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Orthomolecular Nutrition and Megavitamins: 
from quackery to mainstream?

The History of Modern Medicine and Orthomolecular Nutrition

PART 2
Comprising the following sections:

Section 4 - Beyond Deficiencies: mainstream medicine plays catch-up

Section 5 - The Future: more drugs or less malnutrition?

Science or Progress - a return to common sense?
The Current Medical Paradigm - the use of drugs to conceal malnutrition
The New Paradigm - the use of nutrients to cure malnutrition

Section 4 - Beyond Deficiencies: mainstream medicine plays catch-up

a) Mainstream Medicine Plays the Catch-up Game
As research into orthomolecular nutrition and biochemical individuality accumulated over the past half century, mainstream medicine continued relentlessly with its determination to ensure that the entire human race became dependent upon toxic, symptom concealing drugs. Simultaneously as famous scientists continued to discover the importance of nutrition, particularly cellular nutrition, mainstream medicine sought to outlaw nutrition and label anyone who practiced scientific nutritional therapies as a "quack". To mainstream medicine the scientific approach to "health care" involved utilising toxic foreign compounds which would conceal symptoms (as well as producing new ones) and thereby allow the underlying disease to deteriorate without inconveniencing the patient. This approach was based upon the belief that health could only be attained by an ever increasing dependence upon drugs. Mainstream medicine clearly distanced itself considerably from both scientific evidence and common sense and has much "catching-up" to do. The real problem confronting mainstream medicine though is not simply to "catch-up", but rather to do this inconspicuously without "losing face". As we shall see, particularly since practice makes perfect, mainstream medicine has become quite adept at this entire process.

Although pressure on mainstream medicine to adopt a more positive and scientific approach to health care had been rapidly increasing, it was not until 1992 that the first signs of a significant breakthrough began to emerge. It was in February of that year that the New York Academy of Sciences held a conference, entitled (148 ) "Beyond Deficiency: New Views on the Functions and Health Effects of Vitamins", which signalled the beginning of a new era in mainstream medicine. Although Machlin, co-organiser of the conference, claimed in his introductory address (149 ) that the fifth and current stage in the history of vitamins began in 1955 with the use of vitamin B3 to lower cholesterol levels ( 11, 150 ), such an interpretation would seem to ignore increasing evidence of the nutritional ( as distinct from pharmacological) use of megavitamins. Interestingly, in spite of the five stages of Machlin, according to Challem ( 192 ) we may now be entering our third "vitamin paradigm."

If we accept that the arbitrary fifth stage of Machlin is still continuing then it becomes abundantly clear that the sixth stage, the stage when mainstream medicine accepts the widespread need for nutritional use of megavitamins, has not yet begun. Although progress is agonisingly slow and there is still a long way to go before medicine catches up to the research of Williams and colleagues, there is some evidence to suggest that this sixth stage commenced with the Sauberlich and Machlin conference in 1992. This conference tended to legitimise and raise the profile of nutritional therapy amongst the medical profession at a time when accumulating evidence of the importance of nutrition was challenging the prevailing mainstream view that nutrition was merely quackery. Of course it is no coincidence that the rising profile of nutrition also correlated with a growing recognition of the failure of conventional drug therapies. However, while the dividing of nutrition into rigid historical periods may be of academic interest it is the practical "real" world aspects of nutrition with which this discussion is primarily concerned.

A number of important points were made by contributors to the 1992 conference which clearly represent a move towards the teachings of Williams and colleagues some 30-40 years earlier. As pointed out by Machlin for instance ( 149 ), the orthodox medical view that vitamins are only useful for preventing the classical deficiency diseases is a "very limited view" and "vitamins have significant health effects beyond preventing deficiency diseases." Machlin also concedes that ( 149 ) "we are now finding that whereas levels of vitamins may be adequate in blood and most tissues, there can be specific and localised tissue deficiencies that can lead to pathological events." Of course this would hardly be of surprise to anyone even remotely familiar with the basic principles of nutrition as taught by Williams who repeatedly emphasised the importance of the nutritional microenvironment of the cells and the difficulties involved in constantly transporting around 40 nutrients to the billions of cells in the body. Nevertheless, this represents a major shift in the thinking of mainstream medicine.

On the other hand, as if to justify medicine's traditional paranoia about nutrition and their vehement condemnation of nutritional therapy as quackery, Machlin makes the following remarkable statement ( 149 ): "the history of vitamins unfortunately is replete with extravagant claims of health benefits of vitamins, often based on anecdotal reports or poorly designed and controlled trials." The fact that the conference which he co-organised, far from disproving such "extravagant claims" and "anecdotal reports", actually supports the vital importance of nutrition, seems to be overlooked by Machlin. It always appears so incredibly insulting when mainstream medicine, after having totally abandoned the entire field of nutrition and sought to deny nutritional researchers both funds and publication, then turns around and criticizes the poor quality of nutritional research. Perhaps Machlin's statement needs to be reworded slightly: the history of prescribed drugs unfortunately is replete with extravagant claims of health benefits of drugs, often based upon industry propaganda or poorly designed and biased trials (see Medical Bias ). Orthodox medicine has had such a persistently obsessive and negative attitude to health, and nutrition that change is likely to be slow, irrespective of scientific evidence. Rapid change can only occur if science is most concerned about truth and the health of the human race.

Other vitally important points raised at the conference include a recognition of the need to understand the meaning of the term "optimum" when it comes to health and vitamin requirements ( 149, 151 ), the fact that some people require vitamin intakes well in excess of the RDA's to maintain health ( 149, 151-155 ), and the existence of localised tissue deficiencies of vitamins in persons considered to have normal vitamin status ( 149,156, 157 ). Block ( 155 ) noted in her study of vitamin C and cancer that "for at least some cancers even intakes at the RDA level may place individuals in a high-risk group" and "a considerable proportion of the population consumes levels of vitamin C that may be associated with an increased risk of cancer."

In his concluding address to the conference, Butterworth ( 158 ) emphasises that the theme of the conference, namely, "Beyond Deficiency", signifies the beginnings of new directions in medical research, an opening door for new possibilities. According to Butterworth ( 158 ): "it is indeed a time to look beyond the old classical vitamin deficiency syndromes"..... "it is becoming evident that vitamin requirements are influenced by dynamic external forces, such as viruses, drugs, and pollutants, as well as by genetically determined weaknesses of metabolism"..... "I would venture to suggest that vitamins, as a group of potent parent compounds, have not yet received the attention they deserve. They represent a field of investigation that is still ripe for further exploitation. As the conference organisers are well aware, the identification of an essential nutrient is only the beginning. We still have a long way to go 'beyond deficiency'."

It seems, in spite of the tireless efforts of Williams and colleagues, that modern medicine now claims ( ie. in 1992 ) that vitamins have not yet received the attention they deserve. The accuracy of this statement is abundantly clear. Also abundantly clear is who is responsible for this despicable neglect of nutrition.

In a follow up interview about the proceedings of the conference, particularly the effect of vitamin E upon heart disease, Machlin ( 159 ) claims that preoccupation with "dietary fat as the main nutritional risk factor for cardiovascular diseases" has "probably slowed scientific progress." But Machlin also claims ( 159 ) that the matter of vitamin E and heart disease "was a field that had to be approached quite cautiously" because we are "still living under the shadow of the reports of the Shute brothers that were derided by most of the medical community." The Shute brothers of course, pioneered the use of large doses of vitamin E to treat heart disease at a time when medicine was obsessed with drugs and paranoid about vitamins ( 3, 42, 55, 56 ). It is interesting to note that, according to Machlin ( 159 ), the medical profession's "caution" regarding vitamin E was not because of its toxicity or because the Shute brothers were unsuccessful with their use of this vitamin to treat heart disease, but rather simply because they had been "derided by most of the medical community." As has been pointed out by Hoffer ( 11 ), the refusal of the medical profession to acknowledge and accept the work of the Shutes has resulted in an enormous amount of human suffering. It is a tragedy that medicine was not equally cautious about the use of toxic iatrogenic disease causing drugs.

In a subsequent incriminating comment about the attitude of mainstream medicine to nutrition, Machlin ( 160 ) claims that following the elimination of classical vitamin deficiency diseases and the establishment of the RDA's "vitamin research appeared to languish." This period of "languishing" vitamin research of course, was characterised by the extensive and brilliant research of Williams, Hoffer, Pauling, the Shute brothers, and many others. To describe the contribution of these famous pioneers as languishing research is absolutely despicable. Perhaps Machlin was drawing attention to the fact that vitamin research just "appeared" to him to have languished. However, if the work of the Shutes had not been "derided" by most of the profession, perhaps nutritional research would not have had this languishing appearance. Medicine continues to reveal an extremely ugly and mercenary underside by its absolute determination to resort to any degree of vitriol and personal vilification to ostracise and destroy anyone who supports nutritional therapies. On the other hand, medicine regards perpetrators of medical disasters such as that caused by thalidomide with infinitely higher regard.

The reader will note that contributors to the conference are just beginning to confirm the earlier work of Williams. The importance of optimum health and optimum intake of nutrients, the existence of cellular nutrient deficiencies, and the individuality of nutrient needs which necessitated the use of megavitamin therapy, were all clearly elaborated by the extensive studies of Williams and colleagues. In spite of this there seems to be a determination within modern medicine to pretend that this research is new and thereby refuse to appropriately acknowledge the contribution of distinguished pioneers of nutritional medicine. There are grave implications here for the credibility of science and scientists and the future of science. Such actions are borne out of insecurity and petty self interest and a desire to maintain the status quo at all costs. Legitimate scientific evidence which is perceived as threatening the status quo must be rejected and ridiculed, regardless of the cost in terms of human lives and suffering. Even when progress ultimately makes the orthodox position unsustainable, science displays a persistent determination to refuse to acknowledge responsibility for past mistakes. To science and scientists, it is apparently more important to save face than to accept responsibility and move on. Scientists of all people, should be setting the example when it comes to honesty, integrity, impartiality, and acknowledging responsibility for mistakes. The worst part of all this is the fact that the unrepentant attitude of scientists reveals both a lack of conscience and a determination to continue such behaviour indefinitely. Even massive human suffering is not sufficient to promote repentance and subsequent change.

b) Genetic Nutrition - catch-up practice continues
Following the Sauberlich and Machlin conference ( 148 ) progress in nutritional research has continued although still agonisingly slowly considering that much of the research is simply a confirmation of earlier research. One of the negative aspects of the conference was the lack of emphasis upon the distinction between the nutritional and pharmacological use of vitamins and the use of the term "beyond deficiency" to imply non-nutritional applications of nutritional therapy. It is implied ( 149 ) that any use of vitamins for conditions other than the classical deficiency diseases is non-nutritional or "beyond deficiency." The suggestion is made by Leklem ( 151 ) that there is a difference between "preventing a deficiency" and "understanding what the needs are for optimal health." Clearly, the implication here is that additional vitamins above the intake required to eliminate deficiencies can somehow bring about a condition of optimum health. This of course is at odds with the very fundamentals of nutrition. It should be borne in mind that the term "malnutrition" refers to both undernutrition and overnutrition ( see Introduction ) and it hardly seems likely that deliberately causing malnutrition could bring about a condition of optimum health.

