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Comment by 6stringmerc | Hacker News Reader

Regarding your question at the end - I firmly believe that doctors and day-to-day medical professionals traditionally despise discussions regarding supplementation. This his extremely anecdotal of course, but there seems to be some kind of 'wall' - probably on purpose - where medical professionals believe that only the knowledge on the inside of the wall has merit. This can be seen in the marketing/'re-evaluation' of opiates like Oxycontin, where once the establishment type leadership said it was okay, a lot of doctors started writing up scripts with this encouragement, and now the US is in the grips of a horrible addiction crisis.

It's not that medical professionals don't appreciate healthy living - it's that I frankly don't believe they're trained to promote healthy living. Rather, they treat symptoms. Some things are easier to figure out than others, and anything outside of the 'wall' is more often than not viewed in a negative light.

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I don't think it's half as bad as you seem to think. My wife's an NP, so I have an inside view of Syracuse, NY's medical situation. There's two issues at hand:

1. The quality of evidence for most supplements ranges somewhere between Bigfoot and Flat-Earth society. That's not to say it's all bad, but it's generally unstudied and unproven.

That being said: it's standard practice to strongly recommend vitamin D supplements for us northerners. That's reasonably new, high quality supplement data and it's not ignored. There's no bias for these types of medical practitioners, the data's just not there.

2. A lot of older docs are untrained when it comes to new studies about various things: pain meds (don't use them), alternative pain management (can be useful), H. Pylori (a proven explanation for stomach ulcers). These docs don't keep up to date. They're otherwise excellent doctors. Most of them care deeply about their patients and are fiercely defensive of them and their care (exceptions abound, but giving people the benefit of the doubt is a good way to live life a lot happier).

There's tons that's wrong with our medical system, try not to generalize it too far.

Also tell your doctor about ALL supplements you take. Some can react terribly with other medications and supplements.

1. Elsewhere I definitely agree that advertising and claims in the supplement world are a real bothersome issue. However the exact same criticism can be levied at the official medical community which has a habit of prescribing lots of different drugs for things such as "restless leg syndrome" or in the case of Lyrica, advertising it for all sorts of different applications until one finally gets market traction. Selling quick fixes is a long, glamorous and shady business.

Also, in my experience, a good deal of the actual, effective supplements that have been on the market are now illegal for suspect reasons. As in, because it actually works we're going to ban it.

2. A lot of older docs are pretty much what I was getting at, re: the 'wall' of knowledge. They've got long, strong careers in medicine doing things the way they've always done them, occasionally updating their knowledge but not really putting in a lot of effort. That breeds 'know it all syndrome' which, again anecdotally, tends to be a little bit more prevalent in that professional field.

Do you have any examples of where actual, effective supplements have been taken off the market? And if you do, can you say why the removal was suspect?

Sure, the easiest is 4-Androstenedione. It worked as intended. Maybe a little hard on the liver but that's pretty common for the type of compound it was. I say the removal is suspect because the claims of its dangers outwardly appear politically motivated.

Keep in mind this was what Mark McGwire claimed he was taking legally during the height of the steroid era in baseball (which he may have been - but if Canseco is to be believed he was using "real" AAS as well).

Another would be ephedra, in that it did what it claimed, but irresponsible people (apparently) thought eating handfuls of the pills would be a great idea. Several high-profile heat stroke cases as well. I'm not saying it's 100% side-effect free or safe or whatever, but it did what it stated, got a bad rap, and is now banned/illegal.

I'd love to see a comparison between the number of 4-AD and Ephedra related deaths vs. acetaminophen poisoning, which the CDC notes is about 33,000 cases per year (25% unintentional).

It's really just that most nutritional supplements have either low-quality supporting data or contradictory data. The hype surrounding the field of nutrition is not matched by its benefits.

This is not to say that there is no future for it. Rather, it is to say that there is a huge future for it, because at present the field has little to offer backed by strong evidence.

