In May 2018, a petition signed by more than 70,000 people was submitted to the National Assembly of Quebec, with the goal of “authorizing” vitamin C injections in cancer patients. Asked about the petition, the Minister of Health at the time then said that, according to oncologists consulted, this intervention “had no added clinical value”.
A second petition, started in January 2019, collected more than 120,000 signatures and asked even more, notably adding vitamin C injections under the list of medications reimbursed by the government. It received a lot of positive media coverage and was promoted by several well-known public figures.
People living with cancer go through extremely difficult times, and are very brave. Some of them already receive vitamin C injections at this time and believe that it helps them to tolerate their chemotherapy better; I sincerely wish that these people will be able to keep receiving these treatments.
However, the issue here is broader.
It’s not an issue that a few people receive such injections. The problem is that the current enthusiasm and fascination around this story suggests that it should be a widespread, easily accessible, and regularly used treatment for cancer patients. It is not the case.
Unfortunately, by reading comments left online under the news articles or on the the petition itself, it is obvious that many people do not really understand the real issues at play. And I can’t blame them; it’s actually quite hard to grasp the facts here, especially if one relies on what is said on social networks and in the media.
This article therefore aims to review the differences between the popular perceptions VS the reality of vitamin C injections.
(Note: the comments analyzed below are real and quoted verbatim)
Vitamin C injections are not a cure for cancer.
The suggested indication is to reduce the side effects of chemotherapy, which would improve patients’ quality of life. And unfortunately, to date, the data are not conclusive for this use either.
(In other words, there are some positive trials, and some negative ones… but these trials do not have an adequate placebo group that would tell whether the effect is actually due to vitamin C, or do not have a design that allows to draw conclusions about the effectiveness of the treatment. So overall, the efficacy is not clear and remains theoretical, see here, here, here and here among others).
The belief that vitamin C cures all kinds of diseases dates back to the 1970s, but proved to be wrong when tested scientifically.
As far as we know, the only thing that is cured with vitamin C injections is scurvy, an uncommon condition in this post-Jacques Cartier era.
It is not “illegal” to inject vitamin C in Quebec, even for cancer.
The issue is not legality, but the fact that it is not ethical, rational or justified to do so in the absence of solid scientific evidence.
More importantly, it is not more acceptable in Ontario than in Quebec. The media mentioned a clinic offering these injections there; it is not a medical clinical, but a center for “integrative medicine” (i.e. the new name given to complementary and alternative therapies). Its founder and executive director is a naturopath. According to its website, there is only one physician who seems to practice there as a clinician, and she is not an oncologist.
In short, the fact that clinics in Ontario, in the rest of Canada and in the United States (there’s many of them) offer vitamin C injections is not proof of effectiveness.
A lot of comments draw a comparison with the legalization of cannabis. But again, there is no question of “legalizing” anything, so this analogy does not hold water.
(note : true story)
Vitamin C injections do not typically seem to cause a lot of side effects, that much is true.
But here’s the real problem: preliminary data suggests that vitamin C could interfere with the effectiveness of chemotherapy.
[When chemo is administered for incurable cancers (e.g. palliative care), it is not to treat cancer as such, but to reduce pain and prolong life. So if vitamin C decreases the chances that this approach works, we should definitely take it into account.]
Clinics offering such injections say so in their own references:
Other trials with oral vitamin C had to be stopped prematurely because of toxic effects that appeared to be caused by vitamin C itself.
These effects are not surprising. Vitamin C is an antioxidant, and some have theorized from in vitro data that it may also have opposite effects (i.e. pro-oxidant). In any case, we’re talking about reactions within the human body that are subject to a very delicate balance, with health effects that remain little known and therefore largely unpredictable.
In short, it’s a mistake to see these injections as harmless. Besides, administering megadoses of vitamins is always dangerous.
Meanwhile, we know that people with cancer who use alternative / complementary / integrative therapies are at higher risk of dying from their cancer: we’re talking about a 2- to 6-times higher risk of mortality (see here, here and here).
In summary, if we accept preliminary data suggesting efficacy, we should also accept preliminary data suggesting potential hazards.
Let’s try to look at this logically…
In fact, a woman in Quebec who is currently receiving vitamin C injections recently mentioned on a radio show that these treatments allowed her to stay longer on chemotherapy.
In other words, if vitamin C injections work, they are ultimately profitable for Big Pharma.
Actually, natural health products are a multi-billion dollar industry. There’s a lot of money to be made, despite extremely poor regulation.
