Dr. Michael Holick’s enthusiasm for vitamin D can be fairly
described as extreme.
The Boston University endocrinologist, who perhaps more than
anyone else is responsible for creating a billion-dollar vitamin D sales and
testing juggernaut, elevates his own levels of the stuff with supplements and
fortified milk. When he bikes outdoors, he won’t put sunscreen on his limbs. He
has written book-length odes to vitamin D, and has warned in multiple scholarly
articles about a “vitamin D deficiency pandemic” that explains disease and
suboptimal health across the world.
His fixation is so intense that it extends to the dinosaurs.
What if the real problem with that asteroid 65 million years ago wasn’t a lack
of food, but the weak bones that follow a lack of sunlight? “I sometimes
wonder,” Holick has written, “did the dinosaurs die of rickets and osteomalacia?”
Holick’s role in drafting national vitamin D guidelines, and
the embrace of his message by mainstream doctors and wellness gurus alike, have
helped push supplement sales to $936 million in 2017. That’s a ninefold
increase over the previous decade. Lab tests for vitamin D deficiency have
spiked, too: Doctors ordered more than 10 million for Medicare patients in
2016, up 547 percent since 2007, at a cost of $365 million. About 1 in 4 adults
60 and older now take vitamin D supplements.
But few of the Americans swept up in the vitamin D craze are
likely aware that the industry has sent a lot of money Holick’s way. A Kaiser
Health News investigation found that he has used his prominent position in the
medical community to promote practices that financially benefit corporations
that have given him hundreds of thousands of dollars — including drugmakers,
the indoor-tanning industry and one of the country’s largest commercial labs…
Holick’s crucial role in shaping that debate occurred in
2011. Late the previous year, the prestigious National Academy of Medicine
(then known as the Institute of Medicine), a group of independent scientific
experts, issued a comprehensive, 1,132-page report on vitamin D deficiency. It
concluded that the vast majority of Americans get plenty of the hormone through
diet and sunlight, and advised doctors to test only patients at high risk of
vitamin D-related disorders, such as osteoporosis.
A few months later, in June 2011, Holick oversaw the
publication of a report that took a starkly different view. The paper, in the
peer-reviewed Journal of Clinical Endocrinology & Metabolism, was on behalf
of the Endocrine Society, the field’s foremost professional group, whose
guidelines are widely used by hospitals, physicians and commercial labs nationwide,
including Quest. The society adopted Holick’s position that “vitamin D
deficiency is very common in all age groups” and advocated a huge expansion of
vitamin D testing, targeting more than half the United States population,
including those who are black, Hispanic or obese — groups that tend to have
lower vitamin D levels than others.
The recommendations were a financial windfall for the
vitamin D industry. By advocating such widespread testing, the Endocrine
Society directed more business to Quest and other commercial labs. Vitamin D
tests are now the fifth-most-common lab test covered by Medicare.
The guidelines benefited the vitamin D industry in another
important way. Unlike the National Academy, which concluded that patients have
sufficient vitamin D when their blood levels are at or above 20 nanograms per
milliliter, the Endocrine Society said vitamin D levels need to be much higher
— at least 30 nanograms per milliliter. Many commercial labs, including Quest
and LabCorp, adopted the higher standard.
Yet there’s no evidence that people with the higher level
are any healthier than those with the lower level, said Dr. Clifford Rosen, a
senior scientist at the Maine Medical Center Research Institute and co-author
of the National Academy report. Using the Endocrine Society’s higher standard
creates the appearance of an epidemic, he said, because it labels 80 percent of
Americans as having inadequate vitamin D.
“We see people being tested all the time and being treated
based on a lot of wishful thinking, that you can take a supplement to be
healthier,” Rosen said…
In a 2010 book, “The Vitamin D Solution,” Holick gave
readers tips to encourage them to get their blood tested. For readers worried
about potential out-of-pocket costs for vitamin D tests — they range from $40
to $225 — Holick listed the precise reimbursement codes that doctors should use
when requesting insurance coverage. “If they use the wrong coding when
submitting the claim to the insurance company, they won’t get reimbursed and
you will wind up having to pay for the test,” Holick wrote.
