Clinicians should feel comfortable with recommending nutritional supplements for patients with or at risk for AMD. Reports published in highly respected journals such as Archives of Ophthalmology have reported that hundreds of thousands of people could benefit from vitamin supplements shown to help prevent macular degeneration, the condition that is one of the leading causes of vision loss.
By October 2001 and earlier, researchers had found a reduced risk of advanced age-related macular degeneration (AMD) and vision loss for test subjects who had been given high-dose antioxidant supplements -- vitamins C, E and beta carotene -- as well as zinc (at levels that far exceeded the safe upper limit). This report reduced the criticism of those physicians who advised nutritional supplements for at-risk patients, but questions of ethical promotion remained. Physicians who made these products available in their offices were often criticized.
Researchers at the Johns Hopkins Medical Institutions in Baltimore in their November 2003 report concluded that there were 8 million Americans at least 55 years old at high risk for AMD. "If even half of the individuals at high risk for AMD were identified and compliant with the recommendations, it is likely that more than 150,000 individuals would avoid vision loss," according to the study (their words, not mine).
In a dramatic reversal of its long-held policy of opposition to nutritional supplements, the American Medical Association in June 2002 announced the recommendation that everyone supplement their diet with a full-spectrum multiple vitamin /mineral /antioxidant formula to help prevent and slow the progression of all chronic degenerative diseases. This followed a 2001 report of the National Center for Chronic Disease Prevention and Health Promotion, (a division of the Center for Disease Control) that fewer than 25% of the American population ate 5 fruits – the recommended daily amount at that time. Today the recommendation is 9 to 13 servings (a serving is about half a cup) of a variety of fruits and vegetables, to meet the daily requirements of vitamins, minerals and antioxodants. Fewer than 10% of today’s population consumes 9 to 13 servings per day, according to recent government reports.
Because advances in science come so rapidly today it is hard for physicians to keep up. Leaders in traditional medical care, governmental and institutional, consistently lag behind new developments, and pharmaceutical companies oppose anything that reduces their monopoly in healthcare. Opposition to new science is frequently based on ignorance of new discoveries, and early adapters to breakthrough discoveries are criticized by those preferring to stay in their comfort zone using older methodology.
The ethical issues and conflicts facing ophthalmology and optometry today have precedents in the past. Early intraocular lens implanters were accused of planting “time-bombs” in eyes. Early refractive surgeons were called “buccaneer eye surgeons”. What is different about them now is that the conflicts are played out in new areas with added complexities, and, as with other major advances in health care, it is likely that those who are leaders in the field of nutritional therapy today will be hailed in years ahead as pioneers and honored for their foresight.
There are lessons to be drawn.
First, the problem of identifying ethical principles in a rapidly changing world. Today, society demands open disclosure. Physicians are more informed and do not need “authority figures” to tell them how to make ethical judgments. To the question, “to whom is the physician accountable,” the answer remains, “the patient”.
Ethics is that which results in the greater good. Our patients deserve it.
Those who use the information and products resulting from this research will live longer and healthier lives.
Spencer Thornton, MD FACS
Biosyntrx PresidentReferences• Bressler N, Bresler S, Congdon N, et al. Potential public health impact of Age-Related Eye Disease Study results: AREDS report no.11. Age-Related Eye Disease Study Research Group. Arch Ophthalmol 2003;121:1621-1624.
• Bressler N, Bresler S, Congdon N, et al. Age Related Eye Disease Study. The AREDS Research Group. Arch Ophthalmol 2001;119:1434.
• Fairfield K, Fletcher R. Vitamins for chronic disease in adults: scientific review. JAMA 2002;287:3116-3126.
• Lee P, Feldman Z, et al. Longitudinal prevalence of major eye diseases. Arch Ophthalmol 2003; 121:1303-1310.