According to the information I was able to collect:
It’s expensive and not accessible to everyone.
OK, we’re far from the billions of dollars generated by the industry … but for a therapist or a clinic that follows many patients, there are tens or even hundreds of thousands of dollars to be made each year.
(Just to be clear, I’m not saying that the therapist or clinic administers vitamin C in order to make money, but simply that yes, it can generate significant profits)
That’s what the United States just did.
The Right to Try Act, signed by Trump in May 2018, allows terminally ill patients to have access to any experimental treatments, regardless of their efficacy or safety.
At first, it may seem like a good idea …
When they invoke Right to Try instead, patients essentially become guinea pigs for unsupported therapies and lose their basic rights in case of problems. They can easily become the victims of charlatans ready to sell them a miracle therapy (it has already started elsewhere). And nobody can be held responsible.
For the protection of the public and the sick, I hope we will not choose this route in Canada.
(sorry for this lame title design, I can’t help it)
I understand those who are committed to this cause, and the topic of cancer is very important to me.
Also, I realize that by talking about this subject in a very matter-of-fact way, making jokes to lighten the subject, I probably sound – to some people – as closed-minded, or even insensitive.
But one of the most important messages I am trying to convey with The Pharmafist / Le Pharmachien is that applying the scientific approach when making health choices is one of the best things when can do for ourselves, collectively and individually, especially for people who are vulnerable.
What I find the most unfortunate here is that many people will stay with a feeling of injustice. And yes, it may seem unfair. But when we choose to support a cause, we have the responsibility to ensure that we understand the deep issues, not to select what pleases us or not.
If vitamin C injections really had “proven” benefits, they would be prescribed regularly in oncology, because everyone (patients, doctors, industry) would be a winner.
Yes, some people may derive benefits from them (real ones or through the placebo effect). But to this day, it remains a treatment that seems to involve risks and whose benefits are uncertain, and so it is quite normal that it is little or not used in medicine at the moment. It’s in the best interest of people with cancer.
P.S. I did a mini-investigation and there’s currently an oncologist in Montreal who prescribes vitamin C injections for cancer. Despite all my efforts to get his name, he wants to remain anonymous … which is really strange, considering that he is allegedly heading an oncology research center (not found via Google) that is about to start a clinical trial on vitamin C injections (not found on any registry). I found the phone number of the center and I spoke to his coordinator, a very kind lady, who said to me: “I know you, and I know you don’t believe in that kind of things…”. Actually, I won’t need to “believe” when the results of the clinical trial are published and we can analyze them. In the meantime, I think we should remain skeptical and cautious.
*** UPDATE – JANUARY 21, 2019 ***
A new version of the petition is circulating. The petition again calls for “authorizing doctors to prescribe vitamin C“, and also proposes “to set up a vitamin C injection registry in Quebec“, as well as coverage on the list of reimbursed medications. The petition was also mentioned on national TV, on the popular show “Tout le monde en parle“, on Jan. 20, 2019.
Here are some thoughts and developments on this topic:
- As explained in my article, “authorizing” vitamin C injections is still not a real issue, since this intervention is already allowed. It’s the scientific and ethical aspects that are problematic. Creating a registry will not address these issues either.
- In 2018, Montreal-based oncologists said they were preparing to start a clinical trial on vitamin C injections fore cancer. To date, no information has been provided to this effect. It’s important to note that all research must be approved by ethics committees well before it can begin. And the last time a trial protocol on the topic was submitted in Montreal, it was back in 2010.
- Some people are currently promoting a scientific publication by Alexander et al. (2018), claiming it “proves the benefits of vitamin C injections” for people on chemotherapy. This publication proves nothing of the sort; it includes mainly pre-clinical data (in vitro and animal experiments), as well as a brief overview of preliminary data for a pilot study (Phase I) in humans in relation to radiotherapy (not chemotherapy). But above all, this type of trial (Phase I) is not designed to support efficacy claims, something the authors themselves mention – subtly – later in the publication. In fact, I even took the initiative of writing to the editors of the journal Cancer Research to inform them that the summary of this publication contains, in my opinion, misleading and possibly unethical statements.
*** UPDATE – JANUARY 30, 2019 ***
*** UPDATE – FEBRUARY 5, 2019 ***
Some people are currently promoting a news item stating that Sherbrooke University has received a $ 2.8 million grant to study vitamin C injections.
It’s true … but it’s for a totally different indication, namely septic shock (a serious complication of some infections). It involves a completely different mechanism of action being studied, and no link can be drawn with cancer at this point.
