
Vitamin D deficiency and Covid-19 mortality [pdf] - black6
https://borsche.de/res/Vitamin_D_Essentials_EN.pdf
======
conorh
I've mentioned this before, but my wife is a parathyroid surgeon (parathyroids
are the glands that regulate the calcium in your neck) and would beg you to
PLEASE monitor your calcium levels if you are supplementing with Vitamin D.
She often sees patients on high doses of Vitamin D from well intentioned
doctors, but with out of whack calcium levels because of it, and the patients
can be very sick without understanding why. Often their doctors don't
understand the processes either which is why they end up with her. I'll have
her write a blog post about it at some point, but it is a real risk with
possible severe long term consequences and she sees it a lot more often these
days. She is getting her blog kicked off here (just yesterday actually)
[https://devaboone.com](https://devaboone.com) if you want to follow along.

~~~
wpasc
Would you mind elaborating on what you mean by "wacky" levels? I can't tell
from your comment if that means high or low. Asking as a Vitamin D supplement
user who uses 2-3k IU a day

~~~
devaboone
Hi, I'm the wife. High dose Vitamin D can cause elevated calcium levels
(meaning over 10.0 mg/dl for adults over 40, it can be a little higher for
younger adults). I usually don't see that occur with doses at 2-3 K IU daily.
You can also check your Vitamin D 25-OH levels (the level that will be done if
you just get a standard "Vitamin D level") and these should be in a reasonable
range. What constitutes reasonable may be debatable, but in general I do not
see elevated calcium levels with Vitamin D levels that are under 50 ng/ml
(unless the person has parathyroid disease, another topic). The "toxic" range
for Vitamin D is usually set to 100, but this is well over where most people
should be. Toxicity with regard to Vitamin D means high calcium - that is the
toxic effect. And I have seen this toxic effect occur with Vit D levels in the
50s.

~~~
cactus2093
Would you still consider 5,000 IU of Vitamin D per day safe as far as these
calcium issues go?

I had a doctor tell me to take that dose for at least a few months a few years
ago after low levels in my bloodwork during the winter. But I've never known
if I should lower the dose to take on a continuing basis or adjust during the
summer when I get a little more sun (but I still work in an office/at home so
spend a lot of time indoors, especially now).

~~~
devaboone
I do see people get high calcium levels after being on this dose for years.
But not always. You may be able to handle that dose. If you are getting
"routine" labs done, then there is likely a calcium level in there. If your
calcium is normal (under 10.0 mg/dl for adults over 40, younger adults can be
a little higher), then your Vitamin D dose is ok... but I would still
recommend coming down a bit on that dose. It is a high dose, and Vit D builds
up in your body, since it is a fat soluble vitamin.

~~~
ausjke
just checked my "Vitamin D, 25 OH" test:

result: 13.3 ng/ml, normal range: 25.0 - 80.0 ng/ml

I'm taking Vitamin D3 Max 125MCG per day, is this "overdose"?

Thanks,

~~~
valarauko
Since the doc hasn't replied to this question (yet), your Vit D levels are low
enough to warrant supplementation. In my country it is common to supplement
with 60K IU once a week, for 8 weeks, before moving to a maintenance dosage of
60k once a month. That's almost 10k IU/day during the loading phase. You're at
5k IU/ day, so should be fine. In comparison, a fair skinned person at the
beach on a sunny day will make over 10k IU of D3.

~~~
ausjke
Thank you!!!

------
ve55
Although this is a notable finding it's important to remember that it doesn't
lead to the conclusion that supplementing vitamin D will be very beneficial
here. When vitamin D is produced in the body naturally via exposure to
sunlight there's a huge amount of other things that occur as well, and we
don't have a ton of good science to back up if curing a vitamin D deficiency
via supplementation of pure vitamin D is really nearly the same as getting it
naturally, which is a common problem for supplementing things and nutritional
science and epidemiology in general.

The extent that covid harms those that are metabolically unfit in many
different ways much more than those that are perfectly healthy is still pretty
under-discussed imo though, and this is yet another good data point in favor
of it, even if Vitamin D is much more of a different proxy than some of the
other large correlations we see with covid mortality.

