Assessment Task Force Report Definition Value Statement: Fill & Download for Free

Why is Trump ignoring the people whose data proves him wrong about social separation's effectiveness in stopping communicable diseases?For the most immediate context, this official CDC chart follows the total cumulative growth of USA case numbers since 3-4-2020: Coronavirus Disease 2019 (COVID-19) in the U.S.This one shows the number of cases by the dates that people's illness began:Here is Trump's latest "Gut Feeling" about the viruses probable arc: Trump said that getting people back to work is the most important goal, because recessions & depressions kill people. So he's in favor of ending the social separation program as early as Easter: President Trump, COVID-19 Task Force provide update(See the video of his statement there.)"When the 15-day period ends next Monday, he said, “We’ll assess at that time and we’ll give it some more time if we need a little more time, but we need to open this country up.” He added, “We have to go back to work, much sooner than people thought.”Here are the folks who have visual proof that Trump is catastrophically wrong, or lying, or both. (What do you value most? Your money, like Trump, or your life?)Kinsa’s fever map could show just how crucial it is to stay home to stop COVID-19 spread – TechCrunch"Smart thermometer maker Kinsa has been working on building accurate, predictive models of how seasonal illnesses like the flu travel in and among communities — and its fever map is finding new utility as the novel coronavirus pandemic grows globally.While Kinsa’s US Health Weather Map has no way of tracking the spread of COVID-19 specifically, as it looks only at fevers tied to geographic data, it could provide easy-to-grasp early indicators of the positive effects of social distancing and isolation measures at the community level.At the time that Kinsa’s health weather map was covered in the New York Times in February, the company had around a million thermometers in market in the U.S., but it had experienced a significant increase in order volume of as many as 10,000 units per day in the week prior to its publication.That means that the company’s analytics are based on a very large data set relative to the total U.S. population. Kinsa founder and CEO Inder Singh told me this allowed them to achieve an unprecedented level of accuracy and granularity in flu forecasting down to the community level, working in partnership with Oregon State University Assistant Professor Ben Dalziel.“We showed that the core hypothesis for why I started the company is real — and the core hypothesis was you need real-time, medically accurate, geolocated data that’s taken from people who’ve just fallen ill to detect outbreaks and predict the spread of illness,” Singh said.“What we did with our data is we punched it into Ben’s existing, first-principle models on infectious disease spread. And we were able to show that on September 15, we could predict the entire rest of cold and flu season with hyper-accuracy in terms of the peaks and the valleys — all the way out to the rest of flu season, i.e. 20 weeks out on a hyperlocal basis.”“We’re taking our real-time illness signal, and we’re subtracting out the expectation,” Singh says, explaining how the new view works. “So what you’re left with is atypical illness. In other words, a cluster of fevers that you would not expect from normal cold and flu time.So, presumably, that is COVID-19; I cannot definitively say it’s COVID-19, but what I can say is that it’s an unusual outbreak. It could be an anomalous flu, a strain that’s totally unexpected.”“In the example above, Singh says that the spike in fevers coincides with reports of Miami residents and tourists ignoring guidance around recommended distancing.The steep drop-off, however, follows after more extreme measures, including beach closures and other isolation tactics were adopted in the area.Singh says that they’re regularly seeing that areas where residents are ignoring social distancing best practices are seeing spikes, and that as soon as those are implemented, via lock-downs and other measures, within five days of those aggressive actions, you begin to see downward dips in the curve. (...)(...) As Singh pointed out, Kinsa’s data is strictly about fever-range temperatures, not confirmed COVID-19 cases. But fever is a key and early symptom of COVID-19 in those who are symptomatic, and Kinsa’s existing work on predicting the prevalence of fevers related to cold and flu strongly indicate that what we’re looking at is in fact, at least to a significant degree, COVID-19 spread.”Monitor their results in real-time from here: US Health Weather Map by Kinsa"The U.S. Health Weather Map is a visualization of seasonal illness linked to fever - specifically influenza-like illness. The aggregate, anonymized data visualized here is a product of Kinsa’s network of Smart Thermometers and the accompanying mobile applications. Kinsa is providing this map and associated charts as a public service.”