Smoking prevalence is way down in the US, and you likely don't need to be screened for vitamin D deficiency. It's good news all around on Healthcare Triage News.

(Intro)

I feel like I bring you a lot of bad news on Healthcare Triage. So when we have the opportunity to give you some good news, we jump at it. And with respect to smoking, there's a decent amount of good news to go around.

In 2005, almost 21% of adults in the United States smoked cigarettes. In 2013, that number dropped to less than 18%. That's three million fewer smokers in the United States in less than a decade. That's the lowest percentage of adults smoking in the United States since the CDC started collecting data in 1965. Even those who are still smoking are smoking less. Almost 81% of smokers smoked every day in 2005. That's down to 77% in 2013. Among those people, the average number of cigarettes smoked in a day dropped from almost 17 in 2005 to just above 14 in 2013.

That doesn't mean that there still isn't a lot to do; too many people still smoke. It's still the leading preventable cause of death in the United States, killing almost half a million people a year. There are more than 30 million adults who have a smoking-related disease in the United States right now. Brian King, a senior scientific advisor at the CDC said that smokers who quit before they're 40 can get back almost all of the 10 years of life expectancy that smoking would otherwise take away.

Our second story, and I don't know if you saw, but I got to attack the milk emperor in the New York Times a few weeks ago. The comments are awesome, you should go read 'em. People really, really do love their milk. They're sure that you need the calcium and the vitamin D that's added to it. So I was thrilled to see that the US Preventative Services Task Force had my back last week with their new recommendation on vitamin D deficiency screening.
They said that for healthy adults, we shouldn't do it. It may do more harm than good.

Look, everyone needs vitamin D. It helps to keep your bones healthy by regulating calcium and phosphorus, and yes, being deficient in vitamin D is bad and causes problems with bone health as well as many other health issues. But here's the thing: most people have plenty of vitamin D. They have this without even worrying about it. They have this without even eating a ton of vitamin D. The studies that look at problems for vitamin D deficiency often use very low cut-off points - much lower than you'd see in healthy people. There's so little consensus on what constitutes 'low', that many tests that are available for screening don't even agree on how to work. There's no internationally recognized reference standard. The USPSTF report found that results are all over the map, based not only on the testing method, but also between different labs that used the same methods.

Further, they found no studies that looked at whether there was any direct benefit from screening for vitamin D deficiency in adults. None! They did find studies though showing that there's no proven benefit for treating asymptomatic vitamin D deficiency to improve outcomes for cancer, diabetes, fractures or even death. Since there was no evidence of harms for screening, they came out and said that they can't make a recommendation.

But we're allowed to consider things that they can't. Screening costs money. Supplements to treat the results we don't understand costs money. And taking too much vitamin D can cause you harm. This is a good example of where we have a hammer and we're looking for a nail. We don't need to do the screening. Most people aren't vitamin D deficient, and they don't need to be screened or treated. They also don't need milk.