~~~
sharpneli
In Finland we put Vitamin D in milk that’s sold on normal shops. And taking a
supplement is heavily recommended.

Though this is mostly because for 6 months of a year one simply cannot get it
the natural way (too cold and sun is too low). And thanks to this we don’t
have much deficiency, long time ago we used to have.

Not saying it means it would help with covid. But the supplements definitely
help with deficiency in a way that does cure/prevent rickets.

~~~
BurningCycles
>In Finland we put Vitamin D in milk that’s sold on normal shops.

I'd wager it's the same in all the Nordic countries, at least it's the same
here in Sweden.

A couple a months ago when I spoke to my dad, he told me he had a checkup
because he had been unusually tired, turned out that the only thing the
testing showed was that he had d-vitamin deficiency.

What surprised me is that he was given prescription d-vitamins, since you can
buy them anywhere without prescription.

~~~
pkaye
You can get larger doses of vitamin D in one pill as a prescription. Like
20000 IU once every week or two instead of daily.

Also there is vitamin D2 and D3. The normal stuff you take is called D2. The
D3 is made by the kidneys from converting D2. But those with certain diseases,
the kidneys don't do the conversion so they provide vitamin D3 in the form
called calcitriol. Its something I need to take due to my kidney failure.

~~~
nicoburns
At least in the UK, it's pretty easy to get D3 over the counter too. I've been
buying D3 drops off of Amazon.

~~~
pkaye
Looks like I misunderstood it. Calcitriol is different from D3. Normally your
body converts D3 to calcitriol but those with certain diseases will not get it
converted.

Calcitriol is actually the most confusing of my medications to manage since
the dosage needs to be adjusted based on monthly blood tests. Things like
amount of sun exposure can swing my numbers around. And it interacts with so
many blood test numbers like PTH, phosphorus and calcium levels.

------
batrachom
This article is (badly) written by un-qualified authors (two software
developers). This would be enough to raise at least a few red flags on the
conclusions drawn here. Has it even been peer reviewed? From a first look,
there no way this work would have been published by any reputable journal.

If there is any truth in what the authors claim, the best they could do is to
work with field experts and/or submit their findings to a reputable journal
for review and publishing. Someone's health might be on the line following
pseudo-scientific works.

~~~
rtlfe
> This article is (badly) written by un-qualified authors (two software
> developers)

Indeed the first sentence talks about "corona deaths." No qualified medical
professional would write that in a paper.

~~~
unethical_ban
Is English their first language? .de and all.

------
et2o
Vitamin D has been endlessly promoted as a treatment for many diseases due to
evidence from observational studies, but hundreds of millions of dollars in
randomized controlled trials have never demonstrated it to be effective for
any disease except rickets.

There was just a large trial published in JAMA [1] examining its effectiveness
for depression given solid observational data. It was not at all effective.

The reason that Vitamin D is associated with many diseases but is not
causative for anything is that Vitamin D level is highly correlated with other
metrics of health such as socioeconomic status, active lifestyle, nutritional
sufficiency, etc.

We are wasting our time and money looking at Vitamin D again and again and
again.

1\. [https://jamanetwork.com/journals/jama/article-
abstract/27689...](https://jamanetwork.com/journals/jama/article-
abstract/2768978)

~~~
tekgnos
This study used a tiny amount of Vitamin D (2,00IU/day) which is absolutely
not enough Vitamin D to have any affect on someone who is deficient. Going
outside in a swimsuit produces 10,000+IU equivalent. We evolved nude,
outdoors.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/)

~~~
AQuantized
It's not a tiny amount, probably about 40% of what most adults should be
getting optimally, and significantly better than having almost no intake,
which is the case for a lot of people who rarely go outside and don't eat any
fatty fish.

~~~
tekgnos
That's fair. The RDA at 400 is tiny.

------
tekgnos
It is not surprising at all that Covid-19 matches what we already know about
Vitamin D and Influenza. There are consequences for radically altering the
environment in which humans evolved. We were nude outdoors and now we are
clothed and indoors. When we do briefly go outside, we are all conditioned to
slather on sunscreen, which blocks all Vitamin D generation.

Why do people tend to get sick in the wintertime and not the summer?

[https://pubmed.ncbi.nlm.nih.gov/16959053/](https://pubmed.ncbi.nlm.nih.gov/16959053/)

~~~
baix777
Humans have being wearing clothes for about 170,000 years, indoors and
outdoors, long enough for a evolutionary response. Along with fire, clothing
is one of our great inventions and allows humans to live in colder climates
than we could otherwise. We have, along with other creatures like lice, been
evolving since we started wearing clothes.