[This is a static screen-shot example; taken 7:00 pm PST, 3–24–2020]“The map shows three key data points: (1) the trend in how illness levels are changing in the past week, (2) the illness levels we’re currently observing, and (3) the degree to which those levels are higher than the typical levels we expect to see at this point in the flu season. (See technical approach document for details.)We believe this last data point — which we’re calling “atypical illness”, may in some cases be connected to the COVID-19 pandemic.Please note: We are not stating that this data represents COVID-19 activity. However, we would expect to pick up higher-than-anticipated levels of flu-like symptoms in our data in areas where the pandemic is affecting large numbers of people. Taken together with other data points, we believe this data may be a helpful early indicator of where and how quickly the virus is spreading.’”“This chart allows you to compare Kinsa's observations of the influenza-like illness level in the U.S., in orange and red, against where we’d expect them to be, in blue.Based on our data, influenza-like illness levels in the U.S. are higher than what we’d expect at this time of year."SO, who you gonna trust your life to people, Trump’s “Gut” or your truth-telling eyes?

The value of sterling is directly correlated to confidence in the British Government.The more unreliable the British Government, the more the value of Sterling drops.The British Government manages the British Economy - and their words, their policies - their lack of policies - are what give confidence to investors and therefore business and the country’s prosperity.Mark Carney is rightly very careful about what he says: he explains his statements thoroughly, he puts them into context and he outlines his intentions for the future.The same is true for the Chancellor of Exchequer. Their words are measured and it comes at a personal cost for them because they cannot make the public statements about their Government and those within it that they would like. This is currently what is constraining Sajid Javid.It used to be true of the British Prime Minister too.When Theresa May was faced with having to publish DexEU’s “sectoral analyses” for leaving without a deal and saw that they were no more than titles and cut and paste descriptions of how those sectors work whilst we are in the EU, she couldn’t go ‘Oh My God, David Davis has done fuck all. He said he’d do this shit and now he’s throwing around the No Deal card and I have absolutely no idea what No Deal means.’She had to shut her gob and try to avoid publishing them to her personal detriment.The much maligned Mark Carney is believed by the financial markets.One of the men who has certainly done so is Boris Johnson.“I don’t think that’s where we’re going to end up. I think it’s a million to one against, but it is vital that we prepare," he told a leadership contest event Wednesday.Johnson has built a broad coalition of supporters within the Conservative Party, from arch-Brexiteers to modernizers who wanted to stay in the bloc. He has taken turns to offer each side what they want to hear -- both in public and in private. The pound was unchanged’ - Boris Johnson Predicts ‘Million-to-One’ Chance of No-Deal BrexitIf the premise of market forces is that the markets are an impartial arbiter of confidence in national economies, then the markets don’t believe Johnson. It really is that simple.His words have no effect. His actions do.‘LONDON (Reuters) - The pound held on to the day’s gains on Wednesday, trading just off two-month highs against the euro as British Prime Minister Theresa May saw off a no-confidence vote, a day after MPs defeated her Brexit divorce deal.“Attention will now swiftly turn to Plan B. Our suspicion is that when we hear the PM’s next steps on Monday, it will look remarkably like Plan A, which won’t offer markets much guidance,” said Dean Turner, UK Economist at UBS Global Wealth Management.He said that “unknowable political outcomes” made it unwise to take outright bets on sterling at present’ - Pound holds gains as May wins confidence voteThe fall in Sterling upon the announcement of the Referendum result was a judgement upon the lack of planning for a vote to leave, it was a lack of confidence in an undefined Brexit and unknowable change in the Government’s management of the economy.I don’t know what Boris Johnson intends to do having lost control of Parliament.I do know that Parliament does not accept No Deal.Furthermore, I have no idea what mitigation is in place if we exit on the 31/10/19 without a deal. The Government’s future management of the economy - their plans, if any - are locked in big black box that if Boris Johnson has his way will never be opened. It’s why he’s lost control of Parliament. The same lack of confidence in the Markets is matched by the lack of confidence in Parliament.Johnson constrained by a Parliament that does not accept No Deal reduces the risk of less reliable outcome. The risk of the outcome is a byproduct of reliability - and Johnson is the human embodiment of its very opposite.It is the lack of a plan not so much forecasts that affect confidence.During the leadership campaign, Johnson said ‘No Deal was a million to one against’.The markets did not move.When May survived the confidence vote, sterling went up.It could have been a turn of phrase, but at the end of August, as PM, he clarifies that it was a ‘statistical estimate’. He really didn’t have to.In fact, he’s constantly giving a running commentary on his ‘statistical estimates’ for the chances of No Deal. He’s more optimistic of a deal at the end of August than he is when it was a million to one that he wouldn’t get one. He is at the point of absolutely certainty according to Boris, yet according to Boris, he also isn’t.How confident are Parliament with this?How confident are the markets with this?Is Johnson a reliable indicator of the future and is his calibration any good or meaningful? Mark Carney, remember, is thought reliable over decades of a career.