Looking Back, Looking Forward

Editorial I n the mid-1700s, the medical establishment believed that scurvy was a disease of putrefaction that was treatable with an elixir of vitriol and wort. The benefit of citrus was dismissed as unproven despite the fact that its regular consumption to prevent scurvy had been used by some cultures since antiquity and the English military had recommended citrus for scurvy for more than 50 years. In 1747, Scottish physician James Lind chose 12 sailors suffering from scurvy for a clinical trial. Those treated with citrus fruit quickly recovered. In Lind's day, it was not known that vitamin C was necessary for the maintenance of healthy connective tissue. Today, people around the world are spending billions of dollars annually on vitamins and supplements despite limited scientific evidence that regular supplementation is useful for the prevention of disease. A recent article concluded that " β-carotene, vitamin E, and possibly high doses of vitamin A sup ple ments are harmful " and that " other antioxidants. .. are ineffective for preventing mortality or morbidity. " 1 How and when are vitamins and supplements useful? In 1900, the annual mortality rate from infectious diseases in the United States was approximately 800 per 100 000, falling to 63 deaths per 100 000 in 1996. 2 In 2013, the US Food and Drug Administration issued voluntary " guidance rules " to reverse the steady increased usage of antibiotics to promote animal growth that accounts for 80% of the antibiotic usage in the United States. According to the US Centers for Disease Control and Prevention, more that 20 000 people die annually from an antibiotic-resistant infection. Have we entered an era in which one of the foundations of modern medicine is marginalized? The emergence of H7N9 influenza virus, a virus with a high case-fatality rate (50 deaths) in the population-dense areas of Asia, is a concern, as is the reappearance of the H1N1 influenza strain that caused the worldwide pandemic in 2009 and the Middle East respiratory syndrome , which has a primary case-fatality ratio of almost 75%. Can we develop vaccines that are safe and effective in a timely fashion? Statins are routinely prescribed for the prevention of cardiovascular disease. The statin industry, driven by industry-sponsored trials, has been a spectacular commercial success, overshadowing the need for attention to lifestyle interventions, exercise, and nutrition. A recent randomized trial showed that a Mediterranean diet reduced the …