Loading...
Vitamins were among the most exciting discoveries of the early 20th century. Since then, however, doctors have been expressing a lot of skepticism about the value of taking vitamin supplements. A pronouncement in 2022 from the United States Preventive Services Task Force (USPSTF) continued that tradition. Readers are curious about the potential value of supplements for specific purposes, such as preventing cataracts.
Can Taking Vitamin Supplements Help You Avoid Cataracts?
Q. As a registered dietician, I have been amazed at the number of people who get less than the recommended daily intake of vitamin C. I recently read a research article suggesting that higher vitamin C intake is associated with lower risk of cataracts. I wonder whether eye doctors ever recommend this crucial nutrient as a preventive strategy.
A. We tracked down the research you located in Acta Ophthalmologica (May, 2016). The authors reviewed the scientific evidence and concluded that high vitamin C intake “is associated with a reduced risk of cataract, especially in America and Asia.” They advocate for vitamin C as a “primary prevention of cataract.”
Many ophthalmologists do recommend the AREDS formulas to slow the progression of macular degeneration. These supplements contain 500 mg of vitamin C, which is substantially higher than the RDA. For men, that is 90 mg a day, while for most women it is 75 mg. You can learn more about strategies to maintain eye health from our Show 1402: How You Can Protect Your Precious Eyesight and Keep Your Eyes Healthy.
Research on the Value of Multivitamins:
Despite the lack of enthusiasm from some healthcare experts, evidence is building that older people who take multivitamins may be slowing cognitive decline. The COSMOS trial (Cocoa Supplement and Multivitamin Outcomes Study) was a large, randomized controlled trial involving more than 20,000 participants for five years (American Journal of Clinical Nutrition, June 2022). The researchers had focused most of their attention on cancer and cardiovascular outcomes. Volunteers taking multivitamins (Centrum Silver daily) were less likely to develop lung cancer. There were no significant changes in the risk of heart attacks, strokes or other types of cancer.
Do Multivitamins Help Preserve Memory?
The investigators also included cognitive tests on three different subsets of COSMOS participants. In the first one, reported last spring, 3,500 older individuals took online cognitive tests at the beginning and yearly during the trial for a total of three years. Those taking multivitamins performed significantly better than those on placebo for immediate recall (American Journal of Clinical Nutrition, May 24, 2023).
The researchers concluded:
“Daily multivitamin supplementation, compared with placebo, improves memory. Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age.”
Global Cognition Improves; Executive Function Doesn’t:
Now, results from two other groups in COSMOS have been analyzed. Even more important, a meta-analysis covers results from all three of these investigations (American Journal of Clinical Nutrition, Jan. 18, 2024). Some of these volunteers were tested in the clinic (COSMOS Clinic), some online (COSMOS Web) and some were evaluated each year over the phone (COSMOS Mind). The results were broadly consistent among these different groups. People taking multivitamins scored better over the years than those on placebo. The benefit overall could be compared to a two-year delay in cognitive aging. Not all aspects of cognitive function got the same boost. Episodic memory improved quite a lot, while executive function (the ability to plan and prioritize) did not.
We should point out that multivitamins are not a magic bullet against cognitive decline. To preserve brain power, people should probably also be getting adequate sleep, physical activity and a healthful diet rich in vegetables and fruits. To learn more about this holistic approach, you may wish to listen to our interview with Dr. Dale Bredesen. It is Show 1269: How the First Survivors of Alzheimer’s Saved Their Brains.
USPSTF Threw Shade on Taking Vitamin Supplements:
The USPSTF did not consider cognitive function when it published a review of the evidence on vitamins and minerals against heart disease or cancer (JAMA, June 21, 2022). The authors reviewed 84 studies including people with no known cardiovascular problems or cancer at the outset. They also had no vitamin or mineral deficiencies. In this population, multivitamins were linked to a small but statistically significant drop in the risk of cancer, including lung cancer. On the other hand, beta carotene was associated with a higher risk of lung cancer as well as death from cardiovascular diseases.
The USPSTF presented this evidence to support its recommendations, also published this week (JAMA, June 21, 2022). The committee recommends that people avoid taking beta carotene or vitamin E supplements. In its view, the evidence is not adequate to recommend either for or against multivitamins or other supplements to prevent cancer or heart disease.
