Vitamin C Causes Cancer! St. John’s Wort Useless for Depression!
Alan L. Mille
The above headlines aren’t real, but are unfortunately not far from what was published recently in the popular press. An article in the June 15, 2001, issue of the journal Science revealed that in vitro ascorbic acid catalyzed the conversion of lipid hydroperoxide into a substance that can damage DNA. Of course, for anyone following the scientific literature, this is not new information. We have seen studies on vitamin C and other antioxidants, showing that they can easily be converted to pro-oxidants with the right in vitro stimulus. This type of study is interesting at best, but does NOT reveal how an antioxidant will respond in the complex biochemical and energetic milieu of the body. When the article was published, the authors of the study even stated, “Please don’t say vitamin C causes cancer.” This didn’t stop the Associated Press from using the headline, “Lab Study Finds Possible Villainy in Vitamin C Pills.” Neither did it stop the The Arizona Republic (Phoenix) from publishing, “Research Finds an Ill Effect of Vitamin C — Nutrient Can Aid Cancer-Linked Toxin,” which sends the wrong message about this study. The worst of the print media came from the Vancouver Columbian (Vancouver, WA), which stated, “Cancer Link Found With Vitamin C.” The interesting fact in this case is that all three headlines were attached to the same story, written by AP science writer Paul Recer. A credit to Mr. Recer is that the story itself was pretty fairly written, with quotes from the study authors and a representative of the Linus Pauling Institute. But the point here is, it is very easy to mislead an attention-deficit-plagued public that is used to getting news in snippets from the talking heads on television news, which, by the way, faired just as poorly at fully informing the public about this story. For example, ABC news used the teaser, “Vitamin C May Be Harmful,” to get the viewer’s attention, followed by Dr. Timothy Johnson’s fair reporting of the study. But he had to work against the headline, which may have already made the viewer believe vitamin C was bad.
Reporting on a recent St. John’s Wort (SJW) study was much worse. An AP story by Tammy Webber used the headline, “Study: St. John’s Wort Ineffective in Treating Major Depression.” However, other newspapers that reprinted the AP story must not have understood the important word in the AP headline, regarding this particular study, was major. Instead, they used the headlines, “St. John’s Wort May Not Help Depression” (Philadelphia Inquirer), “St. John’s Wort Fails Test on Depression” (The State — Columbia, SC), “St. John’s Wort Useless?” (The Arizona Republic — Phoenix), and “St. John’s Wort Ineffective, Study Says” (Contra Costa Times — Walnut Creek, CA). The San Jose Mercury News got it very wrong, stating, “First Major Study on St. John’s Wort Says it Doesn’t Aid Serious Depression,” the inaccurate part here being that this was NOT the first major study. The winner of this headline inaccuracy derby, however, was Time Magazine, which used “St. John’s What? The `natural’ antidepressant may not work. Bummer,” as the title of their article about the study.
The study in question, published in the April 18, 2001, issue of JAMA (a journal not known for its positive articles on alternative medicine issues) showed a SJW extract versus placebo did not benefit patients with severe depression in an eight-week trial. The researchers gave patients with severe depression 900 mg/day (a dose found to be effective in mild-to-moderate depression in numerous studies) for four weeks. If they did not respond, the dose was increased to 1200 mg/day. In a previous study in severe depression, patients improved significantly on SJW, compared to placebo and the antidepressant drug imipramine, on a higher dose of 1800 mg/day. On this information alone, it seems the JAMA study was destined to be a negative study, as it was inadequately designed, using a less than efficacious dose. Interestingly, the authors assail the 30+ previous studies on SJW as being inadequately designed. Unfortunately, the AP writer did not include information about the previous study on severe depression or the dosage issue. She did correctly state that the study was funded by Pfizer, the manufacturer of the antidepressant Zoloft, which makes one wonder about the rationale behind the study.
The media doesn’t always get it wrong, however. Their reporting of a recent article in JAMA regarding the use of botanical supplements in patients scheduled for surgery was pretty fair. The JAMA article itself had some flaws, most notably that this was a review article that relied heavily on the theoretical “potential” for eight botanicals to cause problems for surgery patients — an obviously cautious approach. The authors concluded that certain herbs should probably not be used perioperatively, including St. John’s Wort, Ginkgo, garlic, Valerian, Kava, Ephedra, and Echinacea. The media’s reporting of this story used headlines such as, “Herbal Danger,” “Herbs and Surgery Often Don’t Mix,” and “Study Finds Herbs, Surgery Don’t Mix.” These headlines grab the reader’s attention, and hopefully they read the full article. These three pieces (from the ABC, MSNBC, and CNN websites, respectively) all included information about the JAMA article, as well as a table from the article suggesting specific times that these herbs should be discontinued before undergoing surgery. All three articles also included the important message that patients need to communicate information to their surgeon regarding intake of botanicals.
Unfortunately, health reporters for newspapers and magazines usually do not have a background in medicine, and they or their editors often see the sizzle in the story, instead of the steak. They might believe the public is too stupid to understand complex scientific issues, or that they would be bored by more than a quick overview of a study. Time constraints in broadcast media usually necessitate a perfunctory review of a particular study; however, to their credit, the networks all have MD medical reporters (albeit MDs who don’t have a background in nutritional/botanical medicine).
The answer to the media game? When you see articles or television news stories about a new study, read the study) If you don’t have a medical school library close by, there are ways to purchase the full text article over the web. After you read the article, inform your patients in person, in your newsletter, on your website, or other medium. Don’t let the media tell you their version of the truth. Find out for yourself.
Alan L. Miller, MD
[1.] Lee SH, Oe T, Blair I. Vitamin C-induced decomposition of lipid hydroperoxides to endogenous genotoxins. Science 2001;292;2083-2086.
[2.] Shelton RC, Keller MB, Gelenberg A, et al. Effectiveness of St John’s wort in major depression: a randomized controlled trial JAMA 2001;285:1978-1986.
[3.] Vorbach EU, Arnoldt KH, Hubner WD. Efficacy and tolerability of St. John’s wort extract LI 160 versus imipramine in patients with severe depressive episodes according to ICD-10. Pharmacopsychiatry 1997;30:S81-S85.
[4.] Ang-Lee MK, Moss J. Yuan CS. Herbal medicines and perioperative care. JAMA 200;286:208-216.
COPYRIGHT 2001 Thorne Research Inc.
COPYRIGHT 2001 Gale Group