‘Meanwhile, Mr Johnson said he was "marginally more optimistic" about the chances of striking a deal following meetings with EU leaders in Berlin and Paris despite on-going discussions on how to remove the controversial Irish backstop proposal from any new deal.He said: "Remember that all statistical estimates that I give about the chances of a deal - whether they are expressed in odds of millions to one, or getting closer, or hotter or colder, or whatever - they all depend exclusively on the willingness of our friends and partners to compromise on that crucial point and to get rid of the backstop and the current withdrawal agreement." - Boris Johnson refuses to rule out suspending Parliament to force through no-deal BrexitThe ‘statistical estimates’ of getting a deal depend entirely on EU willingness.Johnson is literally not a factor in his own calibration.Johnson is pursuing a mystery last minute blink strategy, but he started as PM with a million to one against, so the EU was very fucking willing to give him a deal, according to Boris. His strategy is intended to make the EU even more willing to secure a last second deal. At the end of August, the EU are less willing by implication as his estimates have dropped, yet he’s more optimistic of success.Really, what the actual fuck?‘Closer, colder, hotter’ or whatever is not a ‘statistical estimate’. It is a children’s party game. A mystery deal is hidden somewhere and we should all let ourselves be blindfolded whilst Johnson directs us to it, though that deal is not dependent upon him, so how does he know where it is and that it’s there?I am fairly sure I’d be safe in a car with Johnson, but I wouldn’t guarantee a loan for him, especially if he’s going to gamble with it.His financial backers who are taking out short positions for the end of October are making a statement of their confidence. It is not a flattering one. If I were him I’d be quite offended, then bricking it, then thinking I’d better get some competent help in. This would not be Jacob Rees-Mogg.The short explanation is that the markets do not believe what Boris Johnson says, but they will react to what he does and to what other people stop him doing.That is what confidence in our country looks like right now - £.up and down.It’s not the fact of Brexit: it is its delivery and the person delivering it.On the Sectoral Analyses and Lack of ConfidenceThe “sectoral analyses” by Davis’ own definition were not ‘forecasts’ they were a qualitative analysis of the practical changes that would need to be made in order for those sections to function outside of the EU.‘On 14 December 2016, in an oral evidence session to the Select Committee for Exiting the European Union, the Secretary of State for Exiting the EU, David Davis, said: We are in the midst of carrying out about 57 sets of analyses, each of which has implications for individual parts of 85% of the economy. Some of those are still to be concluded. We have work still to be done on justice and home affairs, so there is a fair number of things still to do’March 2017What are those Sectoral analyses according to Davis, who is carrying them out?Oral evidence - The UK’s negotiating objectives for its withdrawal from the EU - 15 Mar 2017January 2019What were the Sectoral Analyses one year after publication, according to Davis?Oral evidence - UK Exit from the EU - 16 Jan 2019Nearly a year after saying he was in the midst of carrying them out, some still to be done, having defined for himself exactly what they were and were not (both sides of publication), Parliament is concerned - especially the Select Committee whose job it is to scrutinise DexEU’s preparations to support the delivery of Brexit.Lacking confidence, they have reached the stage of compelling the ‘sectoral analyses’ to be show to the Select Committee.On 1 November 2017, at the end of an Opposition Day debate on Exiting the EU: Sectoral Impact Assessments, the House of Commons resolved that the list of sectors covered by the Government’s analysis should be laid before the House, and that the impact assessments arising from those analyses be provided to the Committee on Exiting the EU. The committee tasked with scrutiny. No more.We know a ‘sectoral analysis’ is not a ‘forecast’ and a bunch of numerical predictions. Parliament knows it. Davis chose it. On and on bang the Minister of DexEU: forecasts are wrong, stop asking for forecasts, a sectoral analysis is not a forecast, you all hate Brexit …. blah, blah, bullshit …The House resolved, without division, that: That an humble Address be presented to Her Majesty as follows, Most Gracious Sovereign, We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, humbly pray Your Majesty will be graciously