There is considerable controversy about the soundness and relevance of so-called "megavitamin" therapy for various illnesses. In this article it is suggested that this disagreement is caused to a large extent by the use of two very different approaches to nutrition, which are referred to here as the "nutritional need" and "optimal intake" approaches. It is clear that a re-evaluation of the goals of nutrition is required, as nutritional recommendations deal mainly with the prevention of deficiency diseases and are not concerned with optimal levels of intake.