ments of doubtful taste or accura- cause of endemic goitre but has Thus, it does not refer to the cy do, from time to time, make not been seen in Canada since the double-blind controlled studies of their way to the pages of profes- introduction of iodized salt. How- niacin (nicotinic acid) in the treat- sional journals. But the primary ever, in recent years iodine excess ment of schizophrenia beginning goal of the PAAB is to consider has also been identified as a cause in 1952 in Saskatchewan."2 Wit- companies' ads before they are of thyroid disorders, particularly tenborn's findings3'4 corroborated published. As a result, readers sel- hyperthyroidism in euthyroid the conclusions made from the dom see how much the board goitre patients and euthyroid or initial studies. The Nutrition actually does.' As I mentioned in hypothyroid goitre in healthy sub- Committee refers only to the the article, health professional jects. 1-3 In addition there is some Montreal studies by Bann and journals will not accept pharma- evidence that excess iodine may Lehmann,s who reported they ceutical ads unless they have been predispose to autoimmune thy- could not confirm. The committee approved by the PAAB; herein roid disease.3 refers to an American Psychiatric lies the board's most effective I have seen hyperthyroidism Association task force report6 but sanction. brought on in goitrous patients not to a reply.7 There is no doubt that phar- with the 150-,ug dose of iodine in In its discussion of niacin the maceutical companies will contin- multivitamin preparations and committee leaves the inference ue trying to persuade consumers goitrous hypothyroidism in kelp that this vitamin is toxic but ne- that their products are better than or dulce eaters. I feel strongly that glects to inform the reader that it their competitors', and they will iodine should be withdrawn from decreased the death rate and in- use creative and sometimes objec- all over-the-counter preparations creased longevity in the Coronary tionable or misleading means for and that so-called health food Drug Project.8 Cardiologists using doing so. There is also no doubt stores should not be allowed to niacin to lower the blood choles- that the PAAB program still has sell kelp or dulce. terol level are not afraid of using some way to go; that is why the large doses of this vitamin.9 board is preparing a revision of its Allen Gold, MD, FRCPC The committee's discussion code. 360 Victoria Ave. of pyridoxine fails to refer to over Although the program has not Montreal, Que. one dozen double-blind controlled yet met Lexchin's utopian stan- References studies showing that this vitamin dards, I still believe that pharma- is safe and effective for the treat- ceutical advertising has come a 1. Okamura K, Kaori S, Hiroshi I et al: ment of infantile autism. long way under the PAAB and Re-evaluation of thyroid radioiodine The position statement is in- that the board and its hard-work- uptake test with special reference to accurate because it refers to the reversible primary hypothyroidism. J ing commissioner and staff de- Clin Endocrinol Metab 1988; 67: 720- American Psychiatric Association serve much credit for the change. 726 task force report6 as a report of 2. Braverman LE: Chapter 35. In Ingbar the Research Advisory Committee Bruce P. Squires, MD, PhD SH, Braverman LE (eds): Werner's The to the National Institute of Men- Editor-in-chief, CMAJ Thyroid, 5th ed, Har-Row, New York, 1986: 737-742 tal Health, which it was not. It 3. Idem: Iodine-induced hypothyroidism was only a report by a subcommit- and hyperthyroidism. In Post-Graduate tee of the American Psychiatric Assembly Syllabus, Endocrine Society, Association. Megavitamin Bethesda, Md, 1989: 483-484 Moreover, the position state- and megamineral ment neglects to point out that the therapy in childhood I would expect any position state- Bann-Lehmann studies' did not ment by a medical society to be repeat the original double-blind his review (Can Med Assoc both fair and accurate. In my controlled studies done in Sas- J 1990; 143: 1009-1013), opinion this report has failed on katchewan. We in Saskatchewan by the Nutrition Commit- both counts. My conclusion is used a true double-blind design tee of the Canadian Paediatric based upon an examination of with niacinamide (nicotinamide) Society, omits adequate emphasis only portions of the report, those as a hidden control and claimed on iodine as a trace element and covering the subject matter with that the addition of niacin im- does not include it in Table 1, which I am most familiar and proved the rate of recovery from which lists the toxic amount and have had the most experience acute schizophrenia, not chronic recommended daily intake of over the past 35 years. schizophrenia. Bann and Leh- minerals in children. The position statement is not mann did not use a double-blind Iodine deficiency has been fair because it fails to give a bal- design, because it is impossible to recognized for over 70 years as a anced review of the literature. double blind the flushing effect of

CAN MED ASSOC J 1991; 144 (7) 845