Someone with what I can only describe as a messiah complex* is travelling the world parting the unwell from their money, and on some occasions from this world (a terribly sad tale which I read on @alicebell's blog).
*According to Wikipedia this term isn't in the DSM - perhaps they'll make an exception ;-)
Miracle Mineral Solution (MMS) is a form of industrial bleach which is being sold as a preparation that is drunk in order to restore or maintain health. After considerable effort by skeptics and scientists no-one has found any evidence that suggests that this is a good idea, and plenty that suggests that it isn't.
There is literally nothing that I can think of that could be said in favour of drinking (swallowing) bleach. It's vastly wrong to conclude that just because one can use bleach to wipe down and disinfect surfaces then drinking it will have a similar effect in the body.
MMS appeared on my radar after I saw a tweet from @rhysmorgan highlighting his suspicions about the product.
He's a young man who sought advice and support from a Crohn's forum and noted with concern that MMS was being touted as something that might help. His investigations and swathes of evidence showing it was dangerous bunk ultimately led to his suspension from the forum for pointing this out. It was pretty startling.
Within about half an hour of seeing his tweet and watching his video I'd half-jokingly named it #bleachgate and was delighted to see the topic trending on Twitter. More recently it got a mention in the Guardian thanks to @mjrobbins writing about it.
Alice's post has reminded me of @paulbradshaw's cunning suggestion that we all write blog posts and link to the Guardian piece with the word's Miracle Mineral Solution. I am only too happy to help. For good measure I'm linking to the words Miracle Mineral SolutionS and MMS too.
@noodlemaz has also written a series of posts on the topic: Link roundup: Bleachgate Bleachgate link roundup: 2nd and last #Bleachgate: the plot thickens
@penguingalaxy wrote a post unpicking the chemistry of bleach and chlorine
Friday, 17 September 2010
Monday, 13 September 2010
Trying out the new (to me) Google Blogger stats tab
Edit: The pictures didn't come out at all (bitmaps) so have added them manually and had to resize them up, sadly this has blurred them almost to the point of uselessness.
---
Trying the post-to-Blogger function that I’ve apparently set up on my blog…
I am quite enjoying this new Stats button that has recently appeared, or I only recently spotted, in the Blogger dashboard. After being amazed at how many more people than I would possibly imagine were interested in the ScicommJobs Posterous (in that I’d not expect more than a couple of hundred people to click on any one job advert but some of them have amassed almost 2,000 hits) I decided, in May this year, to add Google Analytics to my blog. It delights me to find that occasionally my blog gets read – it doesn’t surprise me at all that the most popular page is the Science Communication Jobs Vacancies pages.
Anyway here are a couple of snapshots from my Blogger stats (not the Google Analytics, which seem to give a separate set of information although I’m not sure how that works).
The first one shows the number of page views in a month but includes every single page view – ie if someone is on your site and returns to the page etc. It seems no-one looked at my blog very much in May though, or the system wasn’t working too well ;-)
The second one shows the times of day when people do or don’t visit the blog
If your blog has vastly more hits than mine I hope you won’t laugh too much, and if yours has less than mine I hope you don’t think I’m showing off – I just thought it was interesting. Since this blog is more of a personal and somewhat random diary of occasional sensible things mixed with blethers I’m delighted that anyone looks at all :-)
The y axis at the top goes up to 4,000 and the second one to 60.
Friday, 10 September 2010
Athens passwords available for some voluntary sector organisations
******************************************************************
Edit: 3 October 2012
See also this great question, and answers, from people on Quora
How do you get access to papers online if you don't belong to any academic institution?
******************************************************************
Top line: Charities / voluntary sector folk may be able to register for an NHS Athens password from NHS Scotland
I wonder if I should now be registering with all the other NHS Consortia to increase my access...
More detailed information
I have spent a very pleasant morning with my new Athens password which gives me some / limited access to some of the items below (see further down).
In June we came across "The Knowledge Network: Scotland's source of knowledge for health and care" and discovered that to access it more fully we needed an Athens password.
When I previously worked in academia I had an Athens password which opened up an entire universe of literature and databases to me and when I left, and the password stopped working, a little bit of me died with it.
For a number of years I believed that it was the Athens password which had brought me these fortunes, and I tried in vain to get another one - before someone explained that the Athens password is merely a way of accessing the subscriptions that you already have, it's not a magical 'open sesame' sort of thing.
Because I slotted into one of these categories I thought I might as well apply.
You can apply for an NHS Education ATHENS username and password if you
belong to any of the following groups :
• Staff of NHS Scotland (including contractors such as general practitioner staff, community pharmacy staff, dental surgery staff
• Undergraduate or postgraduate students working or training with NHS Scotland
• Social services, public library staff and other local authority staff working in partnership with the NHS
•Other partners including staff in higher and further education, Scottish Government staff, voluntary sector organisations, nursing homes, the armed services and patient/public representatives on NHS groups
Others may also be eligible. A full guide to who is eligible can be found here. If you are unsure which group you fit into, or feel you need access and don't belong to one of these groups, please get in touch with your local ATHENS administrator for advice.
