Vitamin D Supplementation and Total Mortality A Meta-analysis of Randomized Controlled Trials Philippe Autier, MD; Sara Gandini, PhDBackground: Ecological and observational studies sug-
varied from 300 to 2000 IU. The trial size–adjusted mean
gest that low vitamin D status could be associated with higher
daily vitamin D dose was 528 IU. In 9 trials, there was a 1.4-
mortality from life-threatening conditions including cancer,
to 5.2-fold difference in serum 25-hydroxyvitamin D be-
cardiovascular disease, and diabetes mellitus that account
tween the intervention and control groups. The summary
for 60% to 70% of total mortality in high-income countries.
relative risk for mortality from any cause was 0.93 (95% con-
We examined the risk of dying from any cause in subjects
fidence interval, 0.87-0.99). There was neither indication
who participated in randomized trials testing the impact of
for heterogeneity nor indication for publication biases. The
vitamin D supplementation (ergocalciferol [vitamin D2] or
summary relative risk did not change according to the ad-
cholecalciferol [vitamin D3]) on any health condition.
dition of calcium supplements in the intervention. Conclusions: Intake of ordinary doses of vitamin D supple- Methods: The literature up to November 2006 was
ments seems to be associated with decreases in total mor-
searched without language restriction using the following
tality rates. The relationship between baseline vitamin D
databases: PubMed, ISI Web of Science (Science Citation
status, dose of vitamin D supplements, and total mortal-
Index Expanded), EMBASE, and the Cochrane Library.
ity rates remains to be investigated. Population-based,placebo-controlled randomized trials with total mortal-
Results: We identified 18 independent randomized con-
ity as the main end point should be organized for confirm-
trolled trials, including 57 311 participants. A total of 4777
deaths from any cause occurred during a trial size–adjustedmean of 5.7 years. Daily doses of vitamin D supplements
Arch Intern Med. 2007;167(16):1730-1737ECOLOGICALSTUDIESINNORTH productsmayalsorepresentasourceofvi-
tamin D, although of highly variable content
(eg, fortified foods, oily fish, eggs, and but-
ter). Hence, low vitamin D status could pro-
ceed from the conjunction of insufficient in-
cer, cardiovascular diseases, and diabetes
takes (exogenous source) and of insufficient
mellitus would increase with increasing lati-
skin synthesis (endogenous source) of vita-
tude, that is, with residence increasingly dis-
min D. Biological findings have reinforced
tant from the equator.1,2 Other studies have
the likelihood of the vitamin D hypothesis.
shown that the survival of patients with car-
First, vitamin D receptors have been found
diovascular disease or with some cancer (eg,
in various organs, and activation of these re-
greaterifthediagnosiswasmadeduringsum-mer as compared with the winter.3,4 Increas-
For editorial comment
ing distance from the equator and winter pe-
see page 1709
riod were equated to decreasing exposure tosunlight, especially to UV-B radiation (280-
CME available online at
315 nm) because with increasing latitude,
www.archinternmed.com
amountsofUV-BradiationreachingtheearthsurfacedecreasefasterthanamountsofUV-A
(calcitriol), the physiologically active form
radiation(315-400nm).5Also,seasonalvaria-
of vitamin D, induces cell differentiation and
tions are more pronounced for UV-B radia-
inhibitsproliferation,invasiveness,angiogen-
tion than for the UV-A radiation.5 Because
esis, and metastatic potential.11,12 These bio-
UV-B radiation is necessary for the synthe-
logical phenomena are typical of cancer gen-
Author Affiliations:
sis of vitamin D in the skin, it has been hy-
pothesized that associations found between
proliferation) are also involved in cardiovas-
latitudeorseasonalityandmortalityfromsev-
cular ischemic diseases. Second, many tis-
France (Dr Autier); and theEuropean Institute of Oncology,
eral chronic conditions could be owing to
sues express the 1␣-hydroxylase enzyme.11
variations in vitamin D status.6-10 Some food
So, after 25-hydroxylation of vitamin D in
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved.
tervals (CIs) (ie, crude data or adjusted
were used: vitamin D, cholecalciferol, and
RRs and standard errors, 95% CIs, or Pergocalciferol. For methods, the follow-
vitamin D intake vs placebo or control.
