This column provided a string of narratives from people with wellness issues who report personal benefit from supplementation with vitamin B12. In so doing, the story made vitamin B12 appear to be the solution to many of life’s ills without thoughtfully examining alternative sources for the problems listed, the quality of the evidence indicating the vitamin’s benefit in the absence of deficiency, and was not even clear about the benefits that might be obtained from vitamin B12.
By suggesting that supplementation with vitamin B12 is the solution to some of life’s common complaints, the column might have the unintended result of delaying attention for potentially serious medical problems. The column could have quite easily given more context and more evidence, and thus, more meaningful information for readers.
The costs of vitamin B12 supplements were not discussed and whether they are often covered by insurance was not explored.
This article presented no data whatsoever. In terms of descriptive information about benefits, it had, on the one hand, the expert, Irwin Rosenberg indicating that if individuals are not vitamin B12 deficient, then there is no evidence that B12 supplements are of benefit. On the other, you had an individual (Jane Riester, 27) indicating that although her B12 level was in the normal range (i.e. 200 pg/ml), she personally experienced benefit from supplementation.
By juxtaposing anecdote and evidence, it confuses the value of evidence.
Irwin Rosenberg was quoted as stating that taking too much vitamin B12 is unlikely to cause harm. However – there are specific conditions where the use of injectable vitamin B12 can be problematic (e.g. in those with Leber’s disease or allergy to cobalt) and any regular injections are associated with risk of blood borne infection.
There was little critique regarding the quality of the evidence discussed. One clinician was quoted as observing that many patients treated with B12 “feel better” even though she admitted that this was not a controlled study, only adding that “I see a lot of them”. This statement should not be left without some evaluation because personal experience is radically different than clinical study. An individual clinician often has no idea what proportion of patients have responded to this sort of treatment and no way to tease out the proportion of benefit due to placebo effect.
At the end, the story postulated that vitamin B12 might reduce homocysteine which may be associated with heart disease before going on to indicate that clinical studies have demonstrated that vitamin B12 does not reduce the risks of heart disease. While it is good to clear up that vitamin B12 does not actually help – it seems confusing that the story indicated that it might.
This story including many laundry lists of symptoms ranging from the commonplace (sluggish) to scary (irreversible neurological problems) without appropriate context as to the incidence of the more serious problems or bothering to discuss that many of the problems described commonly result from problems other than vitamin B12 deficiency.
There were several sources interviewed for the story. However, the one independent source’s insight was greatly overwhelmed by the personal anecdotes without critical evaluation of their statements. Nonetheless, because there was independent perspective, we’ll give the story the benefit of the doubt on this criterion.
There was no discussion about alternative sources for the problems reportedly resolved by B12 nor was there any information about other options for managing problems such as depression, loss of appetite, or lethargy.
The text mentioned that vitamin B12 supplements were available in pill and injectable form; a table listing food sources of B12 was included.
The story did not indicate that vitamin B12 was a new or novel treatment for any of the possible complaints listed.
It does not appear that the column relied solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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