Mannatech is a scam - here is a summary of the "evidence" their science website provides

Mannatech is a pyramid scheme.  Ahem. Sorry - multi-level marketing scheme.

For more information and excellent research on Mannatech and their tactics - here you go:

http://mannatechscams.com/

A while back, an old friend from high school phoned me and asked whether I would like to make some money.

Tip: If any conversation starts like this, you are either going to end up broke and/or in jail.

He was selling Mannatech.  But I was not sure he knew what he was selling. So I offered to read up, in detail, about the product (which I knew to be a scam) - and get back to him.

We never did get to discuss the issue, but I did spend quite a few hours reading Mannatech's literature and writing a report on their "proof".

http://mannatechscience.org/home/publications

So now I have this piece, and no-one to share it with.  Except for the internet.

Maybe he reads my blog.

Maybe no-one in their right mind reads this.

So, well done for making it this far, you.

*playful shoulder punch*

Titled as "Love Punch 3". Wow. Such flirtation.

So here is a short (and perhaps not so sweet) shot at a company that can afford to pay 7 million dollars in fines and still be, well...fine.



First: Levels of evidence:

This diagram represents with how much confidence we can make claims about certain topics.  Not everything in medicine will ever be meta-analysis supported and this is partly due to ethics and practicality.  Anything that wants to make it into medicine has to, first of all, be based on a high level of evidence.

The evidence pyramid  is one of the great scientific wonders of the world.

The role of expert opinion, anecdotes and testimonials:

Firstly – when measured against the above – Mannatech's marketing, based on many testimonials is inappropriate, no matter how tempting it is.

Secondly, anecdotes are easily selected through cherry-picking and are subject to a confirmation bias.

Dr Darryl See, is/was Mannatech's science man.

He has had to surrender his medical license after a deluge of many, many accusations.

So...yeah.

Lastly, even if the internet is flooded with people making claims about Mannatech (or penis enlargement or weight-loss products) we must look beyond testimonials and look for evidence.

Sample sizes, p-values and confidence intervals

So say a study is a randomized controlled trial which has been double blinded.  Great.  But what is the P-value (measure of how likely this outcome was the result of chance), confidence interval (of the P-value), and overall quality of the research? 

Many studies, through their design, introduce biases which make positive results inevitable.  This is why it is very important that investigators share this information in great detail.

Large sample sizes which are representative of the population you want to apply the evidence to must be present in order to ensure that the findings are meaningful.

Patents are not evidence

A patent on any substance does not prove efficacy.  There are hundreds of thousands of patents on things which don’t work.

Trademarks and Registration are not evidence

The fact that Smarties™ is a trademarked, does not allow Nestle™ to make the claim that eating Smarties™ will make you smarter.

Citing inappropriate research

Research must directly support the claim that is being made, preferably in as similar a setting as possible.  If a claim is made about something for a certain condition – I must have the best available evidence at hand, done in as similar a population as possible for the same indication.

For example – if I want to prescribe a drug to reduce post-operative nausea and vomiting in children after anaesthesia for tonsillectomies, I need evidence gathered in as similar a setting as possible.

So if I want to claim that a drug works for people with MS, SLE, ischaemic heart disease, etc, I need to have evidence (high up on the diagram above), with a large sample size (determined statistically), and done in a population similar to the one I want to apply my results to.

With that in mind, let’s discuss the articles cited as proof for Mannatech.  The same articles were listed multiple times.  All of them were inappropriate.  

Virtually all of them are either completely unrelated for the claims being made, suffer from major methodological flaws, such as small sample sizes or lack of controls, or do not support the notion that supplementation offers a significant benefit:

BounceBack™ capsules for reduction of DOMS after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

·    The fact that it is randomized, double-blind and placebo controlled sounds impressive, but it is unimportant.

·    Study only contained 10 participants.  The confidence intervals (which were not given) would most likely make the P-values meaningless

Brain-Specific Effects of Ambrotose® Products: A Preliminary Animal Study to Investigate Cognitive Benefits Found in Humans

·    Looks like a Meta-analysis, but is a collection of studies on healthy people, (each with its own major limitations (small sample sizes, lack of third-party involvement) and, most importantly, the use of healthy subjects precludes any possibility of generalizing to a diseased population.

·    The study itself is done on mice.  No health claims can be made from this.