MeSH terms used were randomized con-trolled trial and placebo. A first general
DESCRIPTION OF STUDIES RETRIEVED
A total of 992 articles or abstracts were re-
trieved and checked for relevance in terms
words with the following outcome key-words (and their corresponding MeSH
of intervention, design, and reporting of
terms): congestive heart failure, coro-
mortality data. This process resulted in re-
nary heart disease, cardiovascular dis-
trieving a total of 27 articles or abstracts
ease, fracture, bone mineral density, and
bone turnover. Mortality was not a help-
ized clinical trials evaluating effects of vi-
point and reporting data on deaths. Ofthese 27 articles, 9 were not included in
1 trial in the United Kingdom,16 had mor-
sons: (1) Two articles referred to the same
trial.17,18 (2) Three did not report deaths
erences cited in the selected articles and
trieved.19-21 (3) In 2 trials, the interven-tion consisted of a set of drugs including
stract or article whose title or summarycontained at least 1 intervention key-
vitamin D.22,23 (4) Two trials were basedon cluster randomization,24,25 and 1 of
synthesis of randomized controlled trials
cluding 3717 participants with a mean age
SELECTION OF ARTICLES
of 85 years. The intervention was equiva-lent to a daily dose of 1100 IU of ergocal-
INTERVENTION
ciferol. (5) A placebo-controlled random-
AND OUTCOME
label trial with a subgroup of the placebo-
ation of Calcium Or vitamin D) trial.28 We
used the data from the open-label trial and
trial to have independent studies. For the
estimates derived from the same trial. Table 1 summarizes the 18 studies that
calcidol), the physiologically active form
D3 [calcitriol]), or other vitamin D ana-
STATISTICAL ANALYSIS
end-stage renal disease or in patients un-
rates in each randomization group were all
(intent-to-treat analysis). Some trials, such
LITERATURE SEARCH
as the RECORD trial,28 had a factorial de-
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved. Table 1. Vitamin D Supplements and All-Cause Mortality: Overview of Trials Selected for Meta-analysis Baseline, in Control Follow-up, Point(s) Population Intervention
(300 IUϩcalcium [0.5 g]during 3 first years and 100IUϩcalcium [0.5 g] in thelast year)
1 group with single-injectionergocalciferol(300 000 IU)ϩoral calcium(1 g), 1 group with daily oralcholecalciferol (800IUϩcalcium [1 g])
(10 000 IU), followed by dailyoral ergocalciferol (1000 IU)
a Women randomized to multivitamin supplement containing vitamin D were not included in the meta-analysis.
b Women randomized to hormone therapy or to hormone therapy and vitamin D groups were not included in the meta-analysis.
c Cod liver oil without cholecalciferol.
d The same article reported 2 randomized controlled trials. We took into account only the open label trial because the placebo-controlled trial was a part of the
RECORD trial.28 Mortality data of the open label trial we used were those reported by Avenell et al15 in 2005.
e Intervention assumed to be the same as in the RECORD Trial.28
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved. Table 2. Serum Levels of 25-Hydroxyvitamin D in Randomized Trials With Vitamin D Supplementsa Mean Serum 25-Hydroxyvitamin D3 (ng/mL)b Daily Dose of Vitamin D Ratio for In-Study Level, Intervention Group Control Group Follow-up, in Intervention Intervention vs Group, IU Baseline Baseline Control Group
a Trials in Table 1 not included in Table 2 did not report serum 25-hydroxyvitamin D levels.
b Measurements of serum levels were always performed in subsamples of subjects in intervention and control groups.
c In-study serum 25-hydroxyvitamin D levels were derived from Figure 1 in the original publication.33
d Estimated from oral cholecalciferol, 100 000 IU every 4 mo.
studies that is attributable to heterogeneity
coming from the “intervention group” and
data related to groups not receiving vita-
ments in the largest trials (see “Trials
tality was a relatively rare event, and we
lication bias: the sensitivity analysis of
Figure) was 48% in the RECORD
tween the various measures of relative risk
Copas and Shi47 and the funnel plot regres-
(ie, odds ratio, rate ratio, and risk ratio).
