Vitamin C and the Common Cold: A Comment on the Review by Franklin C. Bing

   A review of my book Vitamin C and the Common Cold, by F'ranklin C.
Bing, was published in the JAMA for 1 March 1971.

   I do not object to the expression by the reviewer of his opinione.  I
feel, however, that it is essential that the several untrue statements and
thoroughly misleading statements that he makes be corrected.

   The author states that "Unfortunately, many laymen are going to be-
lieve the ideas that the author is selling--that ascorbic acid is a completely
harmless chemical which will prevent or mollify infectious diseases such as
the common cold, if taken in doses of from one to ten gm daily throughout
life, and possibly extend that lifetime from two to six years. "

   In fact, I do not state that ascorbic acid is a completely harmless
chemical.  I describe it as a natural, essential food that is nontoxic, and has
far fewer side reactions than aspirin and other common cold medicines.

   I do not recommend taking doses of from one to ten grams daily
throughout life.  Instead, I say that there is evidence that some people re-
main in very good health, including freedom from the common cold, year
after year through the ingestion of only 250 mg of ascorbic acid per day,
that the requirements of a few people for ascorbic acid may be expected to
be even smaller, that for many people one gm to two gm per day is approx-
imately the opttmum rate of ingestion, and that for some people optimum
health may require larger amounts, up to five gm per day od more.

   The reviewer states that "Actually, when used as recommended by
Professor Pauling, neither the safety of all dosage forms, nor the efficacy
of ascorbic acid in any dosage form, has been proved. "

   In fact, I compare the evidence about the safety of ascorbic acid with
that of the usual cold remedies, and conclude that the usual cold remedies
are more dangerous than ascorbic acid.

   Also, I present in my book a careful analysis of the controlled trials
of ascorbic acid that have been published, and point out that several of these
investigations have shown, with statistical significance, at the confidence
level of 95 percent or higher, that ascorbic acid has value in decreasing both
the incfdence and the severity of the common cold.  There has been no con-
trolled study that has shown, with statistical significance, that ascorbic acid


admfniatsred regulerly to a popwlrtion e;rpoe4d to cold virw48 in the normal
w9p doeo not bav4 the amount of protective value th4t I dwcribe for it, in
my book.

   The author otrrtw that `In raviewiag publirb4d reporter P~uling ex-
plrinr naglsive finding4 by implying that positive rerult8 would have bean
obtained if larger deree of vftamfn C h4d be4n rsmployed. "  Thir rtatement
ia thoroughly mirleuiing, in that it is eorrslct only if it ir applied to the
published report4 of inv48ttgation4 iin which vitamin C wu @m to patienta
who had etreuly contructed eold8. or who bed been rubjectad to the unwurS
fnrrult of inoculation with 14rge doass of cold tirww.  The several publiehed
report8 of controlled hadies in which aamrbic acid ir complrrrd w\itb a
placebo, with both @vup during 4 pcsriod of time beginning befon cold8 burd
beers contracted llxid wit& rubj44U 4xposad to c&d vrzCwes in the normal waya
h4ve led to th4 rtrtistfcally rignifkud conclwton that uleorbiu acid Herr pro-
tmttve valw; that fr, they have given ptMtiv4 rerult8, rather than negative
reaultr.  No eoatroll4dtrial8 ofthi 80~4 have givennegativ4 r88ult8 with
rtrtistical ei@fitm~e, and It wu1 not neua~sarg for me to explain any nega-
ttve findiaga for imidier of thi8 602-L

   The reviewer statar thd iPauling hop44 that there will be a thor-
ougb, large-rc4l4 WMy 011 vituain C and th4 common cold.  Becawe he
hu already convinced hfnualf that vitamin C in lurge darer doe8 avert or
ameliorate th4 common c&d, th4 qusrtkm ~rirest what kind of rereuch
doerhehrwsi.nmbdP

   Here the ravtewtm hu thoroughly mirrepr4rented my 4taterrz9ntsr
pre8ummMy because he hm be4n careleas iu rtmding the book.  On pege ID1
I say "So far u I am aware, IPQ 14rga-scrrts rtudy, involving sevrrccl hundred
or thawand oubjectr, harr b4en curi4d out to show to what sactent th4 regular
iqpation of ucorbic acid ia large amounta ir effective in preventisq and
ameliorating the comlllon cold aad mmoetatid infection.  I hop4 thut home
rawh lunge-real4 etudiea will b4 ouri4d outg but in the memtims I am con-
vbacbd by the sv1dan44 aWmdy avatlablr thut amxwbie: acid ir to be preferred
to the anrlgsricrr, untihiatuaixmr, md other dangerma druge thut 4r4 recom-
mend4d for the trertment of tbs common cold by tb4 purv4yor8 of &uga. "

