After The Multivitamin Study Comes Multimedia Ad Campaign

Yesterday, many major news outlets covered the story of an 11-year study of multivitamins that suggested men who take them have a slightly reduced risk of developing cancer.

The vitamins’ effect on cancer was “modest — an 8% reduction in the risk of total cancer," said the study’s co-author, Dr. Howard Sesso, an associate professor of medicine at Brigham and Women’s Hospital. But he said the findings were important  “given how little we know about the prevention of cancer in general.”

But perhaps even more striking than the vitamins' modest health benefit was what happened today: a decidedly un-modest advertising campaign on television and in newspapers touting the multivitamins used in the study — Centrum Silver, owned by drug giant Pfizer.

There was a full page ad in The New York Times promoting the vitamins as: "Most doctor recommended; Most preferred; Most studied." Interestingly, the ad doesn't mention any reduced cancer risk, but maybe in this age of tainted drugs, "most studied" is an even more reassuring claim.

And here's what CommonHealth's co-host Carey Goldberg confronted during her morning workout:

I was on the elliptical at my gym at a little after 8 this morning, looking up at the array of a half dozen television screens, and was amazed to see ads for Centrum Silver on three televisions at once, apparently all three major networks, touting the vitamins as not just most recommended by doctors but "most studied." It surely is "most studied" after a trial of 15,000 men over more than a decade, but I felt like a total tool for writing about that trial yesterday.

Indeed, as soon as the study was released, the promoting kicked in. For instance, here's part of Pfizer's cheerleading press release on the vitamins and offers of myriad company executives to interview about the results:

Pfizer Consumer Healthcare, the makers of the number one doctor-recommended Centrum® multivitamin, is very pleased that study investigators at Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, chose Centrum® Silver® for the Physicians Health Study II. The Centrum® multivitamins’ quality, among other factors, led investigators to choose Centrum® Silver® for the duration of the 12-year study that tested the role of multivitamins in relation to long-term health benefits. Centrum® Silver® multivitamins currently available in stores have since been updated and improved to reflect advances in nutritional science. Being selected to be a part of such a landmark study adds to Centrum® multivitamins’ proud heritage of being the most-studied, the most-recommended, and the most-used multivitamin brand in America, which helps people fill dietary gaps when they aren’t fulfilling all their nutritional needs through food alone...

We can also help identify key opinion leaders that are experts in the area of nutrition and dietary supplements, such as Dr. Balz Frei, PhD. Again, Pfizer Consumer Healthcare, the makers of Centrum® Silver®, is extremely pleased to be a part of this historic study and we are happy to be of any help as you are covering the story.

I asked Gary Schwitzer, publisher of HealthNewsReview.org, which analyzes media coverage of news stories, for his thoughts on the big ad buy so closely timed to the study's release (and whether journalists should worry about it). He wrote back:

...reporting on a study published in JAMA does not in and of itself make one complicit in a marketing campaign. But failure to connect the dots, failure to point out how marketing often leapfrogs/exaggerates/oversells the science does begin to make messengers complicit in a marketing campaign. in the face of the firehose of marketing messages drowning journalists and the public at times like this, journalists are obliged in my view to scrutinize evidence, critically analyze the evidence, quantify the potential harms and benefits in terms the public can understand, seek independent perspectives, use the kind of tools we provide in our toolkit on HealthNewsReview.org and avoid becoming a tool of industry themselves.

Schwitzer's reviewer is currently writing a separate post on the study's findings, but he offered this:

I'll share with you the preliminary comments made by one of our reviewers, Kevin Lomangino, journalist who is Editor-in-Chief of Clinical Nutrition Insight, a monthly evidence-based newsletter which reviews the scientific literature on nutrition for physicians and dietitians. He thought AP did a better job. Kevin is really good. Excerpts of his review:

"As the AP coverage explains, the benefit worked out to about one fewer cancer per thousand men each year. In the AP's words: "For every 1,000 men per year in the study, there were 17 cancers among multivitamin users and more than 18 among those taking the placebo pills." That's a much more informative way to describe things than simply calling it an 8% reduction, as Reuters did.

AP explained that these results in and of themselves do not justify a broad recommendation to take a multivitamin. "...the results need to be confirmed by another study before recommending multivitamins to the public," the AP noted. The AP was also a bit clearer on the fact that questionnaire-based studies (observational studies) are generally considered less reliable than the trial being reported on here.

In lots of little ways, this AP piece exemplifies the difference between very good and outstanding health reporting. Compared with the solid effort from Reuters, the AP's take was just a little more thorough in its evaluation of the evidence and its implications for readers. Some examples:

The story breaks down benefits in terms of absolute, not just relative, risk.
There is a clear differentiation between observational studies and randomized, controlled, trials.
The involvement of commercial support, small though it may be, is acknowledged.
The story cautions that specific groups of people may be at risk of harm from vitamin supplements
The AP did require about 100 more words to deliver these details, and we realize that space is always a concern. Sometimes it does take a little more space to thoroughly address all of our criteria.

The story was very cautious in its framing of the results, quoting a researcher who called the effect "very mild" and who said he wasn't sure it's significant enough to recommend to anyone. The story also took the time to explain exactly what the benefit looked like in absolute terms: "After about 11 years, there were 2,669 new cancers, and some people had cancer more than once. For every 1,000 men per year in the study, there were 17 cancers among multivitamin users and more than 18 among those taking the placebo pills. That worked out to an 8% lower risk of developing cancer in the vitamin group." The competing Reuters coverage didn't provide these details.

Current evidence is unclear as to whether vitamin supplements help prevent chronic diseases, and they’ve been shown to cause harm in some cases. That's why, with the exception of people suffering from a vitamin deficiency, most of us are advised to get our vitamins from food instead of supplements. The current consensus, however, is based on studies that typically used high doses of a single vitamin. The low-dose multivitamin used here doesn't seem to cause the same problems seen in other research, and may even offer a benefit for men similar to those in this study. That's good news, of course, but it's hard to get too excited considering the very small size of the reduction, which is barely outside of the range that would be considered statistical noise. It's the kind of finding that could easily be reversed when the next study comes around--and readers should be warned accordingly.