Truswell ( 179 ) has also distinguished between the RDI and optimal intake of vitamins although once again the distinction between nutritional and pharmacological use of vitamins is not clear. According to Truswell ( 179 ): "perhaps for some nutrients there is an intake above the RDI ( ie the amount that prevents deficiency disease or subclinical deficiencies ) where the state of health is further enhanced, eg by partial protection against the degenerative diseases of old age." Truswell is clearly suggesting here that RDI levels of vitamins will prevent both classical deficiencies as well as subclinical deficiencies and therefore the health benefits of doses above the RDI are due to some other non-nutritional mechanism. Such a belief is inconsistent with the existence of biochemical individuality and the fundamentals of nutrition.

According to Mackay and co-workers ( 180 ), once again in utter disregard of the principles of biochemical individuality and cellular nutrition, "the amount of any particular nutrient required to prevent a deficiency is inherently defined in the Recommended Dietary Allowances (RDA). This standard is being revised to include nutrient intakes associated with reductions in the risk for chronic disease, values often higher than those necessary to prevent deficiency."  Here yet again the suggestion is made that nutrients have an ability to prevent chronic diseases by some unspecified non-nutritional mechanism. As has been pointed out by Challem ( 192 ) however, preoccupation with the classical deficiency diseases and the RDA's has resulted in many researchers relying on "outdated signs and symptoms in assessing nutritional deficiencies."

Although Williams, Pauling, Hoffer and others had previously discovered that there is a huge difference between taking sufficient vitamins to prevent the classical deficiency diseases and taking a sufficient dose to promote optimum health by completely eliminating any cellular or subclinical deficiencies, this point continues to be overlooked by medical orthodoxy. In spite of the fact that the existence of nutritional individuality and inefficiencies in nutrient utilisation have been consistently demonstrated, mainstream medicine still struggles with the idea that megadoses of vitamins could have nutritional benefits. Even today some medical authorities continue to suggest that the use of megavitamins commonly has no nutritional basis and merely represents the pharmacological use of vitamins ( 191 ).

Even though science is no closer today than they were 100 years ago at being able to positively identify the precise point at which a person becomes nutritionally deficient (this includes cellular deficiencies), there are still those within medicine who claim that the effects of megadoses of vitamins are pharmacological rather than nutritional. There remains an extreme reluctance within modern medical science to admit that their traditional definition of a nutritional "deficiency" was unfounded, inaccurate, and premature.

In considering nutritional research which has been done in the past decade there seems to me to be little point in citing the results of research which merely represents a repetition of work which has already been done many years earlier. However, for the sake of completeness I will consider a cross section of what some may consider to be "new" research. My concern here is that until the original researchers receive appropriate recognition and acknowledgement it is inappropriate to describe any research as being new unless it is indeed original research, although this seems to be an accepted practice in modern medicine ( 204 ). A monumental injustice continues to be perpetuated here against brilliant scientists whose contribution to the field of nutrition has continued to lead the scientific world for more than half a century. We should not have to pretend a discovery is "new" simply to protect the egocentric insecurity and professional jealousy of those members of the "scientific" community whose contribution has not only been inconspicuous and quite forgettable, but perhaps has also been confined to negative comments.

As progress in nutritional research continued following the 1992 conference there was increasing evidence of the ability of nutrition to treat or prevent cancer ( 146,160, 161, 162, 163, 164, 165, 166, 167,168, 171, 172, 193, 194, 206, 213, 214, 234 ), heart disease ( 146,160, 162,164, 169, 194, 195, 206, 207, 208, 209, 211, 212, 228, 229, 230, 231, 232, 233 ), diabetes ( 146, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226 ), dementia ( 164, 167,173,174, 193 ), cataracts (162, 175, 176, 196, 197 ), macular degeneration (177, 178, 198 ) and psychiatric disorders ( 84,166, 168, 170, 193, 199, 200, 201 ). While the effect of nutrition on homocysteine metabolism is also believed to have the ability to counteract various chronic diseases, including heart disease, I have considered this matter elsewhere ( see Health Trends, B vitamins ). 

Increasingly, nutritional research is revealing that many people are suffering from subclinical or cellular deficiencies resulting from suboptimal vitamin intake ( 165, 166, 167, 168, 170, 171, 172, 173, 209, 318 ). It is also being increasingly recognised that these subclinical deficiencies can only be corrected by the use of supplements or megavitamins containing doses well in excess of the RDA's ( 162, 163, 165, 166,167, 171,172, 175,176, 177, 178, 179, 180, 181, 182, 183, 184, 185 ). In fact, according to Mooney (333), there are "over 20,000 studies in the National Library of Medicine showing health benefits of vitamins and minerals at much higher than Daily Value (RDA) levels." Evidence of the need for megavitamin supplements is so extensive that Hathcock ( 185 ) has recently concluded : "substantial evidence indicates that intakes greater than the recommended dietary allowances (RDA's) of certain vitamins and minerals such as calcium, folic acid, vitamin E, selenium and chromium reduce the risk of certain diseases for some people. Limitation of intakes to the RDA's would preclude reductions in disease risk from these nutrients." Additionally, Fletcher and Fairfield (171,172 ) have recently claimed that the evidence in favour of vitamin supplementation is such that all adults should take multivitamin supplements everyday. The urgency of this situation has been further accentuated by the growing realisation that vitamin pathology tests do not necessarily detect deficiency conditions ( 182, 209 298, 299, 317 ), a fact which should be obvious from the existence of localised tissue deficiencies in people who have normal vitamin status ( 149, 156, 157, 160 ). In spite of all this evidence however, according to Herbert ( 296 ) the suggestion that most people would benefit from a multivitamin supplement is "bad advice".

The positive curative effects of nutrition are also being increasingly shown to contrast sharply with the negative effects of drugs which interfere with nutrient metabolism and therefore have a detrimental effect upon the body. Conventional medical treatment for heart disease for instance, such as the use of diuretic drugs, may actually cause heart disease by causing vital nutrients which are necessary for heart function such as thiamine and magnesium ( 4, 10, 102, 145, 146, 186, 187, 188 ), to be lost in the urine ( 145,146, 186, 187,188 ). Evidence reveals that even some asthma drugs may cause a vitamin B6 deficiency and aggravate deficiency symptoms ( see B vitamins ). I have already mentioned the fact that the ill effects of thalidomide were believed to be due to the negative effect this drug had on the metabolism of certain vitamins ( 4 ), more well nourished mothers producing normal offspring in spite of taking thalidomide (10 ).

I should emphasise here that the idea, which I discussed previously, that increased nutrient intake somehow has significant health benefits "beyond deficiency" or in other words in the absence of any nutritional deficiency, is slowly giving way to the realisation that these benefits of supplementation are in fact nutritional and not pharmacological ( 156, 164,166,168, 169,170, 171,173,174, 192, 202 ). Gradually it is being realised that people can suffer from vitamin deficiency symptoms without developing full blown classical deficiency syndromes ( 171, 192 ). Just why medicine has refused for so long to accept the reality of minor ( ie chronic or subclinical ) degrees of  nutritional disease remains one of the outstanding mysteries of the modern world. Modern medicine is now beginning to realise that subclinical nutritional deficiencies abound throughout affluent modern society ( 170, 171, 172, 174, 209 ). The repercussions of this are absolutely enormous. For instance, since many chronic disorders are increasingly being linked to nutritional deficiencies, conventional medical treatments for these disorders amount to no more than attempts to conceal symptoms of malnutrition ( see Holistic Medicine or Reductionism, Symptom Suppression- the science of concealing illness ).

The matter of nutritional versus pharmacological use of nutrients is indeed complex and detailed consideration of this topic is beyond the scope of the present discussion. Some general comments may however be helpful. It must be emphasised firstly that most nutrients have no positive effects unless a deficiency is present and rectification of a deficiency condition will result in the nutrient concerned having no further effects. As I have indicated elsewhere (see Dietary Supplements), although nutritional supplements have undeniable biological effects when a deficiency is present, this biological effect of supplements normally ceases when a point of optimum nutrition status is attained. For this reason, increasing the intake of most nutrients beyond the point where any deficiency condition is corrected will have no further benefits. There are clearly established exceptions to this since nutrients with "hormonal" effects such as vitamin D and essential fatty acids ( via prostaglandins ) may have dose related effects beyond correcting deficiencies. Other nutrients such as vitamin B3 and minerals such as calcium and magnesium may also have pharmacological effects beyond correcting deficiencies. 

One of the major difficulties in differentiating between nutritional and pharmacological effects of nutrients relates to the influence of biochemical individuality. Challem ( 192 ) argues that the distinction between nutritional and pharmacological is "meaningless since high doses of micronutrients may be required to achieve normal metabolic processes in some people." The fact that megadoses of a nutrient may have a nutritional effect in one person who utilises the nutrient inefficiently and a pharmacological effect in another person whose metabolism is more efficient clearly complicates the situation. However, this does not mean that the distinction between nutritional and pharmacological effects is meaningless, it simply means that these effects cannot necessarily be reliably differentiated by dose alone. While pharmacological effects of nutrients are frequently consistent and dose related this is not so for nutritional effects ( once the dose necessary to correct a deficiency has been determined ). Nutritional effects, unlike pharmacological effects, contribute to optimum health. In general terms, and in the absence of evidence to the contrary, the positive effects of nutrients are overwhelmingly nutritional rather than pharmacological. Claims that the effects of nutrients are pharmacological rather than nutritional seem frequently to be no more than a red herring to protect those whose neglect of nutrition is bordering on criminality.

Other "recent" nutritional developments include reports of the effects of subclinical vitamin A deficiency during pregnancy (189 ), but Williams warned of the consequences of vitamin A deficiency upon the unborn three decades ago ( 4 ). It has also been recently pointed out by Wickramasinghe ( 166 ) that some people suffer from subclinical vitamin B12 deficiency because of "mild" malabsorption of this vitamin. This conflicts sharply with the traditional view that vitamin B12 is either absorbed perfectly or it is not absorbed at all due to a lack of the intrinsic factor. Once again, through the principle of genetic gradients, Williams has underlined the existence of such variations more than four decades ago ( 4, 61 ).

