An open letter to Medical ProfessionalsOpen letter to Medical Professionals:
While our web site deals with the issue of problem pregnancies, it has much broader implications.
Our nation is at a crossroads in the delivery of quality health care. Costs continue to escalate along with chronic disease. Medical Professionals' salaries are being squeezed as these costs rise unsustainably. This in turn only feeds the problem as physicians spend less time with patients requiring more tests to diagnose problems.
I feel medical professionals need to be adequately compensated for their services. Their education is expensive and their services are essential. Many take on a debt that will require years sometimes decades to repay. The overhead of doing business as a physician is also expensive adding to the frustration of delivering health care.
The Health Care Legislation that just passed will deal with several of the areas responsible for some of the high costs, but it does little to slow down the rising costs due to continuing increases in chronic disease.Cost benefit analysis of vitamin d supplementing
One solution to reducing chronic disease and in turn reduce costs requires a partial paradigm shift in medical thinking. Actually many doctors today are already making this shift. Before considering this solution, I want to talk about cost benefit analysis. This is used to weigh the benefits of any medical treatment used for chronic disease and vaccines for prevention. It helps answer the question, is the financial cost and health risks of treatment outweighed by the results and quality of life given to the individual?
There are certainly treatments being used that have many contraindications. Listening to the pharmaceutical ads on TV certainly attest to this. We vaccinate children and adults knowing that a very small fraction will have complications but many more lives will be saved making it far more beneficial than than the risk. I don't have to give you many examples because you make these decisions every day in treating your patients. You recommend a treatment because it will improve the quality of life or even save the life of your patient. Often a treatment with side effects is chosen because it is the best choice at the time given what is known about your patient.
In the last 5 years there has been an explosion of research by leading Universities in the US and abroad published in medical journals showing a full spectrum of chronic diseases that are prevented to some degree by adequate levels of cholecalciferol (vitamin D3) in our blood. This is not the supplement d'jour with only a few studies and conflicting outcomes. There are literally thousands of studies showing the possible benefits in the prevention of many of the most costly diseases including cancer, auto-immune diseases such as MS, diabetes, bone health etc. The RDA for vitamin d has been 200 to 600iu daily. People are developing chronic disease and dying because these recommended levels are much too low. Because vitamin d in very high levels can be toxic causing hypercalcemia and many medical professions have not known where these toxic levels begin, recommended doses have remained much too low. The fear that keeps these levels low appears to be from unsubstantiated information. There is no evidence that intakes of D3 less than 10,000iu daily and blood levels of 25(OH)D under 200ng/ml will cause toxicity. There are only a few medical exceptions. Dr Cannell's article on vitamin d toxicity best describes this unwarranted concern. (1. see link below)
But let's for a moment, consider the possibility of vitamin D toxicity in relationship to cost benefit analysis as it compares to one of the most prescribed medications today. Most doctors won't hesitate to recommend statins for high cholesterol even with potential complications including diabetes, statin myopothy/myalgia, and liver damage. As long as liver function tests are done regularly and a supplement of CoQ10 is taken, the most severe possible complications are mitigated. Occasionally complications will lead to liver failure or even death but most often the risks aren't this severe and the benefits for most are living a longer and more productive life.
Vitamin d not only improves heart health but protects us from cancer, autoimmune disease, lung issues, diabetes, cognitive health, infections and many more health issues. Supplements are inexpensive (pennies a day) and even if there is a concern about toxicity, a simple blood test can make sure this does not happen. Not one recorded death that has been associated with vitamin d toxicity. There is no apparent reason that most people should not be able to take a vitamin d3 supplement 10 to 20 times the RDA levels and could very well be necessary to maintain optimum health.The major toxicity issue, hypercalcemia, is easily detected and is reversible which is the only known toxicity issue. Vitamin d blood levels are simple to measured and making a goal for patients to reach levels above 40ng/ml preferably 60 to 70 ng/ml should be easy to attain and highly beneficial according to many recent studies. There is every reason to believe, given the vast amount of research, that Vitamin d is a tool that can be used to reduce costs in health care. From a cost benefit analysis, it should not be a concern to recommend the higher doses. Once you begin to fully understand the physiology of vitamin d (2. see link below)
, it will be clear to you, the potential of this gift for everyone.
While people do not need to see their physician to take vitamin d, it is necessary for doctors to be involved for a number of reasons. While it is unlikely that people will reach toxic levels, there will always be a few who don't understand the concept of too much of a good thing. Your patients should have their 25(OH)D levels checked at least once a year as not everyone responds the same way to supplements and sun exposure. I am taking 7500iu and have reached 48 ng/ml (far below toxic levels). My wife is taking 4000iu and has reached 44ng/ml. And as I mentioned before there are several medical conditions needing a physician's attention which can result in hypersensitivity vitamin D syndrome (1. see link below)
While it appears vitamin d can have amazing results, people will still get sick and still need medical treatment. You will need to be well informed about vitamin D as more of your patients will requesting information about it. I am seeing articles almost weekly now, not only in medical journals but in the mainstream media. It is important that you can give your patients good advise about this nutrient. When I give talks to groups about vitamin D, I tell them it is our first line of defense against chronic disease and given the all the research being published, I do not think I am exaggerating. Please take the time to understand the physiology of vitamin d. (2. see link below)
Buck Kopietz - D for DetroitLink #1 - Vitamin D3 Cholecalciferol Toxicity http://www.vitamindcouncil.org/vitaminDToxicity.shtml Link #2 - Vitamin D3 Cholecalciferol Physiology http://www.vitamindcouncil.org/vitaminDPhysiology.shtml