Our charity works with the NHS and we are clearly in the voluntary sector, so I was pretty delighted to see that I might be able register for an Athens password that would give me access to some NHS resources - and so it does. It's not a very quick process to register (presumably they had to check my story out as I expect lots of people try to sign up to get an Athens password, and who can blame them).
I should add that in addition to working for a health charity I also work at UCL and so I do already have a magic open sesame password - but I wanted to see what I could get for charity purposes.
I can now access ScienceDirect which I couldn't really get at before (without using my UCL account) and it looks like I can access more databases on OVID than with our current subscription.
In short, while it's not giving me everything, it's also giving me, for free, quite a lot of what I already subscribe to (which may mean that I can save the charity some money by not renewing some subscriptions) and giving me access to a few extra diabetes journals among other things.
It's definitely worth investigating if you use academic literature and databases and work in a health charity or other voluntary sector. I'm thinking specifically of the medical research charities which are members of the AMRC (Association of Medical Research Charities).
Here's the full list, although I've not managed to get anywhere with Nature.com
Barbour Index Online Services
Best Practice
BMJ Journals Collection
BNF for Children
British National Formulary
Clinical Evidence
CSA Illumina
ebrary
EBSCOhost databases
EBSCOhost EJS
Emerald Management eJournals
GOODPRACTICE.NET
INFORMAWORLD
IngentaConnect
internurse.com
MD Consult
Medicines Complete
METAPRESS
Nature Publishing Group (www.nature.com)
NetLibrary
Ovid Online
Oxford Journals
Pier Professional
ProQuest
RefWorks
SAGE Journals Online
ScienceDirect
SilverPlatter Arc2
SNOMED BROWSER
SwetsWise
The Learning Exchange
Wiley Online Library
Wounds-UK Journals
ZETOC - BL Electronic Table of Contents
EDIT: Friday afternoon 5.30pm 10/09/2010
I've heard from Graham Steel who found in 2008 that he could access the service as someone who works in patient advocacy in a personal capacity. He also pointed me towards another blogger who commented on his being able to access literature.
The concept of an NHS Education Athens appears, from Google, to be Scotland based but searching for NHS Athens brought up this registration page for England. It seems to want you to be either at university or working in a GP surgery, so it might be a bit tougher to gain access - and of course I don't know if it's offering anything different from the NHS Scotland version. The registration page for the England one is here NHS England Athens Registration.
From Graham's blog post I also spotted that there's such a thing as the Directory of Open Access Journals.
I've also heard from @chibbie that the service has gone "out to tender for national ejournal collection".
Almost every time I write a blog post I learn something useful from commenters either here or on Twitter.
Edit: 3 October 2012
See also this great question, and answers, from people on Quora
How do you get access to papers online if you don't belong to any academic institution?
******************************************************************
Top line: Charities / voluntary sector folk may be able to register for an NHS Athens password from NHS Scotland
I wonder if I should now be registering with all the other NHS Consortia to increase my access...
More detailed information
I have spent a very pleasant morning with my new Athens password which gives me some / limited access to some of the items below (see further down).
In June we came across "The Knowledge Network: Scotland's source of knowledge for health and care" and discovered that to access it more fully we needed an Athens password.
When I previously worked in academia I had an Athens password which opened up an entire universe of literature and databases to me and when I left, and the password stopped working, a little bit of me died with it.
For a number of years I believed that it was the Athens password which had brought me these fortunes, and I tried in vain to get another one - before someone explained that the Athens password is merely a way of accessing the subscriptions that you already have, it's not a magical 'open sesame' sort of thing.
Because I slotted into one of these categories I thought I might as well apply.
You can apply for an NHS Education ATHENS username and password if you
belong to any of the following groups :
• Staff of NHS Scotland (including contractors such as general practitioner staff, community pharmacy staff, dental surgery staff
• Undergraduate or postgraduate students working or training with NHS Scotland
• Social services, public library staff and other local authority staff working in partnership with the NHS
•Other partners including staff in higher and further education, Scottish Government staff, voluntary sector organisations, nursing homes, the armed services and patient/public representatives on NHS groups
Others may also be eligible. A full guide to who is eligible can be found here. If you are unsure which group you fit into, or feel you need access and don't belong to one of these groups, please get in touch with your local ATHENS administrator for advice.
Our charity works with the NHS and we are clearly in the voluntary sector, so I was pretty delighted to see that I might be able register for an Athens password that would give me access to some NHS resources - and so it does. It's not a very quick process to register (presumably they had to check my story out as I expect lots of people try to sign up to get an Athens password, and who can blame them).
I should add that in addition to working for a health charity I also work at UCL and so I do already have a magic open sesame password - but I wanted to see what I could get for charity purposes.
I can now access ScienceDirect which I couldn't really get at before (without using my UCL account) and it looks like I can access more databases on OVID than with our current subscription.
In short, while it's not giving me everything, it's also giving me, for free, quite a lot of what I already subscribe to (which may mean that I can save the charity some money by not renewing some subscriptions) and giving me access to a few extra diabetes journals among other things.
It's definitely worth investigating if you use academic literature and databases and work in a health charity or other voluntary sector. I'm thinking specifically of the medical research charities which are members of the AMRC (Association of Medical Research Charities).