pleased to give directions that the list of sectors analysed under the instruction of Her Majesty's Ministers, and referred to in the Answer of 26 June 2017 to Question 239, be laid before this House and that the impact assessments arising from those analyses be provided to the Committee on Exiting the European Union.Address to be presented to Her Majesty by Members of this House who are Privy Counsellors or Members of Her Majesty’s Household.Exiting the EU: sectoral assessmentsWhat the Select Committee got were names of sectors and cut-and-paste description about those sectors and how they operate right now whilst we are in the EU.The end of the first rounds of UK-EU negotiations has happened and from the work DexEU have published, they have no idea whatsoever of how they will practically manage the change for these sectors if we leave without a deal.Stop asking for forecasts!MPs have not. They have been asking for assurance that DexEU had plans to manage the practical changes a No Deal Brexit would mean.This is precisely why Parliament does not want No Deal.It is why Parliament is extremely dubious - as are the financial markets - of anyone who was happy for a No Deal Brexit at that time or to throw it around as a ‘threat’ to the EU.This is why Johnson does not have the confidence of the financial markets.David Davis appeared before the Committee on 6 December 2017 to answer questions about the reports. The Committee queried how he could state that there was no detailed information to publish, even though he had talked previously about the 58 studies existing “in excruciating detail”.The Committee voted on whether Mr Davis was in contempt of Parliament by misleading it; ten Conservative MPs and one DUP MP voted against while eight opposition MPs voted in favour. Accordingly, the Committee agreed the following resolution: That, in view of the statement that no impact assessments have been undertaken, the Committee considers that the Government’s response to the resolution of the House of 1 November has complied with the terms of that resolution.This is what a ‘sectoral assessment’ looks like in December 2017 according to DexEU.It does not match the Minister’s definition.It does not contain any planning for managing that change in the national interest.Theresa May cannot threaten a No Deal Brexit in December 2017 because DexEU have done fuck all and she cannot even blame them without trashing the negotiations and the financial markets. She has no idea what it means.https://www.parliament.uk/documents/commons-committees/Exiting-the-European-Union/17-19/Sectoral%20Analyses/2-Sectoral-Analyses-Agriculture-Report.pdfIt is the end of January 2018 and here is some of the kind of information that has been leaked to Buzzfeed from DexEU and that Steve Baker says he had not seen.Unfortunately, says Mr Baker, in that paper I have never seen until this morning, there are not so many details on the impact of a No Deal Brexit, because that work is still being done.This is the No Deal Brexit which is probably the easiest scenario to qualitatively assess and problem solve. Tell you what, says Mr Baker, you can have the finished product after the negotiations are concluded and before the meaningful vote.The negotiated deal was published on 14/11/2018.The first meaningful vote was the 15/1/2019.That’s when Steve Baker thought MPs should get DexEU’s analyses of No Deal.Before that MPs should just leave them to it and be content with whatever they had planned - or not - if we left without a deal. On behalf of all their constituents.This is why we are where we are. Avoidance of scrutiny.

Vitamania: Our Obsessive Quest For Nutritional Perfection by Catherine Price (1) is an invaluable 2015 roadmap through the world of Vitamins and other dietary supplements.This answer describesVitamins Glossary and a few other basics.How, in the US, Vitamins and other dietary supplements get to market without prior approval by the FDA for safety and efficacy.How the central role of Vitamins in our lives is a seemingly inevitable outcome of two century-long trends.Relentless marketing, a consequence of being subject to less stringent laws.The perhaps unholy marriage of industrial food production and ability to synthesize and/or purify Vitamins and other essential micronutrients. The former depletes essential micronutrients in food, the latter lets them be added back in as enrichment or fortification. In fact, our relationship to food is today so absurdly artificial, people who eat enriched and fortified foods as a bulk of their regular diet probably already consume more Vitamins compared to those who largely eat natural foods, i.e., fresh produce.Vitamins Glossary And Some BasicsThe US Dietary Supplement Health and Education Act of 1994 - Wikipedia (DSHEA) defines a dietary supplement as 'a product taken by mouth that contains a dietary ingredient intended to supplement the diet'.Recommended Dietary Allowance (RDA): The average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97–98 percent) healthy individuals in a particular life stage and gender group.Adequate Intake (AI): The recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate—used when an RDA cannot be determined.Tolerable Upper Intake Level (UL): The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects may increase.Estimated Average Requirement (EAR): The average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group.Dietary Reference Intake - WikipediaVitamins are essential micronutrients, with essential and micro signifying their two cardinal featuresEssential meaning our bodies need them but don't make them in sufficient quantities, their primary role being to facilitate essential chemical reactions.Micro meaning a little Vitamin goes a very long way (see below from 1).'The amount of folic acid that pregnant women are told to take to prevent devastating neurological defects in their babies is 240 micrograms a day, less than the weight of two grains of Morton salt. The Recommended Dietary Allowance for vitamin D, without which you won’t be able to properly absorb calcium and your bones will soften, is 15 micrograms (600 IU), one-sixteenth of that for folic acid. And the RDA for B12, a vitamin whose deficiency can cause depression, delusions, memory loss, incontinence, nerve damage, and in extreme cases life-threatening anemia, is smaller still, just 2.4 micrograms—0.0000024 grams. That’s 1/100th of the weight of the requirement for folic acid, the equivalent of 1/67th of one grain of salt...Even the highest RDA—which is for vitamin C—is just 90 mg per day, about one-thirtieth of the weight of a Domino sugar cube. And C is extreme: the RDA of the second highest, vitamin E, is 19 mg'As such, RDAs of most Vitamins are tiny. Rather than immutable mantras, RDAs themselves are merely the best guess at any given moment sinceWe still know too little about how Vitamins do what they do. For example, the US Food and Nutrition Board has still not established adult RDAs for Biotin (Vitamin B7), Pantothenic acid (Vitamin B5) and Vitamin K (1).There are still standardization problems with many Vitamin tests, and measuring their blood levels isn't always most relevant. For example, levels in liver are the most accurate snapshot of Vitamin A levels (1).Stability varies greatly between Vitamins. Vitamins A, C, B1 (Thiamine) tend to be more unstable.Our bodies can maintain stores of each of these micronutrients for varying lengths of time so getting 100% of the RDA of a particular Vitamin every single day is unnecessary.Diet is not the only source of Vitamins.Sufficient exposure to sun's UV rays suffices for our skin to synthesize enough Vitamin D for our needs.Provided our diet has sufficient essential amino acid tryptophan and provitamin beta-carotene, our body can synthesize enough Niacin (Vitamin B3) and Vitamin A, respectively.Microbes in our gut produce Vitamin K and Biotin (Vitamin B7).A perpetual moneymaking bonanza for their manufacturers, a century into our collective obsession with them, Vitamins embody our subliminal desire to eat our way to eternal health and perhaps eternity itself. For example, studies have shown >50% of Americans report taking dietary supplements (2). But how did this come about?Vitamins: Regulated Loosely or Not at all?Vitamins and other dietary supplements are little regulated. The US history is particularly far-reaching in its consequences. Specifically, the Proxmire amendment sponsored by William Proxmire - Wikipedia, and signed into law as part of a health bill in 1976 (1),'made it illegal for the FDA to ever establish standards for supplements, classify them as drugs, or require that they only contain useful ingredients. It forbade the FDA from ever setting limits on the quantity or combination of vitamins, minerals, or other ingredients that a supplement could contain, unless the FDA could prove (usually after the product was on the market) that the formulation was unsafe—an extremely important shift of responsibility.'This process was only accelerated and expanded by the 1994 Dietary Supplement Health and Education ACT (DSHEA), a law largely written by the supplements industry itself. DSHEABroadened the legal definition of 'dietary ingredients' in supplements beyond Vitamins and minerals to also include 'herbs, botanicals amino acids, enzymes, metabolites, organ tissues and glandulars' (1).Expanded the forms of supplements: liquids, powders, gelcaps to teas and bars (1).Automatically grandfathered in all dietary ingredients on the market as of October 15, 1994.As for new ingredients, companies are just required to send the FDA documentation indicating why they believe the new ingredient to be safe (1).Specifically (see below from 1, emphasis mine)'despite the fact that, thanks to the Proxmire amendment, dietary supplements can contain nearly any combination of dietary ingredients in any dosage, today’s supplement manufacturers do not have to prove that their products are safe or effective before selling them. Instead, the burden of proof is on the FDA to demonstrate, at taxpayer expense, that supplement products are unsafe after the products are already on the market. Thanks to DSHEA and all the consumers, industry representatives, and politicians who supported it, America’s supplements have largely been made exempt from nearly a century’s worth of tighter regulation for food and drugs'Rather, the FDA has the onus to show that a dietary supplement is 'unsafe' after it's already on the market, meaning it can only pull Vitamin products