It's pure association, it may very well be pure confounding. In favor of the authors: The only thing they really claim is that an RCT should be done. Which I guess is an okay'ish conclusion from such a study.
Larger randomized trials are in progress [1][2] but the results won't be published until July.
[1] https://clinicaltrials.gov/ct2/show/NCT04344041 [2] https://clinicaltrials.gov/ct2/show/NCT04351490.
This is often the first stage before an RCT. Don't see what's confusing about this.
> As the COVID-19 situation evolved, we decided from 6 April 2020, to start DMB on all COVID-19 patients above 50 years old upon hospitalization and before the onset of the primary outcome event. Patients admitted during this period who did not receive DMB before event onset were served as control. Therapy comprised a single daily oral dose of vitamin D3 1000 IU, magnesium 150mg and vitamin B12 500mcg for up to 14 days
Turning round in a circle three times before you leave the house is almost entirely harmless, and there's no evidence that doesn't stop you getting coronavirus...
To play the devil's advocate, no, that's not true. What we have are just associations which could be spurious. It is often said the general population is deficient in this or that vitamin, but in the west at least we are no longer in danger of developing scurvy or rickets and beyond that there's actually not much evidence that vitamins improve our health.
(Note — not enough evidence means just that, and is certainly not evidence of absence)
Of course, take your vitamins, I've taken vitamin C and D long before this coronavirus and I've caught colds less frequently — but truth be told, I haven't isolated the variables, I have no idea why I felt better and it could be just coincidence.
The problem in believing diet can make a difference is that it may take resources away from investigating treatments that actually work.
In a clinical setting we are talking about high intravenous doses, which are supposedly meant to give the immune system a boost and not to fix prior deficiencies. There's not much evidence that high intravenous doses work either.
In the context of the population, keeping your distance, washing your hands, wearing masks and even if you catch the virus, minimizing the viral load you're exposed to, will probably do much more good than a healthy diet. If you do everything else, then fine, optimize your diet too, but often people get lost in minutiae, forgetting proper hygiene.
UPDATE: edited multiple times, sorry.
“Several studies have shown that megadoses of the vitamin can lead to outbreaks of acne and rosacea, a skin condition that causes redness and pus-filled bumps on the face. Yet, it should be noted that most of these studies focused on high-dose injections rather than oral supplements (5, 6, 7).
There is also some evidence suggesting that high doses of B12 may lead to negative health outcomes in those with diabetes or kidney disease. One study found that people with diabetic nephropathy (loss of kidney function due to diabetes) experienced a more rapid decline in kidney function when supplemented with high-dose B vitamins, including 1 mg per day of B12. What’s more, the participants receiving the high-dose B vitamins had a greater risk of heart attack, stroke and death, compared to those receiving a placebo (8).
Another study in pregnant women showed that extremely high B12 levels due to vitamin supplements increased the risk of autism spectrum disorder in their offspring (9).“
From: https://www.healthline.com/nutrition/too-much-vitamin-b12#he...
The odds of turning round in a circle three times helping are 0.000000001%. The odds of DMB helping are probably less than 50%, but more than 5% at this point. The cost is minimal.
Generally, one does an ROI calculation. To mix units and otherwise have zero rigor:
Return: P(treatment helps) * how much
Investment: P(treatment hurts) * how much + financial cost
My math on most cheap interventions, including vitamin D, are that they're obvious no-brainers, if done competently (e.g. not taking 600,000 IU per day, or sunburning oneself on a crowded beach -- dumb stuff like that always comes up in counterarguments).
Without math: There's evidence (although not proof) that they might help. They can't hurt.
I do a lot of things like that. When COVID19 first showed up, I was super-careful about contact transmission, large droplet, and aerosol, although I had no evidence which of those dominated. Were some of the things I did a waste? Indubitably. Was it a good idea to do that together? Without a doubt.
AFAICT Vitamin D supplementation may well be snake oil, as low vitamin D levels may be symptomatic of another condition which supplementing won't help.
Vitamin D pills cost $12 per bottle where I live. I would guess the economic damage from COVID19 is going conservatively going to be $10,000-$20,000 for a typical family. We can do the math.
If vitamin D has a 3% chance of reducing the economic impact by 3%, even health implications aside, we're best off with everyone taking it.
The evidence isn't strong enough to support even 50% odds of it working, but it's definitely strong enough to support greater than 3% odds.
Similar economics apply for in-hospital use, only even more so.
And yes, I'm aware of all the other correlations. Exercise, sunlight, time outdoors, wealth, and vitamin D all correlate pretty well. We need a robust set of RCTs.
Here in the UK you would expect the monetary cost to be zero. That doesn't mean you shouldn't look after your health, but seriously, wtf?
That's not to mention secondary effects, such as how that level of unemployment feeds into anxiety which inflames the current riots.
