Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Behind the fetish of vitamin B12 shots

Roy Benaroch, MD
Conditions
February 3, 2013
2K Shares
Share
Tweet
Share

shutterstock_94207294

Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if there’s a medical diploma on the wall.

The story: a woman brings in her teenage daughter, complaining that the girl is tired a lot. It turns out that mom herself has had some blood tests that showed a low vitamin B12 level, so her doctor is giving her regular B12 injections. Can her daughter get some, too?

I realize that B12 injections are common. Many docs administer these, and many adults get these—probably some of you reading this. So what’s the science behind this practice?

Vitamin B12 deficiency is a real thing. It can occur because of a poor diet, or because some medications (like acid blockers) interfere with absorption. Or it can occur because of a specific autoimmune disorder called “Pernicious Anemia.” Whatever the cause, the health consequences of vitamin B12 deficiency can include anemia, neuropathy, irritability, and depression.

There is a simple blood test to measure vitamin B12 levels, though the levels in the blood don’t always correlate with whether there are enough B12 levels in the cells themselves. We can test for this, too, indirectly, through other blood tests including methylmalonic acid and homocysteine levels. So we can, in fact, know if a person is truly deficient. These confirmatory tests are rarely done.

Instead, many adults are told that their vague symptoms of tiredness or fatigue are caused by B12 deficiency, instead of actually trying to address genuine issues like insufficient sleep, sleep apnea, overreliance on caffeine, and depression (to name a few of the many genuine causes of fatigue.)

It gets worse. The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.

So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.

So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?

I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.

More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using  genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

Image credit: Shutterstock.com

Prev

3 reasons why patients should use social media

February 3, 2013 Kevin 5
…
Next

A view from Mexico: Reforming resident work hours

February 3, 2013 Kevin 4
…

Tagged as: Medications, Neurology

Post navigation

< Previous Post
3 reasons why patients should use social media
Next Post >
A view from Mexico: Reforming resident work hours

More by Roy Benaroch, MD

  • Goodbye, Benadryl: It is time for you to retire

    Roy Benaroch, MD
  • Telemedicine overprescribes antibiotics: Are you really receiving the best care over the phone?

    Roy Benaroch, MD
  • No, phones don’t cause horns to grow on skulls

    Roy Benaroch, MD

More in Conditions

  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Changing the pediatric care landscape: Integrating behavioral and mental health care

    Hilary M. Bowers, MD
  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Revaluating mental health assessments: It’s not just the patient you should consider

    Tomi Mitchell, MD
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 56 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Sam Neill's Rare Lymphoma
  • Day in the Life of a Doctor: Treating a Patient With Septic Shock
  • Paxlovid May Lower Long COVID Risk, VA Study Suggests
  • Digital Inhalers May Improve Uncontrolled Asthma Management
  • Another Win for Zolbetuximab in Advanced Gastric/GEJ Cancer

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Behind the fetish of vitamin B12 shots
56 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...