Human Colonic Bacteria Can Utilize Stabilized Aloe Vera Gel Polysaccharides and a Mixed Saccharide-Based Glyconutritional Dietary Supplement, Advanced Ambrotose

·    This study doesn’t show anything.

·    It shows that a bacteria can metabolize a polysaccharide.  Anyone could show the same with a petri dish, their own stool, and some agar gel.

Effect of a combination dietary supplement product (BounceBack^TM) on the signs and symptoms of delayed onset

muscle soreness after eccentric exercise: a randomized, double-blind, placebo-controlled, crossover pilot study

·    This study is the same one as the first one.

·    Only ten people participated.

·    The results (which would only be applicable to post exercise muscle soreness) are meaningless.

Effects of a Glyconutritional Supplement on Brain Potentials Associated with Language Processing

·    This study’s results are reported as “not statistically significant”. 

·    If you were to make generalizations from its findings, (which you shouldn’t), it would only be useful in refuting claims that Ambrotose works at all.

·    The most concerning is that this poster is happily cited as proof in the second article.

Immunomodulatory dietary polysaccharides: a systematic review of the literature

·     Nothing to do with Mannatech

·    Literally every English study ever  conducted on polysaccharides and the immune system.

·    Applicability:

o    “Taken as a whole, the oral polysaccharide literature is highly heterogenous and is not sufficient to support broad produce structure/function generalizations.”

Chemical characterization of polysaccharide-rich ingredients from Aloe vera, Larix laricina, Larix occidentalis, and Undaria pinnatifid

·    Nothing to do with Mannatech

·          Just a description of polysaccharides in terms of molecular weights and sugar contents.

Immunomodulatory activity of polysaccharides isolated from Clerodendrum splendens: Beneficial effects in experimental autoimmune encephalomyelitis

·    This study was conducted on a special type of mutant mice.

·     No generalizations can be made unless you are treating these mutant mice.

Intestinal microbiota’s naturally occurring enzymes and their  effects on plant polysaccharide digestion

·     This poster only showed that certain bacteria can digest polysaccharides.

A sensitive in vitro method for evaluation of immunostimulatory properties of natural products

·     This poster does not provide any proof for Mannatech at all and merely describes chemical analysis method and the effects of these chemicals when added to petri dishes of cells.

The Effect of Dietary Supplements on the Quality of Life of Retired Professional Football Players

·          Sample size was fifteen

·          Many, many different substances were used.

·          Self-reporting was the measurement.

·          No evidence for Mannatech’s efficacy.

An open-label dosing study to evaluate the safety and effects of a dietary plant-derived polysaccharide supplement on the N-glycosylation status of serum glycoproteins in healthy subjects

·          Sample size was 18

·          No confidence intervals given.

·          Limited information on samples.

·          Not clear how this relates to Mannatech products.

Effect of Ambrotose AO^® on resting and exercise-induced antioxidant capacity and oxidative stress in healthy adults

·     Sample size is 25.

·     “No statistically detected difference is observed in resting or exercise-induced oxidative stress biomarkers, in quality of life, or in GXT time to exhaustion.”

·     Study shows no statistically significant change.

Best, T. Bryan J, Burns N. An investigation of saccharide effects on memory performance. Abstracts of the 12th Annual Australian Psychiatry Conference, 2005.

·     “There were no statistically significant effects of the treatments on  the performance on any of the outcome measures”

The influence of a pre-exercise sports drink (PRX) on factors related to maximal aerobic performance

·     Sample size is 29

·     No confidence intervals given

·     Not generalizable

The Effectiveness of a Pre-Exercise Performance  Drink (PRX) on Indices of Maximal  Cardiorespiratory Fitness

·    Sample of 24

      Water might not be an appropriate placebo in this case.

·          The finding of increased cardiorespiratory fitness measurements after ingesting an energy drink is bizarre.

The effects of whey protein on cardiometabolic risk factors

·    This is an actual study on whey protein.  Which appears to be scientific.

·    It has nothing to do with Mannatech and was conducted by an independent research group.

Conclusion

Mannatech’s own website offers no evidence for their own products or any claims regarding their products’ efficacy.  

They just think that you are too stupid to read that which they have given you.

Essentials for Battling Bad Science

So, in scouring the web, one must sometimes take a break from fighting bad science (in your own, humble, insignificant way) and reflect upon your motives.