Here's the full list, although I've not managed to get anywhere with Nature.com
Barbour Index Online Services
Best Practice
BMJ Journals Collection
BNF for Children
British National Formulary
Clinical Evidence
CSA Illumina
ebrary
EBSCOhost databases
EBSCOhost EJS
Emerald Management eJournals
GOODPRACTICE.NET
INFORMAWORLD
IngentaConnect
internurse.com
MD Consult
Medicines Complete
METAPRESS
Nature Publishing Group (www.nature.com)
NetLibrary
Ovid Online
Oxford Journals
Pier Professional
ProQuest
RefWorks
SAGE Journals Online
ScienceDirect
SilverPlatter Arc2
SNOMED BROWSER
SwetsWise
The Learning Exchange
Wiley Online Library
Wounds-UK Journals
ZETOC - BL Electronic Table of Contents
EDIT: Friday afternoon 5.30pm 10/09/2010
I've heard from Graham Steel who found in 2008 that he could access the service as someone who works in patient advocacy in a personal capacity. He also pointed me towards another blogger who commented on his being able to access literature.
The concept of an NHS Education Athens appears, from Google, to be Scotland based but searching for NHS Athens brought up this registration page for England. It seems to want you to be either at university or working in a GP surgery, so it might be a bit tougher to gain access - and of course I don't know if it's offering anything different from the NHS Scotland version. The registration page for the England one is here NHS England Athens Registration.
From Graham's blog post I also spotted that there's such a thing as the Directory of Open Access Journals.
I've also heard from @chibbie that the service has gone "out to tender for national ejournal collection".
Almost every time I write a blog post I learn something useful from commenters either here or on Twitter.
Saturday, 4 September 2010
I think I need a bit more information for ISS passes
There's an ISS pass coming up at 21.45pm tonight but I seem to be missing either a bit of information, or the skills to understand the info below.
It's easy if the ISS is passing over close to 90 degrees as I just look West and look directly up and I'll see it. But the lower the degree value the further away it is from 'straight up' - but on which side? I know there are other sites on the web where you can get more information about length of transit and the arc it will sweep, but I don't think there's quite enough info below, especially if the ISS pass was at 23 degrees say. Or am I just being dense?
I've drawn a diagram of me happily spotting the ISS (artist's impression, not drawn to scale you understand) at 45 degrees but what if I'd been looking at the other side?
It's easy if the ISS is passing over close to 90 degrees as I just look West and look directly up and I'll see it. But the lower the degree value the further away it is from 'straight up' - but on which side? I know there are other sites on the web where you can get more information about length of transit and the arc it will sweep, but I don't think there's quite enough info below, especially if the ISS pass was at 23 degrees say. Or am I just being dense?
Is it a good one?But on which side of the West?
This time, the International Space Station will be flying over at 55 degrees. Its magnitude will be -3.2: extremely bright!
Where to look?
ISS will come up at the horizon from the west.
I've drawn a diagram of me happily spotting the ISS (artist's impression, not drawn to scale you understand) at 45 degrees but what if I'd been looking at the other side?
Friday, 3 September 2010
Not really enough evidence for NaturEra's "Sugar Crush" diabetes supplements
I will preface this by pointing out that I am not medically trained and that these views are mine alone.
----------------------------------------------------------------------------------
EDIT: 14 December 2010 - I received earlier today an email from the President of NaturEra with comments from one of the authors of the articles mentioned below, in response to my queries. I've posted their comments below my original post; their text is in blue.
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Response to One Natural Supplement with a Good Rep: Sugar Crush a post by DiabetesMine looking at a new nutritional supplement for people with diabetes which has been advertised (EDIT: this was not a paid-for advert and I mean the word in the colloquial sense, however NaturEra have asked me to make clear that their product and information were not advertised and I am happy to do so) presented at the American Diabetes Association and the American Association of Diabetes Educators.
I started writing this as a comment on the blog but realised it was getting rather long. It's here so I can link to it, prune or refine it, and also to prevent me losing it (also I don't know how to put links in blog comments). These are just some preliminary thoughts and may well change on further reading, or after discussions with others.
I have used the rel="nofollow" command in links to the company's websites, thanks to a helpful explanatory post from @rhysmorgan this means that my linking to these pages shouldn't enhance their market advantage ;)
------------------------------------------------------------------------
Very interesting, although my response is still to be somewhat skeptical.
Who, at the ADA or AADE, determines what research is shared at the conference and what are their criteria for inclusion? I'd always treat research from a conference with interest, but not much more because I'm always a little wary because it perhaps hasn't been through the same degree of peer review* that would happen before (and after) publication. In other words, no offence to either the organisation or the conference, but 'publication' at a conference isn't really sufficient to calm me in my skepticism ;)
*Not that peer review is perfect but that's for another discussion
Why does the company have two websites? There's one under the name of the company and another 'buysugarcrush' one which is linked from the product name website. Also, it's a bit strange that the right click function which normally would let you open something in a new tab or window is disabled, but that's more of a web design criticism than anything against the product of course!
I picked one link at random from the 'NaturEra makes news' but it says "Source: NaturEra" and it seems to be a repost of a press release from the organisation.
