Cobalamin communication in Sweden 1990 – 2000 : views, knowledge and practice among Swedish physicians

Sammanfattning: Cobalamin (vitamin B12) is one of several essential micronutrients needed by the human organism. Other important micronutritients, which interplay with vitamin B12, are folate and iron. During the last ten years, the attention has been drawn to different forms of neurological disorders supposed to be caused by vitamin B12 deficiency. Vitamin B12 deficiency states are common among elderly patients in primary health care and sometimes in hospital care, especially in geriatric practice. This is a study to define the cobalamin treatment traditions, among Swedish physicians in the period 1990 – 2000. The period was distinguished by an intense debate on the issue by the physicians, an increase of cobalamin consumption, and a shift from parenteral therapy towards oral high-dose therapy. It had been known that symptoms of cobalamin deficiency could start in the nervous system. This knowledge was reinforced by the application of homocysteine and methyl-malonic acid (MMA) in deficiency diagnosis. Introduction of homocysteine and MMA in deficiency diagnosis changed the view on deficiency prevalence, by identifying persons at risk to develop B12 deficiency prior to established symptoms. In this study, Swedish physicians are regarded mainly as receivers of communication about the markers homocysteine and MMA, and deficiency states of cobalamin and folate. The main senders were scientists from North America, Norway, Denmark, and Sweden. This study sets the senders and the receivers of cobalamin communication on a collegial level and quantifies and evaluates the feed-back from the receivers. The receivers, gen¬eral practitioners and geriatricians, appeared to be familiar with old knowledge and frontier concepts in the field. Thus, it is suggested that the increase of B12 prescriptions in Sweden 1990 – 2000 reflected an increased awareness of B12-associated clinical problems among the physicians managing the majority of deficiency patients, although a possible overconsumption of pharmaceutical drugs must be kept in mind.