But why do people get more sick in the winter, when they are forced into close
proximity with other people, making illness easier to spread, rather than the
summer, when people are outdoors more, and can do things like walk to work in
the warm summer sun rather than take the bus in the cold winter rain and snow?
Stated differently, we naturally do more social distancing in the summer.

~~~
tekgnos
Sure, there has been evolution. Like the adaptation of white skin for humans
in northern latitudes. Why was it so important to evolve pale skin for humans
living in high latitudes?

Social distancing in summer as a reason why people don't get sick is an
interesting theory, any studies that support it?

------
ColanR
Looks like this has been posted a lot on HN recently [0]. Previous Vitamin D &
Covid-19 discussions that garnered some comments:

[https://news.ycombinator.com/item?id=23023703](https://news.ycombinator.com/item?id=23023703)

[https://news.ycombinator.com/item?id=22463713](https://news.ycombinator.com/item?id=22463713)

[https://news.ycombinator.com/item?id=23119949](https://news.ycombinator.com/item?id=23119949)

[https://news.ycombinator.com/item?id=23390264](https://news.ycombinator.com/item?id=23390264)

[https://news.ycombinator.com/item?id=23349962](https://news.ycombinator.com/item?id=23349962)

[https://news.ycombinator.com/item?id=23167802](https://news.ycombinator.com/item?id=23167802)

[https://news.ycombinator.com/item?id=23188675](https://news.ycombinator.com/item?id=23188675)

[https://news.ycombinator.com/item?id=23083619](https://news.ycombinator.com/item?id=23083619)

[https://news.ycombinator.com/item?id=22600685](https://news.ycombinator.com/item?id=22600685)

[0]
[https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=tru...](https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=true&query=vitamin%20d%20covid&sort=byPopularity&type=story)

------
yelloworangefog
People need to be really careful when sharing papers like these and repeating
their conclusions without the appropriate disclaimers. That's always the case,
and _especially_ during a time when so many people are unable to consult their
doctors and resorting to self-medicating based on hearsay and overconfidence
in their own ability to interpret scientific papers.

To be clear, I'm not saying vitamin D deficiency in relation to Covid
mortality isn't a valid line of inquiry for the health community to take their
research in. But from what I can tell, this is far outside the authors' areas
of expertise.

I'd say this kind of thing in particular has the potentially to be even more
dangerous than irresponsibly discussing the effects of something like
hydroxychloroquine, because so many people don't realize how dangerous
vitamins and other such 'natural' remedies can be when taken without the
supervision of a medical professional.

------
aauchter
Interesting but a there's a decent chance of correlation not causation.
Unhealthy people and people over 65 (i.e. those most susceptible to serious
COVID complications) are the same group that are most likely to be Vitamin D
deficient. The primary source of Vitamin D is sunlight. People over 65 tend to
stay indoors, etc. People with darker skin are also more prone to D deficiency
due to increased melanin, but also have higher rates of obesity, more likely
to suffer from diabetes, are more likely to live in cramped conditions, etc.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/)
[https://www.cantonmercy.org/healthchat/42-percent-of-
america...](https://www.cantonmercy.org/healthchat/42-percent-of-americans-
are-vitamin-d-deficient/)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/)

~~~
nostromo
From the paper:

> _After correction for age, sex and previous illnesses,_ the risk of death is
> 10 times higher for people with vitamin D deficiency.

