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I was told about an interesting website yesterday, called Sunlight Robbery. The enclosed report by Oliver Gillie comes from that site (I haven't had a chance to read it yet, but it promises to be interesting). Avril Avril Wayte Consultant Biochemist Clinical Chemistry Ysbyty Gwynedd ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Reynolds Tim Sent: 11 June 2009 08:28 To: [log in to unmask] Subject: Re: Vitamin D over requesting Perhaps the vitamin D story is a lesson for us all to ignore Nanny and go out in the sun without sunscreen. That way we can make a bit more of our own vitamin D. OK, a few people might develop skin cancer and an even smaller number might die as a result but a far greater number would benefit from the higher vitamin levels they will have. Perhaps Jean Baptiste Luc Planchon was correct. ************************************************************************ ************* Prof. Tim Reynolds, Queen's Hospital, Belvedere Rd, Burton-on-Trent, Staffordshire, DE13 0RB work tel: 01283 511511 ext. 4035 work fax: 01283 593064 work email: [log in to unmask] home email: [log in to unmask] ************************************************************************ ************** IMPORTANT: This email is intended for the use of the individual addressee(s)named above and may contain information that is confidential privileged or unsuitable for overly sensitive persons with low self-esteem, no sense of humour or irrational religious beliefs [if you want to believe in fairy stories and hug pixies that's up to you]. If you are not the intended recipient, any dissemination, distribution or copying of this email is not authorized (either explicitly or implicitly) and constitutes an irritating social faux pas. 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If you have received this eMail in error, please add some nutmeg and egg whites, whisk, and place in a warm oven for 40 minutes. -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Fraser, Bill Sent: 11 June 2009 08:01 To: [log in to unmask] Subject: Re: Vitamin D over requesting Dear Mike 1) A lot of the hype has an evidence base to support an association of low vitamin D with disease, morbidity and mortality beyond classical symptomatic problems (severe or otherwise as specified in the Canadian document). What is not so convincing is whether supplementation makes a major difference in many of the areas investigated and at what prevailing concentration of 25OH vit D there are beneficial effects. In bone disease high concentrations (>50nmol/L to>70 nmol/L depending on the study) are recommended for fracture prevention. 2) Are you suggesting that we put vitamin D in the drinking water for all those lacking exposure to a decent amount of sunshine? However cheap this may be there does not appear to be a good reason for giving supplements to all (see 1 above). 3) The limitation in Canada appears partly to be driven by the very high cost of the assay. Several publications have indicated that osteomalacia can exist within bone on histology without significant symptoms and without elevations of ALP, PTH, a low calcium or low phosphate. The best way of detecting vitamin D deficiency is by measuring 25 OH Vit D. 4) The recent renal guidelines have not helped in this matter in the UK stimulating GP requests which have highlighted the level of deficiency in the population and resulted in a significant increase in further requesting. 5) What do you consider sensible? This could be a long and non productive debate with the current state of knowledge and massive variabilty in results produced by the various assays available. Regards Bill Professor William D Fraser Head of Unit of Clinical Chemistry Director of MRes in Clinical Sciences School of Clinical Sciences Duncan Building Daulby St Liverpool L69 3GA Phone 0151 706 4247 (4257 sec) Fax 0151 706 5813 e-mail [log in to unmask] From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Wallace Alan (NHS Greater Glasgow & Clyde) Sent: 10 June 2009 19:20 To: [log in to unmask] Subject: Vitamin D over requesting Dear All, The rapid increase in Vitamin D requests and the current hype about this analyte is an increasing problem for many Laboratories who provide this service. The majority of the population, especially those of us fortunate enough to live in Scotland, are vitamin D deficient. Replacement is cheap and relatively safe so do we really need the measurement at all in the majority of these cases ? Is it not about time the ACB or RCPath put together sensible requesting guidelines before the whole system becomes totally overwhelmed with unnecessary requests ? BW Mike Professor Mike Wallace Consultant Clinical Scientist Department of Clinical Biochemistry Glasgow G4 0SF Tel: +44 (0)141 211 4490 (Internal 24490) Fax: +44 (0)141 552 3324 ************************************************************************ ******************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. 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