Initiative trial,42,43 63% in the trial by
the corresponding variance using the for-
mula proposed by Greenland44 in 1987.
culated them from tabular data, and weused the Woolf formula to evaluate the
trial by Lips et al,30 and 95% in the trial
standard error of the log odds ratio.44 Logit
0.5 in every cell of those tables that con-
tality across selected trials was computed
results of the 18 trials indicated a sig-
as a summary RR (SRR) with 95% CIs. TheSRR was considered statistically signifi-
cant if the 95% CI did not include 1.0.
effect across studies using the large sample
test based on the 2 statistic. Since the 2
for heterogeneity (P=.52) or of pub-
test has limited power, we considered that
lication bias (P=.37 with the method
statistically significant heterogeneity ex-
was 528 IU. Table 2 indicates a sub-
of Copas and Shi47 and P=.77 with the
isted when the P value was Յ.10.45 Sub-
A subgroup analysis (Table 3)
heterogeneity focusing on type of study,type of control, length of follow-up, vita-
groups, translating to a 1.4- to 5.2-fold
using the I2 parameter, which represents
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved. Subtotal SRR (95% CI) 0.92 (0.86-0.99) Subtotal SRR (95% CI) 1.15 (0.79-2.73) All trials 2330/28500 2447/28811 0.93 (0.87-0.99)
χ2 Test for heterogeneity: P = .52
Figure. Meta-analysis of data on all-cause mortality in 18 randomized controlled trials with vitamin D. SRR indicates summary relative risk. Table 3. Vitamin D Supplements and All-Cause Mortality: Subgroup and Sensitivity Analysis
on all-cause mortality is not likely be-cause total mortality did not consti-
No. of Trials Parameter, Heterogeneity, Variable Meta-Analysis P Value
18 trials included in the meta-analysis except 1.16 Timing of deaths
calcium supplements. No relation-ship was found with dose of vita-
Abbreviation: CI, confidence interval; SRR, summary relative risk.
The I2 parameter represents the percentage of total variation across studies that is attributable to
b No placebo for vitamin D in the control group.
tively narrow (ie, 400-830 IU), andlarge variations in size of trials andin compliance to interventions pre-
neity. In this respect, exclusion of this
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved.
have less of an effect (or not at all) on
probability to die because of falls.
P o p u l a t i o n - b a s e d , p l a c e b o -
Accepted for Publication: April 18, Correspondence: Philippe Autier, Author Contributions: Drs Autier
sibility for the integrity of the data and
Study concept and design: Autier. Ac-quisition of data: Autier and Gandini. Analysis and interpretation of data:
Autier and Gandini. Drafting of themanuscript: Autier. Statistical analy-sis: Gandini. Administrative, techni-cal, and material support: Autier. StudyFinancial Disclosure: None re-
en’s Health Initiative trial, rate ratios
Additional Contributions: The li-
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved.
20. Graafmans WC, Ooms ME, Hofstee HM, Beze-
ized, controlled trial of quadriceps resistance ex-
mer PD, Bouter LM, Lips P. Falls in the elderly: a
ercise and vitamin D in frail older people: the Frailty
prospective study of risk factors and risk profiles.
Interventions Trial in Elderly Subjects. J Am Geri-
1. Grant WB. Ecologic studies of solar UV-B radia-
Am J Epidemiol. 1996;143(11):1129-1136.
tion and cancer mortality rates. Recent Results
21. Keane EM, Healy M, O’Moore R, Coakley D, Walsh
36. HarwoodRH,SahotaO,GaynorK,etal.Arandomised,
Cancer Res. 2003;164:371-377.
JB. Vitamin D–fortified liquid milk: benefits for the
controlled comparison of different calcium and vi-
2. Zittermann A, Schleithoff SS, Koerfer R. Putting
elderly community-based population. Calcif Tis-
tamin D supplementation regimens in elderly wom-
cardiovascular disease and vitamin D into
en after hip fracture: the Nottingham Neck of Femur
perspective. Br J Nutr. 2005;94(4):483-492.
22. Hedstro¨m M, Sjoberg K, Brosjo E, Astrom K,
(NoNOF) Study. Age Ageing. 2004;33(1):45-51.