That said, it could still be correlative and not causative with some different
underlying health issue.

~~~
wtetzner
> That said, it could still be correlative and not causative with some
> different underlying health issue.

On the other hand, maybe Vitamin D deficiency is the cause or one the causes
of those underlying health issues.

------
KerryJones
This isn't the first set of studies on Vitamin D3 and COVID-19, and very happy
more is coming out that is supportive:
[http://agingbiotech.info/vitamindcovid19/](http://agingbiotech.info/vitamindcovid19/)

Per Nicholas Taleb this is "optionality", very low risk and potentially very
high reward.

------
dlojudice
"Pending results of such trials, it would seem uncontroversial to
enthusiastically promote efforts to achieve reference nutrient intakes of
vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA.
These are predicated on benefits of vitamin D for bone and muscle health, but
there is a chance that their implementation might also reduce the impact of
COVID-19 in populations where vitamin D deficiency is prevalent; there is
nothing to lose from their implementation, and potentially much to gain."

[https://www.thelancet.com/journals/landia/article/PIIS2213-8...](https://www.thelancet.com/journals/landia/article/PIIS2213-8587\(20\)30268-0/fulltext)

------
aplummer
> The rapid increase of vitamin D levels in covid-19 infected patients with
> vitamin D deficiency (< 30ng/ml), as well as vitamin D supplementation for
> doctors, nursing staff and risk patients to a healthy blood level of
> 40-50ng/ml, is - in the authors' view - the only conceivable solution to
> effectively contain the corona pandemic.

Research paper warning alarm sounding here.

~~~
James_Henry
I don't know if this should really be considered a "research paper" even.

~~~
disgruntledphd2
This is a pretty poor article on an interesting topic.

------
solumos
> Vitamin D deficiency causes a 10 times higher death rate in Covid-19
> patients according to recent studies.

This is a hugely overstated conclusion - and none of the studies presented are
able to make causal claims to back this up. This is a load of malarkey.

------
macawfish
I've been very frustrated in my attempts to raise this issue with the local
health department where I live. I was brushed aside, and was told "correlation
does not imply causation". I doubt that the person on the phone wanted to get
into a conversation about dynamical systems or nonlinear data analysis, so I
didn't even go there.

Instead I sent a letter full of references to published research, and citing
other letters (peer reviewed) urging public health officials to recommend safe
levels of supplementation. I received 0 engagement. I should really send the
letter every day until someone responds.

Aside from all of the promising anecdotal evidence and population studies,
there is plenty of established theory to understand just how Vitamin D might
help lessen the load of Covid-19. Decades of published, reviewed research have
shown that Vitamin D:

\- helps regulate calcium metabolism and ionization... disregulated calcium
levels are also linked to poor covid outcomes

\- downregulates some of the same inflammatory cytokines involved in the
positive feedback loops seen in bad covid cases

\- directly regulates the expression of ACE-2 genes

\- regulates the renin-angiotensin system

\- regulates circadian rhythm

Other supplements that work with Vitamin D to help regulate calcium metabolism
and ionization are also promising, including K2 and magnesium.

[https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v...](https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v2)

A friend of mine who's a doctor also told me that a lot of people with bad
covid outcomes just have general electrolyte imbalances. To what degree is
this pandemic just a manifestation of basic malnutrition on a massive scale?

At this point, I've come to the conclusion that there is a systemic conflict
of interest in many health systems around the world. It's most blatant in the
US. Specifically: It seems that there are certain "neo-Malthusian" individuals
high up in the chains of command who simply have no interest in implementing
low risk, low cost measures that prevent loss of life, and instead use their
power to further cater to the already privileged groups of people they deem
fit for life. This goes beyond covid-19.

~~~
davidwitt415
A simpler explanation is profit motive; it doesn't 'pay' to promote free/low
cost alternatives. Most of western medicine is geared this way, imo.

~~~
macawfish
I agree, and don't believe your explanation is all that different from mine.
Market driven medicine implicitly favors people who for whatever reason find
themselves in the position to pay for care, and slowly but surely culls those
who aren't.

People with the power to regulate health care "markets", to shape the
incentive structures and make them less overtly biased in favor of wealthy
people, sometimes they do this and sometimes they don't. Currently, at least
in the US, in the midst of this unfolding crisis, the power balance seems
skewed toward the "let's take a violent trek toward 'herd immunity' as soon as
possible" decision makers, many of whom are more or less blatantly eugenic.

------
emdowling
This conclusion (10x higher mortality if deficient in Vitamin D) is rather
significant. How trustworthy is this source?

