminCfoundat ion. org

 

27. Gokce N, Keaney JF Jr, Frei B et al: Long-term

ascorbic acid administration reverses endothelial

vasomotor dysfunction in patients with coronary artery

disease. Circulation 99:3234-3240, 1999.

 

28. Herbert. V. Canadian Broadcasting Corporation,

National TV News. Shortly after Dr Pauling died. He

also said that if God wanted us to take vitamin C

tablets they would be growing on trees.

 

A. Hoffer MD, PhD, FRCP©

August 29, 2000

Reprinted with permission of the author.