Dear Dr Cannell,
Thank you for solving what has been a mystery to me for 45 years. I am an orthopedic radiographer (RT(R). I am very involved with Dexa scans and Vitamin D.
Until your recent letter I thought that my son just had poor bones when he was an infant. His x-rays in our office looked like it could be a battered child. Thank God I knew better and was believed. He was then sent to physical therapy to help with balance and coordination, where on the first day fell and broke both wrists. The endocrinologists and orthopedists could find no reason for his soft bones.
That was 38 years ago.
He turned out to be a fine young man and a RN. His life was tragically cut short at the age of 30 but I wish he could read your letter and know that it was not his fault or mine that he had so many fractures. Not until I started doing Dexa scans did I have my 25 OH Vitamin D level checked, it was 9 ng/ml.
Thank you for your dedication to the understanding of Vitamin D. At our orthopedic practice, we are still showing about a 70% vitamin D deficiency on new patients. Some of or family practice and primary care gate keepers are finally seeing the light as it used to be about 85%.
Paul Simpson, USA
You are welcome and I wish he were alive to know what had happened to him as a young child. When I think of the number of families that have been violated over the last 50 years by child protective services, falsely accused of a heinous crime, to live the rest of their lives known as someone who would beat an infant, I feel sick.
It is important to understand just what I am saying. I am saying that perhaps 10% or even more of infants born in the USA incur multiple fractures from the trauma of passing through the birth canal because they had undiagnosed intrauterine rickets. Modern medicine is completely unaware of these fractures. These infants leave the hospital with their multiple fractures undetected. If you are the parent of one of these children — and unlucky enough to have to take the infant back to the hospital in his first few months of his life — child protection may falsely accuse you of child physical abuse.
Who is to blame?
The villain here is the American Congress of Obstetricians and Gynecologists (ACOG). If you search their public website, as pregnant women may do, you will find not a word about the need for physiological amounts of vitamin D during pregnancy. The Vitamin D Council tried to educate the obstetricians, by placing a series of public service announcements in both their flagship journal, American Journal of Obstetrics and Gynecology (AJOG), and in their trade newspaper. The ACOG editors quickly censored the advertisement, that is, they ran it once and then refused to run it again, although we had paid in advance for three runs. Our message in the advertisement was simple; the American Academy of Pediatrics recently recommended that obstetricians check vitamin D blood level of pregnant women so obstetricians should do just that.
Garite TJ, Kim M. The “Vitamin D Council” advertisement. Am J Obstet Gynecol. 2009 Jul;201(1):2.
The editors first assured readers that:
“In the 100 years of the Journal’s existence, none of us or our previous Editors are aware of such an issue arising from an advertisement. Certainly there have been advertisements that made controversial claims, but controversy is a normal and often constructive part of medical science. Because the Publisher and Editors do not believe that there is a need to censor controversy, especially in clearly labeled advertisements, it has been the Journal’s policy not to scrutinize commercial advertisements. However, in the case of this advertisement, we believe that we must take a stand.”
The editors went on to say:
“In the opinion of the Editors, the claims of this advertisement are not founded with any degree of reasonable scientific evidence specifically as it relates to the link between Vitamin D and autism. The references that the advertisement provides to support this association cite evidence that is, at best, suggestive, and the conclusion is little more than conjecture, perhaps enticing enough to warrant real research on this subject but nothing beyond. This is a more difficult issue to deal with from a policy standpoint. Nonetheless, in the future we will be far more vigilant, and any suspicious claims will be reviewed by the Journal Editors.”
In fact, a Vitamin D Council’s source inside AJOG tell us that one of the personnel at ACOG has a child with autism and that person objected to anyone raising the possibility that autism is due to anything but vaccinations. However, the editors kindly allowed me to respond to their editorial, so we ended up getting more publicity than any advertisement would have.
Cannell J. Vitamin D “advertisement”. Am J Obstet Gynecol. 2010 May;202(5):e9–10; author reply e10–1. Epub 2009 Dec 29.
I began my response by saying:
“I fear for the future liability of obstetricians. Autism is but one of several alleged harms that obstetricians may hear about when their attorneys call. Gestational vitamin D deficiency is associated with a significantly increased risk of neonatal pneumonia, a doubled risk for preeclampsia, a tripled risk for gestational diabetes, and a quadrupled risk for primary cesarean section.”
I told them that I knew that:
“Obstetricians are already being driven out of practice by malpractice suits. Now a warning from the American Academy of Pediatricians, combined with an article in Scientific American, should worry obstetricians and their attorneys. Medical malpractice claims may be filed for several years after the injury is recognized; only then do the statutes of limitations begin their sad toll.”
I then explained:
“Because autism is often first diagnosed when the child is 3–4 years of age, a malpractice claim could arise 4–5 years from today, alleging today’s obstetrician did not follow the American Academy of Pediatrician’s advice, was unmindful of the brain damage/vitamin D risk, and did not do a proper risk/benefit assessment.”
In what seemed obvious to me, I wondered if:
“jurors in 2014 may ask themselves what the risk was of diagnosing and treating gestational vitamin D deficiency in pregnant women in 2010. Why did the obstetrician not do it? Such future liability exposure could be lessened if obstetricians would simply follow the American Academy of Pediatrician’s current guidance to diligently diagnosis and adequately treat vitamin D deficiency in all pregnant patients.”
However, ACOG offered not a word of advice to its members or to pregnant women about the need for additional vitamin D during pregnancy. As far as ACOG is concerned, 600 IU is fine for a pregnant woman, only 200 IU more than that recommended for newborn infants. In other words, someone is math challenged. If a 5 pound infant needs 400 IU per day, how much does a 200 pound mother need when she is pregnant? This is not rocket science.