Dr Ken Harvey has issued a challenge to complementary medicines manufacturers to provide evidence to support their products.
Complementary Medicines Australia slammed the reports this week, with chief executive Carl Gibson saying that while it’s important to emphasise that vitamins and minerals are not a substitute for a good diet, supplements do have an important role to play alongside a healthy diet and exercise.
“Australia’s eating habits are less than ideal, with most Australians not meeting the minimum recommended serves for the five major food groups,” Gibson says, citing ABS data.
“The typical Australian is eating plenty of food but is still starving of quality nutrients from vegetables, fruit, diary products, lean meats and grain-based foods, instead filling up on energy-dense, nutrient-poor ‘discretionary foods’ such as cakes, confectionary and pastry products.”
“Complementary medicines, including vitamins, minerals and multivitamins, are generally regulated in Australia as Listed, low risk medicines, used for minor self limiting conditions, maintaining health and wellbeing, or the promotion or enhancement of health.
“Multivitamins, which can contain anywhere from 12-25 plus ingredients per dose, are designed to protect against broad nutritional deficiencies.
“Multivitamins can play a role in improving general health and decreasing the risk of chronic disease. For example, the Physicians’ Health Study II, which is the largest randomised clinical trial of a multivitamin supplement conducted to date, showed a statistically significant 8% reduction in total cancer incidence in male physicians.
“It is perhaps not surprising, then, that in Australia there has been a growing use and acceptance of complementary medicines by individuals keen to care for their general health and wellbeing.
“Many people take multivitamins because they know they don’t always eat as well as they should, with the typical Australian diet shown to fall well short of the recommended daily nutrient requirements.”
However, Prof Harvey told the AJP today that the inclusion of more ingredients in a product does not necessarily mean the product is more efficacious.
“The aim appears to be who can include the most ingredients; presumably on the marketing principle that the more ingredients the greater the appeal to consumers,” he says.
He says he defies Mr Gibson and manufacturers “to provide scientific justification for many of the ingredients in these products, especially the herbs, fruit and vegetable powders”.
“I am unaware of any evidence that shows the small amount of fruit and vegetable extracts in capsules are a substitute for eating the real thing.
“Australians should spend their money on fruit and vegetables; not multi-vitamin pills.”
He criticises the use of the Physicians’ Health Study II as support for multivitamin use in cancer prevention.
“It’s important to use absolute numbers, not relative numbers when discussing treatment benefits,” he says.
“In absolute terms the difference in this study was 1.3 cancer diagnoses per 1000 years of life (18.3 compared to 17 events, respectively).
“This difference may have been statistically significant but is it clinically significant? Mr Gibson did not mention an accompanying editorial to the paper in JAMA which was dismissive of the report on several counts.
“In addition, this is just one study in a crowded field; the majority of studies suggest no effect of vitamin supplementation on cancer risk and some show evidence of harm.
“A subsequent editorial in the Annals of Internal Medicine titled, ‘Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements’ concluded, ‘Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided’.