Author Archives: Mark Pegram

All Vitamin D Brands are not Equal!

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Bare with me, I will get to the vitamin D, but first the story. In July, 2010, I fell when descending stairs in an unfamiliar house. It was really a sort of a stupid thing as I was talking to another person as I descended the stairs. The stair was wide enough so that we were almost side by side. I was totally engrossed in our converstation. Thinking that I was on the bottom step, I took a large step forward to find that I was two steps ups. This resulted in a forward lunge. Let me also say that I had been working hard for the three hours prior. I had lost a singificant amount of body fluid from perspiration, almost seven pounds of weight ( I had weighed before starting this job because I was interested in how much fluid loss would occur under severe heat and work conditions. During the three hours, I had drank three twenty ounce bottles of water). This combination of muscles on the verge of cramping and a clumsy fall resulted in a nasty muscle pull and perhaps an injured spine.

Of course I did not know which at the time. I thought that I had totlly destroyed my back again. After a few days of trying to resolve the pain, I went to my neurosurgeon. After an MRI, it was discovered that I had ‘no change in the appearance of my spine.’ The doc left me alone in the room prior to his arrival with the MRI on the computer screen. It so happened that the 2005 MRI was also on the screen. When comparing the two images, It was apparent that the thickness of my vertebral disc in the lumbar region was twice what it was in 2005. No change was a statement saying that my back had actually improved, but since we know that ‘you cannot grow cartilage,’ we will just not comment on the improvement. Let me be very specific here as the statement of no change was from the radiologist that had read the MRI and not my neurosurgeon. The neurosurgeon was in disblief and amazed.

The spacing between the L4-L5 had not improved and it was apparent that there had been more distortion of the vertibra (hammer shaped). The surgeon felt that the pain I was experiencing was a direct result of this issue. I felt that he was partially right, but what I was experiencing for pain was not like what I had felt before. The pain would initiate in my hip and then descend the leg. Now neural pathways are tricky and to try to pin point the origins of pain is difficult at best. I had decided that my pain was originating from a strained piriformis muscle. This muscle is under the glut muscle and the nerve bundle that recombines and descends the leg goes through the middle of this muscle. Muscle relaxants would make the pain completely go away.

The pain and numbness got much better six months later but was still going on which was not a good thing. I continued to deal with it through the spring until my physical the thrird week in April. I was shooked to see that my serum vitamin D level was 42 ng/ml. I had been taking 10,000 of D3 per day since June of 2005. How was it that my vitamin D level had dropped from an average of 85 ng/ml to 42 ng/ml. It was apparent that the vitamin D3 that I was now using was not the same as before.

I had switched to Pharmassure’s brand that I could purchase from the local drug store. It is apparent that this brand does not have the required 5.000 IU of D3 in the product as described on the label. I had been using the Bio-Tech Pharmacal brand for the 5 years prior with good results. It is obvious to me that the lack of qualily control on such a tiny amount of vitamin D is a very real issue. It could be that one bottle or lot was bad and the rest of Pharmassure’s product is fine. However, you can bet that I will never use this brand again. This is a similar story that was reported by Dr. Davis that writes the Heart Scan Blog. In that case his patients had switched from Vitamin Shoppe brand to Walgreen’s Nature Made brand and it was like the Nature Made product had no vitamin D. For you in trying to maintain an adequate vitamin D level, YOU MUST HAVE YOUR SERUM LEVEL TESTED!

I wonder now if the large range of vitamin D3 intake to achieve an adequate serum level that was reported by the study at Grass Roots Health may partially be due to the fact that all brands that claim 5,000 IU may not be 5,000 IU. I had been part of this test through the spring of 2010, but had not had my serum level tested for over a year. Anytime you change brands or habits, like how much you sun bath or change diet in like how much liver you eat ( more vitamin A an antagonist of vitamin D), you should have your serum level tested.

I took fifty thousand IU of D3 per day for two weeks to get my serum level back up and am now taking 10,000 IU of Bio-Tech Pharmacal’s vitamin D3 per day. Interestly enough, the pain in my leg has gone and my hip seems to be healed. I now have over six thousand hours of studying vitamin D, it is obvious that the single most important thing that you can do in this new medical paradigm is to have your serum level tested! – Pandemic Survivor

Children – How Much Vitamin D

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Children and vitamin D will be the discussion for the next several decades as we try to discover the true importance of how sunshine interacts with growth and disease states.  We have spent the last fifty years figuring out ways to keep children from going into the sun.  The sun, we were told is going to be very bad for your skin and will lead to skin cancer if you get burned as a child.  We were also told even if you do not burn that too much exposure to sun is not a good thing.  We have never been told that low or no exposure to sun is a not good and even a very bad thing because of infections and chronic disease.