Another article - and I may be doing them a disservice by picking these at random - was "American Association of Diabetes Educators (AADE) accepted NaturEra Sugar Crush and Sugar Crush Daily first clinical results" which says that:
In passing I note that they also have a product called PlayOn for 'sexual dysfunction in diabetics' - this is ringing alarm bells I have to confess.
The research itself, as indicated in the ADA abstract, note: this is not 'published' and does not appear in PubMed yet) seems a reasonable enough test - although fairly small (51 patients). There isn't really enough information (in two senses, one this is a brief abstract so info is necessarily not included and two, this is one pilot study and I'd expect that more would be needed before a product could be convincingly sold, based on results of tests - I don't think it's quite right to rely on the results of just one or two small tests).
The abstract implies that no other medications were permitted during the trial "No other glucose-lowering medication was allowed except study medication during the course of the study", this would eliminate confounding by people using other medicines to lower their glucose levels, and hopefully people wouldn't suffer if foregoing their medication.
But the full unpublished manuscript says "Fifty‐one (23 males and 28 females) subjects under a diet‐treatment only, diagnosed with T2DM and between the ages of 18 and 70 years who were not pregnant or nursing a child formed the study sample" and "Fifteen patients (29.4%) were being treated by diet therapy alone, six patients by a α‐glucosidase inhibitor, six patients by a sulfonylurea, three patients by nateglinide, and twenty‐one patients (41%) by a biguanaide" which I have to say confuses me a bit.
This might be a consequence of me reading the article by using Ctrl+F to find keywords and not actually reading the full manuscript, so I might be making a silly mistake or being unfair to the product - will need to read stuff properly later.
What else can affect blood glucose levels though, in addition to medications - did the people change their diet or increase their activity levels as well, or did they keep these constant too? There is no mention in the full length manuscript of exercise or activity relating to physical activity (the term appears only in relation to biological activity).
Blood glucose levels can vary quite a bit over a period of weeks - what is the natural variation (within one person) of their fasting blood glucose level? I wonder if HbA1c would be a better test as well.
It's not that there's anything wrong with the research, just that there's not enough of it to warrant using it to underpin an advertising or marketing campaign.
From a search on PubMed the authors don't appear to have published much in diabetes research - I found one article by a JD Schlosser (might or might not be the same as J Schlosser) from 1998, nothing from VK Podichetty on diabetes although an author of the same name has published in other medical areas and nothing from M Weshler.
But to be fair I've not published a bean on diabetes, or anything else, either ;)
I'm not sure if this is sort of trial that would be registered on either the ClinicalTrials.gov or controlled-trials.com websites but in any case it isn't.
How does the research fit in with other published work on the ingredients in the herbal supplement? The ingredients include sage, milk thistle, cinnamon, fenugreek etc., - all of which have had much claimed for them but I don't think the evidence has been particularly impressive?
I shall have to have a look at the 'Russian research manuscript' linked from the company's website too and see if that answers my queries.
--------------------------------------------------------
EDIT - comment below included within post because adding it just as a comment makes it harder for me to nest my own comments.
These comments refer to the truncated version (which I posted over at Diabetes Mine) of the blogpost above.
Please pass these comments on to the author of the website. I think its wonderful that these blogs exist to help people get the information they need. This should shed some more light on the credibility of our research.
To better understand what recognition the research has received thus far its a good idea to review the criteria for conference acceptance on the conference abstract submission pages of both the ADA and AADE. The Sugar Crush research was accepted for publication by the ADA for the ADA's 70th Annual Scientific Sessions abstract book. The Diabetes Abstract Book is read by ADA Professional Section Members, subscribers to Diabetes, and attendees of the Scientific Sessions, including physicians, medical researchers, epidemiologists, endocrinologists, psychologists, nurses, diabetes educators, and dietitians. I agree it is not an “endorsement," and certainly is not the same as a publication in a peer review journal. Regardless, it is still quite a feat to get a clinical study accepted for publication by the ADA to their annual scientific sessions, especially a clinical study of a natural product. Each year thousands of studies are submitted to the ADA and a small fraction (estimated at less than 10%) are accepted for publication based on the scientific method used and quality of the results. There is a team of more than 15 scientists that review the research studies and select the most appropriate studies for the annual meeting. You can read about the process on the ADA website.
Fair enough. I don't think it's unreasonable for a conference to accept pilot results but I'm less confident about otherwise 'under'published research being used to support the sale of a product.
In the case of the AADE, the research was again accepted for publication to their annual society meeting. Again, a small percentage of clinical studies submitted are accepted for publication. The clinical study was also accepted for Poster Presentation by the AADE, an additional recognition. If you go on the AADE website and read through their conference newsletter you can see that the AADE chose the Sugar Crush clinical study as one of only 3 to be highlighted. In my opinion, the AADE is equally important to the ADA because diabetes educators count on the AADE to learn about the latest advances in diabetes.
Please note that we did not pay for any of these publications or presentations. They are not something companies can just buy. The publications/presentations are earned on merit. One thing that bothers me is that the author of the blog says that our research was "advertised" at these meetings. We didn't do any advertising. Perhaps she will consider changing that sentence. The research abstract was selected for publication by a team of scientists. Its not something you can buy. Sugar Crush research wasn't just 'displayed' at the society meetings either.
I have made these changes as suggested.
