Talk:Orthomolecular medicine/Archive 2

"alternative medicine"
Orthomolecular medicine has conventional and nonconventional aspects. In many cases it was developed by conventional doctors in the forefront of mainstream medicine of their time, and in many cases overseas, OM products and uses *are* conventional medicine. Also the placement of OM's standing with respect to (US) conventional medicine is secondary to its description in the 1st paragraph, so 2nd or 3rd paragraph seems more appropriate if not the "relation to conventional medicine" section.

Regarding "Relation to conventional medicine", I would appreciate your review of the "relation to CM" section's development in Talk thru,  with Doc Johnny so that we can discuss improvements more productively. FYI two conventional medicine oldies that come immediately to mind are coQ10 (Japan) and serrapeptase enzymes (Japan and Europe).--69.178.41.55 08:56, 14 June 2006 (UTC)

added factual accuracy and pov tag
.. as the article is written in a POV and I don't believe it + it's unsourced = ie factual accuracy for me. revert only after prior discussion

The article is heavily sourced with 7 tomes or sets of books, as well as the external links that have substantial material and, at length, incorporate thousands of biomedical references. The article is primarily descriptive, written with an eye to NPOV and SPOV in conjunction with a number of real MD and DO types. Would you like to state what beliefs that it violates? I would appreciate a specific improvement or criticism to address. I would suggest reading the entire talk page above to avoid wasteful repetition. Thank you.--69.178.41.55 07:57, 19 June 2006 (UTC)
 * Why did you remove the "complementary and alternative" from the intro? ackoz [[Image:Flag of the Czech Republic.svg|20px]] 09:43, 19 June 2006 (UTC)
 * CAM's association to OM was modified and relocated to be the 7th sentence in the introductory section. Orthomed therapeutics have a presence in both CAM and conventional medicine. Often, conventional medicine conveniently forgets or overlooks who, what or when, when it accepts/absorbs something new. Not all orthomed is controversial since discoveries & treatments foundational or consistent with it substantially form the dawn of molecular medicine treatments found in conventional internal medicine texts. Because orthomed is so poorly understood by much of the population, the article first focuses on conceptualizing, defining and exemplifyng it to introduce it.--69.178.41.55 19:55, 19 June 2006 (UTC)
 * Honestly, do you earn your daily bread by selling orthomed preparations? ackoz [[Image:Flag of the Czech Republic.svg|20px]] 23:15, 19 June 2006 (UTC)
 * No. Do you have any specific factual, historical or textual disputes or improvements that you can articulate?--69.178.41.55 04:26, 20 June 2006 (UTC)

(reset indent) I would like to incorporate information from these articles/abstracts:


 * PMID: 8364081
 * PMID: 2234152
 * PMID: 3153129
 * PMID: 3737019
 * Barrett S:Orthomolecular therapy, http://www.quackwatch.org/
 * Nutrition Committee, Canadian Paediatric Society. Megavitamin and megamineral therapy in childhood. Canadian Medical Association Journal 143:10091013, 1990, reaffirmed April 2000.

I advise you, that www.quackwatch.org is listed on HONCode, and it is considered reliable among non-CAM physicians. I suggest we create a section called "Criticism", in which we summarise the majority POV on orthomolecular medicine. This will give the article a more NPOV, because there is a lot of criticism of the method, yet the article doesn't mention it sufficiently. ackoz 08:11, 20 June 2006 (UTC)


 * I have added a criticism section and those of your citations which criticise the application of multivitamins. Some are however reporting on dosage of a single vitamin or the effectiveness of one particluar treatment and do not criticise orthomolcular medicine in general. OM does not claim that vitamins and minerals can be applied indisciminantly or that they can treat everything. Removing POV tag Lumos3 09:09, 20 June 2006 (UTC)


 * I have reworked the criticism section. You should note, that only CAM supporters use the term "conventional medicine". I have also cited the BC Cancer Agency, which is: an agency of the Provincial Health Services Authority, provides a province-wide, population-based cancer control program for the residents of British Columbia. ::i.e. government source, valid an reliable, so please don't remove the citation. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 09:50, 20 June 2006 (UTC)

BCCA bias & errors

 * Sigh, we have a long week ahead. There are a *lot* of preconceptions in these statements and errors in the references that we're going to have to cover one by one to get straightened out again.  Let's take that first sentence, "Some health professionals see orthomolecular medicine as an encouragement for individuals to dose themselves with large amounts of vitamins in an unsupervised way,..." So surely blaming all ob/gyns for the coathanger abortionist down the way is then appropriate. These "side effects" are somewhat exaggerated examples of  generally *not* doing vitamins the orthomolecular way, at least for the last 40 years, or more. Conventional medicine likes to test *single* vitamins, often of inferior forms (another discussion), without appropriate cofactors, and without balance or broad chemical spectrum in similar vitamins, a sure prescription for failure and problems. Then blame the molecule or the competition.


 * In a few cases conventional doctors *do* conventionally prescribe megavitamins w/o the balancing and cofactors, over which OM types shudder. I would observe very carefully which way those other four fingers point. Regarding "conventional medicine" there have been horrific arguments at Wikipedia over the best label for general use and to distinguish conventional med from other schools of medical thought. So although suggestions are welcome, it is a well worn(out) subject (see also "allopathic" etc) that hasn't resolved well.


 * Also, although I have long accepted (or tolerated) the QW Orthomolecular article as a notable POV, fair warning that its basis is scientifically weak and contested, "experts" or not. We may get into this more later (SPOV issues).  Also your QW Orthomolecular reference is redundant, please choose *one* (there is another of the exact same article linked at the bottom of the OM page (I thought it was more prominent there) that I left in 10 Jan 06 when I redid the whole Reference section and External links.--69.178.41.55 12:04, 20 June 2006 (UTC)


 * Megavitamin and orthomolecular therapies are unproven methods considered dangerous by mainstream scientists. Dangerous? Megavitamins typically have no reported deaths in a given year in the US, although conventionally recommended iron supplements will kill several, about 5-6 kids & adults in the US each year. (orthomolecular/megavitamin supplement makers are historically more careful about iron supplementation than conventional multiple vitamin makers for a number of reasons)  "This compares with 59 deaths due to aspirin poisoning in 2003, 147 deaths associated with acetaminophen-containing products in 2003, and an average of 54 deaths per year due to lightning for 1990-2003."


