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Covid-19: Public health agencies review whether vitamin D supplements could reduce risk

BMJ 2020; 369 doi: (Published 19 June 2020) Cite this as: BMJ 2020;369:m2475

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NICE blinkered by RCTs

Dear Editor
To the vast majority of scientists not contaminated by NICE-speak the fiasco surrounding D3 for COVID must appear inane. The use of RCTs and no other science input has lead NICE into deciding that >25nmol/L 25(OH)D3 is not deficient. Evolution of D3 signalling over 500 million years has refined our innate and adaptive immunity and endowed us with a physiological level of 100 to 150 nmol/L . NICE like Wilberforce are trying to defy evolution . Do they really think that SARS-CoV2 is so enormously different from other viruses to have escaped 500M years of evolutionary combat ? What peculiar train of thought leads NICE to assume that we are safe with just one fifth of the physiological 25(OH)D3 level. in around half the number of cells in our body that comprise immune systems ? Science is all about understanding a system in its totality, not putting on the blinkers of RCTs and ignoring the ca 5000 research papers per annum that put D3 centre-stage in a host of disease conditions, several of which are known co-morbidities for COVID. Hypertension, T2DM, obesity are in that list but also ignored by the NICE D3 panel because......there are no acceptably large RCTs. (The list of discarded conditions is looooong). Unless NICE change their approach to D3 and stop treating it as if it were a xenobiotic it will lose credibility not only with scientists at large but also with the public. Let's see a report that embraces all of D3 relating to immune defences,including observational studies from Indonesia, Philippines, Belgium, Louisiana, India, all pointing to a dramatic reduction in COVID severity or death at >75nmol/L. NICE have already failed miserably by not conducting UK studies months ago. The see British biological expertise out-paced by developing countries is distressing, and NICE's dilatory intransigence is the culprit.
NICE must embrace in their deliberations the fact that African and Asians are less responsive to 25(OH)D3 than caucasians, which compounds the impact of known lower 25(OH)D3 levels. NICE need to do lots of science homework fast. the job fully NICE, by ditching your fetish for RCTs, or resign. If your terms of office limit you to considering RCTs: resign. If you need help, expand the stakeholder input. Believe me, another trite claim " there is no evidence" will backfire, the pubic at large are now watching. For example:

Competing interests: No competing interests

20 June 2020
Peter H Cobbold
Emeritus Professor, Cell Biology
University of Liverpool, UK
North Wales.