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EricT · 11-29-2007, 01:31 PM

I thought that this letter, posted by the New England Journal of Medicine, was very appropriate here and a good example of some of the things discussed. Specifically, the inappropriate use of studies to cite the effectiveness of certain 'supplements'. In this case, so-called human growth hormone sups.

Quote:

Inappropriate Advertising of Dietary Supplements

Jeffrey M. Drazen, M.D.

Related Article
by Vance, M. L.

PubMed Citation

Information about health is worthwhile only if it is accurate and fairly communicated. Recently, a number of advertisements on the Internet have contained statements about dietary supplements that could lead one to believe, erroneously, that information published in the Journal supported the claims made by the manufacturers.

As the editor-in-chief of the Journal, I spend the bulk of my time working with our editors and outside reviewers to ensure the accuracy of results presented in the articles we publish. The task is complicated by the fact that the work we publish is often at the cutting edge of research, where medical science meets clinical practice, and therefore facts are often not immediately in clear focus. Our reputation has been built, however, on taking a scientifically conservative stance. We often choose not to publish a paper because we believe that doubt remains about the veracity of its findings. When we decide to publish, we work hard to make sure that the statements made by the authors are supported by the evidence, clearly communicated, and fairly presented. Balance and objectivity are our goals.

Sadly, caution and balance are not universal characteristics in advertising about health. New legislation has made it legal for companies to market dietary supplements without approval of the Food and Drug Administration, and on the Internet they can do so at very little cost. Anyone with a public e-mail account is likely to receive hundreds, if not thousands, of messages a year in which unproven claims are made about dietary supplements or other products and the medical wonders they can achieve. Most of these claims seem too good to be true, and nearly all are.

We find one case particularly unnerving. A number of advertisements for human growth hormone or for dietary supplements said to be "human growth hormone releasers" refer to statements made in our pages as evidence of the value of these products. The advertisers cite a study reported in the Journal in 1990 by Rudman et al.1 In this study, 12 men older than 60 years of age who had low plasma levels of insulin-like growth factor 1 (representing about one third of otherwise healthy men 60 to 80 years of age) were treated with injections of human growth hormone three times weekly for six months; these men had statistically significant increases in lean body mass and bone mineral, unlike a group of 9 similar men who received no treatment.

Although the findings of the study were biologically interesting, the duration of treatment was so short that side effects were unlikely to have emerged, and it was clear that the results were not sufficient to serve as a basis for treatment recommendations. Indeed, Mary Lee Vance of the University of Virginia said in an accompanying editorial,2 "Because there are so many unanswered questions about the use of growth hormone in the elderly and in adults with growth hormone deficiency, its general use now or in the immediate future is not justified." Dr. Vance restates her views on the study in this issue of the Journal (pages 779–780); they remain fundamentally unchanged.

In some of the cases of which we have recently become aware, the advertised product is not human growth hormone but, rather, a mixture of substances that is claimed only to stimulate the body to release human growth hormone. There are no data in the advertisements or accompanying the products themselves, so far as we have seen, that support this claim or prove that the substance has no harmful side effects. We have reported our concern to the offices of the attorneys general in two states and are awaiting the outcome of their investigations.

We are especially concerned because the promotional e-mails are apparently sending readers to our Web site; the 1990 article by Rudman et al. receives as many "hits" in a week as other 1990 articles do in a year. If people are induced to buy a "human growth hormone releaser" on the basis of research published in the Journal, they are being misled. In order to warn those who visit our Web site for this reason, this Perspective article and Dr. Vance's commentaries will from now on appear with the article by Rudman et al. each time it is downloaded. The point, as stressed by an earlier editor-in-chief of the Journal, Franz Ingelfinger, is that "advertising is advertising" and nothing more. Readers need to know that the editors of the Journal do not endorse any product for any commercial use. We strongly believe that when scientific information is communicated clearly and fairly, it speaks for itself.

References

Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med 1990;323:1-6. [Free Full Text]
Vance ML. Growth hormone for the elderly? N Engl J Med 1990;323:52-54. [Free Full Text]