Exceptions Worth Knowing:
We are not convinced, however, that taking vitamin supplements is always a bad idea. One study showed that vitamins can actually help reduce the risk of certain chronic diseases. There are also some medications that may increase our need for vitamins. That may tip the balance in favor of supplements.
Do Vitamin Supplements Lower the Likelihood of Autoimmune Disorders?
Autoimmune disorders are common, affecting tens of millions of Americans. Rheumatoid arthritis, psoriasis, lupus, Graves’ disease, Hashimoto’s and polymyalgia rheumatica, among others, all count. Now results from a five-year randomized controlled trial indicate that supplements of vitamin D and omega 3 fatty acids reduce the risk for developing autoimmune disease.
The VITAL Trial:
The VITAL study included more than 25,000 adults. It asked whether vitamin D or omega-3 supplements could lower the chance of heart disease or cancer. The results were disappointing (New England Journal of Medicine, Jan. 3, 2019). Reductions in cancer and heart disease were modest and not significant.
The scientists didn’t stop there, however. During the study, they collected data allowing them to evaluate a link with autoimmune conditions. Analysis shows that people taking vitamin D3 for five years were about 22 percent less likely to get a diagnosis of an autoimmune disease (American College of Rheumatology, Nov. 4, 2021). For omega-3 supplements, the drop in diagnosis was around 18 percent.
Lead author Dr. Karen Costenbader noted in reporting the study that
“there are no other known effective therapies to reduce the incidence of autoimmune diseases.”
To us, that suggests taking vitamin supplements is valuable. However, that hasn’t always been the conventional view.
Are Vitamin Supplements a Waste of Money?
For nearly 40 years, there was a consensus among health professionals that most people should not be taking vitamin supplements. Their view has been that this does no more than lead to expensive urine.
Just Eat a Well-Balanced Diet:
The standard advice is to eat a well-balanced diet. No one can argue with that sentiment, but what does it mean? A well-balanced diet is rarely defined beyond a vague idea of eating your vegetables. The USDA suggests that people should eat between five and nine servings of vegetables and fruits daily. For a person who consumes 2,000 calories a day, that works out to around two and a half cups of veggies and two cups of fruit a day. In reality, not many Americans actually manage that many servings of produce.
As a result, many people fall short on the vitamins and minerals they need for good health. This is especially true for people who take medications on a regular basis. The consequence is that many should be taking vitamin supplements, or possibly minerals.
What Minerals Might You Need?
Magnesium is an essential mineral that is frequently low in American diets. The best sources are green leafy vegetables, nuts, fruits such as figs or raspberries and various types of beans.
Do Medications Affect Magnesium Levels?
Even people who do eat fruits and vegetables could still find themselves in trouble if they must take certain pills for heartburn or high blood pressure, for example. Acid-suppressing drugs like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) limit magnesium absorption. ACE inhibitors such as enalapril or lisinopril deplete magnesium and zinc. So do thiazide diuretics like hydrochloriothiazide (HCTZ).
Low magnesium levels have been linked to depression, diabetes, high blood pressure, heart disease and arrhythmias. Symptoms include insulin resistance, severe menstrual cramps, leg cramps, fatigue and migraine headaches.
Think About Zinc:
A word about zinc: most people don’t think about it very much. Low levels can lead to changes in the senses of taste and smell, slower wound healing, diarrhea and hair loss.
Who Should Be Taking Vitamin Supplements with Vitamin B12?
Vitamin B12 is another critical nutrient that may be affected by medication. This vitamin is found in meat, fish, poultry, dairy products and eggs, so people following vegetarian and vegan diets may come up short. The acid-suppressing medications mentioned above can also interfere with vitamin B12 absorption. That’s because the stomach needs acid to absorb vitamin B12 adequately. Older people, whose stomach acid production often drops dramatically, are at risk of vitamin B12 insufficiency.
In addition, the diabetes drug metformin can also lead to inadequate vitamin B12. More than 80 million prescriptions for metformin are dispensed annually. That doesn’t include millions more for combination diabetes drugs like Janumet that include metformin.
Certain antibiotics such as doxycycline, ciprofloxacin and co-trimoxazole can also affect vitamin B12 absorption.
Vitamin B12 deficiency can lead to serious complications such as neuropathy, which can cause burning, tingling and numbness. Low levels can also contribute to cognitive impairment and mood disorders. People who must take such medicines should ask their doctors to monitor their vitamin B12 levels periodically.