In a world where there are so many bogus products on the market attempting to take advantage of people with diabetes, NaturEra is attempting to prove their products actually benefit people by backing the products with clinical studies. Once our full medical manuscript is published in a peer review journal this will give even more credibility to this study. We will also get the second study, the Russian Ministry of Health clinical study, published once that is completed. Of course clinical studies have significant expense and I am delighted to know that NaturEra plans on completing more studies in the future in addition to the study that was published to society meetings of the ADA and AADE and the Russian Ministry of Health study. Perhaps the author of that blog would be interested in giving us feedback on the protocol for the next study.
This suggests to me that the results are still not published in a peer-reviewed journal. Nothing wrong with that but for the fact that the internet seems to have many pages in which the product is being sold, and sold on the fact that there is evidence for it. If the studies haven't been properly published (they are in press) then this would seem to be putting the cart before the horse somewhat.
I probably don't have the necessary training to comment sufficiently usefully on the protocol for the study but I'll give it a go.
Here are more specific answers to some of the questions you read to me by phone:
1. Criteria for conference acceptance, and how much weight to give conference publication (as opposed to other forms of publication)?
My comments – The author should check “Criteria for conference acceptance” on conference abstract submission page. She is right that conference publication has less weight over a full text journal publication. But you cannot totally discount an abstract. Each society has a team of scientists that review research abstracts and select the most relevant re their own criteria. In the case of the ADA, fewer than 15% of the abstracts are accepted for publication.
This just tells me that the abstract is likely to be a good abstract, it doesn't tell me that the evidence for the product is settled or robust enough to be used to advertise it though.
2. Drawing big conclusions from a small pilot study (anecdotal data is interesting but if we don't know what else that person is doing to manage their blood glucose levels in addition to taking the product then the information is fairly meaningless)?
My comments – The author is correct that subjective bias in clinical studies is unavoidable but type II errors are implied in a statistical equation and you cannot ignore statistically significant results and call them meaningless. If such pilot studies are excluded from mainstream research, there would only be 25% of the studies that will truly enter scientific acceptance. This will lead to no progress in medicine.
I think the commenter has misunderstood me slightly but to be fair my comment as written here isn't very clear - I expanded on this point in the paragraphs beginning "What else can affect blood glucose levels though..."
Pilot studies shouldn't be excluded, but I think more research is needed before this can be used as evidence to support the sale of a product.
3. Slight confusion about the methodology and whether or not other medications were permitted by the 51 trial participants (again, this may be a mistake that I made in my quick skim-reading)?
My comments – Please read the entire study when it’s published. An abstract cannot tell the full study and is concise form as the name suggest. A draft of the full study is available for download at NaturEra.com. The full study will be published in a peer review journal. It is being submitted currently.
Well, to be honest I do find this confusing. Surely if the product is already on sale and reliance is being made on the fact that the research has been accepted (for conference abstracts publication) by prestigious medical conferences then it would seem reasonable for this to be a bit clearer.
This page contains lists of the available research articles. The abstract and manuscript both say that
4. Fasting blood glucose is probably a good marker, but HbA1c might have been additionally appropriate as it's often used elsewhere (eg for comparisons to be made with other studies)?
My comments – Completely agreed. This was the first ever study undertaken by the company and our future studies will include and evaluate HbA1c testing.
Incidentally, the trial also included a survey of patient satisfaction.
5. No mention that I could see of the role of physical activity, and what exercise the trial participants were doing - again, might have missed it.
My comments?– There was no role of exercise that was studies as part of the methodology.
That's fine - my query, admittedly not clearly stated here, was more along the lines of - can activity achieve the same effects on blood glucose levels as Sugar Crush.
6. None of the authors appear to have published on diabetes before - although this isn't particularly critical (I haven't either!)?
My comments –The authors have published on a variety of subjects and established researchers in clinical arena although not experts in the field. I'm not sure this is relevant. Isaac Newton never studied gravity before discovering gravity which changed the world forever. :)
Yes, a fair point here too.
7. How does this research fit into other published research on these plants and their hypoglycaemic effects? I don't think the evidence has been particularly impressive. Cinnamon showed promise in a couple of small trials but when looked at as part of the bigger picture the effect is very small.
My comments – Balanced modulation of several targets in the treatment of diabetes can provide superior therapeutic outcome with decreased side effects compared to the action of a single selective ligand. In order to hit the multiple targets implicated in complex clinical disorders such as diabetes, two strategies have been proposed. The first attempts to employ a single compound to hit multiple targets. The second methodology is the use of multiple active ingredients in one preparation. Although this premise has become a common feature in the drug development process, its principle applicability in developing nutritional supplements is still primitive. A unique novel combination of Trigonela foenum-graecum (Fenugreek), Foeniculum vulgare (Fennel), Salvia Officinalis (Sage), Olea europea (Olive), Cinnamon and Silybum marianum and other ingredients with high insulinotrophic properties holds great promise in this direction influencing multiple biological activities with significant physiological effects. We attempted to do just that.
Well... let's hope so. It's difficult to tell until the evidence is properly published and people much cleverer and pickier than me have had a look at it.