after they come to market and are found to pose a risk to public safety, a largely symbolic and unproductive rigamarole at the expense of the taxpayer, not the manufacturer (see below from 3).For its part, the FDA is left with a handful of fig-leavesIt issues periodic dietary supplement 'Consumer Updates', https://www.fda.gov/ForConsumers/ConsumerUpdates/and supplement Safety Alerts & Advisories, which consumers can sign up for at the FDA web-site.A toothless disclaimer that's required to be tagged on dietary supplements sold in the US (see below from 1),“These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”In essence, due to DSHEA, dietary supplements are regulated in the US like food rather than drugs. A bonanza for the supplements industry indeed. Where the US had ~4000 dietary supplement products in 1994, today there are >85000. Result is a runaway supplements industry that over the course of a century first crept up and then swept across, taking firm root within the culture, successfully peddling all variety of Snake oil - Wikipedia.Since less stringent laws apply to Vitamins and other dietary supplements, the lines between food, supplements and drugs are increasingly blurred, making consumer choice more not less difficult, more not less opaque and more not less confusing.Supplements aren't drugs so other than classic nutrient deficiency diseases such as scurvy, pellagra, beri-beri or rickets, in the US, according to the Code of Federal Regulations Title 21 (4), supplement manufacturers and marketers can't claim they can cure, mitigate, treat or prevent a disease.Thus, supplement marketers engage in relentless, creative hype, using phrases such as 'all natural', '100% natural', 'mega', 'super', 'alive', 'boost', 'blast'', 'pure', 'anti-cancer', 'rejuvenate', 'enhance', 'antioxidant', 'support healthy brain/heart/skin/bone/immune function', 'essential', all in an effort to reinforce their narrative that taking supplements is essential for health (5), all legally allowable yet medically meaningless claims (1).Perhaps the most twilight of the gods type of example of the absurdly privileged position of Vitamins within food is a line of Vitamin-enhanced electronic cigarettes from a company called VitaCig, VitaCig® Official - From Creators Of Vitastik, Featuring Aromatherapy To Go!.Supplement makers navigate the marketing landscape extremely craftily. Supplement labels are regulated by the FDA, supplement ads by the FTC. If worried a particular claim may get them into trouble with the FDA, they can put it in an ad, rather than stick it on the product label. Another option is to have the pitch listed in one of the supplement almanacs usually available for sale near the Vitamin aisle in drugstores, where they're protected as free speech and not regulated by anyone (1).The dietary supplements market is so loosely regulated, regulators may not even know how many manufacturers are even in the market, let alone when new products come into the market.A study (6) reported the US FDA got notification of only 170 new dietary ingredients between 1994 and 2011, a number believed to be a small fraction of the actual number.The FDA's draft guidelines also don't require companies to submit studies in humans nor report unfavorable test results, meaning they could cherry-pick studies that support safety profiles (1).Though the US 2011 Food Safety Modernization Act finally mandated that supplement manufacturers register with the FDA, there is no fool-proof process in place to ensure they have done so, no master list of supplements each manufacturer makes nor is the list of registered manufacturers public (1).Supplement manufacturers tend to elide reports of serious adverse events, which led the US FDA to make them mandatory. SAEs are defined as 'event that results in death, a life-threatening experience, inpatient hospitalization, a persistent or significant disability or incapacity, or a congenital anomaly or birth defect' (1).The number of full-time regulators policing the dietary supplements market is a fraction of what's needed. For example, while total US drug sales in 2004 were 12X those of dietary supplements, the US FDA had ~43X the money and ~48X the staff for drug regulation. Obviously the FDA is woefully understaffed to accurately identify all of what's out there in dietary supplements, let alone contact and rein in problematic manufacturers (7).The FDA doesn't even inspect contract labs that actually manufacture much of dietary supplements (8).The public is largely unaware of the extent to which adulteration and inconsistency are major problems in the dietary supplements business.Saw palmetto extract - Wikipedia from Serenoa - Wikipedia, Saw Palmetto, is a well-known though ineffective home remedy for Benign prostatic hyperplasia - Wikipedia. Mainly grown in the southeast US, the 2005 hurricane season in Florida wiped out that year's crop. Apparently in no time, the market was flooded with 'Chinese saw palmetto' selling for US $60 per pound (1). Obviously not saw palmetto but rather cheap palm oil extract worth < US $1 and not known to have medicinal properties.A 2013 study (9) found variations in the amount of Vitamin D not only from brand-to-brand but also bottle-to-bottle and even pill-to-pill. Some