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Editorial: The Fear Factor - It Makes For Great Headlines.

By Len Monheit
[email protected]

This morning, headlines across the UK call into question the risk/benefit equation of yet another supplement, as the BMJ (British Medical Journal) reported preliminary data generated by researchers following up a trial of folate supplementation in pregnancy from the 1960s to examine any relationship between folate supplementation, all cause mortality and death from breast cancer. At the same time as cautioning that the results were preliminary, and might in fact, be completely due to chance (the results were not statistically significant), the researchers concluded that high dose folate supplementation appeared to correlate with an increase in all cause mortality, as well as a heightened risk of death due to breast cancer. ( )

Commentary on the paper ( ), also published in BMJ, notes the report as non-statistically significant with no pre-specified hypothesis, and cites references which suggest folate supplementation might be protective and actually lower the risk of breast cancer.

The British headlines immediately reflected the take on the 'story' ranging from slightly 'industry negative' to downright biased and non-reflective of the actual findings and significance in their quest for sensationalism:

The Guardian - UK: Cancer link to folic acid played down

The Mirror - UK: Folic acid 'risky link' to cancer

Reuters: Study Raises Questions About Folate Supplements

AFP: Folic acid linked to breast cancer in preliminary study

Medical News Today: Folate Supplements in Late Pregnancy May Increase Breast Cancer Risk

and then as the North American pickup began,

HealthDayNews on Yahoo: Possible Link Between Folic Acid and Breast Cancer Found

It's interesting to observe that the high dose folate noted in the study is 5 mg, higher in dosage than that found in dietary supplements (typical amounts are between 400 and 600 mcg with higher levels observed up to 1mg). This dosage level would therefore be accessible as a pharmaceutical medicine in most, if not all jurisdictions around the globe, yet the headlines deliberately target folate as a supplement.

Obviously, both the result and the perverse glee and sensationalism with which it has been presented are extremely disconcerting, coming, as it does, on the immediate heels of the attack on Vitamin E led by researchers at JohnsHopkinsUniversity. Probably the most unfortunate aspect of each event is the net effect on consumers who will turn away from supplementation to the actual detriment of their health.

I came across an article written by Michael Fumento, syndicated columnist with Scripps Howard News Service, entitled, 'The Vitamin E witch-hunt' ( )

In this article, Mr. Fumento asks, after noting an earlier study and headline targeting antioxidants:

"Why are these pills being persecuted? Among the similarities of the earlier report and this one, ... is that the mainstream media accepted both without question. Both times the researchers smugly declared their work to be the final word on the subject, though both reports were, as the vitamin E one admitted, "a qualitative departure from previous findings."

Fumento goes on to note several reasons for these attacks and the general position of the medical community towards supplements - most of which is really no surprise or 'new' news:

  • Doctors are biased against dietary supplements - generalizing against the entire industry and scope of products
  • Mainstream medicine is also biased toward that which has formal FDA approval - (Fumento notes Vioxx as his example)
  • Doctors worry that people will try to substitute supplements for good eating habits

and perhaps the most telling reason:

  • Medical journals are becoming increasingly sensationalist

As our lives become filled with information and clutter, it becomes even more challenging to get visibility - to stand out from the noise and crowded landscape. Companies in our industry face this all the time, value-building and differentiation exercises are based on it.

In the scientific community, there is increasing competitive pressure and major dollars at stake, leading to sensationalizing of headlines and the use of data selectivity to dramatize and distort study findings. It happens in this industry - we shouldn't be surprised to see it elsewhere. In this case, the net effect is maximized by the credibility and trust associated with the medical community and various prestigious institutions, as well as with the almost joyful pickup by the media of even a hint of negative information - whether the issue is drugs, supplements, politics, business.....

About Fear...

In this day and age, it's mostly about fear, a powerful emotion that can be manipulated and exploited quite easily. It's worth noting, though, that with fear as a weapon, industry really is at a strategic disadvantage, the proverbial 'with one hand tied behind its back'. Despite the fact that 'fear' is implicit in industry messaging, claims for treating or curing disease (the biggest use of fear) are not permitted in the US, and in Canada, any claims relating to the Schedule A list of diseases (all the big ones) are not allowed. This leaves the biggest fear-related argument, the negative potential effects of dietary supplements, as weapons in the hands of industry detractors.

Recent surveys have noted the 'lesser evil' trend as consumers move to products that represent less risk or concern than alternatives. In fact, recent controversy and adversity within the pharmaceutical industry (read Vioxx etc.), makes dietary supplements and functional foods and beverages 'lesser evil' considerations - if positioned properly and within the boundaries of the law.

In 'neuro-linguistic programming', experts on the subject speak about an individual's filters to receive information, that is, an individual's 'map of reality' and how as a communicator, you can increase your chance to impact this map by knowing how your target filters and perceives information. One of the factors measured is whether the target population is 'towards' or 'away from'- whether they are more motivated by the 'carrot' or the 'stick', fear of punishment versus opportunity for reward. I would suspect, as the 'lesser evil' trend suggests, that our entire demographic is currently shifting in the direction of 'away from' behavior, and perhaps this realization should be factored into more marketing messages, certainly 'industry' marketing and positioning messages.

On the subject of folate, or even vitamin E for that matter, until we completely address the first three points Fumento notes above, with consistent, substantiated messaging AND behaviors, there's lots of ammunition for the fourth item and 'fear' to work on.

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