Having reviewed (fairly extensively but one can always do better) the evidence for cinnamon as a treatment for diabetes, it's not been wildly impressive. I can see the logic in trying more than one medicinal plant (while being cautious of interactions with other medications and foodstuffs) but I still have the sense that I'm missing something here and that it's a little bit too early to be selling this product based on the currently available evidence.
Edit: 26 June 2012
I had another look at the original post and was interested to see the 'pingbacks' at the end of the comments. Many of them point to different websites and blog posts but almost all have a very similar version, some translated into other languages, of the phrase "...Diabetes Mine (well respected blog about diabetes)". To me this suggests that the blog provided a useful platform, where the product was written about nicely, and enabling other sites to refer to the blog as evidence that the product is viewed favourably. This is an extremely popular strategy, also incidentally used by affilliate marketers of products (although I don't think that's what's going on here).
----------------------------------------------------------------------------------
EDIT: 14 December 2010 - I received earlier today an email from the President of NaturEra with comments from one of the authors of the articles mentioned below, in response to my queries. I've posted their comments below my original post; their text is in blue.
----------------------------------------------------------------------------------
Response to One Natural Supplement with a Good Rep: Sugar Crush a post by DiabetesMine looking at a new nutritional supplement for people with diabetes which has been advertised (EDIT: this was not a paid-for advert and I mean the word in the colloquial sense, however NaturEra have asked me to make clear that their product and information were not advertised and I am happy to do so) presented at the American Diabetes Association and the American Association of Diabetes Educators.
I started writing this as a comment on the blog but realised it was getting rather long. It's here so I can link to it, prune or refine it, and also to prevent me losing it (also I don't know how to put links in blog comments). These are just some preliminary thoughts and may well change on further reading, or after discussions with others.
I have used the rel="nofollow" command in links to the company's websites, thanks to a helpful explanatory post from @rhysmorgan this means that my linking to these pages shouldn't enhance their market advantage ;)
------------------------------------------------------------------------
Very interesting, although my response is still to be somewhat skeptical.
Who, at the ADA or AADE, determines what research is shared at the conference and what are their criteria for inclusion? I'd always treat research from a conference with interest, but not much more because I'm always a little wary because it perhaps hasn't been through the same degree of peer review* that would happen before (and after) publication. In other words, no offence to either the organisation or the conference, but 'publication' at a conference isn't really sufficient to calm me in my skepticism ;)
*Not that peer review is perfect but that's for another discussion
Why does the company have two websites? There's one under the name of the company and another 'buysugarcrush' one which is linked from the product name website. Also, it's a bit strange that the right click function which normally would let you open something in a new tab or window is disabled, but that's more of a web design criticism than anything against the product of course!
I picked one link at random from the 'NaturEra makes news' but it says "Source: NaturEra" and it seems to be a repost of a press release from the organisation.
Another article - and I may be doing them a disservice by picking these at random - was "American Association of Diabetes Educators (AADE) accepted NaturEra Sugar Crush and Sugar Crush Daily first clinical results" which says that:
"NaturEra today announced that the American Association of Diabetes Educators (AADE) www.diabeteseducator.org has accepted the Sugar Crush line Dietary Supplement Research abstract for poster presentation at the 37th Annual Meeting in San Antonio, Texas August 4th, 2010.The "this is further proof" puzzles me as the way it's written implies that the AADE's acceptance (which presumably is not an endorsement any more than a postcard in a newsagents' window endorses a 'man with a van' removal service) lends weight to the evidence. Perhaps they're not really implying this at all and it's just strangely worded.
AADE is the premier forum for state-of-the-art education and unmatched value of the biggest event for diabetes education and diabetes related health products. The abstract will be permanently hosted on the AADE archives after the annual meeting and will serve as a great educational and marketing tool for distribution of the Sugar Crush product line.
“This is further proof that the Sugar Crush product line works as a therapy helping diabetics to maintain healthier glucose levels”, said NaturEra’s CEO Oren Cohen. “The purpose of the study was (a) to investigate our novel biologically active food supplement (Sugar Crush) in decreasing blood glucose level in type 2 diabetes mellitus and (b) to determine the impact of improved nutritional status in patients.”"
In passing I note that they also have a product called PlayOn for 'sexual dysfunction in diabetics' - this is ringing alarm bells I have to confess.
The research itself, as indicated in the ADA abstract, note: this is not 'published' and does not appear in PubMed yet) seems a reasonable enough test - although fairly small (51 patients). There isn't really enough information (in two senses, one this is a brief abstract so info is necessarily not included and two, this is one pilot study and I'd expect that more would be needed before a product could be convincingly sold, based on results of tests - I don't think it's quite right to rely on the results of just one or two small tests).
The abstract implies that no other medications were permitted during the trial "No other glucose-lowering medication was allowed except study medication during the course of the study", this would eliminate confounding by people using other medicines to lower their glucose levels, and hopefully people wouldn't suffer if foregoing their medication.
But the full unpublished manuscript says "Fifty‐one (23 males and 28 females) subjects under a diet‐treatment only, diagnosed with T2DM and between the ages of 18 and 70 years who were not pregnant or nursing a child formed the study sample" and "Fifteen patients (29.4%) were being treated by diet therapy alone, six patients by a α‐glucosidase inhibitor, six patients by a sulfonylurea, three patients by nateglinide, and twenty‐one patients (41%) by a biguanaide" which I have to say confuses me a bit.