Even if there's not enough data, the risk of supplements is very low , especially compared to the risk of pharmaceuticals.So why not try ?

And the reason they don't have as much high-quality proof as pharmaceutical(clinical trials), is just because of monetary incentives, nothing more.

Part of me agrees with the monetary aspect, but history and current events have shown that the medical community still doesn't even have solid footing for a lot of 'simple' type issues. Nutrition seems to be a relatively new area of study, as evidenced by the seemingly routine changes in 'official' dietary recommendations. I do think the medical profession is working to incorporate nutrition into their concepts of treatment, but it's going to take a lot of time.

When we talk about pharmaceuticals, we talk about financial toxicity. Americans spend over $10 billion on nutritional supplements annually [1], most of which have very poor supporting evidence. Should people be able to spend their money how they see fit? Sure. Are they getting utility from it? Not the utility they're hoping for.

1 = https://www.washingtonpost.com/news/wonk/wp/2015/02/04/ameri...

I'm not denying there's a lot of unsubstantiated or over-inflated advertising within the supplement market, not at all. It takes hours and lots of digging into personal reviews and other sources to begin to find things that are both 1) effective and 2) legal. It's not a quick fix, which is what most advertising claims to provide.

If we're talking about wasting money and health though, then I think it's equally important to point out that homeopathy is apparently a multi-billion dollar industry as well in the US ($6B in 2012 [1]) and if we're going to rank things on effectiveness, I'm pretty sure homeopathy is just about on par with drinking water from a clean toilet.

[1] http://www.nutraceuticalsworld.com/issues/2013-07/view_indus...

When we talk about healthcare, we talk about financial toxicity. Americans spent $3 trillion on healthcare in 2014 [1], much of which had very poor outcomes. Should the healthcare system get a defacto blank check to charge insurance companies as much as they want? Sure. Are the patients getting utility from it? Not the utility they're hoping for.

1 = https://www.cms.gov/research-statistics-data-and-systems/sta...

(lol, sorry. $10 billion on supplements is a drop in the bucket.)

I don't think the risk is as low as you think.

Easy example: St. John's Wort

It's a proven effective anti depressive. It also reacts badly with just about every medication on the market.

Without more studies you can't make the types of statements you just made.

In addition, there is some strong evidence linking medium-term St. John's Wort use with cataracts due to photosensitivity. This makes it risky to combine with light therapy, which of course a lot of people do anyway.

In agreement with you - I'm not trying to really put down the medical establishment outright (they do a lot to resist quackery for sure!) but kind of deal with the lay of the land. I don't think going 'hippie' or all-in with supplementation in nutrition is really going to be a trend within the medical community, but I do think a lot of doctors tend to just, well, use the tools they have. Risk of bad outcomes is real, no doubt, and the US is quite lawsuit happy when it comes to medical cases.

I would definitely like to see more strong evidence regarding supplementation - actually, with a lot of different substances. In a perfect world the DEA wouldn't have the slightest bit of sway in dictating which substances can be researched in traditionally "proper" settings.

> This can be seen in the marketing/'re-evaluation' of opiates like Oxycontin, where once the establishment type leadership said it was okay, a lot of doctors started writing up scripts with this encouragement, and now the US is in the grips of a horrible addiction crisis.

To be fair with doctors when someone goes along and says "I have crippling back pain" and gets told "You need to lose weight and exercise" they bad mouth that doctor online and then they go to a different doctor.

Well, sure, but the patient doesn't write the script so they're not the one with the power, and if it was 'medically approved' to tell patients how to change their diet, what types of exercise would help, then the patient would simply waste their time going from doctor to doctor getting the same response. Thus the medical community is complicit in taking 'the easy way' in this instance. I'm not a fan of for-profit medicine, which could be somewhat responsible for the patient entitlement complex fueled by commercials which say 'Ask your doctor' but probably mean more along the lines of 'tell your doctor to give it to you' in practical terms.

Big pharma push doctors to use their regulated or protected pills. Who pushes vitamins and minerals?

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