You can work the numbers however you like, but the number I gave is VERY conservative. The economic harm of COVID19 is astronomical here.
Much of that could have been mitigated with good policy, but in the US, it wasn't.
If a public health measure has even a slim chance of e.g. shortening the need for lockdowns by a few days, and costs several times more what vitamin D pills do, it's already economically worthwhile. The cost-benefit here (and in many other measures of possible benefit) is so incredibly ridiculously obvious that it's not even funny.
I have someone in another thread making similar arguments about hydroxychloroquine. How many meds and supplements should we take just in case?
There isn't such a thing. We know nothing. We have different levels of confidence in facts.
Even very basic facts ("am I alive") I can only say with pretty high confidence (we might all be living in a computer simulation or somebody's dream). And even things with strong scientific evidence occasionally get disproven. Studies with just one RCT are wrong all the time -- most medical and social sciences studies are wrong (it turns out p=0.05 is nowhere near sufficient in established research fields).
You work through decisions with uncertainty by calculating an expected gain or expected loss:
https://en.wikipedia.org/wiki/Expected_return
The argument for taking hydroxychloroquine is not the same. There is weak evidence it might do something, but the drug also has a whole slew of negative effects (https://en.wikipedia.org/wiki/Hydroxychloroquine#Adverse_eff...). If you compute the expectations of taking hydroxychloroquine prophylactically, it's definitely a very, very, bad idea. The downsides obviously outweigh the upsides.
If you do have a serious case of COVID19, it depends on what assumptions you plug into the equations. Which is to say, I wouldn't recommend hydroxychloroquine based on the last data I've seen (although I haven't followed this closely in a while), but reasonable people looking at the same data (again, ignoring anything from the past month or so) might recommend it. It's not an insane decision.
On the other hand, the data strongly supported ramping up the production of hydroxychloroquine and stocking up on it in case it is eventually shown to work. Hydroxychloroquine costs maybe 30c per pill, and dropping a billion dollars ($1/person) to make sure we have 3 pills per person is an obviously good idea. That's less than 1/1000th the stimulus package. Likewise, we should have used face masks immediately (including a massive push to surge manufacturing) before we knew what effect they had. We have enough data from e.g. influenza to where they were an obviously good idea from day 1. We should have done likewise for manufacturing of ventilators (which are turning out to be less helpful than we though), and for a slew of other things which /might/ be helpful down the line.
For most meds and supplements, we have zero evidence. There's no reason to believe they do anything, and if they do, the odds of it being negative are the same as the odds of it being positive. Don't do it. I think the one exception is zinc, where based on very incomplete data, it seems like it makes sense if you're sick.
Military, financial, and business are domains where there are sophisticated models for how one makes rational decisions with incomplete information (before "knowing"). If you wait for complete information before moving, a competitor or adversary will crush you.
Coincidentally, a lot of people were bothered by shutdowns happening before we knew how serious COVID was or how it spread. Those were also an obviously good idea. But the confidence interval for CFR ranged from a slightly more serious flu all the way up to maybe 8% at the time we shut down here. The _expected_ CFR was 3.4-3.6%, and the shutdown was an obviously good idea based on that incomplete information. But news sources omitted how little we actually knew.
Nicotine patches also have been said to help.
Every study like this distracts from other studies, so it needs to be pushing towards correct.
You're probably right, most things taken at 100x the normal dose for long period of time are toxic. (Water included)
While possible, it does seem unlikely.
I'm curious why an acute high dose would be preferable over a lower dose taken daily.
It's not quite an acute high dose. The body produces the equivalent of 10,000 IU per day in high sun exposure, so 60K per week tries to achieve that level. I believe the high dosage is simply convenience. The 2K IU daily dose is pretty common as well.
Taking 100000 IU per day for months/years is not necessarily toxic, especially when reducing calcium intake.
[1] - https://www.google.com/search?hl=en&source=hp&biw=&bih=&q=si...
(I have already been taking all three as supplements for the last year due to other research suggesting that having a shortage of them worsens ADHD symptoms)
Taking vitamin D for the average American will surely help in keeping good immunity, bone health, etc.
https://www.acc.org/latest-in-cardiology/clinical-trials/201...
I do wonder though if this is an important caveat though:
> among healthy participants.
.. since the rest of the discussion resolves around adding supplements to fight shortages. If "healthy" implies not have said vitamin D shortage then that is still a useful study but doesn't disprove the thesis that taking supplements is probably a good idea.
Beer is mostly water and your body can literally collapse from to much of it. I made a quick search and I didn't find anything that proves what you're saying.
If you look a table 2, the control group was on average 6 years older and had more co-morbidities. This suggests that there was some selection bias and that other undocumented factors could have greatly affected this experiment.
Doing multi-variate analysis with such a small sample size gives rise to huge uncertainties. In all, this study is only very weak evidence.