I have been doing a LOT of reflecting lately. A course in philosophy (along with a bit more free time than usual) can do that to a man.

Here are two videos (one to inspire and one to delight - both can do either, and both can do both, but neither can do neither):

The first is by the greatest philosopher of science, Karl Popper:
It is as relevant today as when it was written.


The second is by the British comedian, musician and science-defender, Tim Minchin:
His exchange might sound familiar if you have been living on principal, as many cannot help but do.



There.  Now you are all fired up.
Go fight argue with a homeopath.

Circumcision craziness

This is really the saddest article I have read in a long time.

http://mg.co.za/article/2013-08-16-00-the-boys-who-lost-their-manhood

Read it and weep.

All of the cost, but probably none of the benefits

Elexoma: CES is almost as trendy as an iPod, even larger, more expensive and potentially useless (with a sliver of questionable evidence)..
You are right.  Your anecdotes are so comprehensively convincing, unique and unlike any other claims made by alternative medicine products, that  I want to buy your device for R4999, now!

Why is it that drugs and therapies which have been shown to work in clinical trials do not rely on anecdotes and testimonials to sell their products?

Why do products which have never been shown to work in a clinical trial and have no or unconvincing evidence, rely on testimonials and anecdotes and shy away from using numbers to convince us?

I think the first group is sure of their claims - because well-designed clinical trials and meta-analyses support them.

The second group is merely afraid of saying that a bottle of sugar pills works just as well.  I can understand that this is not a very good marketing strategy for your banaba leaf extract drug.  Obvious this is an oversimplification and many drugs whose efficacy we currently accept as dogma will fall between these two points on the spectrum.

But what about this:

http://www.elexoma.co.za/

Elexoma is a company which sells a cranial electrotherapy stimulation device (CES).  It is interesting.  They don't seem to fall into either category completely.  Certainly their claims with regards to their product seem suspiciously comprehensive.  But I think we should start digging.

They list tons of literature on their website, but as we have seen with antagolin, this doesn't mean diddly-squat unless it is relevant.  So the question is:

"Is there any evidence that Elexoma works for any of the conditions which the proprietors claim?  If so, which ones and what is the level of evidence?

The Wikipedia article should put us off to a good start.
http://en.wikipedia.org/wiki/Cranial_electrotherapy_stimulation


Ready?
Set?
Go!

Dr. Quack (MD)

An interesting phenomenon in healthcare today is this:
Qualified professionals, using their degrees to make a quick buck.  A quack buck.

Take Antagolin, for example (please see my previous post):
1. Its head of research is a qualified medical doctor.  According to their website, Dr. Conrad Smith is also a screenwriter, whose scripts are wanted in Hollywood.  Lucky for you, the overweight, desperate and easily impressed public, Dr. Smith has decided to use his experiences in the USA to exploit the untapped weight-loss and diet-fad market in South Africa, by systematically corrupting the public understanding of science.  Coincidentally, no further information is given on Dr. Smith's record.  (Other than his stellar script-writing capabilities.  I wonder if his position as a supplement salesperson helps his script applications?)

This will probably have to be a different post, but the only trial ever done with Antagolin, according to their "package insert" (if one could call that referenced piece of propaganda a PI), was done in the USA (to get a patent granted, not FDA approval), and is "on record" and "helped overweight individuals lose weight".  No sample size, control group, concurrent weight loss strategies or other drugs taken are listed, because real science gets in the way of making money.

So what about the claims that it "may reduce insulin resistance"?
Oh, I see.  Is it the experimental data on Bernebine, but not your actual formulation?
Interesting.  So you didn't think that the claims you make about your formulation need to be backed up by evidence about your formulation?

Dr. Quack.  Once again: Well done, Internet!
"The doctor will see you now.  So, take off your clothes, get in the tub and lather up."

2. The CEO of the Medical Nutritional Institute is a pharmacist named Mariaan Du Plessis.
They say that "due to her strong entrepeneurial drive, she soon left corprate employment to start her own business", (and to rip people off by making unsubstantiated claims about her products).

We will need to systematically analyse the data available on MNI's products.  This is just the beginning.  It is overwhelming.  We will start with Antagolin.


I have been in contact with their staff about evidence for their products.  They keep referring me to pubmed.  Pubmed has nothing on Antagolin (but several inconclusive studies on their ingredients).  Their evidence is missing.  I suspect it does not exist.

