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Rickets makes a UK comeback

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Kurt Barling | 10:17 UK time, Friday, 8 October 2010

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So here we are in late 2010 and the wonders of medical science are all around us. And yet an ailment reminiscent of Dickensian London is once more being reported by GPs across the country.

Rickets is being newly detected in several hundred children each year. The cause is Vitamin D deficiency.

This is the tip of the iceberg of a Vitamin D deficit which is affecting increasing numbers of patients including both adults and children.

Some clinical studies are suggesting that up to 50% of individuals in some ethnic minority communities have Vitamin D deficiency.

Although not exclusively a problem for ethnic minorities it could be that migration plays a part in the high incidence amongst groups like Somalis.

Although there is no obvious research link as yet, but common sense tells us that as sunlight is the major source of Vitamin D, insufficient exposure to it may be causing problems.

Those who historically lived at lower latitudes where the sun is more intense may find this may be affecting them.

The symptoms are chronic tiredness, aching joints, dizziness, sometimes seizures or fits in young children.

Abdi Weli Osman who is an advocate for Somalis in Kilburn claims that as well as making it difficult for adults to hold down jobs, Vitamin D deficiency is showing itself in poor performance in school and even stress in relationships leading to marital breakdowns.

Some Somalis are presenting Vitamin D levels 10 times lower than the expected norm.

Unlike back in Victorian times, we understand symptoms and cause and we have a ready medicinal remedy.

GPs like Dr Stephen Nickless at the Brondesbury Medical Centre in West London say the problem is once identified they are struggling to treat the condition.

The reason; Vitamin D clinically prescribed supplements have been in shortage for over a year in some places.

Pharmacists like Mike Ritson of ABC Pharmacies say it has been nigh on impossible to get either the high dosage tablets or injections from the single supplier in this country.

Of course that begs the question why there is only one supplier and other European Union manufacturers have not had their product licensed in the UK.

What seems ridiculous is that Vitamin D supplements, the prescription variety, are declared an essential drug by the World Health Organisation.

You'd think that there would therefore be ready stocks of the medicine in a sophisticated country like our own.

Unfortunately the way the pharmaceutical market works is that the risk associated with producing the drug is with the commercial sector.

In other words, who bears the cost if the drug is produced in large quantities and it is not then prescribed? In the circumstances commercial companies only produce according to predicted demand.

As the problem of Vitamin D deficiency has become more widely recognised in the past few years production has lagged seriously behind rocketing demand.

The Department of Health told me they are in discussions with other suppliers to see if they might like to produce the drug. They blame manufacturers for not alerting them to the ongoing shortages.

They have at least publically, acknowledged that there is an ongoing problem.

The Department of Health went on to tell me that the Medicines and Healthcare Products Regulatory Agency should be doing something to rectify the situation. The MHRA told me that a supply problem is for the Department of Health to rectify.

Well, whilst they argue among themselves we can safely assume that the incidence of rickets will continue to rise and those with the chronic symptoms of Vitamin D deficiency will continue to suffer, creating untold costs for the economy.

In a word: bonkers.

Comments

  • Comment number 1.

    Prevention of Vitamin D deficiency is the most important issue. Apart from enjoying sunshine and eating fish we need to encourage SACN (Scientific Advisory Committee on Nutrition) to make new recommendations for stronger and more widespread fortification of foods and to make clear recommendations about higher levels of supplementation (some Canadians say that optimal blood levels should be nearer 150 rather than the UK Consensus of 75-110. They suggest 1000-2000iu daily for adults during the cold,dark arctic winter - not the 400iu currently recommended in the UK).

    The NHS "Healthy Start" Vitamin scheme needs relaunching and should make vitamin supplements available free on prescription to ALL prospective mothers and to ALL infants (and not just those means tested few on benefits who can be bothered to register for rarely available preparations to be picked up at inconvenient times and places).

    Department of Health needs to ensure (by importation and fast track licensing if necessary) a supply of high strength Vitamin D tablets for treating severe deficiency (no licensed preparations available in the UK and unlicensed imports are very expensive).The UK shortage was anticipated in September 2008 but no effective action has been taken so far.

    An interim measure is to ensure adequate supplies of Vitamin D injections for treating severe deficiency (these have been almost completely unavailable for the last year as a knock-on effect) though tablets are always preferable to injections.

    New preparations of Vitamin D need to be "Halal Compliant" if they are to be acceptable to all members of the communities most at risk.

  • Comment number 2.

    I work as GP in Edinburgh and see many patients with gross vitamin D deficiency, adults, in both, those with dark and those with light skin types. I find them because, once suspected, I check their blood levels. Subsequently they feel significantly better after having received treatment. The treatment I use is produced in Germany and licensed in other European countries, but not in the UK. They are high dosed small capsules, easy to swallow, 20,000 IU per capsule. They are also easy to obtain through any pharmacy and any GP can prescribe them. However, they are UK-unlicensed - and GPs are generally discouraged from prescribing unlicensed medication. I have written many letters/e-mails to all possible prescribing committees, authorities, regulatory bodies. It is in the end, as far as I understand, the decision of the DH, as you also said.
    What I cannot understand is why this preparation cannot be accepted by the UK Department of Health as it is, with its European license. Why do we have to wait for a drug company to apply for the UK license? (Which has not happened because it is probably not lucrative enough for any company to pay the licensing fee, this preparation is actually quite cheap) What could possibly be wrong with this German product? Why can the UK DH not accept another neighboring country's regulatory body? Especially now, when prevalence of vitamin D deficiency has increasingly become known and can be proven by reliable improved biochemical testing methods?
    I am glad that you published this news item and hope you will also be able to put more pressure on the DH.

  • Comment number 3.

    Thanks very much for your programme on this subject. Sorry to hear you got the same run around from the DOH as I have had . As a GP working with many vitamin D deficient patients the DOH told me to contact the MHRA who told me to contact the DOH!. Please keep on highlighting this issue. Treated patients are often delighted with how much better they feel. As a WHO essential drug it is little short of scandalous that the DOH isnt acting to ensure supplies are available. Is this because the issue is perceived as just affecting ethnic minorities?

  • Comment number 4.

    This comment was removed because the moderators found it broke the house rules. Explain.

 

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