Growing up in the fifties and sixties, there were never any of my friends that had trouble with their backs unless they had hurt themselves in some fashion.  Spine issues were minor of course except for the few cases of spina bifida or scoliosis.  I truly believe that both of these diseases are from the mother being vitamin D deficient in combination with other nutrients like folic acid for spina bfida.  Now it is impossible to talk with a teenager that does not know someone their age that has had back surgery.  This is just the beginning of a host of chronic diseases for children of the 1980’s, 90’s, 10’s that will result in mass illness of many forms.

To prevent the most of diseases, both chronic and infectious, vitamin D is a necessity.  So then the question arises how much vitamin D should we get and how should we maintain a healthy exposure to the sun.  Let me first say that exposure to the sun is still a growing science and we do not know all of the biochemical activity that is happening when we expose ourselves to the sun.  Our relationship to the sun has changed forever with the development of sunscreens and sun block.   Only with a consistent effort to redevelop this relationship will health be achieved.   I maintain that the best approach is to just use common sense.  The best common sense approach is to maintain a vitamin D level as if it is summer all year round.  If you read the medical research while using common sense you will discover that is really what the researchers that are proponents of vitamin D are saying.  From your personal perspective you do not get colds in the summertime and the reason is sun exposure.  By maintaining your level of vitamin D in the winter time to the summer level you will most likely not get colds then either.  I have not had a cold since 2004 when I started this effort.

Babies with colds and congestion?- mothers tell me your experience.  I suspect that your child will have significantly less issues if enough vitamin D is made available.

How much vitamin D does it take to achieve this summertime level?  From all that I have read a good rule of thumb is to get about 40 IU of D3 from all sources for each pound of body weight.  So it does not make any difference if you are a ten pound baby or a two hundred pound senior citizen.  For the baby this would give it 400 IU’s per day and for the two hundred pound senior citizen that would be 8000 IU per day.  This level of vitamin D intake or production in the skin should maintain your vitamin D level above 60 ng/ml, which is the bottom of the range for vitamin D for person living in a sunny country.  Work done by Grant and Holick have shown the 25(OH)D level for sunny country people to be 54 ng/ml to 90 ng/ml.

Of course the only way to know if your serum level of vitamin D is above sixty is to test!

If your total level of intake or production is not 40 IU of D3 per pound of body weight and you do not test to maintain your level above 60 ng/ml  then expect disease states.  – Pandemic Survivor

Color My World Ultra Violet B

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“As time goes on, I realize just what you mean to me…..color my world with hope…”  Chicago 1970.

This is a familiar song lyric made popular by the band Chicago.  Our relationship with the sun has forever changed with the introduction of sun screen and staying inside during the highest incidence of ultra violet B in the summertime because of the introduction of air condition and electronic entertainment.  It is a ‘love song’ being song now by many in the world of vitamin D research.  However, what I have discovered in writing this blog is that the researchers seem to be talking only to each other.  What is the point of this?  Until the medical profession embraces the idea that most chronic disease is created by not having enough vitamin D and this embracing is sanctioned by governments, we will continue in a state of severe disease.

The recent release by the Institution of Medicine findings through the Food and Nutrition Board on vitamin D and Calcium has been a major setback for moving forward in resolving disease states.  Even though they qualified the findings as pertaining to bone health only, the statements that there was not enough research to support higher amounts to stop disease gave medical institutions and government time.  Why is this time needed?

On April 27, Natural News published this article by Dr. John Cannell, Vitamin D Council, describing the need of the medical industry for time to develop vitamin D analogs.  Betrayal of a Nation: Why U.S. health authorities are keeping you deficient and who stands to gain.  http://www.naturalnews.com/032202_vitamin_D_deficiency_disease.html  He references an article that I wrote in December, Conflict of Interest at Nation Academy of Science, about the conflict of interest with members of the FNB for vitamin D.