~~~
russfink
From a technical writing style perspective, the thing going against this paper
is the folksy way of writing. It also includes things called weasel words,
such as saying very young doctor, versus young doctor, or even just doctor.

The results are compelling, and I suppose it would not hurt to take a
prophylaxis of vitamin D (5,000 units per the article?) as compared to a
prophylaxis of something else, such as hydroxychloroquine (or Lysol!)

~~~
tehjoker
People in my doctor friend's hospital taking HCQ got arrhythmias at a higher
rate and often didn't get better. It is not a miracle cure and is quite
dangerous in the alleged "treatment ranges".

I am a bit stunned that people are still going on about HCQ after all this
time and the many trials. I feel this comment by a virologist is the key to
understanding why it got so hyped and is not working:

[https://www.sciencedirect.com/science/article/pii/S016635422...](https://www.sciencedirect.com/science/article/pii/S0166354220301145?via%3Dihub)
(May 2020)

"Highlights

• In vitro data suggest that chloroquine inhibits SARS Cov-2 replication. • In
past research, chloroquine has shown in vitro activity against many different
viruses, but no benefit in animal models. • Chloroquine has been proposed
several times for the treatment of acute viral diseases in humans without
success. • The outcomes of some current clinical trials of chloroquine in
China have been announced, without access to the data. • Peer review of the
results and an independent assessment of the potential benefit for patients
are essential."

------
odysseus
As I wrote at
[https://news.ycombinator.com/item?id=23025501](https://news.ycombinator.com/item?id=23025501)
:

There is an app I've been using to track my Vitamin D for a few years now:
[http://dminder.ontometrics.com](http://dminder.ontometrics.com)

(Not affiliated with the app, just happy with it.) It tells you the sun angle,
peak hour of the day, and maximum time you should be in that day's sun based
on your skin type, to avoid getting burnt while still getting enough D.

Be careful though - you might get a little OCD about Vitamin D tracking with
this app. I did, and mainly use it now for checking how long it is safe to
stay outdoors. (Instead of full blown tracking.)

------
hrasyid
Is this a peer-reviewed finding? As someone without expertise in the area how
do I evaluate its credibility?

~~~
shock
How do you evaluate the credibility of anything in life? I'm not being
facetious, it's a question I've been asking myself a lot lately after making
decisions based on the information from a medical doctor, who, turns out, was
not competent to make certain affirmations.

~~~
searchableguy
I have been asking that too.

What steps should I take to verify information without becoming an expert in
the field?

What about more nuanced political topics?

------
thingamarobert
I heard about this just the other day on an episode of the Radiolab podcast,
if you're interested in listening to a nice narration to complement the
article:
[https://www.wnycstudios.org/podcasts/radiolab/articles/invis...](https://www.wnycstudios.org/podcasts/radiolab/articles/invisible-
allies)

------
zaroth
My wife just had a Vitamin D test which came at 15ng/mL, so we are chuckling
right now that she is 100% going to die if she gets COVID.

Dark humor aside, that is one hell of a chart. Really helps explain the huge
drop in death rate over the summer.

I must say it’s a bit of a missed opportunity to build up herd immunity while
the sun is shining here in the northern hemisphere.

------
MontagFTB
Supplementing with vitamin D should be easy enough to test. Given that most
people get their necessary vitamin D by going outside, couldn’t the
presence/lack of this vitamin be an indicator of other lifestyle choices that
may affect the person’s ability to fight off the disease?

~~~
James_Henry
Sure, but a bigger confounder is probably that vitamin D deficiency is
associated with metabolic syndrome, CKD, obesity, diabetes, etc. These may be,
for some people, indicative of lifestyle choices as well, but those choices
are, I'd guess, not the direct cause of a person's inability to survive the
disease.

------
dirtyid
Everyone should try a Vitamin D cycle if only to see if makes a big difference
in daily life, especially if you live in area with sad winters. It's one of
the few supplements that dramatically improves mood for those deficient or
sensitive to large doses.

~~~
y-c-o-m-b
I can provide my anecdote. I live near Portland, OR and been taking 5000IU of
Vitamin D for years. It doesn't do anything to help with seasonal sadness.
Neither do those "sun lamps". The only thing I've found helpful (although
short-lived) for that is literally leaving the state for a week to somewhere
warmer; like Hawaii or San Diego. The sadness comes back shortly after
returning though, and sometimes even worse than before. It seems to me that
treating seasonal depression is more complicated than simply taking medication
or sitting in front of a lamp.