3. Scragg R. Seasonality of cardiovascular disease
Sjoberg H, Dalen N. Positive effects of anabolic
37. Meier C, Woitge HW, Witte K, Lemmer B, Seibel
mortality and the possible protective effect of ultra-
steroids, vitamin D and calcium on muscle mass,
MJ. Supplementation with oral vitamin D3 and cal-
violet radiation. Int J Epidemiol. 1981;10(4):
bone mineral density and clinical function after a
cium during winter prevents seasonal bone loss:
hip fracture: a randomised study of 63 women.
a randomized controlled open-label prospective
4. Lim HS, Roychoudhuri R, Peto J, Schwartz G,
J Bone Joint Surg Br. 2002;84(4):497-503.
trial. J Bone Miner Res. 2004;19(8):1221-1230.
Baade P, Moller H. Cancer survival is dependent
23. Sato Y, Kanoko T, Satoh K, Iwamoto J. The preven-
38. Brazier M, Grados F, Kamel S, et al. Clinical and labo-
on season of diagnosis and sunlight exposure. Int
tion of hip fracture with risedronate and ergocal-
ratory safety of one year’s use of a combination
J Cancer. 2006;119(7):1530-1536.
ciferol plus calcium supplementation in elderly wom-
calcium ϩ vitamin D tablets in ambulatory elderly
5. IARC. Solar and Ultraviolet Radiation. Vol 55. Lyon,
en with Alzheimer disease: a randomized controlled
women with vitamin D insufficiency: results of a
France: International Agency for Research on Can-
trial. Arch Intern Med. 2005;165(15):1737-1742.
multicenter, randomized, double-blind, placebo-
cer; 1992. IARC Monographs on the Evaluation
24. Law M, Withers H, Morris J, Anderson F. Vita-
controlled study. Clin Ther. 2005;27(12):1885-
min D supplementation and the prevention of frac-
6. Giovannucci E. The epidemiology of vitamin D and
tures and falls: results of a randomised trial in el-
39. Porthouse J, Cockayne S, King C, et al. Ran-
cancer incidence and mortality: a review (Unites
derly people in residential accommodation. Age
domised controlled trial of calcium and supple-
States). Cancer Causes Control. 2005;16(2):
mentation with cholecalciferol (vitamin D3) for pre-
25. Larsen ER, Mosekilde L, Foldspang A. Vitamin D
vention of fractures in primary care. BMJ. 2005;
7. Kricker A, Armstrong B. Does sunlight have a ben-
and calcium supplementation prevents osteopo-
eficial influence on certain cancers? Prog Bio-
rotic fractures in elderly community dwelling resi-
40. Flicker L, MacInnis R, Stein M, et al. Should all older
phys Mol Biol. 2006;92(1):132-139.
dents: a pragmatic population-based 3-year in-
people in residential care receive vitamin D to pre-
8. Garland CF, Garland FC, Gorham ED, et al. The role
tervention study. J Bone Miner Res. 2004;19
vent falls? results of a randomised trial [abstract].
of vitamin D in cancer prevention. Am J PublicJ Bone Miner Res. 2004;19(suppl 1):S99.
26. Corless D, Dawson E, Fraser F, et al. Do vitamin
41. Schleithoff SS, Zittermann A, Tenderich G, Ber-
9. Poole KE, Loveridge N, Barker PJ, et al. Reduced
D supplements improve the physical capabilities
thold HK, Stehle P, Koerfer R. Vitamin D supple-
vitamin D in acute stroke. Stroke. 2006;37(1):
of elderly hospital patients. Age Ageing. 1985;
mentation improves cytokine profiles in patients
with congestive heart failure: a double-blind, ran-
10. Grimes DS. Are statins analogues of vitamin D?
27. Avenell A, Grant AM, McGee M, McPherson G,
domized, placebo-controlled trial. Am J Clin Nutr. Lancet. 2006;368(9529):83-86.
11. Ordonez-Moran P, Larriba MJ, Pendas-Franco N,
agement Group. The effects of an open design on
42. Jackson RD, LaCroix AZ, Gass M, et al; Women’s
et al. Vitamin D and cancer: an update of in vitro and
trial participant recruitment, compliance and re-
Health Initiative Investigators. Calcium plus vita-
in vivo data. Front Biosci. 2005;10:2723-2749.
tention—a randomized controlled trial compari-
min D supplementation and the risk of fractures. N
12. Banerjee P, Chatterjee M. Antiproliferative role of
son with a blinded, placebo-controlled design. ClinEngl J Med. 2006;354(7):669-683.
vitamin D and its analogs—a brief overview. Mol
43. Wactawski-Wende J, Kotchen JM, Anderson GL,
Cell Biochem. 2003;253(1-2):247-254.