Holick acknowledged financial ties with Quest and other
companies in the financial disclosure statement published with the Endocrine
Society guidelines. In an interview, he said that working for Quest for four
decades — he is currently paid $1,000 a month — hasn’t affected his medical
advice. “I don’t get any additional money if they sell one test or 1 billion,”
Holick said…
Since 2011, Holick’s advocacy has been embraced by the
wellness-industrial complex. Gwyneth Paltrow’s website, Goop, cites his writing.
Dr. Mehmet Oz has described vitamin D as “the No. 1 thing you need more of,”
telling his audience that it can help them avoid heart disease, depression,
weight gain, memory loss and cancer. And Oprah Winfrey’s website tells readers
that “knowing your vitamin D levels might save your life.” Mainstream doctors
have pushed the hormone, including Dr. Walter Willett, a widely respected
professor at Harvard Medical School.
Today, seven years after the dueling academic findings, the
leaders of the National Academy report are struggling to be heard above the
clamor for more sunshine pills.
“There isn’t a ‘pandemic,’” A. Catharine Ross, a professor
at Penn State and chair of the committee that wrote the report, said in an
interview. “There isn’t a widespread problem.”…
Yet Holick also has extensive financial ties to the
pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from
pharmaceutical companies, according to Medicare’s Open Payments database, which
tracks payments from drug and device manufacturers. The companies paying him
included Sanofi-Aventis, which markets vitamin D supplements; Shire, which
makes drugs for hormonal disorders that are given with vitamin D; Amgen, which
makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corp., which
both make vitamin D tests.
The database includes only payments made since 2013, but
Holick’s record of being compensated by drug companies started before that. In
his 2010 book, he describes visiting South Africa to give “talks for a
pharmaceutical company,” whose president and chief executive were in the
audience…
Holick has acknowledged accepting research money from the UV
Foundation — a nonprofit arm of the now-defunct Indoor Tanning Association —
which gave $150,000 to Boston University from 2004 to 2006, earmarked for
Holick’s research. The International Agency for Research on Cancer classified
tanning beds as carcinogenic in 2009.
In 2004, the tanning-industry associations led Dr. Barbara
Gilchrest, who then was head of Boston University’s dermatology department, to
ask Holick to resign from the department. He did so, but remains a professor at
the medical school’s department of endocrinology, diabetes and nutrition and
weight management.
In “The Vitamin D Solution,” Holick wrote that he was
“forced” to give up his position due to his “stalwart support of sensible sun
exposure.” He added, “Shame on me for challenging one of the dogmas of
dermatology.”…
Some researchers say vitamin D may never have been the
miracle pill that it appeared to be. Sick people who stay indoors tend to have
low vitamin D levels; their poor health is likely the cause of their low
vitamin D levels, not the other way around, said Dr. JoAnn Manson, chief of
preventive medicine at Brigham and Women’s Hospital in Boston. Only really
rigorous studies, which randomly assign some patients to take vitamin D and
others to take placebos, can provide definitive answers about vitamin D and
health. Manson is leading one such study, involving 26,000 adults, expected to
be published in November…
In 2015, Excellus BlueCross BlueShield published an analysis
highlighting the overuse of vitamin D tests. In 2014, the insurer spent $33
million on 641,000 vitamin D tests. “That’s an astronomical amount of money,”
said Dr. Richard Lockwood, Excellus’ vice president and chief medical officer
for utilization management. More than 40 percent of Excellus patients tested had
no medical reason to be screened.
In spite of Excellus’ efforts to rein in the tests, vitamin
D usage has remained high, Lockwood said. “It’s very hard to change habits,” he
said, adding: “The medical community is not much different than the rest of the
world, and we get into fads.”
https://khn.org/news/how-michael-holick-sold-america-on-vitamin-d-and-profited/
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