Talk:Vitamin C megadosage
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Learning to use a talk page and editing megadosage
[edit]I have been doing some editing of the megadosage page, but have not previously used a talk page. My expertise is vitamin C, as some of the edits show. I am currently doing research on vitamin C for cancer treatment, and my 15 minutes of fame was when I was the banner headline of USA Today on Oct 18, 1994. http://chemistry.beloit.edu/Ordman/nutrition/USAtoday.pdf. So as I add things, I will try to leave a note here. Rocordman (talk) 21:46, 3 April 2013 (UTC)
- Your edits will be deleted, as always. This page is censured nonsense. It talks about megadoses and cites nothing but low doses. You better save your effort for some other place. Majkinetor (talk) —Preceding undated comment added 21:50, 2 May 2013 (UTC)
How unfortunate that a software engineer judges the comments of a nutrition researcher who has published extensively on vitamin C as "nonsense". A megadose is a dosage substantially above the daily value. 500mg twice a day is substantially above the 90mg currently recommended in the US. But does wikipedia want to have actual nonsense on their pages, or let Majkinetor exclude legitimate information with peer-reviewed references written by experts?Rocordman (talk) —Preceding undated comment added 16:35, 11 October 2013 (UTC)
- Mhm... I am not sure you understand what I tried to suggest to you. I saluted your efforts, but those will be reverted by other users. I didn't say your edits are nonsence, I said that as it currently stands, this entire page is censured nonsence. See entire talk page if you want to learn whyMajkinetor (talk)
Undue removal of my edits in Common Cold, Heart disease and other sections
[edit]Here I present my edits, removed by Yobol at 9 August 2012, which claimed those were "non MEDRS". As it stands now, entire article doesn't represent "varying viewpoints" as described in MEDRS wikipedia guidance.
What I wrote could be put under the following guidance available on MEDRS article: Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance by experts in the field. Pauling and Hemilia which I cite are clearly vitamin C experts. Some papers I cite are from the same author which Cohrane review was cited in common cold section, which itself is totally inappropriate here since this systematic review uses <1g dose (majority are even less then 500mg, starting as low as 200mg) which has nothing to do with what is claimed by Pauling and others. Even Cohrane review information is presented badly as only abstract is cited, the reference also being outdated (shows review from 2004 instead 2010, the correct reference is here) and so protective information of vitamin C on subpopulatin is missing (i.e. "this effect was variable, ranging from -0.07% to a 39% reduction in symptom days". This is not a good style as promoted by MEDRS section "... as the abstract necessarily presents a stripped-down version of the conclusions and omits the background that can be crucial for understanding exactly what the source says".
I edited few sections to provide more balanced view on the topic and to actually say something about original claims that are now not present and thus entire section is meaningless. Actually, entire article is meaningless which is clearly seen in ratings (currently the rating is 1, with 20++ votes).
I understand that this topic is controversial and is considered to be fringe theory by many, but without presenting correctly the actuall claims we can never have neutral and informed view. This entire article is in extreme opposition of such standards because of few non-constructive individuals.
I didn't delete anything from existing information. Some of my additions were as following:
- My Edits: Common Cold
- Small doses of vitamin C do not offer substantial benefit in treatment of common cold although treatment is beneficial in some populations. The published trials indicate that the effect of a given vitamin C dose is on average greater for children than for adults [1]
- [ I left Cohrane review info intact here ]
- Pauling's advice, 1-2g of vitamin C every hour starting after the first symptoms of common cold and continuing so until resolution of the symptoms [2] has never been tested. Trials analyzed in Cochrane Review mainly used doses lower then 1g. Several physicians have used vitamin C in the treatment of the common cold with doses ranging from 10-30g per day [1]. Linear extrapolation from published trials with doses higher then 1g suggests that 4 g/day can on average reduce the severity of cold episodes by half in children, and 10-18 g/day may produce a similar effect in adults. These estimates should be interpreted with caution but it seems probable that the doses used in the placebo-controlled trials have not been large enough to demonstrate the maximum effect of vitamin C supplementation [1].
- My Edits: Heart Disease
- [ Original content ]
- Pauling recommended 5-20g of Vitamin C and 1-6g of Lysine daily for those diagnosed with cardiovascular disease [3] [4] [5]. The function of marginal dietary Vitamin C deficiency in the development of heart disease was later confirmed in animal model: mice unabled to synthesize ascorbic acid develop aortic wall damage. The authors explanation of the pathology was defective crosslinking of collagen and elastin.[6] Besides its function in collagen synthesis, the role of ascorbic acid in the regulation of cholesterol and lipid metabolism is well described in the literature. [7]
At the end, I think its the best for my edits to be restored as those are neither sensational or promotional - only facts were served. Here you can see how page looked like before it was reverted. (note: on this page some references don't work as they refer to existing references on original article)
This practice of censoring information on this article is obviously well established. Even skim read of this entire talk page shows the problem. User Shbrown previously expressed his concern on his user page. No matter what is offered here as evidence, its never good enough. Majkinetor (talk) 11:29, 27 August 2012 (UTC)
Sources
[edit]Large trim
[edit]I just cut out a large chunk of text from the cancer section. The sourcing was poor-quality and in some cases simply wrongly summarized.
- All references to "orthomolecular" were removed [2], [3]. Orthomolecular medicine is a fringe theory without mainstream acceptance. These are not pubmed articles, they're opinion pieces from people with a reputation for running well in advance of any actual science. One didn't even mention cancer, making it original research.
- Block I retained but the actual findings are not what they are purported to be - there were only three trials, they didn't involve grossly megadosage ranges, they incorporated numerous other antioxidants and the results didn't support the use of vitamin C - no significant results, only "X group was slightly better than Y group".
- Simone 2007 barely touched on vitamin C at all and not in the megadosage range.
- Jaakkola 1992, Lockwood 1994, Osaki 1994 and both levine articles are all primary sources and are thus out. Levine's articles were also in vitro and animal studies - irrelevant to humans.
- Padayatty is a survey of what practitioners do, it's not even a research article and certainly isn't a reliable source for medical claims.
- Ohno I've retained but only to say no protocols actually exist and that someone has said vitamin C should be re-evaluated.
- All of the links to clinical trials were removed. The fact that clinical trials are being tested are meaningless and does not mean we will ever see the results.
The whole set of additions very strongly supported an unjustified POV that vitamin C has been demonstrated to be a clearly effective chemotherapeutic agent when it is very clearly not. Results are equivocal, and no well-designed, large-scale trial has produced indications that it should be considered one. At best we can say there is interest, per Ohno, we should not portray it as an unjustly maligned and neglected effective treatment that mean old allopaths are ignoring out of spite or, (to forestall the usual pharmanoia) that it's all TEH DRUG CUMPANIES CAUSE THEY CANT PATENT IT!!!1!!!!!11!11 If the medical community comes to accept megadosage vitamin C therapy as an effective agent, we document it. Otherwise, it's rank speculation and POV pushing to present it as anything but idle speculation. WLU (t) (c) Wikipedia's rules:simple/complex 03:36, 9 March 2011 (UTC)
Journal of Translational Medicine
[edit]Would User:Orangemarlin like to explain why the Journal of Translational Medicine is not a reliable source? It's a peer reviewed scientific journal that seems to satisfy Wikipedia's Wikipedia:Identifying reliable sources. Its article on the use high doses of Ascorbic acid in the amelioration of cancer-associated inflammation surely deserves a mention in this article. (Intravenous ascorbic acid to prevent and treat cancer-associated sepsis?) Lumos3 (talk) 10:18, 6 April 2011 (UTC)
- Leaving aside the merits of the article itself, your presentation of it was inaccurate. You wrote that the authors "concluded that there was a proven role for high doses of Ascorbic acid in the amelioration of cancer-associated inflammation." In fact, they concluded no such thing. Instead, they discussed this hypothesis as one they found biologically plausible and worthy of further investigation.
For example, the authors write that while ascorbate deficiency has been associated with inflammation, "to our knowledge no interventional studies in cancer patients have been performed to assess the capacity of AA [ascorbic acid] administered i.v. to inhibit chronic inflammation." So the authors explicitly write that AA has never even been tested in this capacity - yet you present the article as evidence of a "proven role" for vitamin C.
I'll assume that the misrepresentation of the article is a mistake rather than a deliberate misuse of sources, but I would assume that the discrepancy between your edit and the article's actual content motivated Orangemarlin to revert your edit. MastCell Talk 16:34, 6 April 2011 (UTC)
- I meant to leave a comment here, but got distracted. I will speak to the quality of the journal first. It has a very low impact factor of 3.5. This means articles are rarely cited, for whatever reason. Consider that Nature is in the 30's. I never trust an "open-source" journal with such an abysmal impact factor. That being said, and I didn't have enough space to say it, but MastCell says it best. The whole article is available online, and I read it. Almost all of the article was speculative. I guess I could write an article for them saying that drinking urine may prevent cancer because of some specious pathway. That doesn't mean it's right. Anyways, I think we've made all of the points. OrangeMarlin Talk• Contributions 18:49, 6 April 2011 (UTC)
- Just because something could possibly have an impact based on some speculative pathway doesn't mean we note that it does or is worth considering. There are several better sources saying vitamin C has been tested and failed, until evidence rolls out that it's actuallly effective, it's undue weight to put a lot of emphasis on speculation. WLU (t) (c) Wikipedia's rules:simple/complex 20:05, 6 April 2011 (UTC)
- Whatever Marlin's opinion is of open source science journals, the cited article still falls within Wikipedia's notability guidelines. Science is a debate between opinions within the scientific community and Wikipedia's neutrality guidelines mean we should report notable opinion without giving it undue weight. I propose that the fact that a few scientists regard high dose treatment with ascorbic acid favourabley be represented with a one line statement along the lines of.
- Just because something could possibly have an impact based on some speculative pathway doesn't mean we note that it does or is worth considering. There are several better sources saying vitamin C has been tested and failed, until evidence rolls out that it's actuallly effective, it's undue weight to put a lot of emphasis on speculation. WLU (t) (c) Wikipedia's rules:simple/complex 20:05, 6 April 2011 (UTC)
- I meant to leave a comment here, but got distracted. I will speak to the quality of the journal first. It has a very low impact factor of 3.5. This means articles are rarely cited, for whatever reason. Consider that Nature is in the 30's. I never trust an "open-source" journal with such an abysmal impact factor. That being said, and I didn't have enough space to say it, but MastCell says it best. The whole article is available online, and I read it. Almost all of the article was speculative. I guess I could write an article for them saying that drinking urine may prevent cancer because of some specious pathway. That doesn't mean it's right. Anyways, I think we've made all of the points. OrangeMarlin Talk• Contributions 18:49, 6 April 2011 (UTC)
A 2011 survey of published research into the use of ascorbic acid to treat cancer-associated inflammation concluded that there were beneficial indications and that more research was warranted.[4] Lumos3 (talk) 19:43, 8 April 2011 (UTC)
- Page content is determined by reliability, not notability.