Molloy and Scott ( 167 ) have recently emphasised again the importance of folic acid for preventing birth defects. According to these workers ( 167 ): "research in the past decade has established that low or inadequate folate status may contribute to congenital malformations and the development of chronic disease in later life." But Williams ( 4 ) warned of the graphic consequences of folic acid deficiency during pregnancy three decades ago and pointed out that even a mild deficiency of this vitamin during pregnancy "may not result in gross deformations like missing limbs, but nevertheless may cause obscure internal malformations which may not give serious trouble until later in life."

Recently it has also been emphasised by Fenech ( 165 ) that "diet", which is a "key factor in determining genomic stability", is "more important than previously imagined." But Williams emphasised around half a century ago ( 61 ), on the basis of the genetotrophic concept, that nutrition could dramatically affect the expression of genetic characteristics. At a time when virtually the entire scientific world was obsessed with reducing the human race to a make believe set of statistical averages where human individuality ceased to exist, Williams emphasised the vital importance of genetic and biochemical individuality. According to Williams ( 61 ): "understanding and appreciating what heredity distinctively does for an individual may make it possible to cope environmentally with his difficulties"........" unless we know about distinctive nutritional needs imposed by one's heredity, we are in no position to meet these needs." In fact, in his classical publication on biochemical individuality ( 61) Williams makes the following plea: "the plea which is the crux of this book is that all human differences, including metabolic ones, but not excluding others, be subjected to intensive and extensive study."

In spite of the extensive research of Williams into nutritional individuality and the increased need for specific nutrients in certain individuals and the implications of these facts as far as genetics is concerned, Fenech has recently claimed that ( 165, 202 ) "to date our knowledge on optimal micronutrient levels for genomic stability is scanty and disorganised." Fenech continues ( 165 ): "that there is a need for an international collaborative group to establish RDA's for genomic stability is self-evident and this paper is a call for such a process to begin." In seeming fulfilment of the plea by Williams half a century earlier for more research into human differences, Fenech ( 202 ) claims that "these studies would have to be targeted to individuals with common genetic polymorphisms that alter the bioavailability of specific micronutrients and the affinity of specific key enzymes involved in DNA metabolism for their micronutrient co-factor." It is gratifying indeed to see science finally beginning to acknowledge the importance of genetics in determining nutrient "bioavailability."

The relationship between genetics and nutrition, or "genetic nutrition", has also been recently acknowledged by Herbert ( 300, 301 ). According to Herbert ( 300 ): "if a gene mutation alters a protein that is part of the biochemical machinery for absorption, transport delivery or utilisation of an essential micronutrient, the amount of that nutrient we must ingest to sustain health may be raised or lowered." Whether we describe it as genetic nutrition or the genetotrophic concept, it is gratifying also to see scientific progress being made in regard to nutritional individuality and acceptance of the need for megavitamin therapy. Another interesting aspect of genetic nutrition is the yet to be determined possibility that such genetic aberrations may be subject to the effects of genetic anticipation (ie. the tendency to occur more severely and at younger ages in succeeding generations).

The groundbreaking work of Roger Williams (2-5,61,139.140,238), Abram Hoffer (46,48,49) and Linus Pauling (39,80,92,97) 50 years ago is being increasingly confirmed by modern scientists who now predict that many genetic diseases may soon be treatable by megadoses of vitamins specifically individualised for each person (334,335,336). Scientists are increasingly confirming that many people have a genetically increased need for specific nutrients which can only be satisfied by taking large doses of the affected nutrients. According to Eckhardt for instance (334), "the advancing wave of knowledge about the human genome has confirmed the idea that each of us must be genetically unique in our nutritional needs."

According to Ames and coworkers (336) the treatment of many genetic diseases will soon be based upon megavitamin therapy using vitamin doses perhaps "hundreds of times" higher than the RDA: "provided safe doses are used there is potentially much benefit and possibly little harm in trying high dose nutrient therapy because of the nominal cost, ease of application, and low level of risk."

The vindication of the work of Williams and Pauling is highly significant. The rejection by mainstream medicine of the scientific facts underlining the importance of nutritional individuality and the use of megavitamins over the past 50 years has resulted in this concept becoming the exclusive domain of alternative medicine. This of course was largely inevitable due to the constructive holistic approach to health care which is central to alternative medicine. Because nutrition was considered incompatible with medicine's reductionist symptomatic drug oriented perspective, Linus Pauling was regarded as a quack by the mainstream medical community (337,338,339). By the late 1990's however Pauling was acknowledged as a genius (338,339) and the concept of megavitamin therapy became a (339) "respectable hypothesis".

Since that time progress has continued with the development of the "new" science of nutritional genomics or nutrigenomics (340,341) which is based upon the principles of the genetotrophic concept described by Williams fifty years earlier (3,4,5,61,140,238,141). Like the genetotrophic concept, nutrigenomics accepts that our nutritional needs are highly individual and largely genetically determined, hence the frequent need for megadoses of nutrients to maintain health.

In order to fully evaluate the progress of mainstream medicine in nutritional science over the past few decades it is appropriate to mention again the four fundamental principles of nutrition cited by Williams and colleagues three decades ago ( 5 ). Since Williams and colleagues noted at that time that these principles had yet to be adopted and applied by mainstream medicine it is pertinent that we explore progress in this regard. Let us examine these principles.

1. Food is part of our environment and forms our internal environment. The fact that medicine still prefers toxic drugs as a first treatment option continues to show flagrant disregard for this principle which involves a general understanding and respect for the internal milieu. The reductionist interventionist approach of science is not conducive to understanding and applying this principle. 
2. Suboptimal nutrition prevails in nature.  Although there has been limited acceptance of the importance of antioxidants, the wider perspective which comes from understanding this general principle is still seriously lacking.
3. Individuality is a crucial factor in nutrition. Although significant gains have been made in this area, there is still a serious lack of appreciation of the general principles involved. Progress is made on a slow case by case basis rather than by an understanding of the underlying principles. However, it is indeed gratifying to see science finally proceeding in the right direction.
4. In nutrition, teamwork is essential. Sadly, in this regard medicine appears to have learnt absolutely nothing.

In spite of obvious progress in the acceptance of the principles of biochemical individuality and the genetotrophic concept, although these concepts have been renamed, perhaps to protect the guilty, there is still this belief that human nutritional needs can be defined by a set of RDA's. Evidence clearly reveals that even amongst individuals with similar genetic traits affecting specific nutrients, there will be wide variation ( ie. genetic gradients ) in the degree of these anomalies. That progress ( ie. catching up to the teachings of Williams and colleagues ) is being made is clear, but we clearly have a long way to go before we realise that the biochemical individuality of human beings cannot be reduced to a set of RDA's!!! 

It is only a decade or two ago that suggestions that some persons required megadoses of vitamins to maintain health were generally regarded by mainstream medicine as quackery. In fact, the practice of megavitamin therapy was such a serious matter that "guilty' practitioners could even be deregistered. The S.W.A.T. team was even called in, such was the seriousness of natural or nutritional healing methods ( 227, 309, 310 ). Now however, people who do not regularly take megavitamins ( ie. in excess of the RDA ) are regarded as risking the onset of serious diseases. In spite of this dramatic turnaround in medical thinking, the experts who pioneered the concept of megavitamin therapy have yet to receive appropriate recognition. This shameful fact continues to reveal the petty, self-interested, introverted and unethical nature of medical science. Any medical scientist who attempts to promote life saving therapies which depart excessively from established medical dogma will be punished and ostracised, regardless of the cost to human life ( 227 ). In modern medical science human suffering is apparently not as important as protection and preservation of the system itself. While we continue to reward those whose allegiance is devoted to the system rather than reducing human suffering we will continue to pay a horrendous price. While modern medicine was more interested in S.W.A.T. teams, people were dying from nutritional deficiencies.

If mainstream medicine had followed the teachings and recommendations of Williams, Hoffer, Pauling, the Shute brothers and other pioneers of orthomolecular medicine 50 years ago, we now know that the savings in human lives and suffering would have been absolutely enormous. This has now become an indisputable scientific fact.

If mainstream medicine had been less preoccupied with "deriding" scientific research which was perceived as threatening medicine's relentless march towards universal dependence upon prescription drugs, then perhaps the research of Williams and colleagues would not have to "begin" again. There will always be the knockers who have nothing positive to contribute. Even today there are still those who promote dependence upon drugs and warn of the "dangers" of nutrition. "All supplements" it seems, should be treated like drugs ( 190 ). Presumably this means that vitamins should be legally monopolised and only be subjected to biased trials conducted and funded by vitamin manufacturers!!! The only thing we learn from history they say, is that we learn nothing from history.

In spite of all these facts many "experts" still argue about the importance of nutrition. One hundred years ago mainstream medicine vehemently argued that pellagra and beri beri were not caused by nutritional deficiencies. One hundred years later mainstream medicine argues about whether heart disease and cancer are caused by nutritional deficiencies. With most diseases we have not yet even begun to consider the nutritional possibilities.

Fifty years has proved insufficient for mainstream medicine to "catch-up" to Williams and colleagues, perhaps in another fifty years...........

a) Science or Progress - a return to common sense? 
There is absolutely no doubt about the direction in which human health is progressing. Whether we consider heart disease, cancer, arthritis, asthma, osteoporosis, diabetes, dementia, obesity, or mental illnesses, the human race is sick and becoming much sicker (see Health Trends ). As I have stated elsewhere (see Health Trends ): "the direction in which public health is progressing under the influence of scientific medicine is made abundantly clear by the astonishing rapidity with which the three leading causes of death have skyrocketed to their current positions of ascendency. There is no cure in sight for the current epidemics of heart disease, cancer, and iatrogenic disease."

The past century of "scientific" drug treatments, particularly in regard to chronic diseases, have been an outstanding failure. Heart disease for instance, has risen from virtual non-existence a century ago to the point where now, after 100 years of scientific "breakthroughs", it is responsible for killing an American every 60 seconds (see Health Trends ) and a total of 17 million people annually throughout the world ( 239 ). In spite of the fact that we are often told that the death rate from heart disease is declining ( see Health Trends ), in fact, the incidence of heart disease is still increasing throughout the world ( 187 ). But there are also the increasing arthritics, diabetics, asthmatics, and the list goes on. Diabetes, the worlds fastest growing disease ( 278, 279 ), also afflicts more than 135 million people globally and this is expected to reach 300 million in the year 2025 ( 239 ). More than 15 million Americans also suffer from asthma ( 240 ) and the global incidence of this disease has risen by an astonishing 50% in ten years ( 240 ), even in spite of the endless asthma "breakthroughs".

