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Discusses Women's Health

Once more I am traveling and I dutifully brought vitamins with me.  (More about where I am and what I’m doing, below…)  I have been unable to find where I packed them for the last four days, but my concern has been lessened by the fact that I’m eating well and just read an editorial in the October 11 JAMA that I brought to read on the plane (together with lighter stuff) titled “The Supplement Paradox”.  The author from Harvard Medical School bemoans the fact that over the last two decades, there has been a steady stream of high-quality studies evaluating dietary supplements, which have yielded predominately-disappointing results.  Despite this, at least half of the population takes vitamins, minerals and other supplements.  In fact, supplement sales have grown to a greater than $32 billion industry by 2012 (and are still growing).  He states that the public’s high consumption increased significantly after the passage of the Dietary Supplement Health and Education Act in 1994.  This was a law that states that all supplements are assumed to be safe until the US FDA detects evidence of harm, usually after consumers have been extensively exposed to the product.  It continues to be the law of the supplement land…

From 1999 through 2012, the NIH invested more than $300 million a year funding dietary supplement research.  Most of the studies failed to demonstrate beneficial effects on health.  There were studies that showed absolutely no benefits to supplements (including multivitamins) to prevent cancer and heart disease, echinacea to treat the common cold, St. John’s Wort to treat major depression, and Vitamin E to prevent prostate cancer.  The author admits that supplements can be essential to treat vitamin and mineral deficiencies and there are indeed indications for some multivitamins, for example, a specific combination of vitamins and minerals can delay progression of early age related macular degeneration.  Apparently only one quarter of consumers do use supplements based on the advice of their clinicians but “for the majority of adults, supplements likely provide little if any benefit.”

The editorial states that there are three main reasons that consumers continue to use supplements even though trials have not found them to be more effective than placebos in many cases: [1] They may not be aware of negative studies. [2] It’s counterintuitive to avoid multivitamins and minerals after we’ve all been taught the importance of having them in our food.  [3] Finally, the law allows manufacturers to advertise supplements for many conditions.  For example, “supplement X will preserve heart health or Y will maintain mental alertness”.  And the disclaimer that “These statements have not been evaluated by the FDA and the product is not intended to diagnose, treat, cure or prevent any disease” appears in very small letters and has limited impact on the consumers’ understanding of the advertised claim.

So I guess I won’t worry about the fact that I can’t find the supplements that I brought with me.

I’m writing this website from Jordan.  I’ve been privileged to come with several board members and the CEO of Save the Children to see the programs that we have established here for the Syrian refugees.  There are currently about 655,000 registered Syrian refugees in Jordan, although the government estimates that there are 1.4 million Syrians currently residing in the country.  Nearly 53% of them are children, 18% are under the age of five.  Since the outbreak of the Syrian crisis, Save the Children has supported more than 570,000 children, youth, and their families through our programs.  On the first day, we visited the largest refugee camp Za’atari.  It was started five years ago at the beginning of the conflict and 80,000 refugees are now living here.  It is enclosed with barbed wire fences but some of the residents manage to get in and out to do illegal work in neighboring areas and unfortunately, some of the children are impelled to leave daily to engage in child labor.  The refugees were initially housed in tents but now most of them live in caravans, which are essentially containers similar to those transporting goods on container ships.  There is no heat (and in the winter the temperatures go below freezing) and no cooling systems (in the summer the temperatures are 110° or more in that desert region).  Save the Children distributes bread and food ration cards to the residents so that they can use them to obtain food through the World Food Program.  We also deliver 514 metric tons of bread daily.  We run kindergartens and also provide early education to 5,000 children under the age of four.  We run infant and young child feeding programs where women who breast-feed are monitored, and the children needing supplemental feeding are treated.  We visited psychosocial, literacy and life skills programs for youth.  I was especially impressed with a session that I attended in which young girls were talking about their reproductive health rights, ways to protect against sexual and gender based violence and prevention of early marriage.  The next day, together with our regional refugee coordinator from Save The Children we met with the USAID mission director at the American Embassy and discussed the coordination of our programs.  (It’s clear that everyone at USAID is concerned about the results of our current election and the future of ongoing funding.)  The next day we met with representatives of the UN Refugee Agency.  The dedication, intelligence, and compassion of those who devote their lives to this mission is phenomenal.

The beginning of this article was written for my patients and readers who essentially have excellent nutrition and access to high quality food, unlike so many in the world and those I saw at the refugee camps.  No, you probably don’t need to take multivitamins.  But perhaps we should make sure that the millions of refugees who don’t have access to nutritious food, education or ability to care for their children are not forgotten and get our help.  I know I’m not supposed to request donations on this site but you might want to look at Save The Children‘s website and consider making a donation before the end of the year…

One more note: I decided to try and keep this website going after I closed my practice two months ago, but will do so only every other week.  I will continue to update you on new medical data and perhaps blog about my post retirement activities.  Many of my former patients received unsolicited letters and emails from my ex nurse suggesting that they continue their care with a physician with whom she is currently employed.  While I’m delighted that she’s working and feel that she’s phenomenal nurse, I do not personally know this physician.  Please note that I did not authorize the letters or emails to be sent to those who have not requested it.  I did send a letter to all my patients months ago when I announced I was closing my practice, suggesting names of physicians who would be able to continue their care and whose medical standards are similar to mine.

Finally have a wonderful Thanksgiving.  Despite the election results, we have much to give thanks for…

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