 * "Scientific research has found no benefit from orthomolecular therapy for any disease." (Cassileth)  This statement is simply incorrect as presented here, by at least 20 to 50 years depending on how you count.  The grand old man of orthomolecular medicine and editor-in-chief of Journal of Orthomolecular Medicine, Abram Hoffer, MD, PhD, postulated & discovered the lipid lowering properties of megadose niacin (vit B3) in 1954, and along with credible conventional co-authors, published the result in 1955, the first mainstream recognized megavitamin (later orthomolecular) therapy. This lipid lowering was confirmed by Dr William Parsons, a graduate medical fellow at the Mayo Clinic in 1956, further confirmed in the early 1960s for titrated patients with individual care by Dr Edwin Boyle, a section chief in the Miami National Inst of Health for a 90% reduction in cardiovascular mortality over 10 years.  Boyle then consulted on the massive Coronary Drug Project (1966-1975) & which the Canner Study's analysis (1985) showed that 6 years of niacin treatment, even underdosed, at 2 g/d (vs 3 - 6 g/d clinically recommended) plain niacin, added an average of over 2 yrs of life for six years treatment in a 15 yr observation period.--69.178.41.55 15:04, 20 June 2006 (UTC)


 * Megadose vitamin therapy is believed to have started in the early 1950s when "a few psychiatrists began adding massive doses of nutrients to their treatment of severe mental problems." (Hafner) Only off about two decades. Actually several megavitamin therapies were developed and being actively used by a number of doctors, perhaps most notably including IV vitamin C in the 1940s by FR Klenner, far & away the largest megadose, and natural form RRR-tocopherols, vitamin E, by the Drs Shute in the 1930s.


 * Vitamin K: "Large amounts of vitamin K in pregnancy can cause jaundice in the newborn..." - Medical Letter (Anonymous). Toxic effects of vitamin overdosage. Medical Letter 1983;26 (667):72-74. This almost surely refers to the synthetics, either the vitamin K precursor, menadione aka (pro)vitamin K3, or one of the water soluble derivatives that metabolize to menadione. Human form vitamin K2 menaquinones (MK-4, MK-7, MK-9) were essentially commercially unavailable in 1983, are still expensive and not so common, and nontoxic at very high dosages.  Phyto-, phylloquinone, vitamin K1 , likewise has a low toxicity profile. "...menaquinones are nontoxic to animals, even when given in huge amounts." - Goodman & Gillman's Pharmacological Basis of Therapeutics (1996).  Synthetic menadione, cheap to manufacture, has long been banned for human use in most countries because of neonatal (and adult) liver damage.  Isoprene deficient menadione and its relatives would not be an orthomolecular choice. ...Dietary supplements high in vitamin K can block the effects of oral anticoagulants.  Orthomed MDs apparently have their own algorithm for this, monitoring prothrombin times, titrating and/or using vitamin E.


 * I have not fully picked apart the BC-CAC page yet, but hopefully you will agree that it is a fatal trend and an unfair quote, if not source. I respectfully suggest that you note that some of this issue *was* addressed in the "Relation to conventional medicine" section (and the January talk notes!) and try to recast "Criticism" constructively.  Mainstream medical POV on orthomolecular medicine is notable, and can be described, but it will be reviewed for gross inaccuracy and priority.--69.178.41.55 05:14, 21 June 2006 (UTC)

Come on, you are a POV yourself. Wikipedia should reflect the mainstream view, which is NOT that one you are presenting here - the majority of physicians simply don't believe in orthomolecular medicine. BC - CAC is a government agency, a reliable source, however unfair to you. Moreover, I revert your last edits, if you object, I will take my cecil medicine book and beat you on your head with that, so that you finally learn that vitamine overdoses are not healthy. You must have spent two hours writing this BC-CAC criticism, but it is a reliable source anyway.

ackoz 06:44, 21 June 2006 (UTC)

This article is describing Orthomolecular medicine and needs to describe what proponents of this field see are its benefits. Other points of view can then be fairly described alongside it. You do a diservice to your medicine books. Dangers from overdoses of some vitamins are recognised and OM does not recommend these are taken without supervision. Others such as Vitamin C are some of the least toxic substances known to man. Lumos3 10:27, 21 June 2006 (UTC)


 * Wrong, per WP:NPOV, the majority viewpoint should be the backbone of the article, and the most important minority viewpoints should be represented in the article. Read the Orthomolecular_medicine section and the appropriate sourrce given. The majority of people don't use CAM methods, and the majority of healthcare professionals don't believe in it. Therefore, according to wikipedia's central (there are 3 main policies as you probably know) policy, the article should represent the skeptic or conventional medicine viewpoint on Orthomolecular medicine. And instead of criticism, there should be a section for Advocacy. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 11:02, 21 June 2006 (UTC)


 * No you are wrong, read WP:NPOV . I know of no article that follows the lines you describe . Perhaps you'd like to give an example. I agree there should be a mention in the introduction that OM is a view held by a minority of practioners , but it represents a debate within science and its proposition should be fairly set out before oppossing views and evidence is presented. Lumos3 12:34, 21 June 2006 (UTC)


 * We are probably both wrong. But the fact that you or I know no CAM article that would follow the policy of WP:NPOV is caused by inevitable presence of CAM practitioners and supporters on wikipedia. Noone else is fanatic enough to edit articles that are rewritten 5 times a week by someone with strong pro-CAM POV. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 12:55, 21 June 2006 (UTC)

Ackoz, you are using WP:NPOV to drive counterfactual points and promote clearly counterfactual opinions in a brief, simply descriptive article on Orthomolecular medicine that avoids most claims and counterclaims, *not* one on "Medical politics". Please try to briefly describe your perceived physicians' group view with NPOV and some degree of SPOV. Please also consider many doctors may generally not be as familiar with high dose vitamin literature details as might be desirable for this article (I personally hear this from MDs, too). High dose therapeutic nutrition is simply not well addressed in US medical education (I am looking closely at the US med education system for a good answer). After personally discussing niacin for dyslipidemias with about 20 MDs and PAs (socially), I still haven't found one that is really conversant about its use and properties despite its many superior aspects well documented in the conventional medical literature over the last 50 years - and that is one of the cheapest, easiest orthomolecular therapies to find and verify conventionally.