Around 2.5 million Australians ( 241 ) and 40 million Americans ( 242 ) suffer from arthritis and this is increasing around 8% every year ( 241 ). As bad as these figures are it seems they may seriously understate the problem, recent estimates claiming the true incidence of arthritis in America to be around 70 million ( 243 ), which represents more than a 400% increase in three decades ( 17 ). Osteoarthritis, which has long been considered the classical "wear and tear' or "ageing" disease ( 280, 281 ) , is now claimed to be actually improved by additional wear and tear ( 244, 245 ). Perhaps the joints are not "worn in" rather than being worn out! It is absolutely astonishing that it has taken modern science until the 21st century to discover that osteoarthritis is not a wear and tear disease after all. This is in spite of the fact that Williams emphasised the importance of the nutritional microenvironment of the joints decades ago, a fact which has still not been recognised by modern scientists.

In considering so called ageing or wear and tear diseases such as arthritis it should be borne in mind that not all elderly people suffer from such disorders. Even some centenarians have been shown to be largely free of so called ageing diseases ( 246 ). As has been pointed out by Cheraskin ( 210 ), the fact that not all elderly persons suffer from these disorders, combined with the fact that some younger people are affected more than other much older people, indicates that so called ageing diseases are not due to ageing but rather are simply due to "pathosis" or disease. In spite of these well known facts modern medicine has persisted with the view that these disorders are due to ageing, apparently the younger persons so afflicted have aged prematurely, although this does not explain why some centenarians have not "aged"! There seems to be no precise scientific definition for the term "ageing diseases." After all, how can a disease be described as an "ageing" disease when the cause has yet to be determined?

Then there are the psychiatric disorders. According to Charlton ( 247 ), many people "suffer from psychiatric symptoms for most of the time and very few people live out their lifespan without suffering periods of significant psychiatric illness." Charlton ( 247 ) lists among the various categories of the mentally ill, those with a "formally diagnosed psychiatric disease," "the vast army of the anxious who go through life in a state of gnawing angst," "the more or less miserable people who are ill and in pain," the huge numbers of people who are "intoxicated and brain impaired from alcohol, opiates, uppers, downers, solvents and the like," the people who are taking prescribed drugs which have "side effects of a psychiatric nature," and the people without a psychiatric diagnosis who are nevertheless "taking prescribed psychoactive medication" such as tranquillises and antidepressants. Modern drug treatment it seems, is causing more and more psychiatric illness as a result of the psychiatric side effects of medication ( 248 ).

The failure of modern scientific medicine has not only proved to be exceedingly costly in terms of human suffering, but the economical cost of this failure has also been absolutely phenomenal. According to Null ( 227 ) in this regard: "we have spent over fifty billion dollars on cancer research" and "over one trillion on treatment." Null continues (  227 ): "when you spend a trillion dollars on something, you're going to assume you're going to come up with some positive ideas. But there ARE no positive ideas in cancer. The mortality rate is increasing at 1.3% per year."

Not only are costly medical drug treatments ineffective, but these substances which are supposed to be curing us or alleviating our various afflictions are actually making us sicker. Modern medicine has succeeded in "inventing" a whole new group of diseases termed "iatrogenic diseases" which are caused by the hazardous and toxic nature of "scientific" treatments ( see Holistic Medicine Sets the Standard for Safety ). Recent American figures for instance, reveal the following startling facts ( 249 ):

• 12,000 people die annually from unnecessary surgery. 
• 7,000 people die annually from medication errors in hospitals. 
• 20,000 people die annually from other errors in hospitals. 
• 80,000 people die annually from hospital acquired infections. 
• 106,000 people die annually from non-error, adverse effects of medications.

As is the case in Australia ( see Holistic Medicine Sets the Standard for Safety ), these figures reveal that modern scientific medicine is the third leading cause of death behind heart disease and cancer, a costly price indeed for medicine's preference for toxic drugs rather than nutrients.

Deplorable and unbelievable though these figures are, they do not include non-fatal adverse reactions to modern medical treatments. According to Starfield ( 249  ) in this regard: "between 4% and 18% of consecutive patients experience adverse effects in outpatients settings, with 116 million extra physicians visits, 77 million extra prescriptions, 17 million emergency department visits, 8 million hospitalisations, 3 million long-term admissions, 199,000 additional deaths, and $77 billion in extra costs."

In spite of the voluminous and indisputable evidence, not only of the failure of medicine, but also of the exceedingly hazardous nature of modern scientific "therapies", health authorities still seek to blame the public, suggesting that the reason for this failure is that people are "behaving badly" ( 249  ) by smoking and drinking etc. Starfield ( 249  ) points out however that the evidence clearly contradicts such assertions and indicates instead that it is the incredibly inefficient and hazardous nature of modern medicine which is to blame. At the risk of inviting considerable condemnation for stating the obvious, I would suggest also that medicine's longstanding rejection of nutrition and the resultant current epidemic of nutritional diseases may also have had some influence. For so long so many so called scientific experts from around the world have been telling us that the use of natural medicines serves no purpose other than to enrich both the sewage effluent and the bank accounts of the manufacturers and retailers of these products. These same experts now however, are seeking to convince us that these substances are so potent that they must not be mixed with drugs or taken without medical approval!!

Not only does modern medicine have an exceedingly dangerous and ineffective track record, but it is expected that this will continue well into the future. Such is the failure of medicine that future failures can be reliably predicted. For instance, the number of Americans with diabetes is expected to increase from 11 million in 2000 to 29 million in 2050 ( 250 ) while globally it is anticipated to increase from 135 million in 1995 to 300 million in 2025 ( 239 ). In Australia the number of people suffering from arthritis is expected to increase from almost 3 million in 2001 to around 5.25 million in 2051 ( 241 ). In America, predictions that the number of arthritics will increase from 40 million in 1997 to 60 million in 2020 ( 242 ) are already out of date, the incidence of arthritis currently estimated as being 70 million ( 243 ). All this is not too surprising when we realise that modern science has only just discovered that arthritis is not a wear and tear or ageing disease ( 244, 245 ). Having just discovered what arthritis is not, we could not reasonably expect the discovery of a cure in the foreseeable future.

Clearly, not only are the strategies of modern medicine a total failure when it comes to maintenance of optimum health and prevention of chronic diseases, but furthermore, preoccupation with predicting the rate of failure is a curiosity which seems to be confined to modern science and medicine.

If we are at all serious about reversing these health care trends we must recognise the limitations of our current reductionist symptomatic interventionist approach to "disease care". We must recognise the advantages of holism and nutrition. We should despise the use of toxic foreign compounds ( largely to satisfy commercial interests ) to conceal symptoms ( of malnutrition ) and deceive patients into thinking their disease is improving. We must encourage dependence upon nutrition and natural supplements and actively discourage dependence upon drugs.

Instead however, our current system continues to promote an ever increasing dependence upon drugs. Not only do we require drugs to conceal our aches and pains, to enable us to breathe, to enable us to sleep, to enable us to cope, to improve our moods and relieve our anxiety, to relieve our allergies, and the list goes on, but increasingly we are using drugs where no disease exists or simply to modify our life style. There is increasing dependence upon cholesterol lowering drugs in an attempt to counteract dietary indiscretions. We increasingly require drugs simply to be happy and content. There are drugs for shyness or drugs to stop us spending money. Not only do we require drugs to help us sleep, but now we have a drug to keep us awake ( 251, 252 ) when sleep becomes such a nuisance that it interferes with our productivity or enjoyment. It has even been predicted that within ten years we will be able to select the type of personality and disposition we require simply by choosing from the wonderful new range of brain altering drugs ( 253 ). Doctors and medical scientists remain totally devoted to ensuring we continue to become increasingly dependent upon the concoctions of the drug companies. By comparison, there is considerably less interest in addressing the current epidemic of iatrogenic diseases.

In addition, the replacement of "worn out" body parts is also a boom industry, even though we now find out that these parts are simply diseased and not worn out after all. In spite of this there is little interest in the nutrients from which these "worn out" parts are formed. The nutritional microenvironment of the cells never seems to be considered.

The answers to most if not all of these problems are already well known. Through recognition of the importance of diet and nutrition, common sense has traditionally led the way in health care, even in spite of the negative influence of what is loosely described as "science". While "scientific" evidence has consistently shown that we need more and more drugs, common sense on the other hand continues to underline the importance of nutrition and natural supplements. Health authorities simply need sufficient conviction to apply these solutions by appropriately choosing between the business of disease care and the art of health care base upon sound common sense principles.

b) The Current Medical Paradigm - the use of drugs to conceal malnutrition 
It is abundantly clear that the reductionist interventionist drug paradigm of orthodox medicine is of no relevance for treatment or prevention of chronic diseases or for the maintenance of optimum health. Modern science has been responsible for promoting a paradigm of disease care rather than health care for the past two or three centuries. In spite of the fact that medicine has been deliberately structured on a presumption of failure, an approach that permits intervention only after a diagnosable disease has become established, there is still a widespread view within mainstream medicine that the solution to these problems is simply to provide more of the same (  227 ). According to this line of reasoning we just need more doctors, more drugs, and more hospitals and fundamental change to our system of health care is unnecessary (  227 ). When the doctor has become the "agent of disease" ( 254 ) however, fundamental change is urgently required.

Scientific evidence I have cited throughout this discussion reveals increasingly that many chronic diseases may in fact be caused by nutritional deficiencies even though modern medicine continues to treat these disorders with toxic symptom concealing drugs. The use of drugs to conceal symptoms of malnutrition continues to be the prevailing medical paradigm. It is pertinent to examine some instances of this approach prior to proposing future directional changes.

Evidence of a nutritional basis for diseases which are normally treated with drugs is extensive. In my own case for instance, I have mentioned elsewhere ( see Holistic or Reductionist?, B vitamins ) that vitamins, especially vitamin B6, were much more effective for reversing my asthma than were an entire lifetime of prescription drugs.

I have also considered elsewhere the considerable scientific evidence in support of my experiences of B6 deficiency and asthma ( see B vitamins ). There is also a huge amount of scientific evidence revealing that B6 deficiency may also cause cardiovascular disease ( see B vitamins ) although modern medicine prefers to treat these disorders with drugs and surgery without any nutritional investigation whatsoever. Vitamin B6 deficiency also commonly causes depression ( see B vitamins ) and even though it is well known therefore, that both depression and heart disease may have a common nutritional cause, modern medicine prefers to treat these disorders separately on a purely symptomatic basis.

