Vitamin D: COVID-19 quacks embrace more general quackery

Remember how I said that I’d get back to normal posting this week? I lied. Well, not exactly. My intentions were good, but family and life interfered. (I won’t provide any further details.) That is why next week is more likely to be when I get back to normal blogging. Still, I couldn’t leave you hanging until next week without commenting on at least one thing I’ve been noticing in the COVID-19 “contrarian” (translation: antimask, antivax, science-denying) crankosphere, namely a little post in which a prominent COVID-19 contrarian and antivaxxer decided that vitamin D is the answer to nearly everything. It came in the form of a post by someone who’s been a dominant subject even during my current posting drought, namely Dr. Paul Marik, cofounder of the quack group Frontline COVID-19 Critical Care Alliance (FLCCC).

What does vitamin D have to do with a bunch of right-wing COVID-19 antivax quacks like the FLCCC? The title of the article is the giveaway. It’s on a Substack, albeit not Dr. Marik’s Substack, by “The Vigilant Fox” (a pseudonymous COVID-19 antivax antimask crank) who describes itself as a “pro-freedom citizen-journalist,” allegedly with “12 years of healthcare experience,” whatever that means. The article is entitled The Healing Power of Vitamin D: What Big Pharma Doesn’t Want You to Know—because of course it is—and leads to an article on Vigilant News with the same title. The tagline just cracked me up, too:

We know the medical establishment lied to us about COVID. And according to esteemed physician Dr. Paul Marik, they are also lying to you about the sun.

Yes, Dr. Marik is the featured physician interviewed for the piece, and the ad that preceded the video was for some sort of “chakra balancing” mat:

If there’s one thing that the last three and a half years of pandemic has taught me, it’s that there really is a “rabbit hole” effect when it comes to misinformation, pseudoscience, and quackery and that physicians are just as prone to it as anyone else. Early in the pandemic, seemingly respectable physicians with ideological views that went counter to the sorts of public health interventions being instituted to slow the spread of COVID-19 started believing somewhat “contrarian” things, such as the idea that COVID-19 was not as big a threat as advertised, that masking is not as effective as promoted, and that perhaps the economic effects of “lockdowns” (although the US never had a true “lockdown” anywhere) outweighed the benefits.

It’s the sort of beliefs that led formerly respected doctors like Dr. John Ioannidis to publish lowball estimates for COVID-19 case fatality rates very early in the pandemic and advocate for a “natural herd immunity” approach to the pandemic, the sorts of ideas that by October 2020 had gelled into the Great Barrington Declaration (GBD), in which a trio of “contrarian” doctors and researchers brought together by a right wing think tank proposed a “let ‘er rip” approach to the pandemic in which the young and healthy (and presumably at low risk for COVID-19 complications) allowed to go on with their lives and catch COVID-19 whenever they catch it to contribute to “natural herd immunity,” with an ill-defined strategy of “focused protection” proposed to keep those at very high risk of COVID-19 complications safe. (Also, remember that the GBD was issued months before any vaccine was expected to be available and more than two months before the vaccines did arrive much faster than expected.) It was a eugenicist approach to the pandemic that never would have worked, as one of its proponents ultimately accidentally sort of admitted, albeit inadvertently.

In any event, I watched as formerly respected physicians, particularly those with large social media followings, went further and further down the rabbit holes of misinformation, becoming more and more indistinguishable from “old school” antivaxxers (and even embracing many of their claims, while others increasingly embraced quackery not just for COVID-19 but for cancer and other diseases as well; e.g., when Tess Lawrie embraced ivermectin for cancer and homeopathy for, well, everything. The point is simple: Once you embrace the Dark Side of medical misinformation, forever will it dominate your destiny, and it’s rare for physicians who’ve started down that path to reverse themselves. Quite the opposite, in fact. Nearly all of them keep going further and further down the dark path.

Which brings us back to Dr. Marik and vitamin D:

“I think everyone on this planet should take vitamin D, and I don’t think that’s an underestimate,” expressed accomplished physician and author of 500 peer-reviewed journal articles Dr. Paul Marik.

In an interview with Children’s Health Defense, Dr. Marik explained — similar to how Big Pharma doesn’t like the “I drug” (Ivermectin) for treating COVID-19 — they also don’t like Vitamin D for general health and well-being. Because if you are in good health and devoid of chronic disease, there’s less money to be made.

If you’re the subject of fawning interviews with Robert F. Kennedy, Jr.’s antivax organization, you really have lost any claim to being a science-based physician.