- It's already noted that some scientists think vitamin C has merit, and also more clearly noted that it is not a mainstream treatment. We should not give undue weight to a fringe theory that has essentially zero actual empirical support (and some empirical counterindications). I hadn't even noticed until now that the authors are actually orthomolecular practitioners, giving it even less weight in my opinion. At best, I would give it a "Despite a lack of support, some orthomolecular practitioners continue to claim vitamin C has chemotherapeutic potential" and that's a stretch. Orthomolecular medicine is fringe theory based on case studies, anecdotes and a priori beliefs with little actual science. I am not in favour of giving their viewpoint significant credibility. WLU (t) (c) Wikipedia's rules:simple/complex 00:37, 9 April 2011 (UTC)
- If this were Facebook, I'd give that statement a "like." Furthermore, the article still doesn't say what Lumos thinks it says. And I hadn't noticed that they were orthomolecular pushers. Good catch.OrangeMarlin Talk• Contributions 01:10, 9 April 2011 (UTC)
Since there seems to be no argument against the reliability of the citation I am concluding that the opposition to its inclusion here is based on irrational name calling directed at the scientists who wrote it. The JOTM paper surveys research in the area under study and recommends that there is justification for further research. You seem to be saying that Orthomolecular medicine lacks a research basis but oppose Wikipedia reporting here that a peer reviewed journal has published a paper stating this and concluding that more research is necessary. Lumos3 (talk) 08:38, 9 April 2011 (UTC)
- Orthomolecular practitioners aren't scientists, they don't do research. Ichim seems to be a recent convert based on his mother's recent death. They report on case studies, and in this case, dubious summaries of parts of the literature based on unproven theorizing about a vitamin that isn't expected by most people to have an anti-cancer effect, based on specious assumptions that large doses of vitamins must act like drugs in every way except for having adverse effects. Anyway, it's an extraordinarily speculative piece composed of long chains of speculation about a possible quality of life improvement. I still don't think it's a good inclusion. WLU (t) (c) Wikipedia's rules:simple/complex 12:06, 9 April 2011 (UTC)
- You characterize OM practitioners as not being scientists and not doing research, yet the paper in question is in a scientific peer reviewed paper and is calling for more research. Surely you can see the contradiction here? Speculating on an author's motivation for writing a paper also seems to me to be completely irrelevant. Lumos3 (talk) 21:26, 9 April 2011 (UTC)
Large trim (2)
[edit]I removed references to the common cold studies, as they didn't use megadosage vitamin C and therefore are unrelated to this topic. If there's a study that looks at colds and megadosage vitamin c, that would be interesting, please describe that instead. In general, this article needs to stick to the subject of megadosage vitamin c, the practice, reasoning, background, and cite only studies and research where megadosage vitamin c is employed. If the UL is 2gms/day, then this article should cite research that uses dosages that exceed 2gms/day. Also, studies where large doses are injected are also appropriate for this topic. Research using mg doses should be excluded from this topic. Those can be cited in the Vitamin C topic. --Theo0123 (talk) 04:02, 19 May 2011 (UTC) (correcting original signature)
- Vitamin C for the common cold is one of the most common recommendations for megadose range. "Megadosage" is undefined, but the vitamin C-cold relationship should be more prominent. WLU (t) (c) Wikipedia's rules:simple/complex 10:35, 11 May 2011 (UTC)
- I've added details of the 1999 Gorton and Jarvis study, in which those in the test population reporting symptoms were treated with hourly doses of 1000 mg of Vitamin C for the first 6 hours and then 3 times daily thereafter. Those not reporting symptoms in the test group were also administered 1000-mg doses 3 times daily. Vitaminman (talk) 19:42, 15 May 2011 (UTC)
- Reverted per WP:UNDUE. Once you start down this road, then the only way to be NPOV is add the vast majority of articles that show now effect. Pulling out one poorly designed study from 12 years ago is hardly NPOV. In fact, it is anti-NPOV. OrangeMarlin Talk• Contributions 19:50, 15 May 2011 (UTC)
- Since there have been very few studies of the effects of megadoses of vitamin C I doubt it would be possible to find these studies showing no affect of which you speak. Almost all C studies are of low or moderate doses. Lumos3 (talk) 21:26, 15 May 2011 (UTC)
- Except you'd be wrong. The failure of vitamin C supplementation to reduce the incidence of colds in the normal population indicates that routine mega-dose prophylaxis is not rationally justified for community use. But evidence suggests that it could be justified in people exposed to brief periods of severe physical exercise or cold environments. Douglas, R.; Hemilä, H.; Chalker, E.; Treacy, B. (2007). Hemilä, Harri (ed.). "Vitamin C for preventing and treating the common cold". Cochrane Database of Systematic Reviews (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648. Just sayin'. OrangeMarlin Talk• Contributions 23:03, 15 May 2011 (UTC)
- Erm, speaking of poorly designed studies, this review included studies using doses as low as 200 mg. Neither Pauling, nor any other serious orthomolecular researcher that I am aware of, has ever tried to pretend that normo-dietary type doses are effective in treating colds. Surely, Orange, if there is a "vast" number of studies supporting your POV, you can do better than this? Vitaminman (talk) 07:16, 16 May 2011 (UTC)
- You ought to look up what the Cochrane database, if you have the time. Second, you're asserting this shit, not me. It's up to you to bring reliable sources. So, ignoring your snark, which I always do, bring it. And none of that one off, 40 year old, never been confirmed, published in a crap journal stuff. Bring me real clinical trials done by real researchers, double blinded. But for now, yeah, the Cochrane database is the best group for analyzing a large number of studies. I'll go over there, not take excessive Vitamin C, not make my urine fill up with Vitamin C, read a few real medical journals, and wait for a infinite number of years until you bring a real study. But in reality, I won't, because I know there are none.OrangeMarlin Talk• Contributions 08:07, 16 May 2011 (UTC)
- I think part of the problem here is that the ideas of "megadosage" and "orthomolecular" doses are poorly defined and easily lend themselves to goalpost-moving (e.g. "Sure, the study showed no benefit, but they used 500 mg when a true orthomolecular dose is 750 mg!") The bottom line, if I can repeat Orangemarlin's point a bit less stridently, is that the Cochrane Library is as good as any available source to assess the current state of medical evidence. While individual editors are free to quibble with their methodology, those quibbles do not disqualify Cochrane as a reliable source for Wikipedia's purposes.
As a meta-point, I think a lot of this is driven by a basic misunderstanding of how science works. You don't make a claim and then demand that scientists do studies to disprove your claim. That's back-asswards. If you have a hypothesis (e.g., about the "right" dose of vitamin C), then you design and conduct studies to test that hypothesis. Obviously, such studies have either not been conducted, or have failed to convince the expert community when it comes to routine vitamin C prophylaxis. Whether or not we agree with expert opinion in this case, we're obligated to honestly convey it as Wikipedia editors. MastCell Talk 17:24, 16 May 2011 (UTC)
- Setting aside Orange's ongoing anger-management problem, my criticism here isn't of Cochrane itself, but of the fact that the review cited is not suitable for an article on vitamin C megadosing as it relies on studies using doses as low as 200 mg. Moreover, there is now a clear double-standard emerging in this article. For example, Tedwadman removed references to the common cold studies on the grounds that "they didn't use megadosage vitamin C and therefore are unrelated to this topic." His stated rationale in doing so was that "If the UL is 2gms/day, then this article should cite research that uses dosages that exceed 2gms/day" and that "Research using mg doses should be excluded from this topic." As such, either we reinstate the common cold studies, or we remove all studies that, like the Cochrane review cited by Orange, do not meet these criteria. But you can't have it both ways. Vitaminman (talk) 17:51, 16 May 2011 (UTC)
- It sounds like we agree: the term "megadosage" is vague and subject to goalpost-moving. Nonetheless, we need to look for the best available sources. The Cochrane piece (a systematic review, not technically a "study") explicitly addresses "megadosage" vitamin C, using the term explicitly. So while we as editors can disagree over the vagueness of the term, we as Wikipedians should still use high-quality systematic reviews which explicitly address the topic when we construct the article. MastCell Talk 20:47, 16 May 2011 (UTC)
- Ouch Vitaminpusher. I'm hurt. Oh wait, I'm not. The nice people have come, and said the same thing as I did. Oh well, I guess personal attacks from the Vitaminpusher have not value. OrangeMarlin Talk• Contributions 19:57, 17 May 2011 (UTC)
- In that case, the section removed by Theo0123 should be reinserted. The Douglas and Hemilä review, in particular, is appropriate for this article as it explicitly sought to discover whether vitamin C in doses of 200 mg or more daily reduces the incidence, duration, or severity of the common cold when used either as continuous prophylaxis or after the onset of cold symptoms. Criteria for inclusion were placebo-controlled trials to prevent or treat the common cold using oral doses of vitamin C of 200 mg/day or more. Literature from 1940 to 2004 was methodically screened.[5] Can we at least agree that this review is appropriate for inclusion and that it should therefore be reinserted?Vitaminman (talk) 08:08, 17 May 2011 (UTC)
- Let's go ahead and reinsert the section I, Theo0123, deleted. However, the title of this topic is Vitamin C megadose, so the use of this study here will need some additional qualification. Most scientists would agree that megadose is a few grams or more per day up to 100 or 200 grams a day injected. So this study actually supports a hypothesis that low doses of Vitamin C have little effect. It does nothing to support or refute megadose Vitamin C, just as giving adults a quarter of a baby aspirin to treat a headache would neither support or refute the hypothesis that two full-sized adult aspirin would relieve the headache symptoms. In addition to this Vitamin C Megadose topic, there is a "Vitamin C" topic as well if you want to include more non-megadose studies in that topic.--Theo0123 (talk) 04:02, 19 May 2011 (UTC)
- In that case, the section removed by Theo0123 should be reinserted. The Douglas and Hemilä review, in particular, is appropriate for this article as it explicitly sought to discover whether vitamin C in doses of 200 mg or more daily reduces the incidence, duration, or severity of the common cold when used either as continuous prophylaxis or after the onset of cold symptoms. Criteria for inclusion were placebo-controlled trials to prevent or treat the common cold using oral doses of vitamin C of 200 mg/day or more. Literature from 1940 to 2004 was methodically screened.[5] Can we at least agree that this review is appropriate for inclusion and that it should therefore be reinserted?Vitaminman (talk) 08:08, 17 May 2011 (UTC)
- Setting aside Orange's ongoing anger-management problem, my criticism here isn't of Cochrane itself, but of the fact that the review cited is not suitable for an article on vitamin C megadosing as it relies on studies using doses as low as 200 mg. Moreover, there is now a clear double-standard emerging in this article. For example, Tedwadman removed references to the common cold studies on the grounds that "they didn't use megadosage vitamin C and therefore are unrelated to this topic." His stated rationale in doing so was that "If the UL is 2gms/day, then this article should cite research that uses dosages that exceed 2gms/day" and that "Research using mg doses should be excluded from this topic." As such, either we reinstate the common cold studies, or we remove all studies that, like the Cochrane review cited by Orange, do not meet these criteria. But you can't have it both ways. Vitaminman (talk) 17:51, 16 May 2011 (UTC)
- I think part of the problem here is that the ideas of "megadosage" and "orthomolecular" doses are poorly defined and easily lend themselves to goalpost-moving (e.g. "Sure, the study showed no benefit, but they used 500 mg when a true orthomolecular dose is 750 mg!") The bottom line, if I can repeat Orangemarlin's point a bit less stridently, is that the Cochrane Library is as good as any available source to assess the current state of medical evidence. While individual editors are free to quibble with their methodology, those quibbles do not disqualify Cochrane as a reliable source for Wikipedia's purposes.
- You ought to look up what the Cochrane database, if you have the time. Second, you're asserting this shit, not me. It's up to you to bring reliable sources. So, ignoring your snark, which I always do, bring it. And none of that one off, 40 year old, never been confirmed, published in a crap journal stuff. Bring me real clinical trials done by real researchers, double blinded. But for now, yeah, the Cochrane database is the best group for analyzing a large number of studies. I'll go over there, not take excessive Vitamin C, not make my urine fill up with Vitamin C, read a few real medical journals, and wait for a infinite number of years until you bring a real study. But in reality, I won't, because I know there are none.OrangeMarlin Talk• Contributions 08:07, 16 May 2011 (UTC)
- Erm, speaking of poorly designed studies, this review included studies using doses as low as 200 mg. Neither Pauling, nor any other serious orthomolecular researcher that I am aware of, has ever tried to pretend that normo-dietary type doses are effective in treating colds. Surely, Orange, if there is a "vast" number of studies supporting your POV, you can do better than this? Vitaminman (talk) 07:16, 16 May 2011 (UTC)
- Except you'd be wrong. The failure of vitamin C supplementation to reduce the incidence of colds in the normal population indicates that routine mega-dose prophylaxis is not rationally justified for community use. But evidence suggests that it could be justified in people exposed to brief periods of severe physical exercise or cold environments. Douglas, R.; Hemilä, H.; Chalker, E.; Treacy, B. (2007). Hemilä, Harri (ed.). "Vitamin C for preventing and treating the common cold". Cochrane Database of Systematic Reviews (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648. Just sayin'. OrangeMarlin Talk• Contributions 23:03, 15 May 2011 (UTC)
- Since there have been very few studies of the effects of megadoses of vitamin C I doubt it would be possible to find these studies showing no affect of which you speak. Almost all C studies are of low or moderate doses. Lumos3 (talk) 21:26, 15 May 2011 (UTC)
- Reverted per WP:UNDUE. Once you start down this road, then the only way to be NPOV is add the vast majority of articles that show now effect. Pulling out one poorly designed study from 12 years ago is hardly NPOV. In fact, it is anti-NPOV. OrangeMarlin Talk• Contributions 19:50, 15 May 2011 (UTC)
- I've added details of the 1999 Gorton and Jarvis study, in which those in the test population reporting symptoms were treated with hourly doses of 1000 mg of Vitamin C for the first 6 hours and then 3 times daily thereafter. Those not reporting symptoms in the test group were also administered 1000-mg doses 3 times daily. Vitaminman (talk) 19:42, 15 May 2011 (UTC)
A twelve year old primary study does not deserve special mention in the face of the Cochrane review. I do however, support the re-integration of the common cold material below (which I think I actually wrote). I actually thing most of Theo0123's edits to the page were inappropriately editorial, for instance the WHO recommendation should be stated flatly, and juxtaposed to the dosage recommended by various practitioners (the Stone Med Hypotheses article, normally an execrable journal of little merit, is OK in my mind to indicate what the nutters claim). The comparison is self-evident, and acceptable in my opinion. My preference would be to rever to this version, last edited by Vitaminman to remove unnecessary italics.