Your views on vitamin safety (and efficacy) may also reflect common industrial grade vitamers & supplements rather than the preferred orthomolecular versions (usually natural isomers in the oil solubles, more absorbable or active forms), usually not especially more expensive in the US if you shop around. Often medical papers' chemical specifications would not even meet standards in other technical fields. e.g. "vitamin E" papers, which blend of 64 possible optical isomers (R/S,R/S,R/S-toco---) were you talking about and was that the natural alcohol or one of 5-6 common esters and the main cofactors (Se, ascorbate, coQ10) were controlled too? Never mind the "inerts". Often surprisingly missing in *any* detail, *some* conventional researchers finally are acknowledging exact molecular entity and specification are important in vitamin clinical trials and reporting.--69.178.41.55 12:46, 21 June 2006 (UTC)


 * WP:NOR we are not here to discuss the education of practitioners on vitamin dosage. We are also not here to assess the credibility of clinical trials or discuss about the fact that most conventional researchers don't distinguish between different isomers of something. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 12:55, 21 June 2006 (UTC)


 * from WP:NOR, "Like most Wikipedia policies, No original research applies to articles, not to talk pages or project pages,...". I was trying to conversationally illuminate points about orthomed data and common medical communication issues w/o being accusatory and address differences on vitamin safety, your perceptions of vitamin safety, and perhaps relieve self-imposed expectations of expertise.  By the standard of your excited warning statements in "Criticism", one should hunt down almost EVERY pharmaceutical in Wiki and apply a black box as well as add a skull and crossbones for balance.--14:56, 21 June 2006 (UTC)

Ackoz, I have taken pains to address the last BC-CAC sentence in "Criticism" as a counterfactual POV statement by demonstration (the niacin/dyslipidemia example). There are more. The sentence, "Scientific research has found no benefit from orthomolecular therapy for any disease", is factually false & disparaging, stated in a semi-authoritative manner, takes undue space and is placed for undue attention, damaging to unfamiliar readers, and, well, provacative. I will respectfully ask again, please withdraw the last BC-CAC sentence.--69.178.41.55 15:58, 21 June 2006 (UTC)

Criticism section
This is just inadequate as a section from any point of view.
 * 1) The list of risks does not say to which nutrients they apply or in what dosage.
 * 2) The citations are only critical of some aspects of OM and not the whole field yet the reader is led to believe they condemn the whole.
 * Specifically


 * http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3153129&query_hl=1&itool=pubmed_DocSum PMID: 3153129 adds the caveat "Their application is exclusively justified in clinical situations under direct medical supervision"


 * http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3737019&query_hl=1&itool=pubmed_DocSum PMID: 3737019 admits that "There are six categories that require vitamin supplements and, in some cases, megadoses."


 * http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html Uses studies on some aspects of orthomolecular psychiatry, but does not discuss dosage and does not report on supportive studies.


 * Lumos3 16:09, 21 June 2006 (UTC)

appropriate sources
It would be more appropriate, if you could provide us with a source outside of orthomolecular medicine, that would say that there is "scientific research" in it. I dont imply that orthomolecular medicine is a pseudoscience, but you could create any pseudoscience you could wish (for instance petrotherapy - a scientific approach to treating abdominal cancer by eating rocks), and if you had enough, say, ten thousand followers, who are easy to find because people are just crazy and hope in everything when they get sick, you could build some webpages and your followers would put up some webpages and then you could use these webpages as a source for your statements about "scientific approach and research in petrotherapy".

I can do nothing with this argumentation you are using here, but to ask you, please try to find some outer source.

--ackoz 19:33, 21 June 2006 (UTC)


 * Read on the books referenced in the article and their scientific references. Ackoz, orthomolecular medicine's scientific foundations are those of orthodox molecular medicine.  The pharmas pursue synthetic, *patentable* molecules, despite their toxicity and side effect issues.  This situation began to diverge with the pharmas' divestment of most of their vitamin research as of the 1950s. The various pharma positions & campaigns have become more aggressive, pervasive and acrimonious with each decade since.  The slow imposition of RCTs in the early 1960's, fiercely fought by US pharmas then, has become their mantra, a perverse (mis)representation of some accounting techniques as absolute requirements of Science itself, "incidently" marginalizing individual and small group research efforts and limiting direct criticism of the pharmas'  proclaimed results.  A more generalized view of scientific experiments tracks  and evaluates different kinds of uncertainty in the totality & priority of the evidence.  Mere formalsim is no protection against bad science anymore than big Accounting's protection of Enron shareholders.  Both pharmas and the tobacco companies have been shown to abruptly terminate research with potentially negative results as they approach statistical significance, as well as the simple expedient of not publishing adverse results (some authors put the number at 5 out of 6 projects).


 * As far as "mainstream" science, Roger J Williams (Am Chem Soc, Biochemical Institute, UTexas), Volkers (Merck research) and Pauling (Caltech) were all considered mainstream for the bulk of their work. Certain commercial interests wish to rewrite history as well as science.  However, the recent NIH rehabilitation of the "IV vitamin C for cancer" topic, clearly shows that Moertel seriously "erred" on the science part of megadose vitamin C in cancer. Large institutions (and their principals) do not make sharp, major U turns for trivial reasons.--69.178.41.55 06:20, 23 June 2006 (UTC)

--

Orthomolecular medicine is a science based study and represents a minority view among scientists. Its future growth and accetance will be based on evidence. Here are some centres of research and publication. Science is a debate not a doctine. Lumos3 22:51, 21 June 2006 (UTC) Research institutes
 * http://lpi.oregonstate.edu/   Linus Pauling Institute at Oregon State University


 * http://www.drrathresearch.org/  Dr. Rath Research Institute

Journals publishing Orthomolecular research (among other nutritional research)
 * http://www.ajcn.org/ The American Journal of Clinical Nutrition


 * http://jn.nutrition.org/ The Journal of Nutrition:

Report
 * http://www.npicenter.com/anm/templates/newsATemp.aspx?articleid=15698&zoneid=28 Report of the Independent Vitamin Safety Review Panel 2006-05-23

- Lumos, I am not so sure that the "conventional scientists" are the big negative majority here - e.g. witness the Vitamin D Council (Victoria conference in Hoffer's "backyard".) Looks like some of the med school scientists are (have been) in near open revolt on vitamin D "megadoses" & RDAs (was 200 IU ~1992, now 400-800iu, might be 2000+iu if they rationalize with the other oil souble vitamins, up to 50,000iu in single monthly doses. Vitamin D3 in immune function, SAD, MS, cancer.