In addition, Dr. Marik makes some rather bold declarations that would not be out of place over at Natural News:

“What you may not know is if you’re vitamin D deficient, it increases your risk of getting cancer,” Dr. Marik revealed.

“There’s a linear relationship between vitamin D deficiency and cancer. And the further you go away from the equator, the less UVB you get, the greater your risk of cancer. This has been well established!” Dr. Marik stressed.

“And now there’s really good data, really good data. If you take vitamin D, it prevents cancer. Isn’t that amazing?” he asked. In a previous article from Vigilant News, Dr. Marik explained how a daily regimen of taking Vitamin D, fish oil, and a simple exercise program could reduce your risk of cancer by 60%.

“Cancer is going to become the single most important cause of morbidity and death. It’s going to take over from cardiovascular disease, and it’s related to our lifestyle and all the toxins we’re exposed to,” Dr. Marik concluded.

I was curious about the article referenced. Unsurprisingly, it was also published on Vigilant News and entitled Reduce Your Cancer Risk by 60%: 10 Things You Can Do, Per Dr. Paul Marik. Naturally, it begins with an appeal to (false) authority:

Dr. Marik is the world’s second-most published critical care physician and has written over 500 peer-reviewed journal articles.

Even if this were true, let’s just say that a record of publishing a lot on critical care medicine doesn’t make Dr. Marik an expert on cancer prevention. It shows, too:

Conventional medicine suggests mutations in the DNA within cells are the primary cause of cancer, but “it’s really due to lifestyle changes, insulin resistance, vitamin D deficiency, obesity, and processed foods that [are] driving this exponential increase in the risk of cancer,” refuted Dr. Marik.

This is a narrative that cancer quacks have been pushing ever since I started paying attention to cancer quackery back in the 1990s, although this part about the Warburg effect is a bit more recent, dating back to the early 2000s when there was a resurgence of interest in the metabolic contributors to—not “causes” of—cancer:

In 1927, Otto Warburg observed a particular effect present in every cancer cell: they have faulty mitochondrial metabolism and rely on anaerobic means for fuel consumption. As such, cancer cells are heavily reliant on glucose. Dr. Warburg “won the Nobel Prize in 1931 for this finding,” reported Dr. Marik.

Building on Dr. Otto Warburg’s research on cancer cell metabolism, Prof. Thomas Seyfried has further advanced the understanding of cancer. He has compellingly shown that cancer should be viewed primarily as a metabolic disorder rather than a mere chromosomal defect. As such, he argues treatments should target the disease’s metabolic nature rather than just its genetic anomalies.

This narrative is, of course, very attractive for the same reason that a lot of claims about “lifestyle” and health are attractive, because it suggests that we have near-total control over our health, in this case whether we get cancer or not. Of course, I’ve written about the Warburg effect before. Remember dichloroacetate to treat cancer 13 years ago? Let me just recount a bit about the Warburg effect. In brief, Otto Warburg first described this effect in 1928 and reported in Science back in 1956. In the early 2000s, cancer researchers increasingly appreciated the role of abnormalities in metabolism, in particular the mitochondria, in cancer. To put it briefly, many cancers (approximately 60-90%) favor glycolysis, even in the presence of adequate oxygen for oxidative phosphorylation, leading to a voracious appetite for glucose. Indeed, it is this very avidity of cancer cells for glucose that is the basis of the PET scan, which detects the high uptake of a radiolabeled form of glucose by cancer cells relative to the surrounding normal cells.

The problem, of course, has boiled down to a sort of “chicken or the egg” argument about what is more important and what is the first abnormality leading to cancer. The traditional view has long been that mutations in DNA lead to the activation of protooncogenes into cancer-initiating and causing oncogenes and to the shutdown of tumor suppressor genes. Under this model, mutations leading to cancer also lead to the observations of abnormalities in metabolism. In the wake of the DCA furor, there have been data reported suggesting that the metabolic derangements may actually occur first or simultaneously with the mutations. p53, for instance, the granddaddy of tumor suppressor genes, can trigger the Warburg effect when mutated. Whatever the case, it has become fairly clear that abnormalities in cancer cell metabolism are also very important in driving cancer growth and could well represent targets for cancer therapy. AS a result of these new data, studying the metabolism of cancer cells has become a much hotter topic of research than it has been in the past. Everything old is new again, it seems. However, I also note that since 2010 interest in targeting the Warburg effect seems to have waned, likely for the same reasons that interest in targeting tumor angiogenesis, which was all the rage in the 1990s, waned: Real world results in humans didn’t live up to the hype.

