Editorial: When Answers Demand Questions

By Len Monheit
[email protected]

I’m often intrigued by the small print which often concludes press releases about cutting edge research. Here one finds study qualifiers, recommendations on future research paths and numerous unanswered questions. And by the time the release is ‘properly’ positioned in mainstream media, the qualifiers, and more importantly, the critical questions remaining to be answered, have typically been swept under the carpet into the recesses of forgotten science.

We typically want black and white answers-human nature is like that. But the answers research and product development provide us with are typically in shades of gray. Which product is better? Well, it depends. (on application, condition, interpretation of data, and more) But we want the answer simply. And we really don’t want to think too much.

How often have you heard the line, ‘If it sounds too good to be true, it is.’ Yet consumers repeatedly get misled by silver bullets, quick fixes and short answers to long and complicated problems and issues. And instead of investigating further, consumers frequently accept exactly what they are told.

This past week, researchers in Sweden published in the New England Journal of Medicine, results of a study on some 2300 subjects first examined for blood levels of Vitamin A thirty years ago, when the subjects were between 49 and 51 years old. Thirty years later, a correlation was performed between those with high serum vitamin A and later bone fractures. This correlation was extremely significant. The same examination of beta-carotene effect showed no correlation.

Although there are better examples we can point to in recent months where the take on a study was either unsupported by the facts, or where questions and related issues which should have been presented along with the results were not, we’ll use this Vitamin A study as an example, despite its strongly supported conclusion.

The study objective was to establish a biological marker that could be used to predict risk of later fracture. The research was based on animal and epidemiologic studies which indicated that high vitamin A intake was associated with increased bone fragility. The results indicated that a marker could be established and the conclusion drawn by the researchers went on to suggest that levels of vitamin A supplementation and food fortification need to be reassessed.

Predictably, the media take on the story included the risks associated with Vitamin A, and an increase in pressure to lower RDI (recommended daily intake) levels of Vitamin A. In an interview, the researchers admitted they did not have data on whether the Vitamin A had remained high during the entire intervening years, a fact which some would argue is irrelevant to the general research.

Being of a curious sort, I have a few more questions:

Of the 266 men reporting fractures, how many were taking supplements when the original blood work was performed? If they were taking supplements, at what level? Were there other obvious factors which would have placed them in a higher risk category (lifestyle, health conditions, diet etc)? Were there any health benefits associated with Vitamin A that should have been noted in the research? What can be determined from the fact that while Vitamin A had a correlation with fracture rate, beta-carotene did not? Is there something else at work here?

In an examination of other vitamin A research, health conditions ranging from dentition to child health, from immune function to pregnancy have been examined, rarely with any conclusive results. Ironically, one paper deals with the subject of how to prevent and heal pressure ulcers specifically in the elderly, (including those recovering from hip fractures), citing Vitamin A intake as a possible nutritional asset.(1)

While the summary of evidence seems to suggest a link and now a measurement tool between serum blood levels of Vitamin A and fracture, the research generates more questions. The consumer message should generate more questions, but will it?

The same pressure to reevaluate RDA levels of a spectrum of vitamins, minerals and nutrients is quite heated across Europe as the EU attempts to standardize nutrition and food guidelines.

Maybe I’m just a curious sort who sees more questions where others accept the answers provided. I’ve found personally that for every story told there’s another one untold. Maybe others know this too, and our credibility with consumers is the result of a more skeptical general approach. For instance there’s a lot of hype about Coral Calcium and other products and to their credit, many consumers seem to be asking for the science behind the products, and not just relying on ‘expert’ testimonials.

If suppliers and manufacturers in this industry are as committed to education as they proclaim, then there is a responsibility to take a high road, despite the fact that presenting an abundance of data (some of it contrary) may lead to questions they may not want to answer. We must be more critical of ourselves, than our critics will be of us.

This means too that when information appears in mainstream media, questions must be vocally and vehemently asked at every opportunity, and by the most credible and visible among us.

Maybe the show ‘Jeopardy’ has it right after all. It’s not really the answer that’s important. It’s the questions you ask after you have an answer.

1) Isr Med Assoc J 2002 Sep;4(9):713-6

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