As dangerous as a practice as categorization & grouping is, I might still consider these groups as having distinct statistical characteristics: the established conventional doctors, perhaps separately the specialists, the med school faculty, the med students (what's going on, am I being adequately informed for the future?), the PhD medical researchers. I might also pass this along. Several months ago I was briefly talking with a medical school biochem prof/researcher working on potential pharmaceuticals (on a Friday afternoon-evening). When I mentioned "therapeutic natural substances", he was instantly all over me about herbals vs pharmaceuticals. When I clarified that I was talking about "vitamin-like substances" he immediately stopped, expressed interest and a cautiously optimistic note about plausibility and potential.--69.178.41.55 04:56, 23 June 2006 (UTC)

quiet creepy edits by 69 64
69, you remove a link from the article because you don't like it, and you give no reason in the edit summary and neither on the talk page. Do you consider that good editing? Or are you just here to babble about the miraculous effects of orthomolecular medicine? Please stop deleting the things you don't like from the article. ackoz 08:15, 23 June 2006 (UTC)
 * As usual, the facts statements your assertions need  a little sharpening. (1) I didn't remove the link, someone apparently several thousand miles away did - I suggest that you learn how Whois works. (2) It *was* a redundant link, once is enough for loose opinion pieces, as I did previously suggest. (3) I haven't babbled about miracles either, I try to describe others' actions and their rationale. Try to find out what SPOV is.  (4) I've been pretty patient about the outright counterfactual part, trying to give you a chance to improve your edits. (5) IMHO, you are abusing both NPOV to develop literally counterfactual points, presented as an authoritative source about a subject that you have no real b/g, and, now the RArb, policies. You are certainly jumping the gun, bypassing RfC. (6) I think you should attempt to improve your subject background first if you are going to be effective in this article.--69.178.41.55 09:53, 23 June 2006 (UTC)
 * I didn't bypass the RfC. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 10:07, 23 June 2006 (UTC)
 * Well then, at least tell someone, like you did for RfArb, here and on the user talk page. I have been offline for over 36 hours and instead of you cooling off, I come back to an uproar.--69.178.41.55 11:01, 23 June 2006 (UTC)
 * Look, I have already stated my point: the article shouldn't look like this and noone is able to change it because you and Lumos3 will be here forever. I don't want no edit wars, so let's just ask the "elders" what they think about the rules. Thats why the RfArb. No uproar. --ackoz [[Image:Flag of the Czech Republic.svg|20px]] 11:11, 23 June 2006 (UTC)


 * A *lot* of conventional medical editors have accepted my edits without the problems on simple factuality in other far more contestable articles than we are having here. You appear (to me) to misquote Wiki rules to your convienence about a subject that you display little knowledge of the basic subject references or the subject's history.  I use a simple rule in editing, I try to develop an article that is coherent to the overall facts.  You are injecting counterfactual POV that even if you can source it serves no additional purpose except to falsely disparge the subject.  Make accurate, balanced edits, - I'll easily respect them and try my best to improve them.  Just ask the conventional medical doctors & scientists like: Andrew73, InvictaHOG (oh, you already did), Jfdwolffe, DocJohnny, Gleng, Tearlach, even Midgely.  I recently got off someone else's RfC, 4 weeks making peace over far more drastic issues - you, never mind the RfC stage, after a few hours, want to start RfArb over corrections that I assiduously justified but you then exploded just because you "don't believe".  You are treating us very poorly.  Try this, *do your homework*.  May I suggest that you withdraw the RfArb as totally premature.--69.178.41.55 11:35, 23 June 2006 (UTC)


 * What I will suggest is an informal mediation with one of the conventional medical editors, perhaps like User:Gleng, an academic.--69.178.41.55 11:48, 23 June 2006 (UTC)


 * We will do that if the RfArb is rejected. Stop beating me with words like "doctors & scientists", academics etc. I am a doctor myself. I know User:Gleng. He has participated on Homeopathy for a long time. See where the article is now? Still has a NPOV tag and I didn't put it there. In fact I never edited that article. However, the main problem is that the reliable literature / sources are not defined. So the editors who are pro-Homeopathy will use homeopathic journals as a "reliable source", whereas for the rest of the world, the contents of that journals is just plain quackery. We will wait for the ArbCom, if they decide that we have to argue indefinetly about things we can't ever agree on, create extra-long articles bloating with many POVs, I will stop editing the article. If they decide that per NPOV, the article should contain the majority view (which is skeptic) as a backbone, I will start editing the article. Agree? ackoz [[Image:Flag of the Czech Republic.svg|20px]] 19:23, 23 June 2006 (UTC)


 * I cite my previous edit experience with all other "conventional medical" doctors & scientists that *I am a reasonable SPOV editor* where there is an ongoing scientific debate. I have previously managed to resolve differences with them through SPOV. Your words imply that you lump Orthomed in with alternative medicine in general, or more ludicrously, homeopathy, a huge error.  Orthomolecular medicine is all about biologically based science and relatively cheap (unpatented) nutritive substances or nutraceuticals if you will.  In fact, in orthomolecular eyes, "conventional medicine" is literally 10x, 100x, 1000x closer to homeopathy's 10^-30 than orthomed on over two dozen vitamin-like substances, so be careful. On occasion the orthomolecular prescription is substance withdrawal to reduce supply or (over) accumulation of certain substances, e.g. for PKU & galactosemia, sometimes  conventional medicine already agrees. As for science, orthomed emphasizes inexpensive test design (which frequently  suffer *multiple* known or knowable design flaws in conventional medicine/pharma trials) over the expensive accounting apparatus of pharmas required to test dangerous drugs or exotic molecules of little, unknown or negative benefits.