The egregious violations of the National Academy of Science (IOM is a division) rules can only be allowed to occur by the sponsors.  The only answer is that both the government of Canada and the government of the US (primary sponsors) stand to gain significantly by maintaining an unhealthy population.  These governments did not only allow it to occur, but most likely sanctioned the results.  There is no greater institution of science than the National Academy in the minds of the public.  However, politics has entered this arena with the thought that a healthy population would lead to a significant reduction in the health care economy.  (I am not big into conspiracy theories, but here institutions are moving together with what they perceive is best for them without empathy for the individuals they serve.) If you had to make the decision between a healthy population and a healthy economy, which would you chose.  A thirty percent reduction in the healthcare economy from a healthy population would mean a five percent reduction in the total economy.  What would happen with all these additional unemployed people?  There is no simple answer.

With that many more people unemployed in the current economy would the economy of the world collapse?  Here is the fear by our leaders.  There will be no proclamation by the President or by Health and Human Services.  Yes the greed of the medical institutions, in particular medical insurance is driving the decision making process.  Our government leaders are allowing this to occur, not from lack of knowledge, but from fear of total collapse.  It has taken us seventy years to reach this point.  Read how the government was involved with vitamin D misadventure through the courts at my post Vitamin D for Profits – 1923 to 1946 https://pandemicsurvivor.wordpress.com/2010/12/09/vitamin-d-for-profits-1923-to-1946/  Will it take us another seventy years to reach a healthy understanding of our relationship with the sun?

Moving institutions is a daunting task, especially when there are significantly large amounts of money involved.  My hope is that people of science will stop considering only their individual incomes, the incomes of the institutions that employ them, and start considering the individuals they serve.  If not, by definition, they are practicing institutional evil.  Until these institutions start to move, our hope is the individual doctors that have embraced the science like my hero Dr. Joseph Prendergast, M. D., Endocrine Metabolic Medical Center.  Dr. Prendergast has treated upwards of four thousand people with vitamin D.  His take on vitamin D from you tube from 2007:  http://www.youtube.com/watch?v=_PYsXQ16Ztg

Of course, my personal physician, Dr. Mark Perini, is my hero because he was willing to listen to me, watched me healed and has fully embraced vitamin D science.  His practice has even purchased its own vitamin D testing equipment.  The point of this is that the message of the researchers is reaching our doctors and soon, whether sanctioned by government or not, we will move toward health through doctor peer pressure from amazing results.  Researchers, you are my hero as well, keep up the great work.  Keep reaching the doctors in any way that you can.

Color my world with ultra violet B – Pandemic Survivor

Age Related Macular Degeneration

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Researchers have found that higher levels of vitamin will prevent age related macular degeneration or AMD.  Here is the article at ABC News: ‘Vitamin D Protects against Age-Related Vision Loss’ 

The amount of sun exposure that your eyes get is important.  That is exposure without sun glasses.  It may be that UVB light, which cannot penetrated sun glasses, works to maintain eye health.  One of the problems with airplane pilots is that years of exposure at high altitude of UVA without the UVB component that is blocked out by the windows and sun glasses is damage to the eyes.  A study in Iceland found that pilots were three times more likely to develop age related eye disease that non-pilots.

It is always a good idea to let your eyes be exposed to natural sunlight for ten to fifteen minutes per day.  Do this and then put on the sun glasses.

Higher Vitamin D Intake Drastically Reduces Disease

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A new study of serum levels of vitamin D shows that 4000 to 8000 IU per day are required to keep your serum level in a range that will reduce the incidence of disease. This includes cancer, type 1 diabetes, and multiple sclerosis.  Dr. Cedric Garland says that the incidence of many diseases could be reduced by half.

Here is the news article in Business Week: “Higher Vitamin D Level Could Cut Cancer Risk”

As I have described in many post, the amount of vitamin D required is different for each individual.  The only way to know that you are getting enough is to have your serum 25(OH)D level tested.  Serum levels should be maintained above 40 ng/ml, and for best results the level should be maintained between 60 to 80 ng/ml year round.  You should only supplement with Vitamin D3.

For a better understanding of the science, here is the journal article that was published in Anticancer Research, International Journal of Cancer Research and Treatment, made available in its entirety by Grass Roots Health.

Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention

CEDRIC F. GARLAND, CHRISTINE B. FRENCH, , LEO L. BAGGERLY, and ROBERT P. HEANEY (here is the url in case you cannot go there from the above link  http://www.grassrootshealth.net/garland02-11)

“This paper provides a long awaited insight into a dose-response relationship between orally administered vitamin D3 and the resulting levels of serum 25(OH)D in over 3600 citizens. The results will allow new definition of high vitamin D dose safety and reduce concerns about toxicity. This is a landmark contribution in the vitamin D nutrition field!”

– Pandemic Survivor

Scared Out of the Sun for Fifty Years

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It seems the American Academy of Dermatology has released a new position statement for vitamin D.  Here is the PDF. An amazing statement in the opening paragraph is a ‘true grabber’.  “Vitamin D should not be obtained from unprotected exposure to ultraviolet (UV) radiation.”

Our ancient relationship with the sun has changed forever – to paraphrase a statement made by Dr. Edward Gorham, Ph.D. from UCSD about sunscreen.  It is amazing to me that the AAD would attempt to continue its fifty year position on the sun with all of the new science.

Here is the Vitamin D Councils comment via news release:  It seems that Dr. Cannell believes that the AAD is fearful of litigation and lost revenues for their members.  He may be correct.

In 2007, after I knew that my healing from vitamin D was real, I pursued the possibility of litigation for 25 years of physical suffering, lost income, and mental trauma.  I contacted four different law firms and could not find a single one that was interested.  The general comment that I got was that it would take at least ten years to litigate.  Also, I was not interested in naming my  local doctors because they had been miss-directed.  I confirm that AAD is fearful of litigation.  If I could have found a firm, they definitely would have been named as well as others that medically misdirected me.  It is time for litigation, but we need someone with really deep pockets that is willing to take it on.

This battle will only be enjoined when the attorneys finally realize how much money there is to be made.  I suspect that ultimately the Supreme Court will make the final decision.  If the all of the population could be healed of one fourth or more of all chronic disease, just think how many jobs would be lost in the medical institutions?  Economy versus Health! – A battle for the next two decades.  Congress will have to act to finally resolve the issues.  Battling for your health – Pandemic Survivor

How Much Vitamin D3 for Supplementation

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How much vitamin D3 should we supplement is one of the most difficult questions to answer.  With recommendations all over the board by the experts, the average person’s head is spinning.  The thing to remember, there is no harm in your serum level in the range of people in a sunny country.  That is your serum 25(OH)D should range between 50 ng/ml to 90 ng/ml when supplementing with vitamin D3.  It is also extremely important if you chose to supplement or your doctor suggest that you take vitamin D that you take vitamin D3 only.

Dr. Heaney at Creighton University has shown that the average healthy person uses about 75 IU of D3 per kg of body weight per day.  However, very few people in the population are average.  The best approach if you have not been supplementing with vitamin D3 is to take about 1000 IU of D3 per twenty five pounds of body weight per day for three months and then have your serum tested.  You goal should be to have a serum level that stabilizes in the 60 to 80 ng/ml range.  A rule of thumb for adjusting your intake is that 1000 IU of D3 should move your serum level about 10 ng/ml – again depending of lots factors.   Everyone is different in how much vitamin D they need to achieve a sunny country level.  This is because of disease states that require more D3, genetics, cofactors taken, and other activities that include tanning, exercise, and sun exposure.

Use common sense when you supplement.  If you have lots of sun exposure on a given day with few clothes on, do not supplement on that day with vitamin D.  If you go regularly into the sun and most likely for the three to four months of summer, reduce your supplementation by half to allow for casual sun exposure.

Dr. William Davis writes the Heart Scan Blog.  He states that two of his patients of similar age and body weight had to take 2,000 IU versus 12,000 IU of vitamin D to achieve approximately the same serum level.  Here is the article: The Folly of an RDA for Vitamin D

If you are taking vitamin D and are not getting the results you expected, have your serum tested.  The best thing you can do for your health is to have your serum vitamin D tested once per year and maintain it at the level of a sunny country.    – Pandemic Survivor

Vitamin D Saves a Career

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I was recently sought out by a person that had heard about my recovery and wanted to know what I had done to heal my back and have my energy return.  Bobbie,(details of this person have been changed to protect her identity, but the health benefits are what really happened) an air traffic controller at a local airport had told me that after two decades of this demanding job that she did not think she could continue.  She said that her trouble with fatigue was compromising the quality of her work; and the safety of persons that were in her responsible care.  At age fifty with two decades of work, air traffic controllers can retire and she had decided to take this option.