- The reason for the juxtaposition is to emphasize that this is a topic about Vitamin C megadose and to point out that the WHO recommendation is not even close to Vitamin C megadose. In the Vitamin C topic, I would agree that the WHO recommendation should be flatly stated. In this Vitamin C megadose topic, I disagree that this juxtaposition is inappropriate. --Theo0123 (talk) 04:02, 19 May 2011 (UTC)
What would be nice would be a mention that vitamin C is an antihistamine; the fact that it reduces the symptoms of the common cold isn't really surprising since I believe they are caused by histamine as part of the immune response. Vitamin C doesn't do a damned thing for the common cold, all it's doing is disabling an over-active immune response. Needs a source though. How about Quackwatch? WLU (t) (c) Wikipedia's rules:simple/complex 14:23, 17 May 2011 (UTC)
- I'm all right with this WLU. What the vitamin pushing crowd can't and won't explain is how a megadosage can actually translate into a consistent blood level that would have an effect. The intestinal tract controls absorption of Vitamin C, so a steady state of blood levels of Vitamin C occurs at around oral intake of 30 mg per day. Yes, 30 mg per day. So, anything more than that does nothing but get passed in the feces (I suppose), or is absorbed when the blood level drops if you don't take a pill the next day. The few studies that seem to indicate some in vitro toxicity of vitamin C to cancer cells would require extremely high blood levels of it, which would require IV use. Is it possible that IV doses of 1200 mg of Vitamin C would prevent a cold? I don't know. But the risk benefit ratio is quite high, I would have to say that most people would reject even being involved in a trial. Anyways, through all the bandwidth, we get to the place where we're all happy, which is Vitamin C does squat for colds. OrangeMarlin Talk• Contributions 20:12, 17 May 2011 (UTC)
- Ah, I mis-read the page then. I've reverted to the version linked above, which includes the vitamin C-common cold information.
- And as a not-to-mention, not to mention the millions of years of evolution after our common ancestor lost its ability to produce vitamin C endogenously probably resulted in a series of genetic changes allowing us to survive quite adequately. WLU (t) (c) Wikipedia's rules:simple/complex 20:49, 17 May 2011 (UTC)
- Why are you mentioning evolution. You know we've only been around for 6,000 not long enough for macroevolution to get rid of the vitamin C gene. OrangeMarlin Talk• Contributions 21:24, 17 May 2011 (UTC)
- Let's see...Orangemarlin, I'm curious as to your motivations. Do you profit from disease for example? All the megadose practitioners I know don't get colds. Try it. Buy some vitamin C crystals from trader joes ($10 a lb, $20/lb at a health food store, none of which comes to me). Start with whatever your digestive system can tolerate at a time, then up it over time to 10-20gms spread out over the day. When you stop getting colds, you're taking enough in the correct way. The book Ascorbate would be a good one for you to read, as it soundly refutes the issues you have, particularly your issues with blood concentration levels. Blood levels of vitamin c rise above the steady states you point to with large oral doses taken periodically an hour or two apart. Gut concentration is important, urine concentration is important for the systems exposed to those concentrations. Our urine contains large amounts of water, but that doesn't mean we should consume less water, right? Some of the authors of this topic seem to be missing the fact that this topic is titled "Vitamin C megadosage". The discussion in this article should be reserved for documenting the megadosage practice, scientists who advocate the practice, biological reasoning behind the practice, and valid studies that include mega dosages, however we choose to define megadosage. I propose that a good megadosage definition is 2+ grams per day, since 2gms/day is over what is considered the official "tolerable UL" and then exclude any discussion that talks about effects with studies that use less than 2gms? How many gms per hour should be considered megadosage if injected? 100? 500? What references can we point to to support our definition. Then, if an author wants to write about lower dosage effects, we can direct the author to the topic on Vitamin C or elsewhere.Theo0123 (talk) 02:32, 20 May 2011 (UTC)
- Do you profit from promoting unproven remedies? Do you own stocks in Trader Joes and health food stores, which is why you are promoting them? Accusations of conspiracy and bad faith are pointless, prove nothing and can not be used to adjust any page. If megadose vitamin C is so effective (and not merely a middling-effective antihystamine) then it should be easy to demonstrate it is effective against colds, cancer, and many other diseases - but to date it has not. The page is governed by WP:MEDRS as well as the other content policies and guidelines - it should record what has been documented in high-quality sources. It should not explore at length any quasi-plausible theory about how vitamin C might work in some diseases.
- Your own proposal for a definition is original research and can not be used. Sadly, the "research" on vitamin C megadosage lacks a single definition of what a megadosage is as well as any well-demonstrated list of benefits. Not that this prevents practitioners from promoting it as if it were a panacea. WLU (t) (c) Wikipedia's rules:simple/complex 17:38, 31 May 2011 (UTC)
- I happen to like Trader Joes. Two Buck Chuck has been the staple of many a drunken night of cheap wine. And with Moon Cheese, it was memorable. OrangeMarlin Talk• Contributions 02:06, 1 June 2011 (UTC)
- Yep, you sure do give real good health advice. Good to know that the med schools are workin' just fine. Move along now people, just do as the doc says and one day you'll be 100% symptom and disease-free, just like he is. Don't forget to keep takin' those pharma pills though, 'cos the doc always knows best. Vitaminman (talk) 20:58, 2 June 2011 (UTC)
- This discussion is the best possible example of the way megadose vitamin C is actually promoted: with infomercial-style testimonials ("All the megadose practitioners I know don't get colds"), confirmation bias ("When you stop getting colds, you're taking enough in the correct way"), and pharmanoiac conspiracy theories (drug companies are evil, greedy disease profiteers, while supplement makers are just an altruistic $25 billion cottage industry). But let's go back to pretending it's about meta-analyses and empiric data now. MastCell Talk 22:27, 2 June 2011 (UTC)
- Yep, you sure do give real good health advice. Good to know that the med schools are workin' just fine. Move along now people, just do as the doc says and one day you'll be 100% symptom and disease-free, just like he is. Don't forget to keep takin' those pharma pills though, 'cos the doc always knows best. Vitaminman (talk) 20:58, 2 June 2011 (UTC)
- I happen to like Trader Joes. Two Buck Chuck has been the staple of many a drunken night of cheap wine. And with Moon Cheese, it was memorable. OrangeMarlin Talk• Contributions 02:06, 1 June 2011 (UTC)
- Let's see...Orangemarlin, I'm curious as to your motivations. Do you profit from disease for example? All the megadose practitioners I know don't get colds. Try it. Buy some vitamin C crystals from trader joes ($10 a lb, $20/lb at a health food store, none of which comes to me). Start with whatever your digestive system can tolerate at a time, then up it over time to 10-20gms spread out over the day. When you stop getting colds, you're taking enough in the correct way. The book Ascorbate would be a good one for you to read, as it soundly refutes the issues you have, particularly your issues with blood concentration levels. Blood levels of vitamin c rise above the steady states you point to with large oral doses taken periodically an hour or two apart. Gut concentration is important, urine concentration is important for the systems exposed to those concentrations. Our urine contains large amounts of water, but that doesn't mean we should consume less water, right? Some of the authors of this topic seem to be missing the fact that this topic is titled "Vitamin C megadosage". The discussion in this article should be reserved for documenting the megadosage practice, scientists who advocate the practice, biological reasoning behind the practice, and valid studies that include mega dosages, however we choose to define megadosage. I propose that a good megadosage definition is 2+ grams per day, since 2gms/day is over what is considered the official "tolerable UL" and then exclude any discussion that talks about effects with studies that use less than 2gms? How many gms per hour should be considered megadosage if injected? 100? 500? What references can we point to to support our definition. Then, if an author wants to write about lower dosage effects, we can direct the author to the topic on Vitamin C or elsewhere.Theo0123 (talk) 02:32, 20 May 2011 (UTC)
- Why are you mentioning evolution. You know we've only been around for 6,000 not long enough for macroevolution to get rid of the vitamin C gene. OrangeMarlin Talk• Contributions 21:24, 17 May 2011 (UTC)
- WP:Pharmanoia exists, you can link to it!
- Wikipedia does not provide advice, see WP:NOT#HOWTO and WP:MEDICAL
- If vitamin C is as effective as claimed, shouldn't it be easy, trivially so, to demonstrate it? Shouldn't all those meta-analyses be positive? If an effect is truly strong, if it's the miracle cure claimed, you could probably demonstrate a statistical difference in a well-controlled trial in as few as n=10. Or in the case of the early days of antibiotics, achieve a 100% cure rate in all cases (for instance, early treatment of syphilis).
- No doctor claims medicines produce 100% healthy, 100% symptom-free patients. There's massive amounts of regulations governing the listing of side effects.
- All doctors recommend evidence-based diet and exercise to control degenerative disease and if patients followed this advice, medicine would be very different in the developed world. But people have to die eventually and chances are because we live so long we will eventually need medication. And if they have a genetic predisposition, poor diet, minimal exercise or unhealthy habits, those medications will come earlier.
- Vitamins have two evidence-based recommendations - correct deficiencies (like scurvy) and avoid excesses (like hypervitaminosis A acutely, or the increased risk of heart failure that chronic vitamin E supplementation poses chronically). They're necessary molecules, not magic. Again, if they have real effects, particularly if they have potent effects, it should be easy to demonstrate - as in a series of trials will converge in short order on a single solution. You're promoting ideology here, not science. WLU (t) (c) Wikipedia's rules:simple/complex 15:39, 3 June 2011 (UTC)
- Well, while we're talking about pretending and winning arguments, let's not forget a couple of key facts: 1) Last year, the pharma industry's total sales amounted to 875 billion dollars [6] 2) Forecasts suggest that, by 2015, global spending on pharma drugs will reach nearly 1.1 trillion dollars. [7] My point, therefore, is that, compared to the pharma industry, the vitamin industry is a cottage industry. Lest anybody get the wrong impression here, however, I am not pretending that such a thing as an overly high vitamin dosage doesn't exist. Far from it, in fact. My edits to the Hypervitaminosis A article prove this. Whilst I would readily admit to a fondness for irony, I strongly believe in objective science. Thing is, however, that this article currently appears to be way short of anything approaching what could reasonably be described as objective. Resolving this issue, however, will require a consensus - something we appear to be some way short of at present. Vitaminman (talk) 23:39, 7 June 2011 (UTC)
- It's important to remember that the cost of bringing a pharmaceutical to market is immense. Because medications have to actually be proven safe and effective to the FDA's satisfaction, which means that a drug company spends millions (or possibly billions) of dollars testing a drug before it earns a dime. In contrast, a dietary supplement doesn't have to prove anything. It doesn't even have to contain what its label claims it contains. It costs a supplement company essentially zero dollars to bring a new supplement to market, so every penny earned is profit.