*** UPDATE – FEBRUARY 11, 2019 ***
Science journalist Jean-François Cliche inquired with the Ontario Ministry of Health about their position on vitamin C injections in cancer cases. Unsurprisingly, this practice is not considered scientifically or ethically acceptable there either, contrary to what is stated in the petition.
*** UPDATE – FEBRUARY 15, 2019 ***
Proponents of the petition are now citing a new article to support their claims. However, by opposition to what its title suggests, it is an in vitro experiments on cells, which is important for stimulating future research, but can not be extrapolated to humans. The article also mentions a phase I trial in 11 individuals, aiming to assess safety of vitamin C injections (also called a “safety trial”). On the one hand, this study is never referenced in the article, which is very bizarre … I presume that it was never published, and therefore it is impossible to analyze or interpret it; I wrote to the editors of the site to have more information. But above all, this type of study can not assess 1) the effectiveness of treatment and 2) the risk of reducing the effects of chemotherapy (because the duration of the study was too short, i.e. 2 months).
Contacted about this, the author of the article in question objected to her text being used in support of the petition, stating:
“I and Cancer Commons have never endorsed [this] position / petition and asked [the organizer] to remove the post from Facebook. While there are some data to support high-dose vitamin C, they are not conclusive. Cancer Commons’ name has been used without permission.”
*** UPDATE – FEBRUARY 20, 2019 ***
Proponents of the petition have adopted a new strategy (visibly effective) over the past few days, probably in a final sprint before filing to the Quebec National Assembly on February 28, 2019. Yesterday, Ms. Chantal Lacroix published a video summarizing the group’s current arguments, which must be analyzed because it underlines how important it is to become familiar with the foundations of critical thinking. The video in question …
1. Continues to spread the idea that vitamin C injections are “illegal“, and that the petition is intended to “legalize” them. This fallacious argument is called “ambiguity of language“; legalizing, or even authorizing anything, in not an issue here, as explained in my article.
2. Implies that if vitamin C injections are not “legalized“, people with cancer may need to turn to physician-assisted suicide, which is legal. On the one hand, this comparison is tasteless, misplaced and indelicate towards the terminally ill. On the other hand, it is a false dilemma, which gives the impression that a person may have to choose between these two options, which is not the case. Above all, this is a bad analogy because both interventions are considered in very different contexts.
3. Adds that dozens of public figures from the artistic world have signed the petition in the last few days, which – according to them – demonstrates the validity of the requests. This is an appeal to popularity; the fact that many people or celebrities sign the petition is not a guarantee of anything.
4. States that “leading experts” in the field of cancer have signed the petition. On the one hand, no such expert has endorsed the petition publicly, to my knowledge. But above all, it is an appeal to authority; even if some “leading experts” had signed the petition, this does not guarantee its validity.
5. States that even if scientific data on vitamin C injections are lacking, “everyone wins” by signing the petition, as it will allow more data to be collected through the creation of a clinical registry. This statement is false because creating a registry is no substitute for clinical research, which is necessary in this case. Clinical registries in Canada are a succession of anecdotes collected in an uncontrolled environment, which makes it impossible to draw conclusions about the effectiveness of an intervention. Drug registries identify certain side effects that appear to occur more frequently, which may result in increased government and manufacturer vigilance, and may stimulate the development of additional clinical studies. In short, creating a registry of vitamin C injections would only be relevant if this intervention was already supported by convincing data and therefore was considered scientifically and ethically acceptable by oncologists.
This is not the first time that Ms. Lacroix has ignored criticism by scientists, or is promoting questionable health practices. She obviously has good intentions, and I do not doubt her sincerity in this process. But again, I would like to invite her to be more cautious and restrained when it comes to health topics, given her vast popularity and influence.
*** UPDATE – FEBRUARY 28, 2019 ***
Youri Chassin, the local deputy politician supporting the petition, is now calling for a special Parliament Committee on vitamin C injections. So I contacted him directly on his Facebook page :
(the following is an image modified in order to include the translation in French)
I did not get an answer, even when following-up with his office by email. However, Mr Chassin answered this to another user:
Mr Chassin later deleted his post from Facebook.
*** UPDATE – MARCH 1, 2019 ***
I explained above why the creation of a clinical registry, in my opinion, is not appropriate in this case, but I realize that I did not explain why I think the same thing about a parliament committee on vitamin C injections.
