Nihilism means a tendency to negate, to the point of rejection of
possibility, (from 'nihil', meaning 'nothing'). Academic nihilism is a
modern contagious disease, which has infected NICE and Cochrane, and now
finally has filtered into the editorial rooms of the BMJ.
Gogia and Singh's analysis of neonatal vitamin A supplementation is a
case in point (1). They conclude: "There is thus no justification for
initiating (Vit A) supplementation as a public health intervention in
developing countries for reducing infant mortality and morbidity".
The correct conclusion is: "Vitamin A deficiency is known to be
important for immune function, (2), and is common in some developing
countries (3). Thus treatment with Vitamin A to those who need it can be
important, (4). Nevertheless, supplementing vitamin A to healthy neonates
at birth produces only a nonsignificant reduction in mortality, with
confidence limits which include harm. Possible explanations for these
conflicting results include poor trial quality or numbers, inadequate
contribution of Vit A to all-cause mortality, infrequency of Vit-A
deficiency in some populations, and counterbalancing harmful effect of
supplementation in those who do not need it.
Because this analysis does not support routine vitamin A
supplementation for all neonates in the populations studied, future
research needs to establish ways of identifying more easily those at need,
and to clarify the putative benefits and harms in such individuals.
Meanwhile, addressing vitamin A deficiency remains important in certain
common situations, such as measles."
Such accuracy makes for less eye-popping headlines, but also less
inappropriate debasement of important interventions.
refs:
1. Gogia, S., Sachdev, H.S., "Neonatal vitamin A supplementation for
prevention of mortality and morbidity in infancy: systematic review of
randomised controlled trials" BMJ 2009;338:b919
2. Stephenson CB Vitamin A, infection and immune function, Annu Rev
Nutr 2001;21:167-92.
3. Busie, B.M-D. et al, "Vitamin A Deficiency Is Prevalent in
Children Less Than 5 y of Age in Nigeria" J. Nutr. 136:2255-2261
4. D'Souza RM, D'Souza R, "Vitamin A for the Treatment of Children
with Measles—A Systematic Review" Journal of Tropical Pediatrics 2002
48(6):323-327
Rapid Response:
Academic Nihilism and Vitamin A
Nihilism means a tendency to negate, to the point of rejection of
possibility, (from 'nihil', meaning 'nothing'). Academic nihilism is a
modern contagious disease, which has infected NICE and Cochrane, and now
finally has filtered into the editorial rooms of the BMJ.
Gogia and Singh's analysis of neonatal vitamin A supplementation is a
case in point (1). They conclude: "There is thus no justification for
initiating (Vit A) supplementation as a public health intervention in
developing countries for reducing infant mortality and morbidity".
The correct conclusion is: "Vitamin A deficiency is known to be
important for immune function, (2), and is common in some developing
countries (3). Thus treatment with Vitamin A to those who need it can be
important, (4). Nevertheless, supplementing vitamin A to healthy neonates
at birth produces only a nonsignificant reduction in mortality, with
confidence limits which include harm. Possible explanations for these
conflicting results include poor trial quality or numbers, inadequate
contribution of Vit A to all-cause mortality, infrequency of Vit-A
deficiency in some populations, and counterbalancing harmful effect of
supplementation in those who do not need it.
Because this analysis does not support routine vitamin A
supplementation for all neonates in the populations studied, future
research needs to establish ways of identifying more easily those at need,
and to clarify the putative benefits and harms in such individuals.
Meanwhile, addressing vitamin A deficiency remains important in certain
common situations, such as measles."
Such accuracy makes for less eye-popping headlines, but also less
inappropriate debasement of important interventions.
refs:
1. Gogia, S., Sachdev, H.S., "Neonatal vitamin A supplementation for
prevention of mortality and morbidity in infancy: systematic review of
randomised controlled trials" BMJ 2009;338:b919
2. Stephenson CB Vitamin A, infection and immune function, Annu Rev
Nutr 2001;21:167-92.
3. Busie, B.M-D. et al, "Vitamin A Deficiency Is Prevalent in
Children Less Than 5 y of Age in Nigeria" J. Nutr. 136:2255-2261
4. D'Souza RM, D'Souza R, "Vitamin A for the Treatment of Children
with Measles—A Systematic Review" Journal of Tropical Pediatrics 2002
48(6):323-327
Competing interests:
None declared
Competing interests: No competing interests