More to the point, think about value for the dollar. Somewhere between 99% (charitably) or 100% (more accurately) of dietary supplements have no known beneficial effect on human health. Even if penicillin cost $1 trillion per mg, it would be a better value than a dietary supplement costing $2.99, because penicillin actually does something beneficial. MastCell Talk 00:05, 8 June 2011 (UTC)
- Also, pharmaceutical companies are regularly subjected to frivolous lawsuits, so they have to pay for lawyers, fees, insurance, etc. Vitamin companies just make a dubious claim, and if it doesn't work, they get to claim "oh, well we really didn't mean that this supplement makes your dick bigger." And if it makes your dick smaller, well, they get to say "we never tested it for whether it made your dick smaller...it's just a vitamin." As MC stated, pharmaceutical companies spend 10 years of hard work to get a drug to market. Many don't get close, because they fail in clinical trials or even earlier in the investigative process. Please show us one supplement that goes through 10 years of carefully controlled studies, then doesn't get on the market because it fails its claims. There aren't any, because Big Herbal gets to say whatever it wants in whatever way it wants. I can think of maybe a handful of reasons to take a supplement, and in those cases, a proper diet would negate the need. So, vitamins=useless shit, pharmaceuticals=useful, evidence-based, necessary items for life. I take one drug, very inexpensive, that keeps me alive every fucking single day of the year. If I were the only one, it would be impressive, but I'm pretty sure that there a few hundred thousand people in the world that need it too. And it's not a vitamin deficiency. But of course some editors refuse to understand science and evidence. It's sad. OrangeMarlin Talk• Contributions 01:24, 8 June 2011 (UTC)
- My god, a pharmaceutical corporation made a profit last year? Well I'm convinced, that means homeopathy, orthomolecular medicine, acupuncture, naturopathy, reiki, primal scream therapy and Laetrile all work!
- If you believed in science you'd believe in evidence, not conspiracy. "Big Pharma" isn't evidence, it's not an argument, it's essentially an ad hominen attack. Unless you've got specific evidence that megadosage of vitamin C is an effective treatment for anything, your comments are irrelevant. Unless you've got specific evidence that a pharmaceutical corporation has dishonestly fiddled with data about megadose vitamin C, your comments are irrelevant. Not to mention, pharmaceutical companies manufacture and sell vitamins making it in their best interest to vindicate studies that 10 grams of vitamin C every day cures cancer. Ignoring data in favour of attacking the messenger (or in this case, a completely unrelated target) isn't the science you're apparently so fond of. WLU (t) (c) Wikipedia's rules:simple/complex 13:26, 8 June 2011 (UTC)
- Also, pharmaceutical companies are regularly subjected to frivolous lawsuits, so they have to pay for lawyers, fees, insurance, etc. Vitamin companies just make a dubious claim, and if it doesn't work, they get to claim "oh, well we really didn't mean that this supplement makes your dick bigger." And if it makes your dick smaller, well, they get to say "we never tested it for whether it made your dick smaller...it's just a vitamin." As MC stated, pharmaceutical companies spend 10 years of hard work to get a drug to market. Many don't get close, because they fail in clinical trials or even earlier in the investigative process. Please show us one supplement that goes through 10 years of carefully controlled studies, then doesn't get on the market because it fails its claims. There aren't any, because Big Herbal gets to say whatever it wants in whatever way it wants. I can think of maybe a handful of reasons to take a supplement, and in those cases, a proper diet would negate the need. So, vitamins=useless shit, pharmaceuticals=useful, evidence-based, necessary items for life. I take one drug, very inexpensive, that keeps me alive every fucking single day of the year. If I were the only one, it would be impressive, but I'm pretty sure that there a few hundred thousand people in the world that need it too. And it's not a vitamin deficiency. But of course some editors refuse to understand science and evidence. It's sad. OrangeMarlin Talk• Contributions 01:24, 8 June 2011 (UTC)
- It's important to remember that the cost of bringing a pharmaceutical to market is immense. Because medications have to actually be proven safe and effective to the FDA's satisfaction, which means that a drug company spends millions (or possibly billions) of dollars testing a drug before it earns a dime. In contrast, a dietary supplement doesn't have to prove anything. It doesn't even have to contain what its label claims it contains. It costs a supplement company essentially zero dollars to bring a new supplement to market, so every penny earned is profit.
- Meanwhile, back on planet Earth, let's examine a couple of these claims a little more closely:
- It costs a supplement company essentially zero dollars to bring a new supplement to market, so every penny earned is profit. Huh? You're joking, right? No costs for purchase of the necessary raw materials, no labeling costs, the attorneys all work for free and you don't do any advertising? And this is before we even begin to consider the ongoing operating costs of the business. Jeez, either you guys are deliberately trying to mislead people here, or you're living in la la land.
- Somewhere between 99% (charitably) or 100% (more accurately) of dietary supplements have no known beneficial effect on human health. And the evidence for this POV is what, precisely? And you make this claim regardless of dose (including RDA-based supplements) and contents (e.g. iron and folate in pregnancy, vitamin D and calcium in osteoporosis)? But I can see that we're starting from first grade here, so let's start with the list of nutrients considered as essential medicines by the WHO. [8] Are you trying to pretend to yourselves that in supplemental form even these have no beneficial effect?
- vitamins=useless shit, pharmaceuticals=useful, evidence-based, necessary items for life I read this one several times, in sheer disbelief. For people who pretend to adhere to WP:NPOV, I'm actually astonished that you would openly admit to this POV. On the positive side, from now on, at least your alt med-related editing can be seen in light of this admission.
- Finally, your use of gutter language aside, your resorting to claims about penis enlargement, and essentially pretending that all supplement companies make these sort of claims, is just laughable. For the record, I don't support these types of claims any more than you do. But as I don't share your fondness for profanity, I guess we're still poles apart. Vitaminman (talk) 20:44, 10 June 2011 (UTC)
- I was really excited to read this article (surprised that they even had one). But when I came upon it I was sad to see so much negativity towards megadoses. Its shocking to me that text and numbers are more valuable then human experiences. I think often you don't see formal studies on megadoses because: 1- its not cool to discover something so simple, researchers just don't want to do it. 2- who would pay for this research since no one can profit from it? 3- vitamins already have such a big stigma in the medical community, you'd be shunned if you committed your time to even 10 years of study. 4- most people do it on their own and see the results, no sources needed. Its fine if you want to reject this evidence in your own mind because it doesn't fit your idea of "facts" but don't silence human experience. I know this is Wikipedia so "credible" sources are required (seems to me Wikipedians "quote" guidelines like evangelicals use scripture [read: misuse]) but if it doesn't fit the guidelines simple state that and move along. Calling hardworking docs "quacks" or simply writing off large databases of information because you've never heard of them is pretty small minded and doesn't bring value to the talk page. You wave science around like the banner of truth but science has plenty of "about faces" especially when it comes to what is good and bad for us to consume. Wisekris (talk) 14:35, 4 August 2011 (UTC)
- I understand what you're saying, but I don't think those reasons necessarily stand up to scrutiny. To take them in order:
- Most cool medical discoveries in fact are really simple. The polymerase chain reaction was simple. Using aspirin to prevent heart attacks is simple. Vaccination is simple.
- If the research is scientifically sound, then the government pays for it, at least in the U.S. Most biomedical research in the U.S. is funded by the National Institutes of Health, and by extension by the American taxpayer. The NIH receives no financial profit from the research it funds. Aspirin is off-patent - who do you think funded the huge studies proving its benefit in cardiovascular disease?
- Plenty of "mainstream" researchers work on vitamins. To the extent that they have a stigma, it's probably because their claimed benefits have repeatedly failed to materialize when subjected to rigorous testing, but that doesn't mean they're not being studied. In the past decade, major studies have looked at folate and antioxidant vitamins in cardiovascular disease prevention (no benefit) and folate supplementation to prevent neural-tube defects (huge success). A number of major trials have studied the effect of antioxidant vitamins on cancer incidence. Insofar as researchers disdain the area, it's because they're often attacked by committed advocates of megavitamin therapy if their results don't meet with the advocates' preconceived expectations.
- Sure. People are free to use vitamins, or any other legally licensed product, on their own. In an ideal world, they'd be properly informed about the evidence supporting those purchases, which is sometimes a struggle, but such is life.
- Anyhow... MastCell Talk 20:14, 4 August 2011 (UTC)
- Mastcell, you're avoiding Wisekris' points, rather dealing with them. But you know this, anyway, so you don't need me to point it out to you. And as you've made a career out of doing this, well hey, why change now? But whilst you will no doubt continue to pretend that vitamins have no benefits, those of us who know differently, and have witnessed lives being saved by them, don't know whether to laugh or cry when they read your comments. Vitaminman (talk) 21:12, 5 August 2011 (UTC)
- Hmmm. I tried my best to respond to his/her points directly, and enumerated my responses to link them directly to the assertions in the original post. I don't see how that's "avoiding" the issues, but OK. MastCell Talk 21:26, 5 August 2011 (UTC)
- Wikipedia's guideline on medical claims (WP:MEDRS) make it clear that we require a higher standard of evidence for health information. The nice thing about science is, it eventually reaches the correct conclusion, even if it can be criticized for taking a while (then again, precognition has never been proven so what do you expect?). New guy may think this is a flaw, and he is welcome to try to change consensus but in the meantime I will continue to wave policies about like a flag because they ensure the quality of the encyclopedia's contents remain consistently high. If vitamin C megadosage has a genuine benefit, it should be easy to demonstrate, yes? So let's wait for that to occur rather than prematurely claiming it does based on poor evidence. WLU (t) (c) Wikipedia's rules:simple/complex 11:03, 10 August 2011 (UTC)
- This quote required me to make a Wikipedia edit "Vitamins are so effective at treating and preventing disease, it's incredibly easy to prove it. That's why there are so many studies demonstrating this point. Oh wait, there aren't. ...and we're done. WLU"
- Wikipedia's guideline on medical claims (WP:MEDRS) make it clear that we require a higher standard of evidence for health information. The nice thing about science is, it eventually reaches the correct conclusion, even if it can be criticized for taking a while (then again, precognition has never been proven so what do you expect?). New guy may think this is a flaw, and he is welcome to try to change consensus but in the meantime I will continue to wave policies about like a flag because they ensure the quality of the encyclopedia's contents remain consistently high. If vitamin C megadosage has a genuine benefit, it should be easy to demonstrate, yes? So let's wait for that to occur rather than prematurely claiming it does based on poor evidence. WLU (t) (c) Wikipedia's rules:simple/complex 11:03, 10 August 2011 (UTC)
- Hmmm. I tried my best to respond to his/her points directly, and enumerated my responses to link them directly to the assertions in the original post. I don't see how that's "avoiding" the issues, but OK. MastCell Talk 21:26, 5 August 2011 (UTC)
- Mastcell, you're avoiding Wisekris' points, rather dealing with them. But you know this, anyway, so you don't need me to point it out to you. And as you've made a career out of doing this, well hey, why change now? But whilst you will no doubt continue to pretend that vitamins have no benefits, those of us who know differently, and have witnessed lives being saved by them, don't know whether to laugh or cry when they read your comments. Vitaminman (talk) 21:12, 5 August 2011 (UTC)
- I understand what you're saying, but I don't think those reasons necessarily stand up to scrutiny. To take them in order:
- I was really excited to read this article (surprised that they even had one). But when I came upon it I was sad to see so much negativity towards megadoses. Its shocking to me that text and numbers are more valuable then human experiences. I think often you don't see formal studies on megadoses because: 1- its not cool to discover something so simple, researchers just don't want to do it. 2- who would pay for this research since no one can profit from it? 3- vitamins already have such a big stigma in the medical community, you'd be shunned if you committed your time to even 10 years of study. 4- most people do it on their own and see the results, no sources needed. Its fine if you want to reject this evidence in your own mind because it doesn't fit your idea of "facts" but don't silence human experience. I know this is Wikipedia so "credible" sources are required (seems to me Wikipedians "quote" guidelines like evangelicals use scripture [read: misuse]) but if it doesn't fit the guidelines simple state that and move along. Calling hardworking docs "quacks" or simply writing off large databases of information because you've never heard of them is pretty small minded and doesn't bring value to the talk page. You wave science around like the banner of truth but science has plenty of "about faces" especially when it comes to what is good and bad for us to consume. Wisekris (talk) 14:35, 4 August 2011 (UTC)
Wow. How about Scurvy? Cured by Vitamin C, also prevented by Vitamin C. Look at the root word in Ascorbic Acid - "scorbic" - http://en.wiktionary.org/wiki/scorbic.
Plenty of papers on Vit C and Scurvy, so claims that there are no papers about effective vitamins just shows ignorance or intent to mislead.