More Research on the Benefits of Taking Vitamin Supplements:
There are studies going back several years demonstrating that vitamin supplements can be helpful in certain situations that may be relevant for you. We got this question from a reader in 2014:
Q. Is it true that taking vitamins is a waste of money since they do not improve our health?
A. An editorial in the Annals of Internal Medicine (Dec. 17, 2013) titled “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements” makes this argument. We don’t entirely agree, however.
Some studies have shown that certain vitamins can improve cognitive function, reduce the risk of cancer or lower the chance of getting cataracts (JAMA, Jan. 1, 2014 & Nov. 14, 2012; Ophthalmology, Feb. 2014).
Learn More:
You can learn more about the pros and cons of nutritional supplements and the interactions of drugs and nutrients from Fortify Your Life: Your Guide to Vitamins, Minerals, and More. The author is Dr. Tieraona Low Dog, one of the country’s leading experts on dietary supplement and integrative medicine.
Cindy
Real food is “packaged” exactly how our bodies have evolved to used what nutrients they contain–in the perfect amounts. Humans never recreate nature very well, especially if profit is involved. Not to mention that every year we learn about more and more nutrients in food.
I say spend that extra money on finding the best real food you can afford. Farmer’s markets, garden, organic, local, in season, frozen veggies in the winter, pay attention to the dirty dozen and clean fifteen lists. I 100% love ice cream more than any vegetable, but sometimes you have to eat food like it’s medicine until your habits change. It’s 120% worth it to feel great and stay out of the drs. office.
It’s possible that supplements help certain conditions. Sure. Experiment a bit. If you sleep better taking magnesium, great! But don’t underestimate looking at a list of high magnesium foods and seeing if you can add those to your diet.
Turn off that screen and go for a walk. Then go to bed. Floss. Cook healthy foods ahead. Do a few stretching exercises. Take it slow. Research on YouTube.
I think the Fit Over 50 program is amazing! Only ten minutes a day. It starts slow based on your age and builds.
Small changes can reap huge rewards! Model good habits for your kids.
Jane
I recently read an article that stated the nutritional value of food today is greatly diminished from 40-50 years ago. Not only are they grown in depleted, dead soil, thus requiring chemicals to even get a crop, but many fruits and vegetables have been developed to have long shelf life, uniformity of size and color and resistance to damage rather than nutritional value. The article stated that the decrease was often 10 to as much as 40% less. I try to eat as much organic as I can find and afford but I also use supplements.
Elizabeth
I have been taking one-a-day vitamins for women over 50 for years. I noticed troubling signs of neuropathy and consulted a neurologist. After blood tests for levels of several components, he advised me that I had excessive levels of B6 and should find and discontinue the supplement that contained B6. It turns out that my one-a-day vitamin provided 465% of B6! I stopped taking it and have noticed a slight improvement. Nerves can take up to 6 months to heal, and I hope I get back some sensation in my lower extremities. My assumption that excess vitamins are just shed in the urine was incorrect! This is a cautionary tale to check what is provided in these multivitamins.
Coleen
How is one to know which brands to buy that contain legitimate sources of the vitamin/mineral? There are so many brands and so much “fake” product these days, my concern has always been about getting “real” product in any of the bottles. Thoughts?
Laura
I have a sun allergy and can’t get my Vitamin D3 from the sun. I started using an under-the-tongue spray and have raised my level from 20 to 90. I backed off one squirt and now use just four and am very happy with the results. I also am on a very limited diet because of Bile Salts Malabsorption. So I also supplement with a variety of other supplements. I am very particular about what I take and do a lot of research for each. I finally found a magnesium supplement that does not loosen my stools and raised my mag level to just above normal range.
Kari
I find it really hard to believe that in those 84 studies, they checked all those people for vitamin and mineral deficiencies. Never is that noted in any study I have read. I also find it really hard to believe that with current diet trends of processed/ultra processed food, medication use, sunscreen use, farming practices resulting in food that has less nutritional value, that they found that many people without ANY vitamin or mineral deficiencies. If you consume excess sugar, it depletes magnesium, for example. I think the USPTSTF is ignorant or maybe has some other end goal but just like during the pandemic, when did you hear the government push health through natural methods like nutrition, water, supplements, exercise, sleep, integrative methods?