I should emphasise here that the ability of B6 deficiency to cause heart disease and depression is well established and is based upon around half a century of research by eminent scientists ( see B vitamins, Health Trends ). The reason that modern doctors prefer to use drugs as a first treatment option for these disorders is NOT because the effects of B6 deficiency are not known, rather it is because of the anti-nutrition bias and pro-drug paradigm of modern scientific medicine. Although vitamin B6 deficiency has also been shown to be associated with kidney stones ( 102, 146 ), arthritis ( 102, 103, 146 ) and seborrhoea ( 102, 146 ). Cancer patients are also commonly deficient in B6 and suffer from disturbed metabolism of this vitamin ( 316 ). Additionally, in spite of a huge amount of evidence demonstrating the ability of vitamin B6 to reverse carpal tunnel syndrome ( 102, 103, 112-117 ), modern medicine prefers to treat this condition with surgery. According to Quillin ( 304 ): "vitamin B6 cures carpal tunnel syndrome in 27 out of 28 patients tested in double blind fashion" ( 115 ). 

The important point here of course is precisely WHY vitamin B6 is so effective at reversing carpal tunnel syndrome. Since scientists know that B6 lacks the symptom concealing effects of drugs they must also realise that this effect of B6 must be nutritional and is therefore curative. They must also realise therefore, that when they use surgery for this condition they are totally ignoring the other consequences of B6 deficiency which must occur sooner or later. For instance, if the B6 deficient person subsequently develops heart disease after the carpal tunnel syndrome is "corrected" by surgery, then this will need to be addressed by symptomatic measures also. Why not address the cause in the first place? There are numerous other examples of medicine preferring to conceal symptoms of malnutrition rather than correct the underlying cause.

Folic acid has recently become the "flavour of the month" since modern medicine realised that a deficiency of this vitamin could cause birth defects and heart disease even though these facts have long been known. Now, as folic acid achieves a "respectable" status, its ability to treat or prevent cancer, dementia, and various psychiatric problems is increasingly being recognised ( 102, 146, 166, 168, 169, 170, 173,174, 182, 193, 207, 209, 307, 308 ). But how many doctors consider the risk/benefit of folic acid therapy and routinely prescribe this vitamin for the treatment of these disorders or simply as a preventative? Drugs or surgery are usually the preferred treatment options for this form of malnutrition irrespective of the risk/benefit and even in spite of the fact that folic acid metabolism is more commonly adversely affected by drugs than most other vitamins ( 307 ).

In spite of the increasing obsession with folic acid however, this vitamin is only one nutrient in the nutritional chain of life. Even when it comes to the effect of folate upon homocysteine metabolism the interdependent nature of nutrients is frequently forgotten. Although the usual approach to lowering homocysteine levels is to promote the use of folic acid, vitamin B6 and vitamin B12 ( see Health Trends ), modern health experts continue to recommend that all these vitamins be taken in the inactive form with absolutely no mention of cofactors which are also necessary. For instance, most experts fail to mention that the normally used form of vitamin B6 may be ineffective if there are associated deficiencies of zinc, magnesium, or riboflavin (127, 128,129, 130, 132, 133 ).

Similarly, the effectiveness of folic acid in lowering homocysteine levels is totally dependent upon other nutrients. Vitamin B12 deficiency for instance, may prevent folic acid from having its homocysteine lowering effects ( 124, 302 ). However, what most modern nutrition experts neglect to mention is that the normally used form of vitamin B12, cyanocobalamin, is biologically inactive and is totally useless for lowering homocysteine levels unless it is converted by the body to methylcobalamin ( 124, 282, 283, 284, 285, 302, 303 ). As has recently been pointed out by Herbert ( 305 ), hydroxocobalamin is a more "physiologic" form of vitamin B12 than cyanocobalamin and is the preferred form in the U.K..

A deficiency of methylcobalamin prevents folic acid from having its effects on methionine synthase, the enzyme which breaks homocysteine down into methionine ( 124 ). Even though the toxicity of the cyanide radical in cyanocobalamin was of such concern three decades ago that it was recommended that this form of vitamin B12 should be banned (see But isn't Holistic Medicine just Quackery? ), it is astonishing that most modern nutrition experts still encourage the exclusive use of this inactive form of the vitamin. Even though there have been more than 330 published studies on methylcobalamin, "virtually no doctors know of it or recommend it" ( 317 ). Especially given the easy availability of methylcobalamin today, this is indeed disappointing.

Sadly, so much nutritional advice today originates from those with a vested interest in selling this product or that product. Put simply, those who do not sell methylcobalamin do not recommend it, even in spite of the obvious superiority of this form of B12 ( 282, 283, 284, 285, 286, 302, 303, 317 ) and the fact that it may be used for nerve regeneration or for glaucoma ( 287, 288, 289, 290, 302, 303, 317 ). Neither do they mention the possible ill effects of the cyanide radical in cyanocobalamin. While this is not too surprising, what is surprising is that scientists and practitioners seem content to allow vested interests to control the nature of, and dissemination of, nutritional propaganda. In the end it is up to consumers to become better informed and demand the superior product.

As the effects of folic acid deficiency become more well known and the use of folic acid supplements becomes more widespread, deficiencies of this vitamin will cease to be a major problem in modern society. At this point some other nutrient will become the weakest link in the nutritional chain of life. Of course there will then be a brand "new" discovery about this "new" nutritional deficiency. One such nutrient is magnesium.

Unlike many other nutrients there is a huge amount of literature confirming both the prevalence and many varied manifestations of magnesium deficiency ( 102,146, 255, 256, 257, 258, 259, 260, 261 ). Magnesium deficiency may cause hypertension, heart disease, kidney stones, muscle spasms and cramps, seizures, irritability, stress, depression, dementia, and sensitivity to noise ( 102, 146, 255, 256, 257, 258, 259, 260, 261 ). From 20%-80% of the population may suffer from magnesium deficiency ( 261, 262 ) while 20%-53% of heart disease patients have also been shown to be deficient in this mineral ( 261, 263-266 ). This is in spite of the fact that magnesium is an intracellular mineral and blood levels do not necessarily reflect tissue stores ( 261, 265 ).

Even though the facts about magnesium are extremely well known, the magnesium deficient patient who attends his/her doctor suffering from hypertension or depression, or muscle spasms and kidney stones, or any combination of these, will normally be treated with drugs even without the possibility of a nutritional deficiency being considered. The magnesium deficient patient may require a combination of different drugs for these various symptoms and perhaps even surgery for kidney stones or heart disease. Once again these treatments are generally preferred by doctors rather than the correcting of any underlying nutritional deficiency.

Another group of nutritional deficiencies, which although very common, have remained largely unrecognised until quite recently, are those caused by a deficiency of the essential fatty acids ( EFA's ), particularly the omega-3 fatty acids. A deficiency of EFA's, which may affect 60%-90% of the population ( 146, 270, 271, 272 ), may cause dry cracked skin and dryness of the hair, eyes, mouth and mucous membranes, stiff aching joints and arthritis, learning problems ADD and hyperactivity, mood swings, depression, excessive thirst, depressed immune function, dandruff, heart disease, numbness and tingling, insulin resistance and even cancer ( 221, 224, 226, 267, 268, 269, 270, 271, 272, 319-323 ). EFA's are known to play an essential role in the integrity of cell membranes, the transport of nutrients into and out of cells, and the function of the mitochondria ( 267, 272 ).

Consideration of EFA nutrition involves an extremely important but often forgotten part of nutrition, namely, the importance of balance. It is well known that various vitamins, minerals and amino acids must be taken in balanced proportions if ill effects are to be avoided ( see B vitamins ). This is especially so in the case of EFA's. Excess consumption of omega 6 fatty acids in proportion to omega 3 fats, from for instance the promotion of omega 6 oils and margarines over the past few decades, is believed to be responsible for the increasing prevalence of cardiovascular and blood clotting disorders ( 306, 319, 320, 323, 327 ). Imbalance in these EFA's may also affect hormonal systems in such a way as to predispose towards such disorders ( see Body Types ).

As is the case with other nutritional deficiencies, the patient who attends a doctor suffering from symptoms of EFA deficiency such as dry eyes and skin, arthritis, dandruff, and insulin resistance, will normally be treated with symptomatic drug treatments in an effort to conceal the underlying nutritional deficiency. Topical treatments will normally be used to treat the skin and the dandruff, artificial tears may be required for the eyes, while anti-inflammatory drugs or perhaps even surgery may be required for the "worn out" joints. The doctor who has not been nutritionally trained will of course not be aware of the possible connection between these various diverse symptoms and will not consider the possibility of a common underlying cause. He/she will therefore be content to treat all these symptoms separately purely on a symptomatic basis.

I am reminded at this point of my first experience with EFA's around 15 years ago. At the time I was consistently troubled by dry cracked skin on the heels, dandruff, and considerable stiffness in the joints. All these symptoms responded completely to oral supplements ( absolutely no topical creams etc. ) of omega-3 fatty acids ( flaxseed oil plus fish oil ) although I noticed that omega- 6 fatty acids greatly exacerbated the joint symptoms. It was amazing to witness the hard calloused skin on the heels become so soft and normal although this is often one of the hallmarks of EFA deficiency ( 267 ). I am both amused and saddened when I witness the continuing advertisements for topical creams and ointments for dry cracked skin and heels. Of course there are other possible causes of dry skin but considering the possible risk/benefits and the curative nature of nutrition, surely nutritional supplements should be the first treatment option not the last. If I had opted for the normal symptomatic medical treatment, what would have happened, over time, to the underlying nutritional cause of these disorders?

The point cannot be overemphasised that even a "minor" symptom of a nutritional deficiency, such as EFA deficiency, is an indicator of an underlying disruption in metabolism which may eventually lead to serious chronic diseases such as heart disease, cancer or diabetes. No nutritional deficiency effects just a few isolated cells in the body without also affecting other vital body processes, whether or not these effects are visible in the short term. We must not be satisfied to relieve external symptoms. We should address the cause and treat the whole person. To conceal nature's warning signs with utter disregard of the underlying cause will predispose to serious diseases.

While deficiencies of vitamin B6, magnesium, and the EFA's are known to be very common and the effects of these deficiencies have been studied in some detail, I would like finally to consider a vitamin which plays a vital role in human metabolism but which has been studied very little. The vitamin to which I refer is pantothenic acid or vitamin B5.