24.222.10.85 (talk) 05:43, 1 April 2014 (UTC)cforgeron
Johnston
[edit]If someone can get a copy, this might be a good article to integrate. May be redundant to the IOM reference already included. WLU (t) (c) Wikipedia's rules:simple/complex 20:59, 17 May 2011 (UTC)
Vitamin C concentrations predict risk of incident stroke
[edit]Here's a finding that should be reported in the article. Myint PK, Luben RN, Welch AA, Bingham SA, Wareham NJ, Khaw , Am J Clin Nutr. 2008 Jan;87(1):64-9. [9]
“ | ...persons in the top quartiles of baseline plasma vitamin C concentrations had a 42% lower risk (relative risk: 0.58; 95% CI: 0.43, 0.78) than did those in the bottom quartile, independently of age, sex, smoking, body mass index, systolic blood pressure, cholesterol, physical activity, prevalent diabetes and myocardial infarction, social class, alcohol consumption, and any supplement use. Lumos3 (talk) 22:07, 7 June 2011 (UTC) | ” |
- Hmmm. Are you aware of any primary observational studies which conflict with this finding? If so, on what basis should we highlight this particular article and disregard others? MastCell Talk 23:55, 7 June 2011 (UTC)
- You are welcome to add citations that conflict with it but it clearly supports a positive result for Vitamin C in clinical trials investigating heart disease. Lumos3 (talk) 09:45, 8 June 2011 (UTC)
- See WP:MEDRS, WP:PSTS (this would be considered a large, but still primary source), WP:NOR for your final point. I also point to the conclusion in the abstract: "Plasma vitamin C concentrations may serve as a biological marker of lifestyle or other factors associated with reduced stroke risk and may be useful in identifying those at high risk of stroke." It's also doesn't relate to vitamin C megadosage (unless that upper quartile were taking megadoses), it's correlational meaning you can't be sure if vitamin C is causing fewer strokes or if people who eat lots of fruits and vegetables or take vitamin C have a variety of other factors that protect against stroke (for instance, people who eat lots of fresh fruits and vegetables may also engage in regular exercise; they may pay more attention to health information; they may take the advice of their physicians more seriously; they may take prophylactic aspirin). This may have a place on the vitamin C page proper, or the stroke page proper, but I would not support its conclusion on this page. This page is vitamin C megadosage meaning unless they did a study of people taking several times the RDI for vitamin C, a study making an extreme claim for this fringe hypothesis is essentially irrelevant. WLU (t) (c) Wikipedia's rules:simple/complex 13:20, 8 June 2011 (UTC)
- Hmmm, careful there Lumos3, hang around and you'll quickly learn that positive studies on vitamins aren't welcome here. But twist the evidence against them and you'll soon find that Masty and his friends will fill your page with barnstars... ;-) Vitaminman (talk) 20:09, 22 June 2011 (UTC)
- I will give you a barnstar if you can find the last time I gave anyone a barnstar. But I assume that was intended as just a general disparagement rather than a factual statement. MastCell Talk 20:37, 22 June 2011 (UTC)
- You are welcome to add citations that conflict with it but it clearly supports a positive result for Vitamin C in clinical trials investigating heart disease. Lumos3 (talk) 09:45, 8 June 2011 (UTC)
Use in burns units
[edit]This is a cited statement of fact about clinical use of high doses not a 'How To'. The Department of Surgical Education, Orlando Regional Medical Center are recommending very large doses of intravenous vitamin C for burns victims. This is a statement of current medical good practice which supports the article topic and not a 'How To' as stated by User:WLU who removed it from the article. Lumos3 (talk) 13:30, 13 September 2011 (UTC)
- It's a statement about how a single hospital unit believes vitamin C should be used. The important fact is that vitamin C is recommended for burned patients, not that some entities are using it. WLU (t) (c) Wikipedia's rules:simple/complex 17:56, 13 September 2011 (UTC)
- The article at the moment does not mention that it is in actual use in burns treatment, only that research has indicated in might be useful. The fact that its is now a recognized approach in some practices needs to be reflected in the article. The acceptance of ascorbic acid for therapeutic use by established medicine, especially in the very high doses stated here is a major change in the relationship of scientific medicine to vitamin c megadosage. The Wikipedia article on vitamin c megadosage needs to reflect changes to medicine taking place and not fixate on past opinion. Lumos3 (talk) 21:49, 13 September 2011 (UTC)
- I agree, of course. Just don't hold your breath while waiting for the usual suspects to agree with you... Vitaminman (talk) 23:28, 13 September 2011 (UTC)
- For any medical intervention, we normally only note that it works and is justified in the peer reviewed literature. It's quite rare that we note where it is used as well. If high-dose intravenous vitamin C is standard treatment for burns, that's that. I wouldn't note that it's actually used or not unless there was significant indication that this was a point of contention in the medical community or there were significant differences throughout the world (for instance, peritoneal dialysis#frequency discusses PD being more or less common in certain countries). I wouldn't include a list of hospitals that conduct coronary bypass surgery for the same reason I wouldn't note that vitamin C for burns is used by certain hospitals - it's simply not necessary. Unless there is an indication that it is not being used and should be (i.e. an editorial or article in a medical journal), there's no reason to include a low-reliability, intra-hospital publication.
- The claim that vitamin C megadosage for burns somehow vindicates vitamin C megadosage as a general treatment for multiple conditions is false. Vitamin C megadosage having an evidence base for being used for burns means it is useful for burn victims - not cancer, not colds, not general health, not longevity, not heart attacks. Medicine doesn't use general tonics to improve health, though CAM is very enamoured of the irrational idea of magical elixers that can preserve health and prevent all disease. Vitamin C ain't such an elixer. WLU (t) (c) Wikipedia's rules:simple/complex 14:14, 14 September 2011 (UTC)
- I agree, of course. Just don't hold your breath while waiting for the usual suspects to agree with you... Vitaminman (talk) 23:28, 13 September 2011 (UTC)
- The article at the moment does not mention that it is in actual use in burns treatment, only that research has indicated in might be useful. The fact that its is now a recognized approach in some practices needs to be reflected in the article. The acceptance of ascorbic acid for therapeutic use by established medicine, especially in the very high doses stated here is a major change in the relationship of scientific medicine to vitamin c megadosage. The Wikipedia article on vitamin c megadosage needs to reflect changes to medicine taking place and not fixate on past opinion. Lumos3 (talk) 21:49, 13 September 2011 (UTC)
← I think we're putting the cart before the horse in our enthusiasm to find support for megadose vitamin C. I don't actually see evidence that it has (yet) become part of standard care, even for burn victims. For example:
- UpToDate states: "Due to the limited data supporting supernormal repletion of any micronutrients, routine practice at our center is to supplement all adult burn patients simply with an adult multivitamin, and all pediatric burn patients with a pediatric multivitamin. This practice is uniform in U.S. burn centers, although some centers provide Vitamin C and Zinc in addition to a multivitamin."
- ESPEN guidelines for nutrition of ICU patients do not appear to recommend supranormal dosing of vitamin C (although they do support glutamine supplementation for burn victims). [10]
- Orlando Regional Medical Center, which seems to be at the forefront of advocating vitamin C supplementation for burn victims, argues that physicians should "consider" vitamin C supplementation, with an evidence grade of 2 (on a scale of 1 [best] to 3 [worst]). [11]
I think that, at most, you could say that there is wide variation in practice, and that at least one burn center recommends "consideration" of high-dose vitamin C in burn patients, acknowledging the lack of high-quality supporting evidence but basing that recommendation on their expert opinion and suggestive evidence. MastCell Talk 18:55, 14 September 2011 (UTC)
- What is exceptional about the Orlando protocol is the size of the dose recommended. There has been previous discussion here about the lack of definition of what "megadose" means. Orlando is talking about 66 mg/kg/hr for 24 hours. I calculate that's over 100,000 mg for an adult . Even in megadose discussions that is very high. The dose needs to be mentioned in the article to put it in context . Lumos3 (talk) 22:29, 14 September 2011 (UTC)
- If it is "exceptional" then it is undue weight to give it too much emphasis. Also, given the unusual circumstances (burn victim) then it's certainly invalid to apply this generally to humans in circumstances outside of major, unusual trauma. WLU (t) (c) Wikipedia's rules:simple/complex 23:15, 14 September 2011 (UTC)
- I disagree with including the "wide variation in practice" followed by a citation which agencies use it and which don't. We are essentially engaging in de facto original research which can never be anything undue weight on one side or another. How many hospitals do we cite that do, or do not, employ vitamin C for burns? Do we just look at the US, just English-speaking, or world-wide? What about hospitals that do not list their treatment protocols?
- It's noted that vitamin C is useful, anything else is inappropriate. WLU (t) (c) Wikipedia's rules:simple/complex 18:36, 17 September 2011 (UTC)
- If it is "exceptional" then it is undue weight to give it too much emphasis. Also, given the unusual circumstances (burn victim) then it's certainly invalid to apply this generally to humans in circumstances outside of major, unusual trauma. WLU (t) (c) Wikipedia's rules:simple/complex 23:15, 14 September 2011 (UTC)
- Updated the section using what secondary sources I could find. I do not think the protocol from one institution is appropriate for inclusion here. Yobol (talk) 02:23, 18 September 2011 (UTC)
- Do any of the sources discuss a specific dosage? That would be valuable to include I think. WLU (t) (c) Wikipedia's rules:simple/complex 13:47, 18 September 2011 (UTC)
- Updated. Is this what you were thinking about? Yobol (talk) 23:03, 19 September 2011 (UTC)
- Good info, I had a go at a bit of rewriting. I think that's far, far better than noting that a single hospital uses it, particularly given the emphasis the studies give that it's not even close to a mainstream treatment. WLU (t) (c) Wikipedia's rules:simple/complex 01:13, 20 September 2011 (UTC)
- This is a good summary . It acknowledges the emerging role of megadosage vitamin c in one area of mainstream medicine. Lumos3 (talk) 10:30, 21 September 2011 (UTC)
- Updated. Is this what you were thinking about? Yobol (talk) 23:03, 19 September 2011 (UTC)
- Do any of the sources discuss a specific dosage? That would be valuable to include I think. WLU (t) (c) Wikipedia's rules:simple/complex 13:47, 18 September 2011 (UTC)
Protection request
[edit]{{adminhelp}}
Uncooperative IP at work on two articles. An IP who changes IPs is edit warring and not discussing. The IPs have been warned.
See: Category:Suspected Wikipedia sockpuppets of 80.133.57.193
Brangifer (talk) 23:38, 4 July 2012 (UTC)
- Protected - it will be quicker to go to WP:RFPP Ronhjones (Talk) 01:16, 5 July 2012 (UTC)
Edit warring about "criticism"
[edit]Brangifer, you are the one who initiated the edit war. I, unlike you, am trying to incorporate scientific contributions. My last two edits, which were again reverted, referenced a peer-reviewed review, not letter. How can this not be considered compliant with WP:MEDRS? You stated that "letters" were not compliant with WP:MEDRS. However, WP:MEDRS only explicitly forbids letters from non-experts. The letters I originally referenced were from university researchers, i.e., experts in their respective fields published in scientific journals. In conclusion, your original claim - and reason for reverting my contributions - that all letters were incompliant with WP:MEDRS is not supported by WP:MEDRS. You further claim that I were using sock puppets when, in fact, I am simply using an Internet connection with dynamic IP address assignment. I do not see Wikipedia as a social network, I do not wish to maintain an identity here and care even less about self-congratulatory user pages plastered with pathetic symbols of virtual achievements. To use Wikipedia's silly jargon, I am generally a "WikiGnome" and hate to be dragged into all this drama just because of power-trippers like you. — Preceding unsigned comment added by 80.133.40.80 (talk) 01:30, 5 July 2012 (UTC)
- See my response here: http://en.wikipedia.org/wiki/Talk:Vitamin_C#Edit_warring_about_.22criticism.22 -- Brangifer (talk) 05:32, 5 July 2012 (UTC)
References
[edit]- ^ a b c Hemilä, H (Feb). "Vitamin C supplementation and common cold symptoms: factors affecting the magnitude of the benefit" (PDF). Medical hypotheses. 52 (2): 171–8. PMID 10340298.
{{cite journal}}
: Check date values in:|date=
and|year=
/|date=
mismatch (help) - ^ Pauling, Linus (1970). Vitamin C and the Common Cold. Freeman. p. 122.
- ^ Cite error: The named reference
Pauling book
was invoked but never defined (see the help page). - ^ Pauling, Linus (1991). "Case Report: Lysine/Ascorbate-Related Amelioration of Angina Pectoris" (PDF). Journal of Orthomolecular Medicine. 6 (3): 144–46.