This might be a consequence of me reading the article by using Ctrl+F to find keywords and not actually reading the full manuscript, so I might be making a silly mistake or being unfair to the product - will need to read stuff properly later.
What else can affect blood glucose levels though, in addition to medications - did the people change their diet or increase their activity levels as well, or did they keep these constant too? There is no mention in the full length manuscript of exercise or activity relating to physical activity (the term appears only in relation to biological activity).
Blood glucose levels can vary quite a bit over a period of weeks - what is the natural variation (within one person) of their fasting blood glucose level? I wonder if HbA1c would be a better test as well.
It's not that there's anything wrong with the research, just that there's not enough of it to warrant using it to underpin an advertising or marketing campaign.
From a search on PubMed the authors don't appear to have published much in diabetes research - I found one article by a JD Schlosser (might or might not be the same as J Schlosser) from 1998, nothing from VK Podichetty on diabetes although an author of the same name has published in other medical areas and nothing from M Weshler.
But to be fair I've not published a bean on diabetes, or anything else, either ;)
I'm not sure if this is sort of trial that would be registered on either the ClinicalTrials.gov or controlled-trials.com websites but in any case it isn't.
How does the research fit in with other published work on the ingredients in the herbal supplement? The ingredients include sage, milk thistle, cinnamon, fenugreek etc., - all of which have had much claimed for them but I don't think the evidence has been particularly impressive?
I shall have to have a look at the 'Russian research manuscript' linked from the company's website too and see if that answers my queries.
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EDIT - comment below included within post because adding it just as a comment makes it harder for me to nest my own comments.
These comments refer to the truncated version (which I posted over at Diabetes Mine) of the blogpost above.
Please pass these comments on to the author of the website. I think its wonderful that these blogs exist to help people get the information they need. This should shed some more light on the credibility of our research.
To better understand what recognition the research has received thus far its a good idea to review the criteria for conference acceptance on the conference abstract submission pages of both the ADA and AADE. The Sugar Crush research was accepted for publication by the ADA for the ADA's 70th Annual Scientific Sessions abstract book. The Diabetes Abstract Book is read by ADA Professional Section Members, subscribers to Diabetes, and attendees of the Scientific Sessions, including physicians, medical researchers, epidemiologists, endocrinologists, psychologists, nurses, diabetes educators, and dietitians. I agree it is not an “endorsement," and certainly is not the same as a publication in a peer review journal. Regardless, it is still quite a feat to get a clinical study accepted for publication by the ADA to their annual scientific sessions, especially a clinical study of a natural product. Each year thousands of studies are submitted to the ADA and a small fraction (estimated at less than 10%) are accepted for publication based on the scientific method used and quality of the results. There is a team of more than 15 scientists that review the research studies and select the most appropriate studies for the annual meeting. You can read about the process on the ADA website.
Fair enough. I don't think it's unreasonable for a conference to accept pilot results but I'm less confident about otherwise 'under'published research being used to support the sale of a product.
In the case of the AADE, the research was again accepted for publication to their annual society meeting. Again, a small percentage of clinical studies submitted are accepted for publication. The clinical study was also accepted for Poster Presentation by the AADE, an additional recognition. If you go on the AADE website and read through their conference newsletter you can see that the AADE chose the Sugar Crush clinical study as one of only 3 to be highlighted. In my opinion, the AADE is equally important to the ADA because diabetes educators count on the AADE to learn about the latest advances in diabetes.
Please note that we did not pay for any of these publications or presentations. They are not something companies can just buy. The publications/presentations are earned on merit. One thing that bothers me is that the author of the blog says that our research was "advertised" at these meetings. We didn't do any advertising. Perhaps she will consider changing that sentence. The research abstract was selected for publication by a team of scientists. Its not something you can buy. Sugar Crush research wasn't just 'displayed' at the society meetings either.
I have made these changes as suggested.
In a world where there are so many bogus products on the market attempting to take advantage of people with diabetes, NaturEra is attempting to prove their products actually benefit people by backing the products with clinical studies. Once our full medical manuscript is published in a peer review journal this will give even more credibility to this study. We will also get the second study, the Russian Ministry of Health clinical study, published once that is completed. Of course clinical studies have significant expense and I am delighted to know that NaturEra plans on completing more studies in the future in addition to the study that was published to society meetings of the ADA and AADE and the Russian Ministry of Health study. Perhaps the author of that blog would be interested in giving us feedback on the protocol for the next study.
This suggests to me that the results are still not published in a peer-reviewed journal. Nothing wrong with that but for the fact that the internet seems to have many pages in which the product is being sold, and sold on the fact that there is evidence for it. If the studies haven't been properly published (they are in press) then this would seem to be putting the cart before the horse somewhat.
I probably don't have the necessary training to comment sufficiently usefully on the protocol for the study but I'll give it a go.
Here are more specific answers to some of the questions you read to me by phone:
1. Criteria for conference acceptance, and how much weight to give conference publication (as opposed to other forms of publication)?
