A trial begins this week in Italy where six leading Italian scientists and one government official are being charged with manslaughter in connection to public advice given on March 31, 2009 regarding the likelihood of a major earthquake in L’Aquila, a town 55 miles northeast of Rome [Hall, 2011].
On that day, the group had met to review evidence on the likelihood of a major earthquake occurring. The day before, a 4.1 magnitude earthquake hit L’Aquila, after a several month series of magnitude-2 earthquakes and increased radon gas emissions from four monitoring stations in the area that month. The scientists largely discounted the evidence as a sign of increased risk. Some of them went on TV and claimed that the situation was normal and that the small earthquakes relieved stress and reduced the risk of a major earthquake.
To boot, the national civil-protection officials forbid Giampaola Giuliani, a retired laboratory technician who observed the increased emissions and made public warnings, from making any further warnings to the public.
At 11 p.m. on April 5, a foreshock hit the town. “That night, all the old people in L’Aquila, after the first shock, went outside and stayed outside for the rest of the night,” Vittorini says. “Those of us who are used to using the Internet, television, science—we stayed inside” [Hall, 2011]. At 3:32 a.m. on April 6, a magnitude-6.3 earthquake hit, killing more than 300 people, damaging thousands of buildings, and leaving 65,000 people homeless [http://en.wikipedia.org/wiki/2009_L’Aquila_earthquake].
According to the article in Nature, a paper published in 1988 states that there is a 2% chance of a major earthquake striking within a few days after a series of small earthquakes accompanied by a medium-sized earthquake [Grandori, 1988].
When thinking of this trial, the tragic earthquake and the scientists’ failure to make the needed precautionary warnings (despite surmounting evidence), I can’t help but think of the Institute of Medicine’s (IOM) failure in late 2010 to make the needed increased recommendations for vitamin D intake and serum 25-hydroxyvitamin D levels.
The Committee to Review Dietary Reference Intakes for Vitamin D and Calcium reviewed evidence from peer-reviewed literature and concluded that the only health benefit of vitamin D with adequate proof was prevention of bone diseases. Their idea of proof was a well-designed randomized controlled trial of vitamin D supplementation. They looked upon ecological and observational studies as unreliable evidence to increase recommendations, yet did not hesitate to point to observational studies reporting increased disease risk with higher serum 25(OH)D levels as reason not to recommend higher intake and serum levels.
The general conclusion of the report was that most people require 600 IU/day of vitamin D and a serum 25(OH)D level of 20 ng/ml, with those over the age of 70 years requiring 800 IU/day vitamin D [IOM, 2011; Ross, 2011].
The committee erred in not using ecological and observational studies as the basis for recommendations.The committee erred in not using ecological and observational studies as the basis for recommendations. People obtain most of their vitamin D from UVB light. An understanding of the mechanisms involved with vitamin D, studies of geographical and temporal variations of disease outcomes from ecological studies, and studies on development and death from diseases related to oral intakes and serum 25(OH)D levels provide more than enough evidence that vitamin D greatly reduces the risk of disease; that recommendations for intake and blood levels need to be higher.
In one of my studies, I estimated that if 25(OH)D levels at the population level increased from 20-25 ng/ml (50-63 nmol/L) to 45 ng/ml (113 nmol/L), mortality rates would decrease by 7-20% and life expectancies would increase by 2 years globally [Grant, 2011]. I also estimated that 400,000 people prematurely die every year in the United States due to inadequate 25(OH)D levels [Grant, 2009]. These data are based on studies that were available the same time that the IOM committee made their recommendations.
Keep in mind that the IOM committee was funded by the Agricultural Research Service, Center for Nutrition Policy and Promotion, Department of the Army, Food and Drug Administration, Health Canada, Office of Disease Prevention and Health Promotion and the National Institutes of Health. The 2011 report on dietary reference intakes for calcium and vitamin D from the IOM can be considered an official government policy report.
The 14 IOM committee members who convened to make recommendations have been publishing papers in leading medical journals promoting their recommendations. In doing so, they are encouraging people to ignore the vast body of literature supporting beneficial effects of vitamin D, thereby, in my opinion, subjecting millions of people to easily prevented illnesses and premature deaths.
The trial in Italy shows that scientists and government officials all over the world can possibly be held liable for their failures in making adequate and precautionary recommendations. If people in the United States prematurely die every year due to the low vitamin D intake and blood levels the IOM recommendations, can we not hold the IOM, the committee members and the government liable as well?
Aspinall W. Check your legal position before advising others. Nature. 2011 Sep 14;477(7364):251.
Grandori G, Guagenti E, Perotti F. Alarm systems based on a pair of short-term earthquake precursors. Bull Seismol Soc Am. 1988;78:1538-49.
Grant WB. In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermato-Endocrinology, 2009;1(4):207-14. http://www.landesbioscience.com/journals/dermatoendocrinology/article/Grant3DE1-4.pdf
Grant WB. An estimate of the global reduction in mortality rates through doubling vitamin D levels. Eur J Clin Nutr, 2011 September;65:1016-1026.
Hall SS. Scientists on trial: At fault? Nature. 2011 Sep 14;477(7364):264-9.
Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011 Jan;96(1):53-8.