 * We probably agree on many things that you don't recognize. For example, vitamin E.  An orthomed probably agrees that that (all-racemic) d,l-alpha-tocopheryl acetate (the cheapest, most common esterified synthetic with only 12% R,R,R-tocopheryl acetate, that is conventionally tested so often) doesn't work too well - said so 50+ years ago (Drs Shutes).  Anyone familiar with the literature and history realizes that the R,R,R gamma-tocopherol fractions and other cofactors are big issues.  Read the US pharmaceutical patents, and you will find some highly paid conventional (pharma) scientists that think R,R,R-delta-tocotrienol can kill cancer cells pretty efficiently and that alpha-tocopherol is worthless killing cancer cells but that the alpha-tocopheryl succinate is useful (pharmas patented a delta-tocotrienol derivative).  Orthomeds just can't figure out why conventional medicine keeps repeating the same brain dead d,l-alpha tocopheryl acetate experiment failures for decades into this millenium, unless (1) it is a smear campaign or (2) the medical curricula are so deficient that no one knows.  Those resources could productively answer a lot of other questions..69.178.41.55 03:39, 24 June 2006 (UTC)

Vitamin E (as d-alpha tocopheryl acetate) in prevention of heart disease, and the Shutes
COMMENT:

The comments above are just unfair in light of available evidence. Recently completed is a prospective randomized placebo controlled trial of RRR alpha tocopherol (just what the Shutes liked) in 4000 people followed for 7 years. The patients had heart disease and diabetes. Basically, RRR-alpha tocopherol (d-alpha = ddd alpha) was a bust. If anything people who took it had more heart failure (though this didn't seem to be too severe a problem). But as for the idea that it clears up coronary disease or prevents heart attacks, the best data available doesn't support that.

Here's the abstract of the study, which is called HOPE-TOO (HOPE-The Ongoing Outcomes = HOPE-TOO . It's an ongoing bit of the HOPE trial (Heart Outcomes Prevention Evaluation). This is the biggest, longest prospective blinded and placebo-controlled prospective trial of d-alpha tocopherol acetate.

"Effects of Long-term Vitamin E Supplementation on Cardiovascular Events and Cancer: A Randomized Controlled Trial" The HOPE and HOPE-TOO Trial Investigators* JAMA, Vol. 293, pp. 1338-47 (March 15, 2005).

ABSTRACT: Context: Experimental and epidemiological data suggest that Vitamin E supplementation may prevent cancer and cardiovascular events. Clinical trials have generally failed to confirm benefits, possibly due to their relatively short duration. Objective: To evaluate whether long-term supplementation with Vitamin E decreases the risk of cancer, cancer death, and major cardiovascular events. Design, Setting, and Patients: A randomized, double-blind, placebo-controlled international trial (the initial Heart Outcomes Prevention Evaluation [HOPE] trial conducted between December 21, 1993 and April 15, 1999) of patients at least 55 years old with vascular disease or diabetes mellitus was extended (HOPE-The Ongoing Outcomes [HOPE-TOO]) between April 16, 1999 and May 26, 2003. Of the initial 267 HOPE centers that had enrolled 9,541 patients, 174 centers participated in the HOPE-TOO trial. Of 7,030 patients enrolled at these centers, 916 were deceased at the beginning of the extension, 1,382 refused participation, 3,994 continued to take the study intervention, and 738 agreed to passive follow-up. Median duration of follow-up was 7.0 years. Intervention: Daily dose of natural source Vitamin E (400 IU) [d-alpha tocopherol acetate] or matching placebo. Main Outcome Measures: Primary outcomes included cancer incidence, cancer deaths, and major cardiovascular events (myocardial infarction, stroke, and cardiovascular death). Secondary outcomes included heart failure, unstable angina, and revascularizations. Results: Among all HOPE patients, there were no significant differences in the primary analysis: for cancer incidence, there were 552 patients (11.6%) in the Vitamin E group vs 586 (12.3%) in the placebo group (relative risk [RR], 0.94; 95% confidence interval [CI], 0.84-1.06; P = .30); for cancer deaths, 156 (3.3%) vs 178 (3.7%), respectively (RR, 0.88; 95% CI, 0.71-1.09; P = .24); and for major cardiovascular events, 1022 (21.5%) vs 985 (20.6%), respectively (RR, 1.04; 95% CI, 0.96-1.14; P = .34). Patients in the Vitamin E group had a higher risk of heart failure (RR, 1.13; 95% CI, 1.01-1.26; P = .03) and hospitalization for heart failure (RR, 1.21; 95% CI, 1.00-1.47; P = .045). Similarly, among patients enrolled at the centers participating in the HOPE-TOO trial, there were no differences in cancer incidence, cancer deaths, and major cardiovascular events, but higher rates of heart failure and hospitalizations for heart failure. Conclusion: In patients with vascular disease or Diabetes Mellitus, long-term Vitamin E supplementation does not prevent cancer nor major cardiovascular events and may increase the risk for heart failure.

FURTHER COMMENTIn the initial shorter duration version of the HOPE trial 3 years ago (>1800 patients per group), congestive heart failure (CHF) came closest of any endpoint to being greater in the d-alpha tocopherol acetate 400 IU group, with the RR 1.21 and confidence limits 1.0 - 1.46) p = 0.05. Hospitalization for CHF didn't come close to significance at p = 0.51. With larger numbers and longer followup, both these are now significant in the HOPE-TOO.

The interesting thing is that CHF is usually a consequence of coronary disease and old MIs. But the number of MIs and other coronary events really didn't come close to being significantly altered by the vitamin E in the full study above (which is the only one I have access to, right now). The closest of anything was stroke, which had a p of 0.2. None of the cardiac stuff was much different from RR =1, so it does NOT look like it was there, but just isn't showing above the noise due to power problems.

So what's going on with the CHF? I don't know. But this kind of "congestive heart failure" is not as bad as it sounds to the layman, if if doesn't increase deaths and doesn't result from any detectable increase in coronary events. It basically means retention of fluid in feet or lungs, and hospitalization means there's enough retention in the lungs to cause problems. We have no way to know if in this study, the extra cases were due to some global weakening of cardiac function, or just some odd changes in salt handling and retention (which would of course be less worrisome). We do know from this and many other studies that blood pressure and renal function (at least, of the gross filtration sort) are not affected at all by doses of vitamin E in this range. So it's a mystery. Still, I'm not going to pretend even this non-MI-related CHF is okay, although in many practices it would simply mean an adjustment of diuretic. The bottom line is the only thing vitamin E does for cardiac patients we can really be sure of, is something (somewhat) bad.

