I would like to introduce this collection of papers with a tribute to Sir Richard Doll, who died in 2005 at the grand old age of 92. Julian Peto and I went to talk to him about vitamin D while he was still fit and well.
Doll had shown that a four-monthly oral doseof 100,000 IUs vitamin D3 reduced fractures in people over 65 [1]. The study, undertaken with Daksha Trivedi and Kay Tee Khaw, also showed a non-significant reduction in mortality in the subjects who took vitamin D. Impressed by these results, and believing that vitamin D probably had beneficial effects other than those on bone, Doll himself took a monthly vitamin D tablet equivalent to about 1,000 IUs per day. In fact the tablet he was taking was vitamin D2, which only has one-third the potency of D3. High-dose vitamin D preparations are only available on prescription in the UK and are all formulated with D2. Most clinicians are not aware of the important difference in potency between D2 and D3.
Doll had courageously changed his mind about the importanceof vitamin D and the beneficial effects of exposure tothe sun. As chairman of the UK Advisory Group on Non-ionising Radiation (AGNIR) he had signed off a report of the National Radiological Protection Board (NRPB) which states that casual exposure to the sun in the UK provides people with sufficient vitamin D [2]. That belief is still a foundation stone of official policy on sunlight in the UK, but when Doll looked further into the evidence he realised that it had little scientific support. However, he did not want his revised opinion to be made public until he had for mally notified the NRPB, so he telephoned Professor Tony Swerdlow, the presiding chairman of AGNIR, to report his change of view.
In the months before his death Doll was reviewing the literature on vitamin D and sunlight. The study he had undertaken with Trivedi and Khaw was intended to be a pilot project, and Doll still hoped to obtain funding for a larger trial which would examine a wider range of possible benefits. He was also seeking support for a conference on vitamin D, and the meeting at the House of Commons at which this collection of papers was presented is a tribute to him and to his interest in vitamin D.
Doll believed in the utility of science and had seen atfirst hand what benefits can come from a clear understanding and exposition of the causes of disease. No doubt with this experience in mind, he left Julian and me with this thought provoking comment as we departed: 'This isn’t difficult science. We should have answers.
He clearly felt that the subject of vitamin D had not had the attention it deserved from scientists and that a great deal could be achieved. There are still major disagreements among health researchers about the strength of the evidence that insufficient vitamin D or sunlight increases the risk of various diseases. But all are agreed that this is an important problem, and that these initiatives need to be supported by substantial funds and positive government action.
The meeting at the House of Commons was hosted and chaired by Dr Ian Gibson, MP. As well as being a member of Parliament Dr Gibson is a distinguished scientist with a long career in scientific research. He has been deservedly chosen on two occasions to be the ePolitix health champion, the member of Parliament who has done most for health causes during the course of a year. We are very grateful for his support.
After the morning meeting I met the speakers and other like-minded people to discuss what can be done to obtain the co-operation of the UK government, the European Union and others for further research and action to improve vitamin D levels in people everywhere. Several of those present said they would raise the issues with their professional bodies and would suggest that meetings and symposia be planned todiscuss the subject. Wealso agreed to set up an organisation, which we have provisionally called the Vitamin D Forum, to keep all those interested in the subject of Vitamin D, Sunlight and Health in touch. Anyone reading this who would like to know more about the Vitamin D Forum should contact me.
I would also like to express my thanks to Ad Brand and the European Sunlight Association who provided financial support for this meeting. The ESA represents manufacturers of sunlamps and their associates. They have been enlightened sponsors and have not endeavoured to influence the choice of speakers or the programme of the meeting in any way. The ESA has paid travel and subsistence expenses to speakers but no honoraria have been paid to speakers for participating in this meeting. I myself have no commercial interests in this work and have received no payments of any kind in connection with it.
Contents
Preface
Introduction
Summary
The vitamin D epidemic: truth and consequences. Michael F. Holick
Health consequences of insufficient vitamin D. Armin Zitterman
Genes, environment and prostate cancer risk. Nicholas J. Rukin, Christopher J. Luscombe and Richard C. Strange 25-32
Vitamin D: photobiology and relevance for cancer. Johan Moan, Zoya Lagunova and Alina Porojnicu
Insufficient sunshine as a cause of multiple sclerosis. George Ebers
How much vitamin D is enough for optimum health? Reinhold Vieth
Vitamin D insufficiency in the UK and diabetes. Elina Hyppönen
Evidence of deficiency and insufficiency of vitamin D in the UK. Barbara J. Boucher
Do we need more sun exposure? Brian Diffey
A new health policy for sunlight and vitamin D. Oliver Gillie
Author Biographies