My comments – The author should check “Criteria for conference acceptance” on conference abstract submission page. She is right that conference publication has less weight over a full text journal publication. But you cannot totally discount an abstract. Each society has a team of scientists that review research abstracts and select the most relevant re their own criteria. In the case of the ADA, fewer than 15% of the abstracts are accepted for publication.
This just tells me that the abstract is likely to be a good abstract, it doesn't tell me that the evidence for the product is settled or robust enough to be used to advertise it though.
2. Drawing big conclusions from a small pilot study (anecdotal data is interesting but if we don't know what else that person is doing to manage their blood glucose levels in addition to taking the product then the information is fairly meaningless)?
My comments – The author is correct that subjective bias in clinical studies is unavoidable but type II errors are implied in a statistical equation and you cannot ignore statistically significant results and call them meaningless. If such pilot studies are excluded from mainstream research, there would only be 25% of the studies that will truly enter scientific acceptance. This will lead to no progress in medicine.
I think the commenter has misunderstood me slightly but to be fair my comment as written here isn't very clear - I expanded on this point in the paragraphs beginning "What else can affect blood glucose levels though..."
Pilot studies shouldn't be excluded, but I think more research is needed before this can be used as evidence to support the sale of a product.
3. Slight confusion about the methodology and whether or not other medications were permitted by the 51 trial participants (again, this may be a mistake that I made in my quick skim-reading)?
My comments – Please read the entire study when it’s published. An abstract cannot tell the full study and is concise form as the name suggest. A draft of the full study is available for download at NaturEra.com. The full study will be published in a peer review journal. It is being submitted currently.
Well, to be honest I do find this confusing. Surely if the product is already on sale and reliance is being made on the fact that the research has been accepted (for conference abstracts publication) by prestigious medical conferences then it would seem reasonable for this to be a bit clearer.
This page contains lists of the available research articles. The abstract and manuscript both say that
'No other glucose-lowering medication was allowed except study medication during the course of the study'in which 51 people participated, but on page 8 of the manuscript it also says
'Fifteen patients (29.4%) were being treated by diet therapy alone, six patients by a α-‐glucosidase inhibitor, six patients by a sulfonylurea, three patients by nateglinide, and twenty-‐one patients (41%) by a biguanaide'.Presumably this must mean that the trial participants had been using these treatments before taking part in the trial and that they gave up their medication during the trial - I just think this sentence could be made clearer.
(emphasis added = 51)
4. Fasting blood glucose is probably a good marker, but HbA1c might have been additionally appropriate as it's often used elsewhere (eg for comparisons to be made with other studies)?
My comments – Completely agreed. This was the first ever study undertaken by the company and our future studies will include and evaluate HbA1c testing.
Incidentally, the trial also included a survey of patient satisfaction.
5. No mention that I could see of the role of physical activity, and what exercise the trial participants were doing - again, might have missed it.
My comments?– There was no role of exercise that was studies as part of the methodology.
That's fine - my query, admittedly not clearly stated here, was more along the lines of - can activity achieve the same effects on blood glucose levels as Sugar Crush.
6. None of the authors appear to have published on diabetes before - although this isn't particularly critical (I haven't either!)?
My comments –The authors have published on a variety of subjects and established researchers in clinical arena although not experts in the field. I'm not sure this is relevant. Isaac Newton never studied gravity before discovering gravity which changed the world forever. :)
Yes, a fair point here too.
7. How does this research fit into other published research on these plants and their hypoglycaemic effects? I don't think the evidence has been particularly impressive. Cinnamon showed promise in a couple of small trials but when looked at as part of the bigger picture the effect is very small.
My comments – Balanced modulation of several targets in the treatment of diabetes can provide superior therapeutic outcome with decreased side effects compared to the action of a single selective ligand. In order to hit the multiple targets implicated in complex clinical disorders such as diabetes, two strategies have been proposed. The first attempts to employ a single compound to hit multiple targets. The second methodology is the use of multiple active ingredients in one preparation. Although this premise has become a common feature in the drug development process, its principle applicability in developing nutritional supplements is still primitive. A unique novel combination of Trigonela foenum-graecum (Fenugreek), Foeniculum vulgare (Fennel), Salvia Officinalis (Sage), Olea europea (Olive), Cinnamon and Silybum marianum and other ingredients with high insulinotrophic properties holds great promise in this direction influencing multiple biological activities with significant physiological effects. We attempted to do just that.
Well... let's hope so. It's difficult to tell until the evidence is properly published and people much cleverer and pickier than me have had a look at it.
Having reviewed (fairly extensively but one can always do better) the evidence for cinnamon as a treatment for diabetes, it's not been wildly impressive. I can see the logic in trying more than one medicinal plant (while being cautious of interactions with other medications and foodstuffs) but I still have the sense that I'm missing something here and that it's a little bit too early to be selling this product based on the currently available evidence.
Edit: 26 June 2012
I had another look at the original post and was interested to see the 'pingbacks' at the end of the comments. Many of them point to different websites and blog posts but almost all have a very similar version, some translated into other languages, of the phrase "...Diabetes Mine (well respected blog about diabetes)". To me this suggests that the blog provided a useful platform, where the product was written about nicely, and enabling other sites to refer to the blog as evidence that the product is viewed favourably. This is an extremely popular strategy, also incidentally used by affilliate marketers of products (although I don't think that's what's going on here).