The main value of these studies is to show that vitamin E as the d-alpha form, in doses large enough to raise blood levels by 70%, has NO effect on heart disease progression. Or on diabetes progression. Not even a hint of it, in a placebo controlled study of many thousands of people extending many years. I have a whole book (by Wilfred Shute, M.D. with Harald Taub: _Vitamin E for Ailing and Healthy Hearts_ 1969, with the 11th paperback printing I have from 1977) claiming that this very d-alpha tocopherol in similar amounts, is a veritable cure-all for all cardiac ailments. These claims by the Shute brothers go all the way back to the 1940's. Every chapter of every health book since the Shutes started blowing this horn, has had an enormous amount of junk repetition of all these claims.

Well, these Shute claims appear to be wishful thinking. The real shame is that it's taken the "medical establishment" half a century to prove it. And no, there's still no good prospective evidence that vitamin E prevents cancer in humans, either. (Frankly, I'm a little more hopeful that selenium will prove out, there. And possibly even vitamin C.) Vitamin E per se in reasonable and traditional supplemental amounts (which 400 IU is) certainly doesn't affect onset of diabetes, or progression of diabetic renal disease. We know that from the HOPE trial also. I would have wagered a modest amount of money that this wouldn't be so, from what I know of oxidative mechanisms in diabetes. But I'd have been wrong. That's why we do these studies.

And no, the HOPE trial goes beyond showing that vitamin E just doesn't heal the diseased-of-heart (though the Shutes claimed just that). Most of the HOPE enrollees were not clinically ill, though they did have coronary disease. If vitamin E even slowed progression of those with disease, it would have been seen here. It wasn't. The idea that vitamin E prevents ONSET of coronary disease in totally healthy people who don't have any at all (if such adults exist in our society), even though it doesn't at all effect progression of disease in people who already have some, is very far fetched. I think it's grasping at straws, in fact. I don't believe it, and can't imagine why anybody would.

Here's the full text of the first phase of the HOPE trial, on the vitamin E trial side (as you know, there was another side looking at preventive effects of giving the ACE inhibitor ramepril): [] Steve 16:55, 24 June 2006 (UTC)


 * Thanks Dr Harris, that is a data driven view of the Hope trials, there are other trials and analyses (sigh). An orthomolecular version might have been in the long expressed therapeutic ranges of 600-3200iu of RRR-alpha tocopherol along with an additional 20-45% mixed tocopherols with provision for oil soluble vitamins(-like) (especially K2, coQ10, and D3) and the C, Se cofactors along with some medical screening & classification. I think that the vitamin E devotees are also concerned about transport & enzyme activation (de-esterification) in damaged and degraded bodies, potentially an important statistical minus for tocopheryl acetate. I would respectfully comment on a series of articles, and biographies, that I have been peripherally interested in since the mid 80s, and unanswered vitamin E hypotheses that mainstream E research & reporting just barely has begun to address (include my comment on specific molecular entity).  You are absolutely right that the Shute brothers, swore by the RRR-alpha-tocopherol label (d-alpha- then, pre IUPAC).  That may have been one of their blind spots, and tragedy.


 * Starting in the 1980s (my perspective), the discussions of the effect of the other natural R,R,R- isomers (beta, gamma, delta tocopherol and the provitamin precursors, tocotrienols) began to surface for the public.  One of the issues was the varied (declining) reported successes of the Shutes, that their claimed/seeming early success was fading into the 1960s.  The question raised was whether the nature of the vitamin E preparations actually consumed changed (ie. -ol becomes -yl acetate; and that by the 1950s, the much more common gamma-tocopherol isomer was being methylated & diverted into alpha-tocopherol production rather than "left in", a freebie), since beta, gamma, delta tocopherols were not allowed to be "marked & discounted" as alpha equivalents, a financial disaster for the natural producers. At the very start, the Shutes, including the father, were using wheat germ oil (ugh) for their treatment, which has lots more gamma- than alpha- (less than 10-20% alpha?).  Starting around 1939 Squibb marketed a popular/common "mixed tocopherols" that should have be easier to produce than purified alpha (I would also wonder if there was unlabeled substitution of isomer "equivalents" for alpha at first ca 1940s, nascent chemical suppliers can be a little loose in their outlook).  The product alpha- purity of the 1930s through 1950s for different brands/sources would be an interesting retrospective, to achieve tocopherol separation at all was the minor chemical engineering miracle of "molecular distillation" (well, they were more proud of it than that), I believe associated with vitamin E (my unresearched impression).  Anyway there is conjecture that the Shutes were blindsided by various commercial changes in the supply chain and their own mental lock-in to "alpha".  I think the natural/orthomolecular problem is that the mainstream has taken over 20 years to even begin to recognize the need for trials to report correct compositional labeling of the active components as manufactured much less differentiate & address the -ol & isomers issues.  A waste of many -yl acetate trials.


 * Anyway, various industry (including the pharmas) articles, patents have mentioned/discussed the varied properties of those other isomers in bits and pieces. But it has not been a timely, incisive well thought area of research, and here I fault the meds & feds too. Gamma tocopherol is being slowly recognized/proposed for a different set of properties possibly including inflammation and angina. Here's my kicker, and it's anecdotal: a *lot* of people when you check into it use(d) mixed tocopherols, including two of the biggest proponents in the business (J.I. Rodale and Roy Erickson) because their (often debilitating) persistent angina disappeared in days, weeks, or at lower dosages, years (YMMV). Although Rodale died of heart failure under stress, it was several standard deviations later than his father and siblings with apparently a higher quality of life. Erickson, obviously came to have a vested interest too with his highly specialized, mixed tocopherol line in the early 60s but claimed satisfaction for another 40+ years.  I have never seen the kind of follow up that I think incisive medical/scientific investigators should given their focus on -yl esters and it is well nigh impossible for the small operators to do it credibly.  I think you will see a lot of open skepticism from both sides, of both sides, until proper -ol & isomers trials are *finally* laid on the table.--69.178.41.55 02:52, 25 June 2006 (UTC)