pills had as little as 9% while others as much as 146% of what their labels claimed.Studies (10, 11) suggest problems associated with dietary supplement use also stem from its underground nature since people tend to hide their use from health professionals.Central Role of Vitamins in Modern Lives: Brief outline of how we got hereVitamins were discovered between the 19th and 20th centuries in the context of terrible deficiency diseases such as beriberi (Vitamin B1), rickets (Vitamin D), pellagra (niacin or Vitamin B3), scurvy (Vitamin C). Back then, the notion that one could get specific symptoms from lack of a particular nutrient was novel. In fact, when the Polish biochemist, Casimir Funk - Wikipedia, coined the term Vitamin (from vital amines) in 1912, these 13 substances (Vitamins A, D, E, K, C and 8 B Vitamins) hadn't even been identified so it wasn't known they weren't chemically related. Based on his isolation of what later turned out to be Vitamin B3 (Niacin), Funk thought these essential nutrients would all be amines, which is not the case.Since they aren't all amines, the e from Vitamine got lopped off. Yet in what proved an enduring bonanza for food marketers, Vitamin could also be parsed as vita, Latin for life, tagged in front of amine. The gory images from the outcome of severe deficiencies of these Vitamins became a terrifyingly effective fear-mongering tactic that allowed Vitamin supplementation to gain a foothold in popular culture. Helped along by savvy marketers and extremely business-friendly laws, total domination followed close behind.Most Vitamins we consume in the form of enriched/fortified foods or even as pills are synthetic, simply because it would be both prohibitively expensive and impractical to extract the quantities needed from fruits and vegetables. Instead a great variety of sources yield Vitamins in our industrialized food supply (1).Vitamin C is the product of microbial fermentation of sorbitol, a sugar alcohol.Vitamin A starts with acetone and formaldehyde.Niacin (Vitamin B3) starts from a waste product of something called Nylon 6, 6, a synthetic fiber often used in commercial carpets, airbags, zip ties and conveyer belts. Take a look at a food ingredients box some day. Niacin is added to many processed food items in the American grocery store.Thiamine (Vitamin B1) is derived from chemical derived from coal tar.Vitamin D from lanolin in sheep wool.Their discovery and our ability to chemically synthesize Vitamins came along at just the right moment as a boon to the modern food industry just as industrial food production methods took off. One trivia suffices to underscore the extent of the reach of the food industry. Already by the end of the 1920s, among US manufacturing industries, the food processing industry was larger than iron, steel and textiles in terms of capital investment (12).Most foods stocked in modern supermarkets are the end-products of a convoluted, time-consuming process of 'refinement and processing' (1), whose focus is transportation- and shelf-stability, not nutrient quality. By the time most shelf-stable food are harvested, milled and processed, they're largely depleted of their natural Vitamins and other essential micronutrients so they're added back in the form of synthetics, either as food enrichment (replacing nutrients lost in processing) or fortification (adding nutrients at levels higher than occur naturally in that food).Thus, starting in the 1920s and 1930s, ability to enrich or fortify foods represents a silent revolution to ensure vast numbers of us consume sufficient amounts of Vitamins and other essential micronutrients (13). Problem is even enrichment has exploded beyond reason with foods being enriched with micronutrients they didn't even originally contain. For example,In the US, enriched bread and flour must contain not just specific amounts of Thiamine (Vitamin B1) but also iron, Riboflavin (Vitamin B2), Niacin (Vitamin B3) and folic acid (1).Milk began to be fortified with Vitamin D starting all the way back in 1933 (1).Today, most bulk synthetic Vitamins are made by two European companies, DSM and BASF and their competitors in China with hardly any made in the US, a consequence of breaking up a price fixing corruption scandal that in 1999 dethroned previous market leaders such as Hoffman-La Roche, BASF, Rhone-Poulenc and Takeda Chemical Industries (1).However, this industrialized approach to essential nutrition is a decidedly double-edged sword.On the one hand, adding iodine to salt, which started in Michigan in 1924 (13), has undoubtedly greatly reduced the pernicious consequences of iodine deficiencies, goiter and mental retardation.OTOH, it lets food producers market and sell even totally unhealthy foods as 'nutritionally complete' (1).Most so-called energy and nutrition bars are actually 'candy bars sprinkled with a multivitamin' (1).Without food enrichment and fortification, the enormous modern American grocery store would be largely empty in the middle where the processed food reigns.Fortifying all manner of food with synthetic Vitamins helped then and now stave off large-scale nutritional deficiency. Pendulum's swung so far to the other side in the US, a 2011 study (14) suggested many Americans would actually be at