~~~
0DHm2CxO7Lb3
Yeah, it would be nice to be able to replicate a warmer and sunnier climate
indoors during the winter.

Another thing you can try is to use red to near infrared light which has been
shown to affect the mitochondrial electron transport chain. I read "Brain
Photobiomodulation Therapy: A Narrative Review" a couple of days ago which is
pretty interesting.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041198/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041198/)

------
tingletech
Dr. John Campbell has a lot of videos about vitamin D and covid-19 -- here is
one from last week
[https://www.youtube.com/watch?v=cv4iINxf4IM](https://www.youtube.com/watch?v=cv4iINxf4IM)

------
vinniejames
"average age group of the 20 patients" == 60 years old

Is 20 a high enough sample size for any meaningful conclusion from a study
like this?

~~~
throwaway6000
The Harvard Gazette: Study confirms vitamin D protects against colds and flu

[https://news.harvard.edu/gazette/story/2017/02/study-
confirm...](https://news.harvard.edu/gazette/story/2017/02/study-confirms-
vitamin-d-protects-against-cold-and-flu/)

University of Colorado Anschutz Medical Campus: Vitamin D reduces respiratory
infections

[https://www.sciencedaily.com/releases/2016/11/161116103005.h...](https://www.sciencedaily.com/releases/2016/11/161116103005.htm)

------
nathwill
the problem with vitamin D is there's a lot of confounders that D is a proxy
for, particularly met-syn and old age, so until there's actual mechanistic
descriptions for how D inhibits covid severity, i'm remaining cautiously-
optimistic-bordering-on-skeptical about its curative powers.

------
FreelanceX
Would it be reasonable to hypothesize that, through lack of sun exposure and
ensuing vitamin D deficiencies, lockdowns kill more people than they save?
(that is, the increase in mortality would more than overcome the decrease in
cases)

We cannot know for sure of course, but is it unreasonable to even consider?

~~~
amanaplanacanal
My state started locking down early, but at no time were people not allowed to
go outside. Closing bars seems unlikely to contribute to vitamin D deficiency,
for example.

~~~
FreelanceX
But strong lockdowns in which you're not allowed to walk outside unless you
have a good reason happened in a lot of countries.

------
archildress
I think the findings are good and interesting but I wish we could dodge the
politicized angle of this:

"A lockdown would then be just as unnecessary as the justified fear of our
elderly fellow citizens and the risk groups, which imposes an abnormal life on
all of us."

------
gshotwell
I've been maintaining a complete-ish repository of vitamin D covid research
here:

[https://github.com/GShotwell/vitamin_d_covid](https://github.com/GShotwell/vitamin_d_covid)

------
kyuudou
Something to consider when sunlight works and Vit D supplementation does not
is how well your digestive tract is absorbing nutrients. Fast, food diaries,
observe reactions especially on the skin.

------
del_operator
I’ve heard people talk in other offline conversations about COVID-19 induced
hyper-coagulability. How much did that play a role in these cases?

------
WhompingWindows
If this work truly is very important, you will read about it from a reputable
journal which properly vets this information. This isn't peer reviewed, it's
just a website's PDF, there is no way to verify anything put onto this PDF.

~~~
neilwilson
This reputable enough for you?

[https://www.thelancet.com/journals/landia/article/PIIS2213-8...](https://www.thelancet.com/journals/landia/article/PIIS2213-8587\(20\)30268-0/fulltext)

~~~
WhompingWindows
I don't understand. The authors for your link are "Adrian R Martineau, Nita G
Forouhi". The authors for the PDF of this thread are "Lorenz Borsche / Dr.
Bernd Glauner".Were you trying to say others in the field are doing similar
work?

My point above was that posting a PDF online is not good enough in scientific
circles. The charts themselves have a number of issues which I'd ask the
authors, I don't know if they've properly adjusted for the risk factors and
I'm not sure I agree with their choice of denominators.

------
RosanaAnaDana
I'm a simple person. I see two y or x axis on the same plot and I cast doubt.