Orthomolecular comments from above, continued

 * We would agree that the conventional medical view is briefly notable, partly as a fair warning. Conventional med does (should) not control the representation & definition of a subject (as you seek) that it studiously knows little about. There are simple, crucial orthomed experiments awaiting conventional, authoritative replication for almost 60 years that were simply ignored despite repeated confirmations - but as of 2005 things seem to be rewarming - give it another 10 years for glasnost!  Use of "quackery" and "pseudoscience" on orthomed is erroneous and are violent pejoratives that will be taken to scientific task.  Instead of playing the lottery, hoping for an orthomed pox, the decent thing to do is to withdraw the RfArb, which should not be there in the first place. Otherwise I am necessarily on defense, and that will be pointed.69.178.41.55 03:39, 24 June 2006 (UTC)

Pauling's definition
Pauling defined OM as the use of any molecule normally present in the human body. This would include application of supplementary amounts of normal human metabolites, not just those found in nutrition. Should this be included more specifically in the article? Lumos3 08:35, 23 June 2006 (UTC)


 * Did anybody say that "This would include application of supplementary amounts of normal human metabolites, not just those found in nutrition." or do you just assume that from the Pauling's definition? If its you assumption, then the answer is no per WP:NOR. If it's something you can find written somewhere, why not include? ackoz [[Image:Flag of the Czech Republic.svg|20px]] 08:44, 23 June 2006 (UTC)


 * Here is the definition
 * Linus Pauling defined orthomolecular medicine as "the treatment of disease by the provision of the optimum molecular environment, especially the optimum concentrations of substances normally present in the human body." or as "the preservation of good health and the treatment of disease by varying the concentrations in the human body of substances that are normally present in the body". He sometimes appended "and are required for health"


 * The key word is "optimum" -- if the optimum has to be supplied in supplements, so be it. --Michael C. Price talk 07:25, 10 August 2006 (UTC)


 * Ackoz, a simple, accurate intrepretation of a direct statement in the English language is not WP:NOR. FYI, Linus Pauling Institute's statement on orthomed definition.  Lumos, since Ackoz didn't catch it correctly, tersely improving sentences may be a good idea. But the article is starting to bloat with both pro & con, and we need to control bloat. One thing I would like to clean up is the list of orthomed docs, both for format (would like to use about 5 names per line - neatly, evenly spaced), and priority, i.e. Dettman is really an indirect link from Kalokerinos and not primary to this article (sorry, John).--69.178.41.55 11:12, 23 June 2006 (UTC)

RfArb
We would end up in edit warring here, so I posted the case to RfArb. ackoz 10:05, 23 June 2006 (UTC)

Guys
I am not here to spend two hours each day polemizing with your arguments. There must be plenty of them because you love the subject so much. I really don't care (don't take it hard .. there's really no personal hatred in this) about your ideas about Orthomed .. you are not important. Please dont whine at the RfArb page about my ignorance to your comments. I don't care about your arguments. I do care about the sources you use. Governmental public health agency= valid. Orthomed central website ~ well anyone can say I'm a god and put up a website and then write something on wikipedia, right? Why are there no "external" sources for your statements? And I don't "explode", 69. ackoz 02:42, 24 June 2006 (UTC)


 * Last time I was in Russia (90s), blind arguments for government agencies' insight and veracity did not seem to carry too authoritative weight w/o the authoritarian part. Also, some of BC CAC's assertions have been outright impeached or superceded by US Nat'l Academy of Sciences & NIH within the past 2 years (finally after 40-50 yrs of blinding bs!), provincial BC-CAC is behind the times, even in mainstream science. Every other conventional medical editor that I have corresponded with here has recognized and honored SPOV with relevant sources, sometimes a discussion.  This orthomolecular article (talk) previously covered the issue that infinitely long specific argumentation in the article is counterproductive, and orthmed is not just anybody (Nobel laureates, separate MD+PhDs, large university department heads & founders, large pharma research heads, very conventionally successful lifelong researchers).  InvictaHOG tacitly agreed, "...practice needs to be described as part of making an encyclopedia..." is a reasonable scope for the orthomed article as a knowledgeable description with pertinent references. In fact please reread 'HOG's answer, my interpretation was "take a deep breath, realize you won't agree with everything at Wikipedia, and carefully consider the optimum selection of articles for your time, expertise, contribution and enjoyment"  If the orthomed article so as much as detectably, or even questionably, errs, I am sure there are at least six pairs of eyes ready, willing and eager to quickly set it straight again, HMS' InvictaHOG included (his watchlist admission & previous edit interests too).--69.178.41.55 04:55, 24 June 2006 (UTC)


 * Double blind trials on Vitamin C Proc. Nat. Acad. Sci. USA Vol. 68, No. 11, p 2678-2681, November 1971. Lumos3 09:20, 24 June 2006 (UTC)
 * Thanks. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 11:07, 24 June 2006 (UTC)
 * Lumos3, I said two three randomized controlled trials, by different teams, different authors. Where are they? If you really understand the concepts of scientific debate, you know, that one study or a series of studies from one author or one author team does not prove anything. I can give you two three (at least) articles from various authors with studies that prove that Pauling was wrong. Plus I can give you the current valid guidelines for common cold (or better cancer) treatment, that would prove that megavitamin therapy is not accepted as a majority view. You want that here? ackoz [[Image:Flag of the Czech Republic.svg|20px]] 16:19, 25 June 2006 (UTC)


 * Basically, the conventional cancer crowd's "refutation" of Pauling is based on the frequently quoted, bogus Mayo-Moertel studies (they simply failed to even replicate a low end administration of the IV ascorbate of at least 10 gram per day of ascorbate, among many problems, much less try the 30-300 grams/day regimes if they were to legitimately try to repudiate vitamin in the general sense). NIH, NCI, ACS have the money, they have been abrogating their duties to run the proper trials for decades.  The two papers below, simply acknowledge that as an "oversight" when in reality the conventional medical "expert" critics have been pummeled.


 * Ultimately, science is a process with varying degrees of evidence. Never mind the double blind RCT, conventional critcs have had nothing, zilch, nada to factually contest with on high dose intravenous vitamin C for years, and now they  do.  Guess what? - Pauling et al seem to be plausible again despite the smear campaign, can't dodge it any more, IV vitamin C needs more testing. Oh, dear!


