I’d want to see a large randomized study of the long term effects of melatonin use in adults to establish the long term effects of melatonin use in adults.
How big a study do you need before you’ll judge something as safe? You selected two examples of a class of therapies that “appeared safe in the short term, exploited a regular physiological process and had a long track record of use.”
From the wikipedia article on the HRT study:
The risk in current users was increased about 1.2 fold; for every 1000 women using HRT, 2.6 developed ovarian cancer over 5 years, compared with 2.2 in those not taking HRT.
The reason huge studies were required to find issues with HRT is because HRT so rarely causes issues. The question you should be asking is: If it is known that a drug is safe in the short term, exploits a regular physiological process, and has a long track record of use, what is the chance that it is harmful in the long term (and to what degree)? The two examples you pointed out are not the entire data set. Your behavior is extremely risk-averse compared to other choices you make daily.
How big a study do you need before you’ll judge something as safe?
I don’t think it makes sense to ask that question in isolation. When judging whether some risk is worth taking I’d generally look at both the evidence for the potential risks and for the potential benefits. I focused on the potential risks in my original post but the reason I’m not convinced that taking melatonin on a long term basis is justified is that the evidence for the benefits is also weak. If there was extremely strong evidence for the claimed benefits of taking melatonin over the long term then I might consider the risks of long term side effects worth taking. My position at the moment is that the balance of evidence suggests that the risk/reward proposition is not compelling for long term use of melatonin, though as I have said I may well try it next time I have a transatlantic flight to counter jetlag.
The question you should be asking is: If it is known that a drug is safe in the short term, exploits a regular physiological process, and has a long track record of use, what is the chance that it is harmful in the long term (and to what degree)?
I don’t think that’s the right question. The right question is whether the evidence for benefits outweighs the evidence for harm. I used to take vitamin supplements because the risk/reward based on the available evidence seemed compelling. In light of more recent large scale studies that show no long term benefits and some evidence of long term harm I no longer take vitamin supplements.
Your behavior is extremely risk-averse compared to other choices you make daily.
I am not risk-averse in general, in fact I think I probably have a higher than average risk tolerance in general. I probably require a higher risk/reward payoff for any kind of long term use of supplements or drugs than the average North American however.
How big a study do you need before you’ll judge something as safe? You selected two examples of a class of therapies that “appeared safe in the short term, exploited a regular physiological process and had a long track record of use.”
From the wikipedia article on the HRT study:
The reason huge studies were required to find issues with HRT is because HRT so rarely causes issues. The question you should be asking is: If it is known that a drug is safe in the short term, exploits a regular physiological process, and has a long track record of use, what is the chance that it is harmful in the long term (and to what degree)? The two examples you pointed out are not the entire data set. Your behavior is extremely risk-averse compared to other choices you make daily.
I don’t think it makes sense to ask that question in isolation. When judging whether some risk is worth taking I’d generally look at both the evidence for the potential risks and for the potential benefits. I focused on the potential risks in my original post but the reason I’m not convinced that taking melatonin on a long term basis is justified is that the evidence for the benefits is also weak. If there was extremely strong evidence for the claimed benefits of taking melatonin over the long term then I might consider the risks of long term side effects worth taking. My position at the moment is that the balance of evidence suggests that the risk/reward proposition is not compelling for long term use of melatonin, though as I have said I may well try it next time I have a transatlantic flight to counter jetlag.
I don’t think that’s the right question. The right question is whether the evidence for benefits outweighs the evidence for harm. I used to take vitamin supplements because the risk/reward based on the available evidence seemed compelling. In light of more recent large scale studies that show no long term benefits and some evidence of long term harm I no longer take vitamin supplements.
I am not risk-averse in general, in fact I think I probably have a higher than average risk tolerance in general. I probably require a higher risk/reward payoff for any kind of long term use of supplements or drugs than the average North American however.