Vitamin B5 was named pantothenic acid because of its widespread availability in different foods ( 4, 12, 17 ), a fact which has resulted in the general assumption amongst the scientific community that a deficiency of this vitamin is virtually impossible ( 12, 17, 124 ). Williams ( 4 ) noted in 1971 that even thirty years after the discovery of pantothenic acid this vitamin had received "almost no attention" from the scientific community. Wardlaw and Insel claimed in 1990 in their standard nutrition text ( 12 ): "pantothenic acid is too widespread in foods to ever allow a nutritional deficiency." It is absolutely deplorable that a nutrition textbook would make such a scientifically baseless generalisation. This statement makes the monstrous assumption that we are all nutritional clones by completely overlooking individual differences in digestion, absorption and metabolism and suggests also that both the total quantity of food consumed and the degree of processing are completely irrelevant.

In spite of this apparent denial of human individuality, Wardlaw and Insel claim in their "Preface to the Instructor" that ( 12 ) "one overriding theme in nutrition research today is individuality " "we often respond in an idiosyncratic manner to nutrients, and that is something we constantly point out in this textbook." Wardlaw and Insel also follow this with a "Student Preface" in which they further add that (12 ) "the need to tailor dietary advice to the individual nature of each of us is the basic philosophy behind this book." Interestingly, Wardlaw and Insel also stress the importance of adopting a proper scientific approach to nutrition research. They also list a number of compounds which they describe as "bogus vitamins" which they claim are "promoted by health food enthusiasts." "None of these compounds", according to these workers, "are important in human nutrition." Wardlaw and Insel claim that "vitamin hucksters" try to pass these compounds off as "being necessary for humans." One group of compounds which are described by Wardlaw and Insel as "bogus vitamins" are the "bioflavanoids", those antioxidants which are widely believed to have anti-cancer properties (146, 194 ). Herbert ( 297, 299 ) has even warned of the alleged dangers of antioxidant supplements. 

When the current generation of nutrition experts have been taught that anti-cancer antioxidant nutrients are "bogus vitamins" promoted by "vitamin hucksters" with absolutely no nutritional value, then the gravity of our current crisis in health care is hardly surprising. 

The widespread availability of pantothenic acid in foods, according to Robinson (17 ), underlines the vital role this vitamin plays in human metabolism, being essential for the production of coenzyme A and cortisol. Pantothenic acid may assist in strengthening metabolism during fasting and weight loss ( 326 ). Williams ( 4 ) has cited evidence that pantothenic acid plays an "unusually vital role in reproduction" and "it is probably an inherent characteristic of the human system to require relatively large amounts of this vitamin." The importance of pantothenic acid in preventing human reproductive failures, according to Williams ( 4 ), has not been investigated. It is interesting to note in this respect, especially given the well known susceptibility of low birth weight infants to chronic ill health ( see Body Types ), that low birth weight infants have been found to have lower blood levels of folate, B12 and pantothenate ( 324 ). Williams also noted a wide variation in the need for pantothenic acid in different people ( 4 ).

The signs and symptoms of human pantothenic acid deficiency have been studied using experimental diets and vitamin antagonists, however these studies tend to be relatively short term because of problems with compliance and the severity of the ill effects. Documented ill effects of pantothenic acid deficiency include the following ( 3, 4, 10, 12, 17. 108-111, 273-277 ).

Given the fact that modern science has now confirmed beyond doubt that human nutritional deficiencies are frequently caused by a genetically increased need rather than dietary inadequacy, how is it possible for medicine to continue to ignore the possibility of pantothenic acid deficiency simply because of the widespread availability of this vitamin in foods? This question applies equally to so called "non-essential" nutrients. Continuing to base scientific research upon such assumptions reflects very poorly upon the credibility of science and the so called scientific method. Eventually of course, the occurrence of genetically caused B5 deficiency will be "discovered." Until then symptoms will need to be concealed with drugs as is the current practice.

It is abundantly clear from the evidence cited above that many of the symptoms of disease which currently plague the human race are in fact established symptoms of nutritional deficiencies. This is a simple indisputable scientific fact. Additionally, it has also been established beyond doubt that for the most part these nutritional deficiencies are extremely common throughout modern society, a fact which is becoming even more apparent as we realise the shortcomings of nutritional tests. In spite of these facts modern medicine prefers to conceal (or remove ) symptoms of nutritional deficiencies by the use of drugs and surgery while completely ignoring the underlying cause. The determination to avoid any consideration whatsoever of a nutritional basis for these symptoms is remarkably consistent throughout the entire world of modern medicine. Unless we conclude that modern medicine is motivated primarily by commercial considerations rather than health care it is difficult indeed to reconcile these seemingly incongruous facts. After all, the suggestion that it is preferable to use toxic drugs to hide symptoms rather than use as a first treatment option harmless cause based and potentially curative nutrients appears to be completely devoid of common sense.

While there is extensive scientific evidence to indicate that nutritional deficiencies are the root cause of many modern diseases, there is no evidence whatsoever that even one disorder is caused by a deficiency of drugs. On the other hand, there is abundant scientific evidence that while nutritional disorders may be completely CURED by the use of nutritional supplements, drugs in stark contrast may be effectively used to HIDE symptoms of nutritional disorders until a point of irreversibility has been reached.

As I have indicated previously, nutrients, during their journey from soil through to incorporation into human tissues, must run the gauntlet of many hazards and obstructions. Whereas the first task of science should be to minimise or remove these hazards and obstructions, in reality the reverse is true. From "scientific" agricultural practices, through to "scientific" food processing, the use of nutrient destroying drugs and the continual discouragement of the use of vitamins and health foods, science actively pursues policies which seek to magnify and multiply the hazards faced by nutrients. Modern scientific medicine has displayed a longstanding determination to frustrate or prevent the attainment of optimum nutritional status, both on an individual as well as a community basis.

This is the current paradigm of orthodox medicine.

c) The New Paradigm - the use of nutrients to cure malnutrition 
A new paradigm is struggling to emerge in the world of health care. This paradigm involves an increasing realisation of the importance of nutrition and the use of nutritional supplements to prevent or counteract various chronic diseases. Unfortunately, the emergence of this new paradigm continues to be driven fundamentally by negative forces, that is by a recognition of the failure of the old paradigm, rather than by any growing realisation of the positive advantages of a new approach to health care. It is for this reason that "breakthroughs" in conventional symptomatic techniques used in the old paradigm continue to delay and restrict the introduction of this new paradigm. The continuing obsession with merely concealing symptoms demonstrates that the cause based and essentially curative nature of the new paradigm is still considered unimportant as a huge volume of research continues to be devoted to prolonging the old symptomatic approach to disease care. There are still those who are waiting for the new miracle drug or the revolutionary new surgical procedure that will solve all of mankind's woes without addressing the underlying cause. Apparently they are still unable to distinguish between health care and disease care.

It is difficult indeed to accurately define or name this new paradigm since it continues to evolve on a haphazard trial and error basis. It is not a paradigm which has been deliberately structured within specific scientific or logical parameters. Since this emerging paradigm revolves around the use of nutrition and the realisation that nutritional deficiencies, which are extremely common in modern society, are the fundamental cause of many chronic diseases, this new paradigm is essentially the use of nutrients to cure malnutrition. Or perhaps it could be considered as the "Vitamin-as-Treatment paradigm" ( 11 ) as distinct from the "Vitamin-as Prevention paradigm" ( 11 ). It involves what has been termed "differential nutrition" ( 291 ) or the recognition that nutritional deficiencies are caused by genetic peculiarities in the metabolism of nutrients as well as by inadequate dietary consumption (291 ).

According to Machlin ( 159, 160 ) the growing recognition of the relationship between nutritional status and chronic diseases is the result of a new field of study which he terms "nutritional epidemiology." Epidemiology is the ( 14 ) "study of the relationships of various factors determining the frequency and distribution of diseases in the human community." Epidemiology in other words is the statistical community based study of diseases and their related risk factors. Applied to nutrition, epidemiology is the study of the relationship between community patterns in food consumption and nutritional status and the incidence of various diseases ( 12 ).

Although epidemiology has traditionally provided the basis for many nutritional discoveries ( 12 ), increased reliance upon laboratory research and short term clinical trials has seen epidemiological studies become less popular, particularly in regard to nutritional research. Machlin points out however ( 159 ) that there is now a growing awareness of the limitations of short term clinical trials when it comes to evaluating the effects of long term subclinical nutritional deficiencies. In contrast with the unreliability of clinical trials in such areas of research, epidemiological data is amazingly consistent ( 159 ). When it comes to nutritional research the shortcomings of clinical trials must clearly be borne in mind.

Although increasing evidence of the vital importance of nutrition is applying more and more pressure to mainstream medicine to accept a fundamental role for nutrition in this new medical paradigm, the longstanding anti-nutrition bias of medicine shows little regard for evidence, be it scientific or otherwise. Even with the introduction of so called "evidence based medicine", evidence of the importance of nutrition is not as important as "evidence" of the importance of drugs. This attitude, which hampered progress in nutritional research throughout the 20th century, promises to continue to retard progress well into the 21st century.

It is astonishing that nutrition continues to play such a minor role in medical education and medical science generally, even in spite of the considerable efforts of earlier pioneers. Davis ( 10 ) cited evidence in 1965 that at that time nutrition was becoming increasingly important to the medical profession. Davis cites for instance the words of Dr. W.H. Sebrell ( 291 ): "today nutrition is finally beginning to be recognised as an important factor in the treatment of and convalescence from-almost every disease." But Williams noted that in 1973, the neglect of nutrition in medical education was such that a bill was introduced into the US Senate to provide for 5 million dollars annually for the teaching of nutrition in medical schools ( 3, 292 ).

In a presentation concerning nutrition and cancer research, which was considered of such importance it was presented to Congress in 1974 ( 292 ), Williams pointed out that "the primary cause of lack of attention to cellular nutrition in cancer research lies in the neglect of nutritional science by medical schools and medical science in general. This has persisted for at least sixty years." Williams further points out that ( 292 ) "in no public or private institute dealing with cancer research anywhere in the world, are there groups of real experts in cellular nutrition." Williams continues ( 292 ): "in keeping with an anti-nutrition bias however, physicians were sometimes taught not to believe in vitamins."

