medical organizations, including the american cancer society, the american psychiatric association, the national institute of mental health, the american academy of pediatrics, champus, and the canadian paediatric society. the american medical association describes as "myths" the ideas that adequate nutrition is not readily achievable with normal food, all food grown with pesticide is poisonous, all food additives are poisonous, vitamin and mineral deficiencies are common, that the cause of most disease is poor diet, which can be prevented by nutritional supplements. similarly, the american cancer society comments that the current scientific evidence does not "support use of orthomolecular therapy for most of the conditions for which it is promoted." some supplements have exhibited benefits for specific conditions, while a few have been confirmed to be harmful; the consumption of nutritious foods is the best recognized method to obtain vitamins, minerals, and nutrients crucial for good health. barrie cassileth, an adviser on alternative medicine to the national institutes of health, stated that "scientific research has found no benefit from orthomolecular therapy for any disease," and medical textbooks also report that there is "no evidence that megavitamin or orthomolecular therapy is effective in treating any disease." a 1973 task force of the american psychiatric association unanimously concluded: this review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. it concludes in this regard that the credibility of the megavitamin proponents is low. their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. under these circumstances this task force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable. in response to claims that orthomolecular medicine could cure childhood psychoses and learning disorders, the american academy of pediatrics labelled orthomolecular medicine a "cult" in 1976. proponents of orthomolecular medicine counter that some vitamins and nutrients are now used in medicine as treatments for specific diseases, such as megadose niacin and fish oil for dyslipidemias, and megavitamin therapies for a group of rare inborn errors of metabolism. a review in the annals of internal medicine concluded that while some therapies might be beneficial, others might be harmful or interfere with effective medical therapy. a recent study of over 161,000 individuals provided, in the words of the authors, "convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women." a recent meta-analysis in jama suggested that supplementation with combinations of antioxidant vitamins (beta-carotene, vitamin a, and vitamin e) may increase mortality, although with respect to beta-carotene this conclusion may be due to the known harmful effect in smokers. safety in the united states, pharmaceuticals must be proven safe and effective to the satisfaction of the fda before they can be marketed, whereas dietary supplements must be proven unsafe before regulatory action can be taken. a number of orthomolecular supplements are available in the us in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are regulated as pharmaceuticals. the us regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests. proponents of orthomolecular medicine argue that supplements are less likely to cause dangerous side-effects or harm, since they are normally present in the body. some vitamins are toxic in high doses and nearly all (with the possible exception of vitamin c) will cause adverse effects given high levels of overdosing for prolonged periods as recommended by orthomolecular practitioners. forgoing medical care in favor of orthomolecular treatments can lead to adverse health outcomes. health professionals see orthomolecular medicine as encouraging individuals to dose themselves with large amounts of vitamins and other nutrients without conventional supervision, which they worry might be damaging to health. potential risks of inappropriate vitamin and supplement regimes include an increased risk of coronary heart disease, hypertension, thrombophlebitis, peripheral neuropathy, ataxia, neurological effects, liver toxicity, congenital abnormalities, spontaneous abortion, gouty arthritis, jaundice, kidney stones, and diarrhea. in their book trick or treatment?, edzard ernst and simon singh conclude that "the concepts of orthomolecular medicine are not biologically plausible and not supported by the results of rigorous clinical trials. these problems are compounded by the fact that orthomolecular medicine can cause harm and is often very expensive." example: vitamin e orthomolecular proponents claim that even large doses of vitamin e pose no risk to health and are useful for the treatment and prevention of a broad list of conditions, including heart and circulatory diseases, diabetes and nephritis. initial hopes for the usefulness of vitamin e in orthomolecular medicine were based on epidemiological studies suggesting that people who consumed more vitamin e had lower risks of chronic disease, such as coronary heart disease. these observational studies could not distinguish between whether the higher