According to the National Assembly of Quebec, “Parliamentary committees are the perfect forum to examine in detail bills or other current issues. The deputies also play a role in controlling government activity and public consultation on the various issues that animate society“.
I have no doubt about the relevance of these commissions for different issues of public interest that are subject to debates of ideas or opinions. But in this case, the issue is the lack of evidence to support vitamin C injections in people with cancer. In other words, it is not a matter of opinions, but of science.
A commission will not generate new data on the effectiveness and safety of the treatment. And even if the goal was to discuss funding for a possible clinical study on vitamin C injections, how could one justify that research funds, so hard to obtain, be awarded on the basis of the popularity of a petition? It is not up to a parliament committee to decide on the funding of clinical research, but to organizations specialized in this field, such as the Quebec Health Research Fund (FRSQ), or the Canadian Institutes of Health Research (CIHR).
It should be noted that, to this day, NO experts have publicly endorsed this treatment.
It should also be noted that during a parliament committee on Lyme disease in March 2018, the National Assembly of Quebec summoned as key expert a French doctor who supports the idea that the progression of Lyme disease is due to a Nazi researcher in hiding in the United States who is genetically modifying ticks on the behalf of the US military. This gives you an idea of the accepted standard in this type of commission regarding “key experts” …
In summary, having a parliament commission to discuss such a niche medical issue, which is primarily a matter of critical analysis of the evidence, is in my opinion a strategy of political lobbying that bypasses the scientific process, involving significant risks for medicine and the healthcare system. It is also, in my opinion, poorly invested public money, considering the limited scientifically and clinically relevant information that can be obtained from such a commission.
Note: I’m far from being a specialist in politics, so if I’m wrong regarding the above, thanks for bringing me specific arguments that will make me reconsider my position. To date, I have had none.
*** UPDATE – MARCH 4, 2019 ***
So here’s what’s happening right now…
And as promised, here is the entirety of my conversation with the initiator of the petition in 2018.
*** UPDATE – MARCH 21, 2019 ***
At last! Experts have decided to come forward on the scientific aspects of vitamin C injections, because of what’s going right now:
- Dr. Denis Soulières, hematologist and medical oncologist
- Dr. Jacques Jolivet, medical oncologist
- Dr. Martin Champagne, Oncologist and President of the Association of Hematologists and Oncologists of Quebec
I also want to tell you how much I’m touched to read all the support I have received in recent days. It would be impossible for me to answer everyone, but I want you to know that I read your messages and that I am deeply grateful.
I also want to say a huge thank you to my broadcaster and to the Quebec Order of Pharmacists, who understand the situation and offered me their support. I consider myself very lucky.
I also thank all the scientists, healthcare professionals and scientific or medical associations who have decided to come forward. Such complex subjects deserve to be the subject of a joint effort of communication.
You will understand that given the gravity of the situation, I can not / do not want to comment on it.
But beyond my case, as many have guessed, it is not so much “me” that needs to be defended: it’s the scientific process. It’s harder than ever to discuss science publicly, and we should not let the situation deteriorate to the point where it’s no longer possible to do it.
On a more cheerful note, this case has initiated a serious reflection about the involvement of scientists in public debates, and how to support them in the current context. There already seems to be embryos of projects in this direction, which I hope will come to fruition soon; stay tuned for updates on this below.
Thank you again everyone, I appreciate your support so much!
*** UPDATE – APRIL 4, 2019 ***
More media coverage can be read here.
*** UPDATE – MAY 1, 2019 ***
I can now confirm that positive outcomes have ultimately emerged from this case:
- A government task force was created in order to protect scientists who speak publicly about sensitive topics (I am fortunate enough to be involved in it);
- Also, an inter-professional advisory committee was created by several professional Orders in order to support healthcare professionals, such as myself, when they speak publicly, so they can do so without fear of disciplinary action.
It is comforting to know that despite the negative events in this case, there are positive repercussions. I hope these initiatives will help others avoid situations like the one I experienced.
*** UPDATE – JUNE 13, 2019 ***
Back in March 2019, there was a joint request by several professional associations, in response to the public controversy that ignited, to mandate the National Institute of Excellence in Health and Social Services (INESSS) to write an official report on the clinical relevance of vitamin C injections. This is now official and will be done. An INESSS mandate is precisely what I was wishing for from the start, so I see this as the best possible outcome.
This case is closed, so far.
Many thanks to all of you for your interest towards this topic!
To read about the original version of this story in French (which includes about a hundred comments and my answers), see here.