The importance of cellular nutrition in regard to cancer research was appropriately emphasised by Williams ( 292 ): 

Williams also notes that ( 4 ) "medical education has neglected to perform a refined study of nutrition in all of its aspects and has diverted attention away from the most promising means of controlling cancer. That avenue is the, nutritional approach which must encompass the human element of individual susceptibility." Williams draws attention to the huge number of different specialists who are participating in cancer research ( 292 ): "we do not believe that the general quality of these investigations or the general competence of the investigators to do what they undertake can be questioned. However, neither do we believe that increasing the number of these specialists or increasing their support would bring about any phenomenal improvement in the over all progress in cancer research." What is needed urgently according to Williams, are experts in cellular nutrition and biochemical individuality.

In an address to the International College of Applied Nutrition in 1974 entitled "The Future of Nutritional Science", Williams continued to draw attention to modern medicine's neglect of nutrition ( 293 ):

While Machlin ( 160 ) claimed that nutritional research appeared to "languish" during the mid 20th century, Williams pointed out that any medical practitioner who pursued an active interest in nutrition was considered to be operating "outside the mainstream of medical approval" ( 293 ).

Perhaps the fact which best illustrates medicine's contemptuous disregard of nutrition is the fact that science has devoted much more attention to the nutrition of the rat than to the nutrition of human beings. The elimination of birth defects by improved nutrition during pregnancy was common knowledge in animal nutrition long before human medicine even considered such matters. Doctors were content to argue about such matters, even citing the alleged dangers of nutritional therapy, while the birth of deformed babies continued. According to Williams ( 293 ): "during the past fifty years, while we have been learning so much about baby rat nutrition, we have not by any means improved the nutrition of human babies and small children in a comparable manner."

Meanwhile, in Australia, health authorities were also investigating the merits or otherwise of nutrition and other forms of alternative medicine. In 1974 the Australian government established a Committee of Inquiry to study the efficacy and scientific basis of chiropractic, osteopathy, homeopathy and naturopathy and the Report of the Committee was published in 1977 ( 294 ). The Committee was comprised of Professor I:. C. Webb, Vice-chancellor of Macquarie University; Dr. C. J. Cumins, Director General of Public Health of New South Wales; Professor M. J. Rand, Professor of Pharmacology; and Professor R. H. Thorp, Professor of Pharmacology. While doctors and pharmacologists were well represented it is noteworthy that the Committee was not comprised of anyone with expertise in nutrition or alternative medicine. This of course is equivalent to establishing a committee comprised exclusively of nutritionists and naturopaths to inquire into the practices of modern medicine.

In view of the structure of the Committee the following comment contained in their report is hardly surprising ( 294 ): " ....if all herbal, homeopathic and naturopathic remedies were channelled through the retail pharmacy system it is reasonable to suppose that the products received by the public would be of improved quality compared to those prepared extemporaneously in the naturopathic dispensary." This comment is consistent with the Committee's recommendation that "pharmacists should be encouraged to accept a greater degree of responsibility for primary health care." However it is hardly consistent with their claim that naturopathic treatments are "unscientific" and "at best, of marginal efficacy". Neither is it consistent with their comments about herbalism ( 294 ): "it is generally accepted that a great deal of herbal folk-lore has little scientific foundation and that which has, has already been very thoroughly explored by pharmaceutical manufacturers in search of marketable preparations. It is unlikely that herbal preparations will yield additional drugs of major importance." Perhaps the Committee is correct, perhaps pharmacists should be encouraged to dispense these unscientific and ineffective treatments!!

Of the various matters which were intended to be addressed by the Committee the following one is particularly relevant to the present discussion. In the case of alternative treatments such as "herbal remedies", "nutritional advice" or "megavitamin therapy", "...is there a clear physical basis for success or are there important psychosomatic considerations in the cases of apparently successful treatment"( 294 )?  Interestingly, although the Committee established a double blind trial of the naturopathic treatment of hyperactive children in order to test the effectiveness and scientific validity of such treatments, and in spite of the fact that there was a "substantial improvement in the treated group" ( 294 ), the Committee made the following recommendation ( 294 ): "the Committee does not recommend licensing of naturopaths as a vocational group as it considers that such licensing may give a form of official imprimatur to practices which the Committee considers to be unscientific and, at the best, of marginal efficacy." We can see here an excellent illustration of the fact that the structure of our health care system has nothing to do with either scientific evidence or the welfare of patients. The primary consideration is the protection and perpetuation of our current medical system.

In regard to dietary advice and nutritional therapy .the Committee stated as follows ( 294 ): "medical students in Australia receive very little or no formal teaching in nutrition and in a short consultation with a patient are rarely in a position to give dietetic advice as part of their therapeutic measures. Apart from dieticians, very few nutritionists exist in Australia. The naturopath has entered this area by default, and has acquired an undue importance." "..... their often expressed reaction against highly processed convenience foods as a major source of calorie intake is, in fact, also a serious cause of concern to health authorities generally." It seems from this statement that health authorities are more concerned about ensuring the continued consumption of "highly processed convenience foods as a major source of calorie intake" than they are about the nutritional quality of these foods. Such statements of course, are a reflection of the deplorable level of nutritional knowledge which exists amongst health authorities.

The Committee continues ( 294 ): 

The Committee made the following telling points in the above discourse. 

• Although virtually no-one is trained in nutrition and we have apparently not yet had a "study of the eating habits of Australians in relation to health", it is well known nevertheless, that "inappropriate nutrition is one of the causal factors in a number of diseases common amongst the Australian population." 
• Naturopaths have entered the area of nutrition because of neglect of this topic by the medical profession. 
• Although nutritional advice dispensed by naturopaths is "unscientific" and "ineffective", nutrition should be taught in medical schools.

Although 25 years have passed since the Report was published it is astonishing just how little has changed. We now have much more evidence of the importance of nutrition and yet our medical educators still ignore this vital topic while medical practitioners are still ill equipped to comment on nutritional matters, let alone diagnose nutritional diseases. During the Report the Committee drew attention to the neglect of nutrition by the medical profession and, in stark contrast, the intense interest shown in this topic by naturopaths and also the media. In 25 years nothing has changed. As a group, doctors are generally amongst the least well informed sections of society when it comes to nutrition. Many in the medical profession still seem reluctant to accept the fact that the reductionist interventionist disease oriented philosophy of medicine is not conducive to developing an understanding of fundamental nutritional principles. It is imperative that we determine the precise reasons for this lack of progress in the past 25 years.

One thing that is made abundantly clear by the Report of the Committee is that no amount of scientific evidence can be relied upon to bring about positive change if there are philosophical and attitudinal problems within medicine which create a refusal to accept such evidence. It is in this area, the area of attitudinal problems and bias, where the Report is especially informative.

Notwithstanding the positive results of the double blind trial of the effectiveness of naturopathy which I referred to earlier ( 294 ), the Committee refers in detail to a study by Parker and Tupling (see Appendix 11 of the Report) who attempt to explain why so many patients support alternative practitioners. Although Parker and Tupling concluded that ( 294 ) "natural therapy patients consult a natural therapist in the main because they feel that their condition has either been ineffectively or inappropriately treated by an orthodox medical practitioner", these workers then make the following astonishing psychoanalysis of alternative medicine patients: 

The attitudes depicted by this analysis are indeed astonishing and should be of fundamental concern to all who seek an unbiased, scientific, evidence based approach to health care. We really must decide as a matter of absolute urgency whether our primary concern is the millions of people who die annually from heart disease, cancer, and iatrogenic diseases or whether we are more concerned about the "deviancy" of those who do not wish to die from these diseases. This really is astonishing. On the one hand nutrition is so important that it should be taught in medical schools while on the other hand patients who utilise nutritional therapies are regarded as "deviants". Of course when reductionist orthodox medicine first began anyone who supported this new scientific medicine, by this definition, was also a deviant. Has the entire practice of orthodox medicine been based upon a few deviants? Parker and Tupling designed a questionnaire to assess the motives of alternative medicine supporters and then they turn around and question whether the questionnaire had produced misleading results by antagonising the participants. If the response to the questionnaire had been more to their liking would they still have found it necessary to to psychoanalyse participants?

Unlike the above study, since this discussion is devoted more to scientific evidence and not ( 294 ) "difficult to verify" speculation, I will make no further comment about the study of Parker and Tupling other than to note that it further substantiates the existence of serious attitudinal problems within mainstream medicine. Such attitudes are a significant deterrent to positive progress and the acceptance of the scientific evidence upon which the emerging nutritional paradigm is based. While these workers seek to psychoanalyse supporters of alternative medicine, those who support the types of orthodox medical practices which have resulted in the current epidemic of iatrogenic diseases seem to be constantly deprived of such an analysis.

Although the general tone of the Report into Chiropractic, Osteopathy, Homeopathy and Naturopathy was clearly intended to favour the practices of modern medicine and pharmacology, the Committee did note that they had received submissions which were critical of orthodox medicine from ( 294 ) "a small number of younger medical practitioners." Since the relevance of the age of these doctors escapes me, I will refer to these doctors instead as "concerned doctors". In their Report the Committee did include a submission from one of these concerned doctors which stated as follows ( 294 ): " many ( probably the vast majority ) of medical students are under the impression that when they have attained their hard-earned degree they will have the power to cure vast numbers of patients. When they finally arrive in their first year they are uniformly shocked by the hopelessness of the vast majority of patients. We find that a cure is an extremely rare event, most of the 'cures' are natural events and the doctor has been no better than an educated observer. "

This concerned doctor noted that although many illnesses are self inflicted because of lifestyle choices "the doctor either realises or somehow suspects that he is not, in fact, helping the community but is rather concerned with patching up the mess, avoiding the real issues ( this patient was killed by cigarettes, instead of he died from lung cancer ), and generally is part of the hideous machinery that is set up to enable society to continue in its all-destroying way."

It is clear that the contribution of this doctor is motivated by a degree of sincerity, concern, and conscience which is rarely expressed in modern medicine. Such attitudes, if encouraged, could produce a health care system which would be genuinely responsive to the needs of patients and scientific evidence and free of the negative effects of bias. This concerned doctor continues with his vitally important submission to the Report ( 294 ):

While the contribution of this doctor is deserving of the highest praise for his honesty and sincerity, the problems to which he referred are so serious that they challenge the very fundamental basis and philosophy of modern scientific medicine. Such are the seriousness of these matters that their mere mention should result in an immediate investigation. In spite of this however, the response of the Committee to the concerns expressed by this doctor were characterised by their indifference and dismissiveness ( 294 ):

According to the Committee then, the criticisms of modern medicine made so often by patients, which although perhaps due to "deviancy", have also been confirmed by doctors themselves, even though the Committee still doubts if the problem exists. If it does exist, according to the Committee, it is confined to GP's, although according to contributors to the Inquiry these problems are due to the fundamental nature of medicine and medical training and are not simply due to GP's. Although orthodox medicine has deliberately relegated nutrition to the realms of quackery for more than 200 years, and the Committee also noted that nutrition was a central part of "unscientific" naturopathy, now it seems, since according to the Committee "the cure must be within the conventional system and not outside it", nutrition should be taught in medical schools. Since the Committee themselves were responsible for organising a scientific trial of the unscientific practice of naturopathy which demonstrated the effectiveness of this type of therapy, then clearly the fundamental meaning of the term "scientific" is being challenged. It is absolutely astonishing that modern medicine now wishes to acquire some kind of monopoly over therapies which they have regarded as quackery for more than 200 years.