 * As for the mainstream view, the primary statement is that mainstream medicine does not accept orthomolecular medicine (already stated at length in "Relationship to conventional medicine"). Perhaps minor elaboration, perhaps including the orthodoxy defenders' absolute dearth of relevant test data could extend a sentence. Your presupposed test data just are not there, the mainstream view happens to be truly baseless opinion or superstition. (show me *any* published conventional medical test using 50-100 grams of oral vitamin C much less closely titrated bowel tolerance or IV vitamin C)  Orthomed's data may not always be multiple, fully bought and paid for dbRCT but there is real scientific evidence (often classed at a lower priority), more than you have.  The article is a simple description of orthomolecular medicine, quit trying to hijack it and malign it with the fatuous, counterfactual dogma parts. That there are scientific disputes is long noted and described, laid out at length in talk for the morbidly curious but is totally non encyclopedic for ordinary readers.--69.178.41.55 21:40, 25 June 2006 (UTC)


 * Pharmacologic ascorbic acid concentrations selectively kill cancer cells: Action as a pro-drug to deliver hydrogen peroxide to tissues, Proc. Nat. Acad. Sci. vol. 102, no. 38, p 13604-13609, September 20, 2005
 * See the comment below. The same we-are-talking-nutrition-and-using-intravenous-usage-as-arguments. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 15:58, 25 June 2006 (UTC)


 * Intravenously administered vitamin C as cancer therapy: three cases CMAJ, 174 (7) March 28, 2006--69.178.41.55 09:47, 25 June 2006 (UTC)


 * I think I heard about vit. C in this context, but what has IV Ascorbic acid to do with optimum nutrition aka orthomolecular medicine? Are you familiar with the meaning of ''IV'?? If the orthomolecular medicine is what the intro paragraph of the article says, this study has nothing to do with orthomolecular medicine. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 15:55, 25 June 2006 (UTC)


 * Once again you are showing how little you know about the main subject, orthomolecular medicine. Please READ the bibliographic references, several are by the generally known authors that DEFINE this subject, not your opinion or desires. One of orthomolecular medicine's longest and greatest unresolved controversies IS intravenous vitamin C, simply because no conventional authority has deigned to repeat or test IV vit C for over 57 years!!!!!--69.178.41.55 21:40, 25 June 2006 (UTC)


 * Plus, before you start beating me with "intravenous nutrition", you can have a nutritient and use him as a drug. Ascorbic acid is a simple chemical, and the articles you provided clearly state that in this case, the vitamin is used as a medicament, not a nutrition component. ackoz [[Image:Flag of the Czech Republic.svg|20px]] 16:48, 25 June 2006 (UTC)


 * Your point here is about the range of "optimum nutrition" as to whether to include therapeutic nutrition in life's time varying optima as synonymous with OM, *not* limiting orthomolecular medicine. Even if you were to restrict "optimum nutrition" to a "preventative nutrition" role, the sentence affected would be the first, "OM or optimum nutrition..." would become "OM and optimum...". Although the article doesn't emphasize it, rectal feeding and transdermal delivery are included...in conventional medicine, too.--69.178.41.55 21:40, 25 June 2006 (UTC)

69
Read WP:NPOV, please. Orthomolecular medicine is a minority viewpoint. There is no reason why the articles about vitamins should be filled with orthomolecular theories. If you want, you can surely add a small section to the article, describing the orthomed POV, but don't add pieces of this to every section of an article, pretty please, respect the NPOV policy. ackoz 16:45, 25 June 2006 (UTC)


 * We are only talking here about OM not all articles on vitamins. Please keep to the subject.Lumos3 21:51, 25 June 2006 (UTC)


 * Ackoz, you repeatedly twist WP:NPOV to badger me. I write conventional subjects too. Orthomolecular medicine has conventional and alternative (unsettled science, not moonbeams) components. When I write, I often use conventional literature (e.g. Goodman & Gilman's Pharmacological Basis of Therapeutics, Krause's on nutrition, or Harrison's Principles of Internal Medicine), just not all of it was in this week's pharma sales literature. I do write for conventional encyclopedic interest.  Like at niacin, the conventional medicine, gold standard stuff that you cut out - ordinary prescription bounds & a maximum use amount warning - you are starting to border on physiologically dangerous, doctor.  And so then you added in valuable text about ancient, small studies with unflinching praises for inositol hexanicotinate that have multiple questions about cholesterol treatment failures from *both* naturopathic & conventional doctors in the US, as well as your re-adding the less documented part about niacin for THC & bad LSD trips that Dr Wolffe previously criticized as "food for drugheads"??? Puhleeeeezzze.


 * Why don't you just stop harrassing me or is that part of your gratuitous, superquickie RfArb plan, too.--69.178.41.55 22:46, 25 June 2006 (UTC)

Ok, I see the withdrawal, thank you. Going forward, the BC-CAC line really has factual conflicts. It might be better to either find a better informed, more precise source to portray the conventional medical view or just write it yourselves. As an example of improved factual balance, I give this as an example: ''"BC Cancer Agency of Canada has said of orthomolecular treatments: Many/most "Megavitamin and orthomolecular therapies are not authoritately proven methods; some are considered dangerous by some/many mainstream scientists. '' "Scientific research has found no benefit from orthomolecular therapy for any disease." (Cassileth) [7] (that last sentence needs some kind of rewrite. Also suggest that we slow down a few days, or perhaps just concentrate on the "Criticism" part. I would like to get back toward a svelte article. Also this is a little duplicative on QW & part of the negative statements in "Relationship..." & "Criticsim"--69.178.41.55 00:09, 26 June 2006 (UTC)

Criticism: "scientific research..."
 "Scientific research has found no benefit from orthomolecular therapy for any disease." Perhaps Cassileth meant something closer to "alternative medicine is no longer alternative when it is accepted conventionally". The statement, as is, is simply false. Since orthomolecular is a discipline that is not exclusive of conventional medicine, the same is not true for orthomolecular medicine. *Some* orthomolecular/megavitamin (and sometime conventional medicine) therapies with scientific research and clinical or epidemiologically demonstrated benefits:
 * B1 - neurological and alcohol related
 * B3 - anticholesterolemic
 * B9 - (folate) tissue issues
 * B6, B9, B12 - homocysteinuria
 * B12 - various neurological conditions and pernicious anemia
 * C - no official research (no find either) see previous above sections on developments at NIH, NAS
 * D - see vitamin D Council", immunity, SAD, cancer
 * K2 - Japanese research on osteoporosis and liver cancer with the menaquinone-4 vitamer
 * coQ10 - CHF

—Preceding unsigned comment added by 69.178.41.55 (talk • contribs)