- ^ Cite error: The named reference
Rath,Pauling 1992
was invoked but never defined (see the help page). - ^ Maeda N, Hagihara H, Nakata Y, Hiller S, Wilder J, Reddick R (2000). "Aortic wall damage in mice unable to synthesize ascorbic acid". Proc. Natl. Acad. Sci. U.S.A. 97 (2): 841–6. doi:10.1073/pnas.97.2.841. PMC 15418. PMID 10639167.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Frikke-Schmidt, Henriette (2009). "Role of marginal vitamin C deficiency in atherogenesis: in vivo models and clinical studies". Basic & Clinical Pharmacology & Toxicology. 104 (6): 419–433. doi:10.1111/j.1742-7843.2009.00420.x. PMID 19489786.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Douglas RM, Hemilä H (2005). "Vitamin C for Preventing and Treating the Common Cold". PLoS Medicine. 2 (6): e168. doi:10.1371/journal.pmed.0020168. PMC 1160577. PMID 15971944.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ Gorton, HC, (1999 Oct;22). "The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections". Journal of Manipulative and Physiological Therapeutics. 8. PubMed: 530–533.
{{cite journal}}
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(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) - ^ Hemilä, H (2000). "Vitamin C for preventing and treating the common cold". Cochrane Database of Systematic Reviews. 3 (2): CD000980. doi:10.1002/14651858.CD000980. ISSN 1464-780X. PMID 10796569.
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Quackery
[edit]There are a large number of quacks and quack websites which make claims of vitamin C megadoses as a "cure" for AIDS, cancer etc. These include Matthias Rath, Patrick Holford, CANCERactive and numerous others. Since this is, in my experience, a very common argument made by quacks, I think it's likely to beone of the things people come to this article looking to read about. I have therefore added a brief summary of this, distilled from the article itself along with a couple of extra sources, into the lede. Guy (Help!) 12:53, 17 November 2012 (UTC)
Circular references?
[edit]I recently posted a question at the village pump[12] about these references, which I believe to be essentially circular: [13][14] Whilst there was not complete agreement over this, what came through strongly was that, at the very least, JzG should expand those references to include specific page or chapter citations, rather than just book titles and author names.Vitaminman (talk) 10:48, 20 November 2012 (UTC)
This one is highly problematic - you can read the criticisms here: http://cancerres.aacrjournals.org/content/69/22/8830.1.long
I will excerpt: "To the Editor:
On the basis of cell and animal experiments with dehydroascorbic acid, Heaney and colleagues state, 'These results suggest that supplementary vitamin C may have adverse consequences in patients receiving cancer therapy' (1). Selectively referring to dehydroascorbic acid as vitamin C throughout the majority of this work may send a clouded message to patients and their caregivers. All known actions of vitamin C are mediated by the reduced molecule ascorbate, not the oxidized molecule dehydroascorbic acid. Mice lacking the tissue transport protein specific for ascorbate (Slc23a2) do not survive because of severe vitamin C deficiency, despite having no impairments in dehydroascorbic acid transport (2).
The suggestion that '…study conditions were relevant to clinical conditions' (1) should be viewed cautiously. Compared with cells devoid of any ascorbate, researchers attenuated cytotoxicity to antineoplastic agents in vitro (11-27%) by prior treatment with 500 μmol/L dehydroascorbic acid, which rapidly elevated intracellular ascorbate concentrations up to 18 mmol/L within 1 hour (1). In vivo, numerous reductive systems ensure plasma concentrations of dehydroascorbic acid do not exceed 1 μmol/L (3, 4). Although alluded to, the actual level of dehydroascorbic acid formed endogenously within the oxidative environments of tumors was not measured in either this (1) or the previous studies cited by this group (5, 6). Most cells in vivo, including cancer cells, maintain a constant intracellular ascorbate concentration of 1 to 5 mmol/L, which never decreases to zero. Data collected in vitro by comparing two extremes, 0 and 18 mmol/L ascorbate for instance, are implausible with regard to tumors and other tissues in general. The investigators conclude that 'This finding could have important clinical relevance given the wide use of vitamin C as a nutritional supplement' (1). However, to produce an effect in xenografted mice, a course of 8 × 250 mg/kg dehydroascorbic acid was administered intravenously (1). This regimen does not simulate oral ingestion of vitamin C supplements. In fact, irreversible diabetes can be induced in rats after intravenous injection of 700 mg/kg dehydroascorbic acid (7).
Because meaningful differences exist in regard to chemistry, bioavailability, and metabolism, it may be imprudent to connect data gathered with dehydroascorbic acid to vitamin C (ascorbate) and oral supplements. Numerous randomized human clinical trials have not shown decreased chemotherapeutic efficacy with dietary supplement usage, including vitamin C (8). Scientific dialogue on the subject may benefit from further preclinical testing of oral vitamin C (ascorbate) supplementation and cancer treatment in addition to experiments deigned solely with dehydroascorbic acid."
Furthermore, this is controverted by the systematic review PMID 17367938, which, while reserved, noted: "Many of the studies indicated that antioxidant supplementation resulted in either increased survival times, increased tumor responses, or both, as well as fewer toxicities than controls" Pottinger's cats (talk) 13:46, 25 January 2013 (UTC)
Removed reference 5
[edit]That dismissal of vitamin C is inconsistent with the actual data. It bases itself on kidney stone claims and vitamin B-12 interference claims.
Regarding Vitamin B-12, a review on the JAMA noted "Harmful effects have been mistakenly attributed to vitamin C, including hypoglycemia, rebound scurvy, infertility, mutagenesis, and destruction of vitamin B12. Health professionals should recognize that vitamin C does not produce these effects.": http://jama.jamanetwork.com/article.aspx?articleid=189543#qundefined
William J. McCormick demonstrated that vitamin C actually prevents the formation of kidney stones: http://www.ncbi.nlm.nih.gov/pubmed/20994442, search google for a pdf of the study.
Other research reports that: "Even though a certain part of oxalate in the urine derives from metabolized ascorbic acid, the intake of high doses of vitamin C does not increase the risk of calcium oxalate kidney stones. . . (I)n the large- scale Harvard Prospective Health Professional Follow-Up Study, those groups in the highest quintile of vitamin C intake (greater than 1,500 mg/day) had a lower risk of kidney stones than the groups in the lowest quintiles.": http://www.ncbi.nlm.nih.gov/pubmed/9429689Pottinger's cats (talk) 14:25, 25 January 2013 (UTC)
dismissal in article
[edit]The dismissals in this article - citations 1-4 from non-peer reviewed sources - blogposts/articles by David Gorski and Stephen Barrett, who are popular with many editors here but are not specialists in the fields they are critiquing, are controverted by the following 2 articles from the JOM:
1) http://orthomolecular.org/library/jom/2009/pdf/2009-v24n01-p015.pdf
2) http://orthomolecular.org/library/jom/2009/pdf/2009-v24n02-p065.pdf
I think these are certainly better overviews for the lede, but I invite others to read them so that a consensus can be established.Pottinger's cats (talk) 15:51, 25 January 2013 (UTC)
- The Journal of Orthomolecular Medicine isn't even MEDLINE-indexed and so does not meet even the bare minimum WP:MEDRS requirements and so should not be used to support biomedical content in Wikipedia articles.
Zad68
16:01, 25 January 2013 (UTC) - I would encourage Pottinger's cats to familiarize themselves with the WP:FRINGE guideline, and especially look at WP:PARITY, under which the Gorski and Barrett sources would be deemed reliable sources. Yobol (talk) 16:21, 25 January 2013 (UTC)
Under parity, it reads - "In an article on a fringe topic, if a notable fringe theory is primarily described by amateurs and self-published texts, verifiable and reliable criticism of the fringe theory need not be published in a peer reviewed journal."
However, the writer is not an amateur in the field and has a doctorate with relevant experience. I believe this is a profile of him: http://www.skokienet.org/node/16787
Here is an item from the Certification Board for Nutrition Specialists with a letterhead bearing his name as Executive Director: http://nutritionalliance.net/uploads/CBNS_letter_opposing_California_AB_575-updated_5-1-11-.pdf
He has published in relevant peer-reviewed literature, such as the following: http://www.sciencedirect.com/science/article/pii/S089990071100414X
see also: http://www.ncbi.nlm.nih.gov/pubmed?term=glade%20m
He has reported to the FDA - as in the following - on relevant matters: http://www.fda.gov/ohrms/dockets/dockets/03q0401/03q-0401-c000006-01-vol10.pdf
So I don't think the issues raised apply as much.Pottinger's cats (talk) 17:00, 25 January 2013 (UTC)
- You appear to have missed the relevant word in the phrase "verifiable and reliable criticism of the fringe theory". Yobol (talk) 17:42, 25 January 2013 (UTC)
Yes, but the writer of the above journal entries is not an amateur.
The problem is that the phrase "no scientific evidence" is wrong - there are many studies, including recent studies showing evidence - a preliminary search gives the following
- Intravenous ascorbic acid to prevent and treat cancer-associated sepsis? J Transl Med. 2011 Mar 4;9:25: http://www.ncbi.nlm.nih.gov/pubmed/21375761
- Megadose vitamins in bladder cancer: a double-blind clinical trial: http://www.ncbi.nlm.nih.gov/pubmed/8254816
- Epidemiologic evidence regarding vitamin C and cancer. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1310S-1314S.: http://www.ncbi.nlm.nih.gov/pubmed/1962588
- Inhibiting effect of ascorbic acid on the growth of human mammary tumor xenografts. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1274S-1280S.: http://www.ncbi.nlm.nih.gov/pubmed/1962582
- Vitamin C reduces the incidence and severity of renal tumors induced by estradiol or diethylstilbestrol. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1256S-1260S.: http://www.ncbi.nlm.nih.gov/pubmed/1962579
- [Radioprotective effect of ascorbic acid on oral structures in patients with cancer of the head and neck]. Av Odontoestomatol, 5(7), September 1989, p. 469-472.: http://www.ncbi.nlm.nih.gov/pubmed/2638825
- Effect of high-dose intravenous vitamin C on inflammation in cancer patients. J Transl Med. 2012 Sep 11;10:189. doi: 10.1186/1479-5876-10-189.: http://www.ncbi.nlm.nih.gov/pubmed/22963460
- Ascorbate induces autophagy in pancreatic cancer. Autophagy. 2010 Apr;6(3):421-2. Epub 2010 Apr 15. "Clinical data show that when ascorbate is given orally, fasting plasma concentrations are tightly controlled by decreased absorption, increased urine excretion, and reduced ascorbate bioavailability. In contrast, when ascorbate is administered intravenously, concentrations in the millimolar level are achieved. Thus, it is clear that intravenous administration of ascorbate can yield very high plasma levels, while oral treatment does not.": http://www.ncbi.nlm.nih.gov/pubmed/20400857
- Biological nature of the effect of ascorbic acids on the growth of human leukemic cells.: http://www.ncbi.nlm.nih.gov/pubmed/4016763
- Dietary vitamins A and C and lung cancer risk in Louisiana. Cancer. 1988 Nov 15;62(10):2267-73.: http://www.ncbi.nlm.nih.gov/pubmed/3179940
- Prolongation of survival times of terminal cancer patients by administration of large doses of ascorbate. Int J Vitam Nutr Res Suppl. 1982;23:103-13.: http://www.ncbi.nlm.nih.gov/pubmed/6811475
- Intravenous vitamin C as a chemotherapy agent: a report on clinical cases.: http://www.ncbi.nlm.nih.gov/pubmed/15377059
- Pharmacologic ascorbic acid concentrations selectively kill cancer cells: Action as a pro-drug to deliver hydrogen peroxide to tissues: http://www.pnas.org/content/102/38/13604.abstract
among others
Also, the following are of interest:
- Increased uptake and accumulation of vitamin C in human immunodeficiency virus 1-infected hematopoietic cell lines. "High concentrations of vitamin C were preferentially toxic to HIV-infected host defense cell lines in vitro.": http://www.ncbi.nlm.nih.gov/pubmed/9038196
- Vitamin C in the treatment of acquired immune deficiency syndrome (AIDS). Med Hypotheses. 1984 Aug;14(4):423-33. "A topical C-paste has been found very effective in the treatment of herpes simplex and, to a lesser extent, in the treatment of some Kaposi's lesions.": http://www.ncbi.nlm.nih.gov/pubmed/6238227
see also
- Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice. Eur J Cancer Prev. 1998 Dec;7(6):449-54. " This study has shown that 4 weeks daily high dose vitamin C treatment in H. pylori infected patients with chronic gastritis resulted in apparent H. pylori eradication in 30% of those treated.": http://www.ncbi.nlm.nih.gov/pubmed/9926292
- Vitamin C for Prophylaxis of Viral Hepatitis B in Transfused Patients. Journal of the International Academy of Preventive Medicine, 1978, Volume 5, Number 1, pp. 54-58: http://www.seanet.com/~alexs/ascorbate/197x/morishige-f-etal-j_int_assn_prev_med-1978-v5-n1-p54.htm
- Serum vitamin C concentration was inversely associated with subsequent 20-year incidence of stroke in a Japanese rural community. The Shibata study. Stroke. 2000 Oct;31(10):2287-94.: http://www.ncbi.nlm.nih.gov/pubmed/11022052
You seem to be very much opposed to the idea of any CAM proposal being valid. If you want a challenge to your ideas - you may wish to look into the following source: http://www.amazon.com/Curing-Incurable-Vitamin-Infectious-Diseases/dp/1401069630/ref=cm_cr_pr_pb_tPottinger's cats (talk) 10:45, 28 January 2013 (UTC)
- When you find a high quality secondary source that doesn't use largely outdated primary studies published in disreputable journals such as Medical Hypotheses we might have something to talk about. As of yet, Quackwatch is a perfectly valid source for discussion of fringe alt med material, and should not be removed unless you can come up with a consensus to remove it. Yobol (talk) 13:14, 28 January 2013 (UTC)
I wasn't using the journals I referenced, nor the book I referenced - I just made a preliminary search using other sources. I only used Medical Hypotheses for one article out of many. Many of the studies are recent. And PMID 6811475 is a replication of Pauling's findings.Pottinger's cats (talk) 01:21, 29 January 2013 (UTC) Here is a high quality secondary source: http://ar.iiarjournals.org/content/29/3/809.fullPottinger's cats (talk) 02:14, 29 January 2013 (UTC)
- All pertinent points from this secondary source appears to be already mentioned in this article. What new text are you suggesting? Yobol (talk) 18:12, 8 February 2013 (UTC)
The review shows that intravenous use has replicated the effects, but oral use (which, because of such profound differences is design, was not even meant to replicate the effects) has not. It also shows the anti-cancer effects of vitamin C megadoseage from other studies. It concludes: "If unambiguous benefit can be shown even in a few cases, the use of ascorbate should be explored in more controlled studies. After all, even a small benefit is worthwhile as ascorbate is nontoxic and inexpensive, in contrast to the many chemotherapeutic agents in use. If the results show a clear lack of benefit, the use of ascorbate as a chemotherapeutic agent in cancer should be abandoned. The role of serendipity in science should not be underestimated. In cancer treatment we currently do not have the luxury of jettisoning possibly effective and nontoxic treatments. We should revisit promising avenues, without prejudice and with open minds, and conduct studies without allowing desperation to diminish scientific rigor."