28. Grant AM, Avenell A, Campbell MK, et al; RECORD
et al; Women’s Health Initiative Investigators.
13. National Center for Health Statistics. Health, United
Trial Group. Oral vitamin D3 and calcium for sec-
Calcium plus vitamin D supplementation and the
States, 2006, With Chart Book on Trends in the
ondary prevention of low-trauma fractures in el-
risk of colorectal cancer. N Engl J Med. 2006;
Health of Americans. Hyattsville, MD; National Cen-
derly people: a randomised placebo-controlled trial. Lancet. 2005;365(9471):1621-1628.
44. Greenland S. Quantitative methods in the review
14. Niederlaender E. Causes of Death in the EU. Lux-
29. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3
of epidemiologic literature. Epidemiol Rev. 1987;
embourg City, Luxembourg: Eurostat; October
and calcium to prevent hip fractures in elderly
2006. Population and Social Conditions—
women. N Engl J Med. 1992;327(23):1637-1642.
45. Sterne JA, Juni P, Schulz KF, Altman DG, Bartlett
30. Lips P, Graafmans WC, Ooms ME, Bezemer PD,
C, Egger M. Statistical methods for assessing the
15. Avenell A, Gillespie WJ, Gillespie LD, O’Connell
Bouter LM. Vitamin D supplementation and frac-
influence of study characteristics on treatment ef-
DL. Vitamin D and vitamin D analogues for pre-
ture incidence in elderly persons. Ann Intern Med.
fects in “meta-epidemiological” research. Stat Med.
venting fractures associated with involutional and
post-menopausal osteoporosis. Cochrane Data-
31. Baeksgaard L, Andersen KP, Hylstrup L. Calcium
46. Higgins JPT, Thompson SG. Quantifying hetero-
base Syst Rev. 2005;(3):CD000227.
and vitamin supplementation increases spinal BMD
geneity in a meta-analysis. Stat Med. 2002;21
16. Trivedi DP, Doll R, Khaw KT. Effect of four monthly
in healthy, postmenopausal women. Osteoporos
oral vitamin D3 (cholecalciferol) supplementa-
47. Copas JB, Shi JQ. A sensitivity analysis for pub-
tion on fractures and mortality in men and women
32. Krieg MA, Jacquet AF, Bremgartner M, Cuttelod
lication bias in systematic reviews. Stat Methods
living in the community: randomized double blind
S, Thiebaud D, Burckhardt P. Effect of supple-
controlled trial. BMJ. 2003;326(7387):
mentation with vitamin D3 and calcium on quan-
48. Macaskill P, Walter SD, Irwig L. A comparison of
titative ultrasound of bone in elderly institution-
m e t h o d s t o d e t e c t p u b l i c a t i o n b i a s i n
17. Komulainen MH, Kroger H, Tuppurainen MT, et al.
alized women: a longitudinal study. Osteoporos
meta-analysis. Stat Med. 2001;20(4):641-654.
HRT and Vit D in prevention of non-vertebral frac-
49. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC,
tures in postmenopausal women: a 5 year ran-
33. Chapuy MC, Pamphile R, Paris E, et al. Com-
et al. Effect of vitamin D on falls: a meta-analysis.
domized trial. Maturitas. 1998;31(1):45-54.
bined calcium and vitamin D3 supplementation in
JAMA. 2004;291(16):1999-2006.
18. Komulainen M, Kroger H, Tuppurainen MT, et al.
elderly women: confirmation of reversal of sec-
50. Bouillon R, Moody T, Sporn M, Barrett JC, Nor-
Prevention of femoral and lumbar bone loss with
ondary hyperparathyroidism and hip fracture risk:
man AW. NIH deltanoids meeting on vitamin D and
hormone replacement therapy and vitamin D3 in
the Decalyos II Study. Osteoporos Int. 2002;
cancer: conclusion and strategic options. J Ste-
early postmenopausal women: a population based
roid Biochem Mol Biol. 2005;97(1-2):3-5.
5-year randomized trial. J Clin Endocrinol Metab.