Noel
There are so many brands of magnesium taurate with such a variety of prices. I am interested in trying some for neuropathy and would like to find an unbiased recommendation.
Terry Graedon
Noel, we usually look to ConsumerLab.com for such recommendations.
Cindy
If I’m going out for the day I cut up a pint mason jar of veggies. I usually have on hand carrots, red cabbage, radishes, cukes, and celery. Plus anything else around – lettuce, kale, broccoli. You don’t have to refrigerate, though I do keep it in a cooler during the summer. At some point I eat these veggies in the car with the idea I can then have whatever I want. Fast food, ice cream, a snack at the grocery store.
99% of the time, I no longer want those things after eating the vegetables. Or I should say, “99% of the time, I can then say no to the ‘treats.’ I also usually bring a hard boiled egg to eat. Easy and convenient and I use up the vegetables I buy or grow – rather than having them go bad. It’s an easy way to get more vegetables in one’s diet.
Cindy
I am extremely health conscious and try to do everything right. I get lots of exercise, enough sleep, and eat healthy food. Only problem? I have basically just LOST MY APPETITE, and I can only manage to force down one or two small meals a day — the second one often only after a couple puffs of (legal in WA) MJ to try and get some kind of appetite. So, supplements are absolutely essential for someone like me!
ALSO: I find it really confounding that, in most every study you read, they’ll talk about
this or that supplement’s efficacy in, say, reducing heart attacks or whatever. The WORTHIEST supplements aren’t really designed to do one particular thing, but to ENHANCE VITALITY AND LONGEVITY in general. Well, they can’t really study that; there are too many factors involved.
Judging a supplement’s efficacy in one certain thing is like judging what car is best, as evidenced by legroom or ease of parking. It’s just totally inadequate and off the mark! Thank you, and cheers from Cindy
Jessica
I recently started taking COQ10 at my dayghter’s suggestion. The effect on lowering my blood pressure has been amazing. Much lower than the Rx BP drugs I’ve been taking for years have ever been able to achieve. I track my BP at home. My PCP recently checked the accuracy of my home cuff against her office cuff, and approved my readings as accurate. Not sure yet if COQ10 will impact my cholesterol. Next blood lipid panel not for another 3 months, but I’m hoping for good news. Meanwhile, I also take krill oil and garlic supplements which are keeping my cholesterol as low or lower than the toxic statin drugs (which put me in a wheelchair), ever did.
Many Rx drugs are developed to “synthesize” naturally occurring medicinal effects of the vitamins and minerals in our foods. So basically, we can choose to ingest egregiously expensive, artificial, synthetic chemical toxins, with questionable, short-term scientific studies to support their use. Or, we can choose relatively inexpensive OTC natural supplements that produce similar results. At 75, I think I’ll stick with the latter.
Cate
I have read Dr. Tieraona Low Dog’s book, and found it very interesting. However, there is one big problem with her book and others like it: they tell you that a particular drug or class of drugs depletes certain vitamins and minerals, but they do not indicate a specific replacement, nor one based on amount of the drug ingested.
For instance, I am taking warfarin, plus monopril, coreg, digitalis, spironolactone, and furosemide plus the potassium chloride pills that go with it. Using the book by Dr. Low Dog, and one by another pharmacist, I made a list of all the nutrients depleted from my body by all of the drugs I take. Wow!
Now, furosemide sucks magnesium and other vitamins and minerals besides potassium out of one’s body, but the only replacement organized medicine offers is potassium.
In addition, one must assume that 20 mg furosemide daily depletes a certain amount of these nutrients, and if you take 40 mg daily, or, as I do, 80 mg daily, then a much higher amount of nutrients are sucked out of the body. So, it would be helpful to know how much we should take of each depleted nutrient, adjusted for the amount of drug we ingest.
Marilyn
I take many supplemental vitamins and minerals. Our foods today are deficient in vitamins and minerals compared to many years ago. If people read how many foods are deficient, they would be taking supplements. I am 65, and everyone tells me how much younger I look. Also, read about orthomolecular medicine, and it will convince many people to take supplements.