levels of vitamin e improved health themselves, or whether confounding variables (such as other dietary factors or exercise) were responsible. to distinguish between these possibilities, a number of randomized controlled trials were performed and meta-analysis of these controlled clinical trials have not shown any clear benefit from any form of vitamin e supplementation for preventing chronic disease. further clinical studies show no benefit of vitamin e supplements for cardiovascular disease. the current position of the american national institutes of health is that there is no convincing evidence that vitamin e supplements can prevent or treat any disease. beyond the lack of apparent benefit, a series of three meta-analyses reported that vitamin e supplementation is associated with an increased risk of death; one of the meta-analyses performed by the cochrane collaboration also found significantly increased mortality for the antioxidant vitamins a and beta-carotene. a subsequent meta-analysis found no mortality benefit from vitamin e, but also no increase in mortality either. use in aids several articles in the alternative-medicine literature have suggested that orthomolecular-related dietary supplementation might be helpful for patients with hiv/aids. a study using 250 mg and 1000 mg doses of vitamin c along with other antioxidants to treat people with aids did not find any benefit. a meta analysis in 2010 (updated in 2017 with different results) found that micronutrient supplementation decreased the risk of death and improved outcomes in pregnant women with hiv in africa. a 2017 cochrane review found no strong evidence to suggest that micronutrient supplementation prevents death or is effective at slowing the progression of disease for adults with hiv. it is important for people living with hiv to eat a healthy adequate diet. for people with hiv that have clinically demonstrated deficiencies in micronutrients or for people who are not able to consume the recommended daily quantities of minerals and vitamins, supplementation is still encouraged. vitamin a in children with hiv appears to be safe and beneficial. vitamin a deficiency is found in children with hiv infection who may or may not have symptoms of aids. vitamin a supplementation reduces morbidity and mortality in aids symptomatic children, but has no effect on asymptomatic children. it does not prevent hiv infection, cannot treat the chronic hiv infection, and will not cure aids. deaths resulting from illegal vitamin trials in south africa matthias rath has been extensively criticized for presenting his vitamin supplements as a treatment for aids and for testing them in illegal trials in south africa. a former associate of linus pauling, rath has promoted vitamins as a treatment for hiv infection, describing treatment with effective antiretroviral drugs as toxic and part of a global conspiracy serving the financial interests of the pharmaceutical industry. in a lawsuit that found against rath, the south african medical association blamed his vitamin products for several deaths. the world health organization and two health agencies of the united nations also described rath's advertisements as “wrong and misleading” and “an irresponsible attack on arv (antiretroviral) therapy.” the south african centre for social science research described the trials as "state sponsored pseudo-science". rath's trials, conducted with the aid of aids denialist david rasnick, were declared unlawful by the cape high court; rath, rasnick and their foundation were barred from conducting further unauthorised clinical trials and from advertising their products. alleged institutional bias advocates of orthomolecular medicine, including pauling, hoffer and ewan cameron have claimed that their findings are actively suppressed by the medical and pharmaceutical industry. hoffer wrote "there is no conspiracy led and directed by a single person or by a single organization. there is no mafia in psychiatry. however, there is a conspiracy led and directed by a large number of professionals and their associations who have a common aim to protect their hard-earned orthodoxy, no matter what the cost to their opponent colleagues or to their patients." the journal of orthomolecular medicine, founded in 1967 as the journal of schizophrenia, is a major publication of orthomolecular medicine. as abram hoffer wrote: we had to create our own journals because it was impossible to obtain entry into the official journals of psychiatry and medicine. before 1967 i had not found it difficult to publish reports in these journals, and by then i had about 150 articles and several books in the establishment press. other members of the medical community deny the existence of such an institutional prejudice. a review in the journal of clinical oncology denied that physicians collude against unconventional treatments. claims of conspiracy were limited to the now defunct linus pauling institute of science and medicine. in its current iteration, the linus pauling institute derives a significant amount of funding from the national institutes of health and other federal sources.