34. Meyer HE, Smedshaug GB, Kvaavik E, Falch JA,
51. Stolzenberg-Solomon RZ, Vieth R, Azad A, et al.
Tverdal A, Pedersen JI. Can vitamin D supple-
A prospective nested case-control study of vita-
19. Bischoff HA, Stahelin HB, Dick W, et al. Effects of
mentation reduce the risk of fracture in the el-
min D status and pancreatic cancer risk in male
vitamin d and calcium supplementation on falls:
derly? a randomized controlled trial. J Bone Miner
s m o k e r s . C a n c e r R e s . 2 0 0 6 ; 6 6 ( 2 0 ) :
a randomized controlled trial. J Bone Miner Res.
35. Latham NK, Anderson CS, Lee A, et al. A random-
52. Palmieri C, MacGregor T, Girgis S, Vigushin D.
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved.
Serum 25 hydroxyvitamin D levels in early and ad-
55. Lee IM, Cook NR, Gaziano JM, et al. Vitamin E in
58. Pe´rez-Castrillo´n JL, Vega G, Abad L, et al. Effects
vanced breast cancer. J Clin Pathol. 2006;59
the primary prevention of cardiovascular disease
of atorvastatin on vitamin D levels in patients with
and cancer: the Women’s Health Study: a ran-
acute ischemic heart disease. Am J Cardiol. 2007;
53. Giovannucci E, Liu Y, Rimm EB, et al. A prospec-
domized controlled trial. JAMA. 2005;294(1):
t i v e S t u d y o f p r e d i c t o r s o f v i t a m i n D
59. Pittas AG, Dawson-Hughes B, Li T, et al. Vitamin D
status and cancer incidence and mortality
56. Bouillon R, Eelen G, Verlinden L, Mathieu C, Car-
in men. J Natl Cancer Inst. 2006;98(7):
meliet G, Verstuyf A. Vitamin D and cancer. J Ste-
diabetes in women. Diabetes Care. 2006;29(3):
roid Biochem Mol Biol. 2006;102(1-5):
54. Bjelakovic G, Nikolova D, Simonetti RG, Gluud C.
60. Barbeau WE, Bassaganya-Riera J, Hontecillas R.
Antioxidant supplements for prevention of gas-
57. Penda´s-Franco N, Gonzalez-Sancho JM, Suarez
Putting the pieces of the puzzle together—a se-
trointestinal cancers: a systematic review and
Y, et al. Vitamin D regulates the phenotype of hu-
ries of hypotheses on the etiology and pathogen-
meta-analysis. Lancet. 2004;364(9441):1219-
man breast cancer cells. Differentiation. 2007;
esis of type 1 diabetes. Med Hypotheses. 2007;
Error in Figure. In the Original Investigation by Fito´ et al titled “Effect of a Traditional Mediterranean Diet on Lipoprotein Oxi- dation: A Randomized Controlled Trial” published in the June 11, 2007, issue of the ARCHIVES (2007;167[11]:1195-1203), an error occurred in Figure 2 wherein the y-axis labels in parts A and C were mistakenly transposed. A corrected figure and legend appears below. Figure 2. Mean±SD changes in plasma ␣-linolenic acid (A), urinary tyrosol (B), and hydroxytyrosol (C) after 3-month interventions. *PϽ.05 vs the corresponding baseline. †PϽ.05 vs low-fat diet group. ‡PϽ.05 vs TMDϩnuts group. TMD indicates traditional Mediterranean diet; VOO, virgin olive oil.
ARCH INTERN MED/ VOL 167 (NO. 16), SEP 10, 2007
2007 American Medical Association. All rights reserved.
DIFFERENCES BETWEEN NEW GENERATION COOPERATIVES AND TRADITIONAL COOPERATIVES David Coltrain Extension Assistant, Arthur Capper Cooperative Center Department of Agricultural Economics, Kansas State University For information call 785-532-1523 or e-mail coltrain@agecon.ksu.edu David Barton Director, Arthur Capper Cooperative Center Professor, Department of Agricultural Econom
Narcotic Educational Foundation of America Drug Abuse Education Provider of the: California Narcotic Officers’ Association VALIUM & OTHER DEPRESSANTS QUICK FACTS : Drugs that slow down mental and physical functions of the body are known generally as central nervous system (CNS) Depressants. Because these chemical agents tend to produce a calming effect, relax muscles, and