We talked on several different occasions about deficiencies of nutrients and she decided to supplement.  Her supplements were vitamin D, vitamin C, magnesium, boron, iodine, and a multiple vitamin.  She noted that the first thing was the amount of energy that she had.  She typically jogs a few miles every day and discovered that she was not tired at the end of her exercise.  She was able to double the mileage that she jogged and told me that she recovered much quicker.

After a few months of this new found energy, she decided that she would return to work as an instructor.  She did this for a month and has now decided to return to work.  She says with the new energy that she feels comfortable about making it to the mandatory retirement age of 56 and may even make it to the age 61 exemption.

She started by supplementing at 3000 IU of D3 per day.  After a month she had her serum level tested and found that her 25(OH)D was 35 ng/ml.  She has decided to supplement with more vitamin D to get her serum level up above 50 ng/ml or more in range with a person in a sunny country.  Bobbie loves her new found energy and is very grateful that she can return to work.

It is truly amazing that with some simple nutrients that this person was able to return to a career that she loves with the confidence that she was not compromising the quality of her work.  – Pandemic Survivor

The Consequence of Institutional Evil

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It is difficult to think about an institution being evil, unless of course we are thinking about institutions that operate outside of the law.  But what about an institution that operates inside of the law, is it still evil?  Before you dive right into this article perhaps you would like a lighter, easier to read understanding – then I would suggest that you read my post from November 21, 2009 Super Duper Vitamin D3!!

To get a better understanding of how evil manifests itself in institutions, I would like to turn to my favorite expert psychiatrist in this area M. Scott Peck, MD well known for his book A Road Less Traveled. This book is a best seller and has sold over six million copies, but less known is his book People of the Lie: The Hope for Healing Human Evil, Simon and Shuster 1983, was a best seller in Japan.  M. Scott Peck died Sept. 25, 2005 at his home in Warren, Conn.  Dr. Peck was 69 and had Parkinson’s disease as well as pancreatic and liver duct cancer.  Wonder if vitamin D deficiency was an issue?

We all recognize individual evil and how it can be manifested as narcissism or malignant self love.  That is a person that cares only about himself without empathy for others.  Institutional evil as described by Dr. Peck arises when an institution only cares about its survival without empathy for the individual.  In institutions, this develops because of specialization without a clear understanding of who is responsible for the moral compass.  Each member of the group does his specialized job without considering the outcome of what it means for the institution and the individuals that are served.  So the scientist researches, practitioners practice, and leaders lead.  Each is assuming that the other has the individual in mind.  We now jump to what happened with the IoM’s Food and Nutrition Board on Vitamin D and Calcium.

The FNB was given the responsibility to give an opinion based on the new research for the many diseases linked to vitamin D and what directions should be given to the general population by the government institutions of health in both the US and Canada.  The FNB members felt no responsibility for individuals except in bone health and stated so in their report.  Could it be that they did not realize that the popular press and the NIH would use this as general guidelines for the entire population?  This included suggesting that there was no need for a serum 25(OH)D level above 50 ng/ml,  and levels higher than that could be risky.  What is interesting about this last statement is that people in sunny countries have serum 25(OH)D levels that range from 50 to 90 ng/ml and yet the epidemiological studies show that many diseases are less prevalent in these sunny countries.  This includes many types of cancer, diabetes, heart disease, as well as many types of mental illness.  Since the FNB stated they considered bone health only, they felt no responsibility to individuals for preventing other diseases.  It has been left up to the individual doctor, responsible for following the medical guidelines, which are defined by Health and Human Services based on the FNB report.  Ah, the circularity in the logic of preventing disease and maintaining empathy for individuals.