Thus it supersedes the two negative items.Pottinger's cats (talk) 04:05, 6 March 2013 (UTC)
lead
[edit]I flagged a statement in the lead that “An article published in International Journal of Oncology, No. 1/2013, confirmed the efficiency of C-vitamin megadoses against cancer” as being non-neutral. To fix it, I suggest changing it to one of the following four versions:
- “An article published in International Journal of Oncology, No. 1/2013, confirmed the efficiency of C-vitamin megadoses against cancer in laboratory mice”;
- “An article published in International Journal of Oncology, No. 1/2013, confirmed the efficiency of C-vitamin megadoses against cancer in mice that are unable to synthesize vitamin C on their own”;
- “An article published in International Journal of Oncology, No. 1/2013, confirmed the efficiency of C-vitamin megadoses against cancer in knockout mice”; or
- “An article published in International Journal of Oncology, No. 1/2013, confirmed the efficiency of C-vitamin megadoses against cancer in vitamin C-deficient mice.”
As I lack the scientific expertise to interpret the original source, I come here seeking advice on which of my four proposed edits is most neutral and accurate. 71.178.188.47 (talk) 04:27, 15 February 2013 (UTC)
deletion of sentence citing to doi:10.3892/ijo.2012.1712
[edit]I see that the above statement has actually been deleted now. When I marked it as being non-neutral, however, I did not mean to imply that it should be deleted, but rather, it should be rewritten to accurately say what the source says (and, like I said, I lack the requisite education to interpret the source and its significance.) 71.178.188.47 (talk) 14:36, 15 February 2013 (UTC)
- Thanks for the suggestions, but normally we do not include primary-source animal study results like this in our articles at all, that is why it was removed. Please see WP:MEDRS for our sourcing guidelines for biomedical information. Cheers...
Zad68
14:37, 15 February 2013 (UTC)- My reading of WP:MEDRS is that primary sources are permitted if they are so new as not to have been mentioned in any reliable secondary sources, and also, animal studies are “pre-clinical” (and therefore should be buried in the middle of the article) rather than being given undue weight. Thank you for removing it from the lead. 71.178.188.47 (talk) 14:46, 15 February 2013 (UTC)
- You're welcome, but it shouldn't be in the article at all. The allowance in WP:MEDRS for the citing of primary studies is restricted to brand new areas of research where there aren't any secondary sources at all, and, honestly, the consensus has been moving to restrict the use of primary studies even more. The use of vitamin C in those with cancer is well-studied and there are literally dozens of high-quality secondary sources that cover it, for example (and I haven't thorougly examined each of these to ensure they're top-quality): Ascorbic acid: chemistry, biology and the treatment of cancer, Antioxidant vitamins and mineral supplementation, life span expansion and cancer incidence: a critical commentary, Vitamin C, gastritis, and gastric disease: a historical review and update, Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients, Antioxidant therapy: current status and future prospects, and that's just a few from the past year or two. With so many up-to-date secondary sources available, there's no reason to include a recent primary research study in mice. If that study is of good quality, it will get picked up in a secondary source, which can be used in the article.
Zad68
15:17, 15 February 2013 (UTC)
- You're welcome, but it shouldn't be in the article at all. The allowance in WP:MEDRS for the citing of primary studies is restricted to brand new areas of research where there aren't any secondary sources at all, and, honestly, the consensus has been moving to restrict the use of primary studies even more. The use of vitamin C in those with cancer is well-studied and there are literally dozens of high-quality secondary sources that cover it, for example (and I haven't thorougly examined each of these to ensure they're top-quality): Ascorbic acid: chemistry, biology and the treatment of cancer, Antioxidant vitamins and mineral supplementation, life span expansion and cancer incidence: a critical commentary, Vitamin C, gastritis, and gastric disease: a historical review and update, Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients, Antioxidant therapy: current status and future prospects, and that's just a few from the past year or two. With so many up-to-date secondary sources available, there's no reason to include a recent primary research study in mice. If that study is of good quality, it will get picked up in a secondary source, which can be used in the article.
Preventing CRPS after wrist injury
[edit]I wonder if my sentence about using vitamin C to prevent complex regional pain syndrome after injury belongs in this article or in the main Vitamin C article. (Is 500 mg a megadose?)
The idea is already mentioned in the article on complex regional pain syndrome, which cites to a petition and to a book by a certain Paul Zollinger. Luckily I have found a more suitable source than the petition.
71.178.188.47 (talk) 15:20, 15 February 2013 (UTC)
Introduction
[edit]Did anyone read this before writing the introduction and saying that there is "no evidence that it works". Perhaps it is time to update the introduction.
http://www.cancer.gov/cancertopics/pdq/cam/highdosevitaminc/patient/page2 — Preceding unsigned comment added by 83.241.227.21 (talk) 14:53, 28 November 2013 (UTC)
Advocacy arguments issues.
[edit]The current text reads: Vitamin C advocates [who?] argue that there is a large body of scientific evidence [specify] that the vitamin has a wide range of health and therapeutic benefits [example needed] but that this belief is rejected by current [when?] science and medical research.[who?][1] There is some evidence regarding the applications and efficacy of vitamin C, but recommended governmental agency doses and frequency of intake have remained relatively fixed. This has led some researchers to challenge the recommendations. In 2003, Steve Hickey and Hilary Roberts of the Manchester Metropolitan University published a fundamental criticism of the approach taken to fix the nutritional requirement of vitamin C. In 2004, they again argued that the RDA, which is based on blood plasma and white blood-cell saturation data from the National Institutes of Health (NIH), was based on flawed data.[1] According to these authors, the doses required to achieve blood, tissue, and body "saturation" are much larger than previously believed.
- ^ Hickey S, Roberts H (September 2005). "Misleading information on the properties of vitamin C". PLoS Med. 2 (9): e307, author reply e309. doi:10.1371/journal.pmed.0020307. PMC 1236801. PMID 16173838.
{{cite journal}}
: CS1 maint: unflagged free DOI (link)
Issues:
The the first sentence treats the issue of higher Vitamin c consumption as a fringe/pseudoscience issue. This is using using paper from 1988, that is primarily about cancer, to vaguely paint broad brushes. The criticism can be enhanced by finding a more up to date source that addresses the actual claims of advocates.
Here is a list of potential sources and other background information that could be of use in this section.
http://www.orthomolecular.org/library/jom/2005/pdf/2005-v20n04-p237.pdf http://orthomolecular.org/library/jom/2007/pdf/2007-v22n01-p021.pdf http://prhsj.rcm.upr.edu/index.php/prhsj/article/view/13/11 http://ar.iiarjournals.org/content/29/3/809.long http://advances.nutrition.org/content/2/2/78.full http://www.ncbi.nlm.nih.gov/pubmed/19874953 https://www.ncbi.nlm.nih.gov/pubmed/18938145 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1236801/ http://www.ncbi.nlm.nih.gov/pubmed/23446899 http://www.ncbi.nlm.nih.gov/pubmed/22332036
The tone of the article needs a pretty major reworking. I'll try it later this week. I just though I'd make this post to state my plans. Cheers. Khimaris (talk) 01:46, 3 April 2014 (UTC)
- It's portrayed as fringe because it is fringe. A quote from one of the links you provided, -"Ascorbate administered intravenously has already been tested in a phase I clinical trial, is in wide use by complementary and alternative medicine (integrative medicine) practitioners"- The references could use some updating but it doesn't appear that your provided sources say what you think they say. As a whole they point to speculation that large doses of Vitamin C "could" be useful but then call for further research. This was a cursory run through so maybe there is actual conclusions in the papers but they didn't jump out at me. --Daffydavid (talk) 02:20, 3 April 2014 (UTC)
- [[User:Daffydavid|Daffydavid], I have problems with that kind of thinking. Most practitioners of alternative medicine would support eating fruits and veg. Well obviously that means anyone who supports eating their five a day is a quack and a nutter /s. I'm not a supporter of Vitamin C megadosing. The links I've posted aren't there simply to support it's use. I simply think the article should attempt to look at the science behind it instead of treating the issue as patent nonsense. This isn't reiki after all. Consuming higher levels of Vitamin C depending on the route, amount and time between dosing could be useful. The article should state as much instead of trying to list as many quacks who have supported it. Using that sort of logic I should add Blondi to the article on pet ownership.Khimaris (talk) 12:23, 3 April 2014 (UTC)
- Covering it in tags is not appropriate and kind of pointy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:01, 3 April 2014 (UTC)
- Please refer me to the rule that states this is not appropriate. Khimaris (talk) 12:23, 3 April 2014 (UTC)
- The problem here is that Khimaris is using non MEDRS sources (letters to the editors, primary studies, non MEDLINE indexed journals, etc) to try to debunk high quality studies. Clearly that is not convincing, and will not gain consensus. Yobol (talk) 14:19, 3 April 2014 (UTC)
- Yobol for the love of christ, I'm not trying to debunk anything. I was posting background information from the perspective of Vitamin C advocates that could potentially be used later. The behavior you're expressing is near bullying at this point. Every edit I make is subject to near immediate revert. I'm not going away. You all need to realize this. Any further misbehavior, whether it be individual or collective, will be reported to the proper channels. Khimaris (talk) 17:03, 3 April 2014 (UTC)
Scientific evidence does not suggest there is no effect.
[edit]It is not "nit-picky" to point out scientific evidence does not suggest there is no effect. What "alt med" people claim or don't claim is irrelevant.
