Vitamin D and Public Health Communications

For a number of years health researchers and communicators have been suggesting that the population may be deficient in Vitamin D and calcium, and this not only is a concern for bone health, but also may have negative consequences on a number of important chronic diseases, such as heart disease, cancer, and diabetes. It has been suggested that the shortage is due to a decrease in milk consumption and growing caution about limiting sun exposure.

No reputable health information source has trumpeted loudly the benefits of taking supplements of calcium and Vitamin D, but there has been much media discussion by "experts" and consumer health advocates, and curious consumers could go to prominent health information websites (e.g. Mayo Clinic, National Institutes of Health) and get the idea that there probably is some benefit to increasing consumption of those two nutrients.  Those consumers would also have found inconsistencies regarding how much intake is recommended and how much is safe.  The U.S. Preventive Services Task Force, well respected as a guide to disease prevention efforts in clinical care has been silent regarding this issue, except in reference to osteoporosis.
 
This week, the Institute of Medicine has issued a report regarding the health claims and hazards of Vitamin D and calcium supplementation.  The Institute determined to thoroughly review the published literature on the topic and issue a report establishing, for now, the state of the science.  The work of the review was the responsibility of a committee of experts from reputable institutions in the U.S. and Canada.  Their findings were: 1) the only certain health benefit of calcium and Vitamin D supplements is to promote bone health; 2) most people are not deficient in these nutrients, and therefore don't need supplements.  Readers are encouraged to review the report to fill in the details.
 
My reason for writing about this is not to add anything to the Institute's work and report, but to consider the implications for public education and health promotion.  We live in a world of unbridled access to health information, some dependable, some not so much.  The profession of journalism seems to be on life-support and anyone (including bloggers!) can be an unfiltered source.  Consumers are covered with a nonstop stream of health-related ideas and are often unprepared to process and detect value.  Furthermore, their task becomes even more difficult when the experts disagree or change the recommendation.  They deal with communicators who have varying degrees of skill; the least effective communicators might be the most accurate and reliable sources, but how is the consumer to know?  I analyzed the Institute of Medicine report and note that the narrative tests at college junior year reading level, hardly suitable for the average consumer.  Finally, those of us living in the health promotion professional world accept the Institute of Medicine as eminently reliable;  the average consumer is much less likely to be impressed by that name.  They have learned that organizations frequently call themselves misleading names (see also, political campaign advocacy groups).
 
There is no question that the work of health promotion would be easier if the flow of information could be managed, but that is not possible, and also not fully desirable in a free and open society.  The problem that confronts us is how to help consumers sort the rubies from the rubbish, and to apply simple rules to assess a source and the specific health information content.  At the present time, no single source is the single go-to place for people to seek answers to health questions.  Significantly not included as the single source is the primary physician, because the practice of medicine in 2010 and going forward is not really hospitable to quality health counseling, and a single practitioner cannot be as fully informed as a large organization with abundant resources.
 
The combination of proliferating sources and the changing nature of health science means that a very important role for health promotion is helping people maneuver the communication environment.  We also have to help people understand that science-based guidance will change as the research machine does it's work.  Everyone's job is to try to find the most accurate advice and follow it until such time as there is a trustworthy indication to change.  There are no simple solutions, and this will not be done with perfect effectiveness.