Brief Critque: Commentary on Medscape's Arefa Cassoobhoy, MD, MPH's Editorial on the Topic of Vitamin D: Observation of a Three Logical Fallacies (Non Sequiturs) within 70 Seconds
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Written and posted 17 Sep 2016; minor update 28 Sep 2016
Strong data, ignored: Medscape Internal Medicine (16 Sep 2016) posted an audio-video review of a recent Cochrane review which "suggests that the addition of vitamin D supplements to standard asthma medication can lead to fewer severe asthma attacks, particularly in patients with mild to moderate asthma." Dr Cassoobhoy summarizes the study with the following points:
"The meta-analysis of nine double-blind, randomized, placebo-controlled trials included more than 400 children and 600 adults.
Adding oral vitamin D to treatment decreased both the risk for a severe asthma exacerbation requiring oral steroids and the average number of annual asthma attacks.
The supplementation also decreased the risk for an asthma attack requiring a visit to the emergency room or a hospital stay from 6 per 100 patients to around 3 per 100 patients."
Conclusion at odds with data: Per this summary, one might reasonably conclude that vitamin D should added to asthma treatment regimens; particularly notable with vitamin D are its safety, low cost, wide availability, and numerous (practically innumerable) direct and collateral benefits. However, in denial of this abundant evidence and in denial of the fact that she is summarizing a meta-analysis of nine double-blind, randomized, placebo-controlled trials which included more than 400 children and 600 adults, Dr Cassoobhoy concludes that "definitive guidelines can't be made until we have more research and a better understanding of the implication of a low baseline vitamin D level." This is the classic conclusion at odds with data (logical fallacy: non sequitur) that typifies many statements and positions in (so-called) mainstream medicine when the opportunity to use nutritional interventions has been justified by data; such medical authors/publications commonly conclude that more data and research are needed before action can be taken, and they commonly (although not in this instance) use anti-nutrition fear-mongering to further solidify their inertia and maintenance of the status quo.
Non sequitur #1: Failure to advocate the positive results she is reviewing: Dr Cassoobhoy's failure to advocate action based on the conclusion—her advocation of intertia—is at odds with the positive findings of the meta-analysis she feigns to review. She should have advocated for use of vitamin D supplementation.
Non sequitur #2: Self-contradiction: Dr Cassoobhoy introduces her review by paraphrasing previous research showing that "Low blood levels of vitamin D have been linked to an increased risk for asthma attacks in children and adults with asthma." And then she "cautions" doctors against using vitamin D because doctors need "a better understanding of the implication of a low baseline vitamin D level." What more needs to be understood? Low serum vitamin D = vitamin D deficiency =with increased risk/incidence/severity of inflammatory diseases, cancer, depression, et al.
Non sequitur #3: Off-the-rails distractor comment: Dr Cassoobhoy's concluding statement "While vitamin D supplementation is an easy add, just to caution—definitive guidelines can't be made until we have more research and a better understanding of the implication of a low baseline vitamin D level." is completely preposterous because the clinical action indicated is not dependent upon "a better understanding of the implication of a low baseline vitamin D level." Furthermore, the situation does not warrant any "caution" because the treatment being discussed has already been established as safe, as noted in a classic and large study study involving more than 10,000 infants.This is the typical inertia-driving statement that does nothing more than confuse.
Logical fallacies: errors in logic
Non Sequitur: “does not follow,” irrelevant reason
Description: proposed argument or position in which the conclusion does not follow from the premises. In more informal reasoning, when what is presented as evidence or reason is irrelevant or adds very little support to the conclusion.
Bennett, Bo. Logically Fallacious (Academic Edition), p. 168
Vitamin D's safety and efficacy have already been established, justifying routine use: In contrast to the unjustified conclusion espoused by Medscape's Dr Cassoobhoy to continue inertia and inaction, the opposite position—that inaction is actually dangerous and unethical—is actually the stronger position, as was published in 2004 by Vasquez, Manso, and Cannell (Altern Ther Health Med 2004 Sep: PDF, PMID 15478784):
"As a medically valid diagnosis (ICD-9 code: 268.9 Unspecified vitamin D deficiency) with a high prevalence and clinically significant morbidity, vitamin D deficiency deserves equal attention and status with other diagnoses encountered in clinical practice. Given the depth and breadth of the peer-reviewed research documenting the frequency and consequences of hypovitaminosis D, failure to diagnose and treat this disorder is ethically questionable (particularly in pregnant women) and is inconsistent with the delivery of quality, science-based healthcare. Failure to act prudently based on the research now available in favor of vitamin D supplementation appears likely to invite repetition analogous to the previous failure to act on the research supporting the use of folic acid to prevent cardiovascular disease and neural tube defects—a blunder that appears to have resulted in hundreds of thousands of unnecessary cardiovascular deaths and which has contributed to incalculable human suffering related to otherwise unnecessary neural tube defects, cervical dysplasia, cancer, osteoporosis, and mental depression. ... Of course, additional lives may be saved and suffering reduced by alleviating the morbidity and mortality associated with hypertension,
autoimmune disease, depression, epilepsy, migraine, diabetes,
polycystic ovary syndrome,musculoskeletal pain, osteoporosis, and cardiovascular disease."
No legitimate reason exists for routinely denying vitamin D3 (cholecalciferol) supplementation to asthma patients, nor patients with other D3-responsive conditions; to the contrary, vitamin D should be used routinely in virtually all patients:
"Until proven otherwise, the balance of the research clearly indicates that oral supplementation in the range of 1,000 IU/day for infants, 2,000 IU/day for children, and 4,000 IU/day for adults is safe and reasonable to meet physiologic requirements, to promote optimal health, and to reduce the risk of several serious diseases. Safety and effectiveness of supplementation are assured by periodic monitoring of serum 25(OH)D and serum calcium." Vasquez, Manso, and Cannell (Altern Ther Health Med 2004 Sep: PDF, PMID 15478784)