   I emphrrrfr4 that I rtrrkd in my book that no lulg4-rc4le etudy hrrr been
cUMPled out to rhow to whrJ 4xtent the regular ingention of ureorbic acid g
luge amount8 ir 4ff4ativ4.  The reviewer mi#quotrd me, by omitting the
rtatement about raw ingrrtioa ix3 l4rg4 amounta.  In fact, lerg4-rcrle
rtudier involving the ngul;rr *eMon of ucorbic acid tn 4m4ll amount8
have be4n carried ant, and have, #ivan rrtatiatically rignificmt remaltb, rhowing
that 4v4n t3mer malII amountr sm effective in prev4ntfag and ameliorating th4


common cold and mmocirted inksctione.  The c8r4le88nbau of the reviewer
is made clear by the fact that on page 61 th4 sentencer immsdiately pr4-
c4ding the rsentencer quokd 4bw4 are the ftiowings "In this chapter I:
have dircwsrd some al &IJ invert@tW aat have tien carried out on
ucorbic acid in relation to the common cofdr others am dirGU888d in
Appendix III. Some of th48e inve8tigatiuns hav4 been well designed but,
unfortunately, have involv4d the ue of rather emall quultitiea of amorbic
acid, and have ishown only that thea rath4r small qupntities have limited
value in preventing or uneliorating the common cold. "

   I find it urtoniehing that th4 reviswer Should miar4prerent my book
80 tho?oughly, and that ha ohotid giv4 the remdare of th4 Journal of the
Amerfean Medical Association the fmpression that th41-4 hws not been any
thorou& hrgs-male studier of vitamin C and the common cold, wh4n I
had included a detailed dtocueaion of eeveral 8uch studies in the book that
h4 ww revfewing.

   A correct revi4w wortfd hav4 included mention of the fact that saw-
errl good controll4d setudiee hav4 been 1md4 of the effect of rsecorbic acid
in amounts of about 200 mg p4r d1y or 1.600 mg per dPy adminiatcaratd r4g-
ularly to subjects, beginning before they had contracted coldr, with other
subjecta rectaiving a placebo, aud that it bed bgen foUnd that the rrcorbic-
acid subjects had fewer coldo than the placebo subjsctca, that the eev4rity
of individual colds wadl leee, and that thee4 results wer4 statietically saig-
nificunt.

   An exmpl4 of such a cmeful double-blind controllcsd trial carried
out by reliabl4 and experienced medicril. investigator8 is that of Dr8. Cowan,
Diehl, and Baker, reported in the JAMA for 1942.  This investigation was
dest?ribed by Dr. Haven Emeroon of New York aa a "good example of a care-
fully controlled study. It The authors reported that th4y hrd found a Ubpst-
cent smaller incidence of coldr in the aecorbic-acid group than in the placebo
group, and that thiar difference ie etatietically eignifie8nt, the probability that
it would occur through a 8tatWical flucttutfon in P -iform population affect-
ed equally by the aecorbic acid and the pleoebo being only 3 or 4 percent.
They duo reported that the average number of d8yr of illnew for the aucor-
b&acid aubjectr WIB $1 plercent less than for the placebo subjects.  Thi8
difference iar ale0 4tattstically s3igniftcant, at th4 l-percent level.  The
amount of suacorbfc scfd given wm about 200 mg per day.

   Ancsth4r vsry cor4ful double-blind controlled study described in my
hook WRIU reported by Dr. G. Ritsst, of Ut4 public School harilul 84XViC4 in
Basel, Switrerland. In thio investigation the 8UbjQCtr received 1,000 mg of


-4-

aecorbic acid per day, with the control erubjsrcts receiving a placebo.  The
detailed account of thr work published by Dr. Rittal in Helvetica Medica
Acta for 1961 ehowe ths care with which it wpa carried out.  Th4 incidence
of cnldr for the eecorbic acid group wae 4b percat leea than that for th8
placebo group, with statirrticsl eignificancet at the l-percent level.  The
total number of day4 of illnere from upper respiratory infectlone w4a 61
percent 1444 for the ascorbic-acid subjacte than for the placebo subjectsi,
and the incidence of individual symptome wall 86 percent lesr, for the ae-
corbic acid 8ubjecte than for the placebo subjectsr.  Th4 author reports
that etatfsticel craalysis by 4n independsnt team of 4tattticians ehowed that
theee diff4rences hod statistical significance at the l-percent level.

   Ths reviewer's statement that thar efilcacy of aarcorbfc acid in any
dosage form has not been proved is f&set.  R48!ilte with high 8tattetic4.l
aignffkance obtained by reliable medical iaveetigatora in carefully con-
trolled studfee, euch 48 the two quoted abov4, have proved the efficscy
of aecorbic acid, administered over a period of time to subj4cts exposed
to cold viruees in the normal way, in decrsaeing the incidence and mvw-
iQ of the common cold, and these reeulta have not been contredictod by
statirtic4lly hlignificant negative resuftr in a eingle controlled teert carried
out under similar circumetances.

The review of my book misr4preaents the facts completely.

Linue Pauling