But back to vitamin D. Leave it to Dr. Marik to parrot all the usual quack tropes about vitamin D, such as cleaning that “They” don’t want you to know about its amazing anticancer properties. (If that’s true, then why are there thousands of articles in PubMed that study just that?) He even doubles down on the conspiracy theory:

They design Vitamin D studies to fail, declared Dr. Marik. “So, when they design studies, they design them to fail using very low doses. To give 2000 units a day in these randomized trials is an absurdity. It’s a tiny dose. But they do that because they want the studies to fail, and they [conclude] it doesn’t work.”

Because of course “they” do. Why else would the expend the years of effort and millions of dollars to study whether vitamin D prevents cancer other than that “they” want the studies to fail? Then, “brave maverick” that he is, Dr. Marik goes all sun worshiper and claims:

Dr. Marik brought up a “really interesting study” about women who were sun averse, or afraid of the sun. What was discovered in that study was “If you avoid the sun, it increases your risk of dying [prematurely] by about 25%,” revealed Dr. Marik.

Dr. Marik recommended going into the sun for about 30 minutes a day. He advised not to use sunscreens because “it defeats the purpose.” “In fact, there’s some data that sunscreens increase your risk of melanoma — paradoxically.”

Going against the medical orthodoxy again, Dr. Marik shared an interesting perspective on sunshine and melanoma.

“Sunshine is really good. Something even more interesting is that sunshine prevents cancer. If you have melanoma, the best thing you can do for melanoma is to go into the sunshine. Isn’t that paradoxical?” he asked. “And, in fact, in Italy, there are spas that offer suntanning excursions for people with melanoma to suntan. Isn’t that remarkable?”

Notice how the article describing the interview with Dr. Marik didn’t include any actual studies to back up those last two claims that sunscreens increase the risk of melanoma and that sunshine prevents cancer. Maybe Dr. Marik lists them in his book that he’s hawking about repurposed drugs to treat cancer. (I wonder if he mentions my favorite one, riluzole, about which I’ve done actual bench research? Probably not.)

Perhaps I should write a more detailed discussion of vitamin D in cancer. Until then, let me just say that the question of vitamin D and cancer is far more complex than vitamin D cancer quacks like Dr. Marik let on. For example, a recent study examining data for the risk of 14 different cancers based on vitamin D levels in the blood came up with disappointing results. It only found a definite association between vitamin D levels and the risk of one cancer suggesting causality: melanoma. It also found a suggestion of a correlation for colorectal cancer. For the other twelve cancers, it found no evidence of a potential causal relationship. One other study suggests that elevated vitamin D levels are associated with an increased risk of melanoma.

The bottom line is that, whatever effect vitamin D levels have on cancer risk, it is nowhere near as simplistic as Dr. Marik’s assertion that vitamin D is always anticancer and that sun exposure is good for you with respect to cancer risk. Not that that stops him from citing elsewhere a study that supports his claim that you can easily reduce your risk of cancer by 60%, specifically three interventions: Supplemental 2000 IU/day of vitamin D₃, and/or 1 g/day of marine omega-3s, and/or a simple home strength exercise (SHEP) programme compared to placebo and control exercise.

The interesting thing about this study is that no one argues that exercise can’t modestly decrease your risk of cancer. It can. However, in this study, none of the interventions tested individually produced a statistically significant reduction in cancer risk. They all produced a modest decrease in risk, but it wasn’t statistically significant. For example, for vitamin D, the adjusted hazard ratio was 0.70 (0.44–1.09, 32 vs. 49). Note that confidence interval. It overlaps 1.0, indicating that the effect size did not reach statistical significance. Only combinations of interventions started to reach statistical significance, and for all three the adjusted hazard ratio was 0.39 (0.18–0.85; 4 vs. 12 cases). (That’s where the 60% reduction comes in, a hazard ratio of 0.39, which would correspond to a 61% risk reduction.) Given the small number of cases and the lack of statistical significance for individual interventions tested, color me unimpressed. Also color me completely unimpressed with the vitamin D arm of this study, which basically showed that vitamin D doesn’t work.

It has been both fascinating and distressing to watch so many physicians dip their toes in COVID-19 contrarian waters, only to wade deeper and deeper into the pool before pounding headfirst into the depths of quackery and pseudoscience. It suggests a process of radicalization with respect to denying medical science that is near-inexorable, at least if the physician (like Dr. Marik) is left to his own devices. The question is: Are there points in the process where an intervention might reverse the quack radicalization? Are there strategies of teaching critical thinking that might—dare I say?—inoculate young physicians against starting down the path to become a quack like Dr. Marik? These are not new questions, but the pandemic has made answering them more urgent.