We should make a very clear distinction between medicine's attempts to justify, protect, and perpetuate the current highly profitable medical and pharmaceutical system and alternatively, genuine patient oriented attempts to establish a safer and more effective health care system. The suggestion that scientific evidence reveals on the one hand that we need more and more drugs, while on the other hand it demonstrates the unscientific nature of nutritional therapies, is clearly inconsistent with both the scientific facts and the welfare of patients. Similarly, those who continue to warn of the dangers of nutrition or natural therapies while displaying a determination to avoid any factual comparison with the dangers of drug therapy or the incidence of iatrogenic diseases, are not displaying an attitude which is in the best interests of patients. Isn't it time we stopped pretending that this singular preoccupation with the "dangers" of nutritional therapies is motivated by concern for the welfare of patients?

It is time to look beyond the petty self interested attitude of modern scientific medicine. What matters is the health of patients and the state of public health. Arguments about whether or not the solution to our health care problems should be the exclusive domain of orthodox medicine reveal a self serving arrogance and incredible contempt for the welfare of patients. Such attitudes continue to prevent positive progress in health care while the incidence of heart disease, cancer, and iatrogenic diseases continue to spiral. Although doctors traditionally have had no positive contribution to make about the CAUSE of these illnesses, for the past 200 years we have been subjected to a constant tirade of negative comments about diet and nutrition from mainstream medicine. We urgently need to move on and express more genuine concern about patients and the deplorable public health trends which these self serving attitudes have created. Sadly, there seems to be a section of modern medicine which remains totally devoted to preserving the status quo and preventing change - at any cost.

The public health consequences of the bias and attitudinal problems within mainstream medicine are absolutely enormous. Today we are just beginning to realise that many diseases of modern society, particularly those diseases which are more common in the elderly, are in fact due to malnutrition. The general acceptance of the nutritional basis of these diseases continues to be delayed by the bias and attitudinal problems which are such an inherent part of orthodox medicine. There is not a sudden abundance of new evidence - the evidence has always been there. It is only now that some of this evidence is beginning to be seriously considered.

Nowhere is medicine's neglect of nutrition more obvious than in the shameful treatment of our elderly citizens. Although it has long been common knowledge amongst the medical profession that nutritional deficiencies are epidemic amongst the elderly ( 164, 173, 174, 180, 182 332; see also B vitamins ), 85% of this group being said to suffer from "nutrition related problems" ( 12 ), the profession's neglect of this problem is absolutely disgraceful. Astonishingly, even in nursing homes up to 85% of patients suffer from clinical malnutrition ( 328 ), a fact which is not too surprising considering "nurses in nursing homes were found to lack sufficient nutrition knowledge to meet dietary needs of elderly residents" ( 329 ). 

It is also well known that the elderly, including nursing home residents, require nutritional supplements to supplement their diet because of reduced appetite, poor mastication, digestion, and reduced absorption ( 330, 331; see also B vitamins ). Elderly people given nutritional supplements have been found to have improved immune function, experience less illness, and require fewer antibiotics ( 331 ). It is also known that 10%-49% of elderly people are unable to properly absorb vitamin B12 from food ( 298, 299 ) and it has therefore been recommended that everyone over 50 years of age should take B12 supplements ( 299 ). In spite of the fact that 88% of nursing home patients had "dietary intakes of three or more essential nutrients which were below 50% of the RDA ( 330 ), nursing homes generally refrain from using nutritional supplements ( 330  ). Regardless of all these facts,  doctors and health authorities still pretend these nutritional problems do not exist.  

At a stage of life when symptoms of disease are most likely to be associated with nutritional deficiencies, doctors completely ignore the nutritional needs of elderly citizens and increasingly resort instead to concoctions of toxic nutrient destroying drugs. This deplorable situation continues in spite of overwhelming scientific evidence. This scientific evidence continues to be flagrantly ignored by doctors who are determined to prescribe more and more toxic drugs to that section of the community which they know is most susceptible to the ill effects of drugs, even though medical  literature repeatedly warns of the increased risks in the elderly. Even in hospitals and nursing homes there is absolutely no emphasis upon nutrition or the prevention of the malnutrition which is epidemic amongst the elderly. These actions continue to demonstrate a contemptuous disregard of all the available scientific evidence.

Especially given the frail condition of many of our elderly citizens it is absolutely deplorable that modern medicine continues to display an absolute determination to avoid utilising constructive, strengthening therapies that will better enable the elderly to heal and resist further disease. Even though doctors have long known that it is the elderly who are most likely to suffer serious adverse reactions to drugs, it is nevertheless this group of highly susceptible patients for whom doctors reserve the most unbelievable cocktails of toxic drugs. It is all about "science" and "risk/benefit" they claim.

Today our so called "health" authorities and politicians constantly complain about the costs of the "health" care of our elderly citizens. But the "health" care to which they refer is the huge cocktail of symptom suppressing drugs and surgical procedures which are increasingly being inflicted upon the elderly.  Yet we continue to neglect the malnutrition which scientific evidence reveals is rife amongst this age group. Instead of addressing these nutritional deficiencies with harmless cost effective nutrients, toxic and costly symptom suppressing drugs remain the treatment of choice. Of course it is expensive to constantly seek to conceal symptoms with toxic drugs while ignoring the underlying cause. However, this is the strategy modern scientific medicine uses to treat everyone, not just the elderly. It should come as no surprise that, following a lifetime of concealing symptoms with prescription drugs, it will become much more difficult and expensive to continue to suppress these symptoms as the underlying cause deteriorates with age.

Why do doctors and health authorities refuse to acknowledge that to reserve the most toxic cocktail of drugs for the most vulnerable section of the community is completely lacking in common sense? Is it just that no one cares? How many clinical trials have there been regarding the importance of caring?

It is true that a nutritional paradigm is struggling to emerge in mainstream medicine. But this struggle has been continuing for the past century. It is amazing that medicine has created a general community acceptance of drug dependence and the consumption of cocktails of 20-30 drugs daily to the extent where this is regarded as the norm, something which has been scientifically proven. On the other hand science claims that nutrition is dangerous and needs to be scientifically justified. Of course this is the reverse of the truth. Nevertheless, it is this biased and unscientific attitude which has been preventing nutritional progress over the past century and, unless reversed, will continue to retard progress well into the future. What we need most is a change of attitude and a willingness to accept evidence, not simply more evidence which will not be accepted. We must work tirelessly to counteract the negative effects of bias and drug industry propaganda which continues to obstruct general acceptance of any emerging nutritional paradigm.

The point cannot be overemphasised that the reason our elderly citizens are being forced to endure malnutrition is NOT because the scientific facts are not known, but rather simply because modern medicine cannot accept the reality of the gross error it has been inflicting upon the human race for the past 200 years. When we are dealing with peoples LIVES we should err on the safe side by ensuring a level of optimum nutrition. This is a basic requirement of health care to which everyone is entitled.

We are now told that medicine has suddenly become "evidence based" but yet evidence of the vital importance of nutrition continues to be flagrantly ignored. Twenty five years ago it was officially recommended that nutrition should form a standard part of medical training, but yet nothing has changed, except perhaps that medicine has been given a new name. The type of scientific evidence which is accepted is that which justifies medicine's drug paradigm and increases the profits of drug companies. While evidence of the importance of nutrition relates to the ability of nutrients to CURE disease by addressing the underlying CAUSE, "evidence" of the "effectiveness" of drugs on the other hand, is generally confined to their ability to HIDE symptoms and permit the underlying cause to continue without inconveniencing the patient. If for instance a drug can be shown during clinical trials to hide a specific symptom of a nutritional deficiency then this will be regarded by the scientific community as irrefutable "scientific evidence" of the effectiveness of the drug.

The definition of what constitutes scientific evidence urgently needs to be updated thus: "a remedy can be shown to satisfy the criteria for scientific evidence for a therapeutic substance if it can be shown by scientific or epidemiological studies to prevent or contribute to a reversal of the cause of a condition. Any treatment which lacks this cause based effect and merely has a symptomatic effect should be clearly distinguished from cause based remedies and should therefore be relegated to a separate and inferior class of therapeutic substances. Such a definition would of course provide an extra incentive for the development of cause based remedies.

We urgently need to concern ourselves with real people, not just statistics. We need to concern ourselves with the many elderly citizens who are lying in nursing homes suffering from malnutrition simply because of the anti-nutrition bias of modern medicine. These are real people who are suffering while doctors are content to argue about how dangerous vitamins are and how instead, everybody needs more and more drugs. In the words of Quillin ( 304 ): "how much proof is necessary to convince the science and lay communities of the value of nutrition? Chronic disease has often been linked to nutrition, yet carping intellectuals continually point out pedantic limitations in research. Meanwhile, innocent people suffer and die needlessly because some people refuse to admit they have been wrong about nutrition." Let us cease this "carping" and begin to show some concern for our malnourished elderly citizens.

Unless we address the philosophical and attitudinal problems and bias which continue to confine medicine to the dark ages, then public health, and particularly the health of our elderly citizens, will continue to suffer. Let us begin to respond to what we all know is simply common sense, and which now has also become scientific fact. But most of all, let us begin to respond to the needs of our elderly citizens.

Let us cease merely "dabbling" in nutritional research ( 3, 123, 293 ) and give this matter the attention it deserves. According to Williams and colleagues ( 3, 5 ) what is needed is a change in the fundamental philosophical direction of medicine: "scientifically, nutritional science is a mere shadow of what it will be when medical science throws its weight behind its development by promoting a health-oriented instead of a disease-oriented discipline." This fundamental change in medical philosophy must result in the matter of nutrition being regarded much more seriously by medical schools ( 293 ): "the future of nutritional science is bright and unparalleled, provided we cease merely dabbling into nutritional problems and carry out in our medical schools and elsewhere extensive and intensive study and research."

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