Jump again to my friend that just recently had a stroke.  I suggested to him that he should to try to maintain his serum 25(OH)D level between 50 and 90 ng/ml as this was common for a sunny country and was most likely his summertime level as he loves to go into the sun.  The long time standards for serum 25(OH)D has been between 20 to 100 ng/ml for several decades.  Higher levels of vitamin D have been shown by medical studies to result in less strokes and heart disease.  He had just read a news article that said anything greater than 50 ng/ml might be risky.  He decided not to supplement or to go into the sun.  When he dies of a stroke or a heart attack, it will just be written off as another victim of chronic disease.  My heart breaks for the millions that have been misled by the newspapers and the scientist just specializing in what they do.  – Pandemic Survivor

Errors Continue in Vitamin D Science at AHRQ and Tufts

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As I begin to research vitamin D and its functions in the human body, the first thing that I noticed was any compound that was related to vitamin D was called vitamin D.  I found these same errors in reading the AHRQ-Tufts Evidence Based Report on Vitamin D and Calcium.  Tufts was contracted by the Agency for Healthcare Research and Quality formerly known as the Agency for Health Care Policy and Research.  AHRQ is one of twelve agencies that report to Health and Human Services.  The IoM then used this report to make decisions about your health. The report was requested and funded by The Office of Dietary Supplements/National Institutes of Health, the Public Health Agency of Canada, Health Canada, and Food and Drug Administration.  You may access the report here as a pdf file.  It is also appendix D in the IoM report on vitamin D and calcium.

I think the ‘Policy’ name fits AHRQ better as they are responsible for maintaining clinical practice guidelines.  If you do not know, these guidelines drive the economy for the medical industry and are used as rules to determine if procedures were followed that can be paid for by the insurers.  As far as quality in the name, they produced a report that was far from what I expected.  As a taxpayer I was failed since they did not meet the quality standard.  Quality, as defined by the experts, is meeting customer’s expectations.  AHRQ mission statement: The Agency for Healthcare Research and Quality’s (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans.

First Expectation:  Vitamin D2 and Vitamin D3 are not to be treated as equivalent substances in the human body.  This is from the report: “Whenever the type of vitamin D supplement (D2 or D3) was clearly reported, we extracted and reported this information. Otherwise, we used the general term “vitamin D”.” – pdf page 52 – report page 36

Second Expectation: The difference between serum levels of 25(OH)D for D2 versus 25(OH)D from D3 should be clearly defined or the research should be considered invalid.  There is no mention whatsoever that a distinction was considered when reviewing the literature.

Why do we expect this distinction between D2 and D3?  Because there are more than 2700 genes with vitamin D pathways and the difference of an additional methyl group or an additional double bond are huge.  As we learn more about how genes are turned off and on, vitamin D has become the major player in controlling gene switching for chronic disease.  I will give you the example of what was batted around by the press after the IoM report was issued about an increase in the risk of pancreatic cancer with an increase in serum 25(OH)D in Finland smokers.  It is well known that this country has offered stoss injections of vitamin D2 and D3.  Is the u-shaped curve that was much discussed different for D2 versus D3?  I think the answer is yes.  There have been many recent papers discussing the difference in the two compounds, but the one that sticks in my mind is the Moon and Reich paper from 1975.  The Vitamin D Problem, and Important Lesson in Orthomolecular Medicine. Link to pdf

In this paper we find that the reports of toxicity did not even start to occur until the introduction of irradiated ergosterol, vitamin D2 or worse an unwanted compound from this process apply named toxisterol.  Vitamin D2 is a compound made from a fungus.  There had been years of supplementing with large amounts of cod liver oil without incidence except for two reported by the same doctor.  During the next several decades the compounds started to be treated as equivalent, for economic purposes I suspect.  The reports on toxicity started rolling in every month.  Only irradiated 7-dihydracholesterol produces vitamin D3, it was much easier to irradiate other sterols for profit.  Moon and Reich listed diseases that are made worse by D2.  Here are a few: Atherosclerosis, Rheumatoid Arthritis, Peripheral Vascular Disease, Idiopathic Hypercalcemia.  Could pancreatic cancer or prostate cancer be a couple of others?

Third Expectation:  The amounts of vitamin D considered should be large enough to make a clinical difference in outcomes.  The IoM committee covered themselves on these diseases by bluntly stating that the report only covered bone health.  The AHRQ-Tufts report in many cases used studies for chronic disease that reported a difference between 400 IU versus 800 IU of intake per day.  Why would they think that two minutes in the sunshine versus four minutes makes a clinical outcome difference in cancer?

Based on this lack quality in the AHRQ-Tufts report and consequently the IoM report, I reject both as not being of quality for my use.  However, the patent holders of vitamin D analogs, I am sure, are delighted.  – Pandemic Survivor