risk of historical scourges like scurvy if not for synthetic Vitamins in 'fortified foods'. Specifically, this study used data from the US NHANES (National Health and Nutrition Examination Survey) for 2003-2006 on 16,100 individuals aged >/= 1 years, and found (emphasis mine)'Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake'.Thus, hapless consumers now depend on foods being enriched and fortified with Vitamins and other micronutrients. However, and this is the pernicious fallacy by now deep-rooted in culture, especially in countries like the US, once people got used to taking a bunch of Vitamin pills on top of regular food, it became natural to extend the idea of taking even more Vitamins to improve health, the idea being if just a small amount of Vitamin staved off the dreadful effects of its deficiency, imagine what could happen to one's health from taking more and more of it. Situation is now so absurd that people who eat enriched and fortified foods as part of their regular diet probably already consume more Vitamins compared to those who largely eat natural foods.The adage the sum is more than its parts is perhaps nowhere more appropriate than with respect to food. Being able to chemically synthesize Vitamins is one thing. Our bodies being able to absorb bolus amounts of them is another thing entirely. How and how much our bodies absorb of the Vitamins and micronutrients naturally present in fresh foods doesn't extrapolate to their enormously concentrated synthetic counterparts. Examples such as synthetic folate, which our bodies absorb more easily, are the exception, not the rule. Does processed food + bulk Vitamin and micronutrients = unprocessed food? Obviously not. During processing, so much else of nutritive value in foods is lost without our slightest awareness of that fact.Meanwhile, some of the largest, most well-designed, randomized, multi-year, double-blind, controlled trials (15, 16) haven't shown tangible benefits to long-term multiVitamin supplements. As well (1, emphasis mine),'US Preventive Services Task Force, the American Cancer Association, the American Heart Association, the American Diabetes Association, and the American Academy of Family Physicians, among other respected health organizations, do not recommend that healthy people with no nutritional deficiencies take multivitamin supplements'Bibliography1. Catherine Price. “Vitamania: Our Obsessive Quest For Nutritional Perfection. Also sold as Vitamania: How Vitamins Revolutionized the Way We Think About Food.2. Bailey, Regan Lucas, et al. "Examination of vitamin intakes among US adults by dietary supplement use." Journal of the Academy of Nutrition and Dietetics 112.5 (2012): 657-663. https://www.researchgate.net/profile/Johanna_Dwyer/publication/227341488_Examination_of_Vitamin_Intakes_among_US_Adults_by_Dietary_Supplement_Use/links/00b495277e48f64b1a000000.pdf3. US Pharmacist, W. Steven Pray, 2008. The FDA, Vitamins, and the Dietary Supplement Industry4. CFR - Code of Federal Regulations Title 215. The Atlantic, James Hamblin, April 10, 2017. Vitamins and the Failure of Free-Market Health6. Cohen, Pieter A. "Assessing supplement safety—the FDA's controversial proposal." New England Journal of Medicine 366.5 (2012): 389-391. http://www.nejm.org/doi/pdf/10.1056/NEJMp11133257. Nutritional Outlook, Jan-Feb, 2012, Sarah Roller, Megan L. Olsen. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0ahUKEwid-7Kf9erUAhUCfiYKHRIaCnsQFgg4MAI&url=https%3A%2F%2Fwww.kelleydrye.com%2Fgetattachment%2F56e85313-3f89-43c1-bada-4086e244c093%2Fattachment.aspx&usg=AFQjCNEaPUaJv-PSv0fH_rM0G2FUFCfmQA8. Dan Fabricant: FDA ‘somewhat aghast’ at degree of cGMP non-compliance9. LeBlanc, Erin S., et al. "Over-the-counter and compounded vitamin D: is potency what we expect?." JAMA internal medicine 173.7 (2013): 585-586.10. Science Daily, October 17, 2005. Cancer Patients Hide Their Use Of Complementary And Alternative Treatments From Their Doctors11. Grant, Suzanne J., et al. "The use of complementary and alternative medicine by people with cardiovascular disease: a systematic review." BMC public health 12.1 (2012): 299.12. Levenstein, Harvey A. Revolution at the table: the transformation of the American diet. Vol. 7. Univ of California Press, 2003.13. Backstrand, Jeffrey R. "The history and future of food fortification in the United States: a public health perspective." Nutrition reviews 60.1 (2002): 15-26. http://globalseminarhealth.wdfiles.com/local--files/nutrition/Backstrand.pdf14. Fulgoni, Victor L., et al. "Foods, fortificants, and supplements: where do Americans get their nutrients?." The Journal of nutrition 141.10 (2011): 1847-1854. Where Do Americans Get Their Nutrients?15. Hercberg, Serge, et al. "The SU. VI. MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals." Archives of internal medicine 164.21 (2004): 2335-2342. https://www.researchgate.net/profile/Paul_Preziosi/publication/8170728_The_SUVIMAX_Study_A_Randomized_Placebo-Controlled_Trial_of_the_Health_Effects_of_Antioxidant_Vitamins_and_Minerals/links/0fcfd513e0e36e0bb2000000.pdf16. Gaziano, J. Michael, et al. "Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial." Jama 308.18 (2012): 1871-1880. http://vitalift.com.br/site/artigos/6.pdfThanks for the R2A, Daniel Kaplan.