Reading list for the struggle against mad science

Okay

So the previous posts are bit content-heavy on my side.
Maybe I should give bit more information to explain where I depart from:

I have always been uneasy with bad science.  Ever since my child-like mind got stuck in the rut of asking "Why?"

I am currently studying medicine, which is profession that struggles to ask that question enough, but does it just enough to keep me excited.

Bad science and bogus claims are everywhere - targeting those whose education moulded them into unquestioning disciples of whatever-the-powers-that-be-say.  These people struggle in life once they leave school, always looking for a new father- or mother-figure to occupy the vacuum created post-school, post-tertiary education and/or post-family.

No-one is overtly telling them what to believe and how to think - and everyone in their life has been afraid of teaching them to think for themselves, as that would question the very authority doing the teaching.

"I expect you all to be independent, innovative, critical thinkers

who will do exactly as I say!"

They are all too happy when a supposedly benevolent tabloid, television channel or Depak Chopra fills that void with the air of calm, self-assured knowledge that permeates those who are trying to sell you something.

But they are in great danger.

And we need to ask people questions and engage them in order to get those dusty cogs in their minds clunking about again, so that they may one day do that for each other.  And close the gaps in society left by education philosophies which fear critical thinking like a monarch fears a Bolshevik.

"Don't think for yourselves, people. Then you won't want to wear your school uniform, attend sports days and  keep quiet whilst I indoctrinate you in assemblies anymore.  The school down the road is full of  free thinkers and they all do drugs and have syphilis."

For your viewing and educational pleasure, I have included two TEDtalks by Ben Goldacre.

Don't take my word for it.  Borrow or buy his books, Bad Science and Bad Pharma and decide what your think for yourself.:

And what's more:

Mad medicine, bad advice, bad reporting - Part 6: Detox

In the final post in my series on Viva Mayr and the tangents one must embark on when discussing this ridiculousness is on that word which is thrown around by every teen magazine and diet guru as if it had meaning:

Your guess is as good as mine:  I don't know what this diagram aims to show.  But it does make a good point: "detox" claims have little regard for even the most well-established science - in this case, basic anatomy.

Detox

I would just like call into question the liberal use of the word detox.  If anyone who wishes to broaden their minds and rid themselves of the yoke of ignorance,  would type the word “detoxification” into Wikipedia, go to the disambiguation page and select the “alternative medicine” option, you would be faced with the following definition:

Detoxification is an alternative medicine approach that proponents claim rids the body of "toxins", accumulated harmful substances that are alleged to exert undesirable effects on individual health. Detoxification usually includes one or more of: dieting, fasting, consuming exclusively or avoiding specific foods (such as fats, carbohydrates, fruits, vegetables, juices, herbs, or water), colon cleansing, chelation therapy, or the removal of dental fillings. (9) (10)  Body cleansing is not supported by science, with no medical benefits demonstrated, and is based on questionable or disproved scientific claims.(11) (12) (13) (14)

Those wishing to defend the embattled term “detoxification”,  will immediately jump to shout that Wikipedia is an undependable resource.  A claim to which I respond in two parts:

1.       All of the references from the article have been added to the table of references available here.  Should anyone wish to scrutinize any of the claims, all of the information which has been used to create the above definition can easily be accessed from any computer with an internet connection.  I am sure that the respective authors would welcome any questions or criticisms on the methodologies or conclusions.

2.       A claim accusing another of unreliability coming from people who depend on word-of-mouth, anecdotes and dubious “professionals” to convince them about efficacy of treatments for which there is, consistently, a lack of evidence could easily reach cataclysmic levels of irony.  I would advise individuals making such accusations to turn that same critical eye upon to the world to which you normally look to guide you with regards to healthcare decisions.

It has been delightful to write this.  It has also been deeply depressing.  The fact that such things exist and are so commonplace makes one feel overpowered, overwhelmed and outnumbered.

If you are reading this blog in agreement, you must realize that it is your task as scientifically minded person to fight bad science and baseless claims.  We must engage with the world around us and question and foil those whose aim is to exploit and prey upon the uninformed and the desperate.

Although it is not always easy (and the varying tone of these post are testimony) to do so with all the kindness and compassion the task requires, this should always be a priority.  Antagonism and ridicule (although great fun to write) is unlikely to convince anyone face-to-face.