Caryn
I had an irregular heartbeat (Dr. detected it, and ordered an EKG and a stress test) and painful, nightly leg cramps. I started on 250 mg. of magnesium nightly and haven’t had an irregular heartbeat or leg cramps since. Believe me, I’ve tried tonic water, Certo & grape jc., tart cherry jc., gin-soaked golden raisins, and many other natural remedies. A tsp. full of yellow mustard worked a bit for me, but who wants that at 2-3 am?
Pamela
I am on several medications that deplete magnesium.
I take B12, as I eat very little red meat.
I take magnesium supplements in a variety of forms for leg cramps. Despite that, my levels are at the bottom of the range.
I started taking zinc supplements years ago and felt 1000% better almost immediately.
I have taken B complex since in my 20’s to combat stress.
I increase my Vit C intake when I’m coming down with something.
I take Vit A supplements because most of those foods are either too high in carbs or in the nightshade family. I was amazed at how much better I felt.
I take Vit D supplements, as I get very little sun in the summer and also support that with Vit K2 as I don’t tolerate most dairy.
I take selenium supplements for thyroid health because most soils are depleted and for several years, you couldn’t find Brazil nuts to save your soul.
I have eliminated chlorine, fluoride and bromine and aluminum from my life as I react to all of them.
With current and past farming practices, the soils have been depleted of significant amounts of minerals and vitamins.
I wonder if anyone has bothered to study those mineral and vitamin amounts in the current food supply. I expect that those levels will be significantly lower than in 2014
Rachel
I believe that each person should use his or her best judgment when deciding whether or not to take vitamins. Many physicians have a distinct bias against vitamins because there is no financial gain for them. However, that being said, it is vitally important to bring a complete list of all of the supplements (vitamins, minerals etc.) that the patient is taking, along with a list of all of the medications that are taken, to each physician. Some people have medical conditions which could be made worse by certain vitamins or minerals. It can be hazardous to take a supplement and certain medications without first checking with each physician.
Charlotte
I read a letter sent by a young man with a-fib, and he started taking magnesium taurate which stopped a-fib. I also just started takin magnesium taurate, and so far my a-fib has stopped. So I believe that taking some supplements are good for you.
Paul
As we pursue healthful living we embrace supplements. We will take E forever. Won’t you?
Cindy
It’s really infuriating to hear arguments against taking supplements. Some 25 years ago I learned about free radicals and started taking antioxidants. In the following years, I studied other categories (adaptogens, herbs…) and incorporated more supplements, each carefully vetted.
I now take a whoppin’ handful each and every day. I cannot count how many young people say that I simply CAN’T be my actual age, that I can run circles around them (and I can!). They demand, “What’s your secret??!” I’m also a black-diamond skier and massive backpacker, take no Rx drugs and have no medical issues… at 74yo. On top of that, I’ve been injured massively doing sports and have broken almost every bone in my body. I also drink quite a bit and have done drugs in the past.
You’d think I’d be a mess, maybe dead by now. But I’m growing stronger by the year, and I look great too! What do I have to thank for all that? SUPPLEMENTS. There’s no other answer. Many supplements have been very well-studied, and the results are ironclad… are the researchers lying? Some do, I’m sure, but most do not.
Just stick to good-name companies and keep away from the bargain stuff, off-brands, etc. Also: read the studies; read the commentaries! Compare various sets of results. Note how the different studies are designed. Takes some time, but the payoff is more than worth it! Ahem.. thank you.
Arie
What about calcium? osteoporosis?
Mickie
If I already have rheumatoid arthritis and polymyalgia rhuematica should I take those supplements?
Will
I’m almost 72 and have been peeing out vits for maybe fifty years. So far as I know I am fit, healthy and most of all take no pharma products. I take specific items that I feel help me avoid cheap multi’s and other over 50 crap.
One thing that is seldom mentioned is the effectiveness of one’s digestion. Weak digestion and hard or coated pills will not breakdown so the body can use them. Perhaps many people should be looking for liquid versions or the soft capsules with powdered ingredients that can be removed and dissolved in water.
So far eating a high fat diet with olive and coconut oils, organic food, low sugar, little meat except fish and chicken, then not much, has been working for me. Also I have read that the nutritional quality of food because of soil depletion is not what it was years ago. It has taken me a long time to follow the advice I was given years ago; “Eat to live, don’t live to eat”.