You have to be concise and get it right. No critic of alt med claims that huge IV doses of vitamin c has no effect. Anonywiki (talk) 16:41, 24 May 2014 (UTC)
- You don't like "nit-picky", how about pedantic. --Daffydavid (talk) 01:15, 25 May 2014 (UTC)
- I have left a disruptive editing warning at Anonywiki's page. In his edit summary he has admitted that the original version was clearer. User has failed to heed WP:BRD but I remain hopeful that he will come to this page to discuss his edit. I feel the edit the user has inserted is not only less clear but is also repetitive in nature. --Daffydavid (talk) 03:34, 25 May 2014 (UTC)
- I did come here to discuss the edit. Once again the original version was inaccurate. It's a very simple and straightforward matter. The version you advocate is clearer but it is false. Anonywiki (talk) 03:49, 25 May 2014 (UTC)
Off target material
[edit]I removed the subsections on the common cold and cardiovascular disease and cataract. I carefully read the sources provided, and none of them disusses megadoses. Jytdog (talk) 17:38, 25 May 2014 (UTC)
I removed the section on "Treatment of phencyclidine psychosis" as this is supported by a single primary source dated from 1987. I checked and there are no recent reviews. As per MEDRS this should not be here. Jytdog (talk) 17:39, 25 May 2014 (UTC)
I removed the section on Prevention of chronic severe pain after injury, since in the 4 studies that the authors of the cited review used, doses were 500 mg/day, the second used 1 g/day, the third used 200, 500, or 1500 mg/day, and the fourth used 1 g/day. None of these are megadoses as defined in this article. Jytdog (talk) 18:03, 25 May 2014 (UTC)
Should include info on the Linus Pauling page about the Mayo Clinic studies
[edit]The progression of this passage:
- The use of vitamin C in high doses as a treatment for cancer was promoted by Linus Pauling, based on a 1976 study published with Ewan Cameron which reported intravenous vitamin C significantly increased lifespans of patients with advanced cancer.[1][2] This trial was criticized by the National Cancer Institute for being designed poorly, and three subsequent trials conducted at the Mayo Clinic could not replicate these results.[2][3]
does not represent the balance of the sides, and underrepresents all this information in the Linus Pauling article that goes on further (my emphasis in bold):
- Pauling denounced the conclusions of these studies and handling of the final study as "fraud and deliberate misrepresentation",[4][5] and criticized the studies for using oral, rather than intravenous vitamin C[6] (which was the dosing method used for the first ten days of Pauling's original study[7]). Pauling also criticised the Mayo clinic studies because the controls were taking vitamin C during the trial, and because the duration of the treatment with vitamin C was short; Pauling advocated continued high dose vitamin C for the rest of the cancer patient's life whereas the Mayo clinic patients in the second trial were treated with vitamin C for a median of 2.5 months.[8] The results were publicly debated at length with considerable acrimony between Pauling and Cameron, and Moertel (the lead author of the Mayo Clinic studies), with accusations of misconduct and scientific incompetence on both sides. Ultimately the negative findings of the Mayo Clinic studies ended general interest in vitamin C as a treatment for cancer.[5] Despite this, Pauling continued to promote vitamin C for treating cancer and the common cold, working with The Institutes for the Achievement of Human Potential to use vitamin C in the treatment of brain-injured children.[9] He later collaborated with the Canadian physician Abram Hoffer on a micronutrient regimen, including high-dose vitamin C, as adjunctive cancer therapy.[10] A 2009 review in the journal Anticancer Research was somewhat partial to Pauling, noting that there were significant methodological differences between the Mayo Clinic's and Pauling's studies (the Mayo clinic did not use intravenous Vitamin C), that other researchers administering intravenous vitamin C to patients reported that the patients gained benefits such as increased survival, improved well-being, and reduced pain, that intravenous administration is necessary to achieve high enough plasma levels for a pharmacological effect, and that convergent evidence shows that Vitamin C is effective as an anticancer agent.[11]
It seems difficult to insert as it should be surgically condensed, and also, the 2009 study listed in my 2nd quote is chronologically after the 2008 study listed in the first sentence following my first quote ("More recently, in vitro data..."), yet before the 2010 review listed right after the 2008. Squish7 (talk) 04:03, 30 May 2014 (UTC)
- ^ Cameron E, Pauling L (October 1976). "Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer". PNAS. 73 (10): 3685–3689. Bibcode:1976PNAS...73.3685C. doi:10.1073/pnas.73.10.3685. PMC 431183. PMID 1068480.
- ^ a b "Vitamin C". American Cancer Society.
- ^ Cite error: The named reference
Cabanillas
was invoked but never defined (see the help page). - ^ Ted Goertzel (1996). "Analyzing Pauling's Personality: A Three Generational, Three Decade Project". Special Collections, Oregon State University Libraries. Retrieved August 5, 2007.
- ^ a b Trevor Pinch; Collins, Harry M. (2005). "Alternative Medicine: The Cases of Vitamin C and Cancer". Dr. Golem: how to think about medicine. Chicago: University of Chicago Press. pp. 89–111. ISBN 0-226-11366-3.
{{cite book}}
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requires|url=
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(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help)CS1 maint: multiple names: authors list (link) - ^ Levine M; et al. (2006). "Intravenously administered vitamin C as cancer therapy: three cases". CMAJ. 174 (7): 937–942. doi:10.1503/cmaj.050346. PMC 1405876. PMID 16567755. Retrieved August 5, 2007.
{{cite journal}}
: Explicit use of et al. in:|author=
(help) - ^ Cite error: The named reference
PNASChen2007
was invoked but never defined (see the help page). - ^ Linus Pauling (1986). How to Live Longer and Feel Better. New York: W.H. Freeman and Company. pp. 173–175. ISBN 0-7167-1781-6.
- ^ Pauling, L (November 1978). Ralph Pelligra, ed. (ed.). "Orthomolecular enhancement of human development" (PDF). Human Neurological Development: 47–51.
{{cite journal}}
:|editor=
has generic name (help) - ^ Andrew W. Saul. "Abram Hoffer, M.D., PhD 50 Years of Megavitamin Research, Practice and Publication". Doctoryourself.com. Retrieved August 5, 2007.
{{cite web}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ^ Ohno, S; Ohno, Y; Suzuki, N; Soma, G; Inoue, M (2009). "High-dose vitamin C (ascorbic acid) therapy in the treatment of patients with advanced cancer". Anticancer research. 29 (3): 809–15. PMID 19414313.
"The available scientific evidence does not support these claims" may be too debatable
[edit]I don't think the scientific evidence is currently overwhelmingly supporting one view or the other.
With cancer, for instance, some studies in rodents (like this one) show a significant increase in survival rates when given large does of C. Others show substantial decreases in metastasis (example). I think this sentence in the article header is too debatable, and suggest rewriting it indicating that the scientific evidence is mixed. --Spenb (talk) 21:27, 2 September 2015 (UTC)
Should clearly separate oral from injected vitamin C
[edit]Intravenous vitamin C deserves its own article (as a medical therapy) but we could start with a section here ? - Rod57 (talk) 22:05, 24 January 2017 (UTC)
Content
[edit]As a lay person with an interest in the subject, I think the worm is turning back in favour of Linus Pauling to some extent. The UK Daily Mail published a rather weak article this year on the subject but if one puts 'Intravenous Vitamin C and cancer' into Google now in 2017 the results are more promising that some trials are producing more positive results: https://www.sciencedaily.com/releases/2017/01/170109134014.htm I read Linus Pauling's book and he certainly put a lot more effort into his research than Stephen Barrett. I'm not saying he was 100% correct but Pauling deserves to be taken more seriously in light of recent developments than being branded a quack.Andrew ranfurly (talk) 12:34, 7 July 2017 (UTC)
- Content about health in WP is sourced per WP:MEDRS.
- The Daily Mail is not reliable for much of anything in WP (see here) and is not a MEDRS source in any case.
- ScienceDaily is churnalism and also not MEDRS
- If there are concrete changes you would like to see, please propose them here based on MEDRS sources. Thanks. Jytdog (talk) 14:39, 7 July 2017 (UTC)
Should be added to this page, "megadosage Vitamin C" in connection with the current coronavirus. — Preceding unsigned comment added by Drsruli (talk • contribs) 19:31, 4 April 2020 (UTC)
C-19
[edit]Can we mention the Vitamin C treatment protocol used in hospitals during the C-19 pandemic?
Drsruli (talk) 16:24, 2 January 2022 (UTC)
- @Drsruli Do you have a reliable source that says as much? CaptainEek Edits Ho Cap'n!⚓ 19:38, 2 January 2022 (UTC)
I think that everybody does.
Drsruli (talk) 23:22, 3 January 2022 (UTC)
https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/vitamin-c/
https://pubmed.ncbi.nlm.nih.gov/32662690/
https://revitalizinginfusions.com/new-york-hospitals-treating-coronavirus-patients-with-vitamin-c/
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00792-3
https://nypost.com/2020/03/24/new-york-hospitals-treating-coronavirus-patients-with-vitamin-c/
https://clinicaltrials.gov/ct2/show/NCT04710329
https://lpi.oregonstate.edu/COVID19/IV-VitaminC-virus
https://nutritionj.biomedcentral.com/articles/10.1186/s12937-021-00727-z
https://www.newsweek.com/new-york-hospitals-vitamin-c-coronavirus-patients-1494407
https://www.frontiersin.org/articles/10.3389/fphar.2021.638556/full
https://www.frontiersin.org/articles/10.3389/fmed.2020.559811/full
https://www.otago.ac.nz/christchurch/research/nutrition-in-medicine/vitamin-c/
https://www.intelligentliving.co/vitamin-c-covid-19-treatment-ny-hospitals/
https://www.revitalaz.com/blog/vitamin-c-treatment-in-the-covid-19-era
https://www.accjournal.org/journal/view.php?number=1289
https://www.medpagetoday.com/casestudies/infectiousdisease/87976
https://www.consultdranderson.com/elementor-247647/
https://www.nature.com/articles/s41598-021-96703-y
Drsruli (talk) 23:31, 3 January 2022 (UTC)
Evidence, explanation of Mayo's flawed methodology and vit. C route of administration and NIH statement being deleted
[edit]I added research explaining why Mayo's studies supposed refutation of Pauling is wrong (in short, intravenous route leading to much higher plasma concentrations and treatment being much shorter), mentioned studies replicating his results in Japan, a more recent review of trials (2018, including a randomized one) and National Health Institute (an organization with the same level of "authority" than the one cited) statement, but it keeps being deleted under accusation of "fringe". I didn't even remove the anti statements and mentions. Where's "neutrality"?
https://pubmed.ncbi.nlm.nih.gov/15068981/ https://pubmed.ncbi.nlm.nih.gov/6811475/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071214/ https://www.cancer.gov/research/key-initiatives/ras/ras-central/blog/2020/yun-cantley-vitamin-c — Preceding unsigned comment added by 2803:9800:9094:dd3:2cd4:62dd:6edd:fd67 (talk) 00:27, 14 October 2022) (UTC)
- My assessment of those 4 sources: https://pubmed.ncbi.nlm.nih.gov/15068981/ Paper is about pharmacokinetics and irrelevant to efficacy; https://pubmed.ncbi.nlm.nih.gov/6811475/ An abstract of a 1982 paper that is unavailable and that is a primary source. It's not a reliable secondary source; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071214/ (Nauman) and https://www.cancer.gov/research/key-initiatives/ras/ras-central/blog/2020/yun-cantley-vitamin-c no clear evidence of efficacy and essentially a call for clinical trials. See the conclusion of the Nauman review and Wikipedia:Identifying_reliable_sources_(medicine). ScienceFlyer (talk) 01:03, 14 October 2022 (UTC)
Primate requirements in zoos, circuses, etc.
[edit]I've asked this elsewhere and no reference or information has been found. How much daily ascorbic acid (i.e. mgs) is legally required to be fed or administered to captive apes and monkeys in zoos, circuses and the like in the U.S., European countries, etc. Thanks. Randy Kryn (talk) 08:30, 16 October 2023 (UTC)
"No evidence" is way too strong
[edit]Saying there is "no evidence that vitamin C megadose can treat anything" is just silly. There's plenty of notes incidents of doctors using it in treatment. In particular for sepsis and burn patients. This needs to be reflected in the article. How do I put myself a reminder in a few weeks to modify the article? EdwinAmi (talk) 22:27, 15 February 2024 (UTC)
- Yes, please put references to reviews and meta-analysis about sepsis. Maxim Masiutin (talk) 11:56, 16 February 2024 (UTC)
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