DD /
I was one of the participants in the VITAL Study. When the code was broken I was in the group that had gotten both of the “real” products. Even running for 5 years, the results were not surprising. Supplements are not instant miracles. It would be interesting if the study could have been 25 years. So many diseases take a life time to develop. Would the Vitamin D and the Omacor, omega-3 fatty acid product, have shown prevention of long term developing disease.
Renee
I take Metformin and 10mg of Prilosec everyday, and I must take 600mg of magnesium bigylsinate(sp) everyday or I have severe leg, foot and hand cramps. I also started talking a mega dose of methyl B12 sublingually and it got rid of the tingling and numbness in my hands and feet.
I have had my husband on the Peoples Pharmacy protocol for cholesterol and triglycerides for years, and his cholesterol is better than mine.
Joseph
A surgeon told me in 1993 to take a multivitamin every day. I have done so religiously ever since and I find that I rarely get sick. Not that I was sickly before taking the supplement, but I can’t help but notice that it has greatly reduced the number of illnesses I’ve contracted, including sore throats and colds.
Anne
Bakersfield, Ca.
I am 73 and take no pills of any sort. I think my health has more to do with my genes than anything else. Some people do well with supplements, and others simply pee them out. I have always had the attitude that if you leave your body alone, it will attempt to heal itself. I know this is not true for others, but it’s true for me and my husband.
Dr Richard R.
West Palm Beach
one important point I left out is that vitamins are not a substitute for food.
Dr. Richard R.
West Palm Beach
First question: can Vitamins hurt you? The answer is yes. Taking too high a dosage of oil soluble vitamins, e.g. Vit A can hurt. It had been a rumor (told to me by a doctor nonetheless) that Vitamin C when taken in high dosages (2500 mg per day) has led to kidney stones. Since I take as well as recommend Vit C and Lysine for viral infections from common colds to HIV, I was alarmed. So I did my homework researching this and could not find one documented case of the rumor being true. In fact there was a call-in show on Public radio on Vitamin C, and I asked the research expert of this and he had never found evidence of this being true. I do believe there is a difference in the quality and freshness of the products sold as vitamins and the consumer must be aware. Some vitamins may not go well with prescribed medicine so we must do or homework and studyi as well as questioning is called for
Sara
Florida’s Suncoast
I take supplements and have seen a drastic change in my health for the better due to taking them. In fact, I recently tried eliminating SAMe from my regimen for two days and noticed it immediately.
However, if your digestive system is having absorption problems, you truly aren’t going to be able to absorb any supplements. In order to fix that issue for myself, I used fulvic-humic minerals, and after that I noticed the effects of supplements; they actually did what they purported to do, as listed on the container.
I also had to clean up my diet, staying away from chemical and pesticide laden foods, excess sugar, and red meat entirely. I also eliminated my contact with fluoride, chloride and bromide, all of which hinder absorption and metabolism of iodine, which is an essential mineral for detoxification at the cellular level.
mar
buffalo ny
unless you have a good knowledge of whatv to eat and youeat fully well balanced meals daily-most of us in this hurry scurry times do need supplements–there have been many studies on vitamin deficencies and the harms they cause
Bithie
Houston
I am 70 and know no one that eats the recommended amounts of fruits and vegetables. If you can afford a personal home chef then you likely do not need a vitamin. And think of the masses that eat fast good. Until science can prove vitamin suppliments are harmful, I’m going to to take them.
K. P.
I’m a 60 year old woman with some health issues.
I decided recently to start taking a multivitamin on a hunch it would help improve the dark discolorations on my skin. After a few weeks I noticed a considerable improvement in my skin. I believe I was vitamin deficient. I’m so happy with the results. I will continue to take vitamins because I have seen for myself that vitamins do work!!
Mary Jewell Baitlon
CA
I have been taking a multivitamin for years and now take ones for over age 50. As long as they cannot hurt, I decided to keep on taking them.
Marie
It was back in the early 1970s when a pharmacist first told me, “As long as you eat a balanced diet, you don’t need to take supplements; you’ll just pee them out.” It took me many years to understand that, because people who take supplements are not depending on prescription drugs to combat their health problems. They are reducing the financial wealth of those involved in the pharmaceutical industry, including pharmacists as well as medical doctors and hospital staff. Now when I hear that old saw about urinating them out, I reply, “And at 71 years old, I am still alive to do so!”