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2006 discussions January 2007 article rewrite

Towards Good Article status

I thought I'd compile here a list of additions which could further improve the article, towards the possibility of promoting its status on Misplaced Pages. Can anyone help with sources for these?

• A picture of the logo
• More product history. When was it first released, and who was responsible for the idea?
• What kind of sales numbers has it had?
• How many people have tried it?
• What kind of market penetration does it have? Is it popular in other countries besides the United States?
• More info about the multi-level marketing aspect of it. How many distributors are there?
• An infobox such as {{Foodbox}}. See Big Mac and other popular foods for an example of usage. --Elonka 03:46, 17 February 2007 (UTC)

I'm trying to anticipate what other types of comments might come up in a formal Peer Review. Can we think of anything else? --Elonka 03:35, 17 February 2007 (UTC)

Some of that information would originate from the manufacturer (NAI) or distributing/marketing company (NSA), if it were available at all. I would guess that we would have a very hard time finding any reliable sources, particulalry for sales figures and number of users. Because it is sold by MLM, rather than by retailers, sales are not monitored by the usual organizations that conduct market data analyses and reliable data probably does not exist. I think I really like the foodbox idea. I don't love the logo/picture idea because it strikes me as a bit promotional, but others might disagree. A bit on product history might be good. According to the accounts I have seen, the inventor is Humbert "Smokey" Santillo (a naturopath), although the product does not have the same composition as Santillo's original, according to NSA. Rhode Island Red 04:10, 17 February 2007 (UTC)

Overall, I like the article and support the food-box idea as well as a survey of the product history. I also think the multi-level marketing should receive more attention, since it seems the distribution and tactics of the sales force are very different than other supplements, food or medication. Some history on why this is would be interesting. Also the reader should be aware of why this product is so controversial; perhaps aided by a reference to the whole idea on the issue of form over substance for food. It is a very unique idea that you can divorce a food from it structure and still retain the health benefits. As if the structure of the food is superfluous. Have there been other movements which deny the gestalt nature of food, i.e. that food is nothing more than the composition of its constituent elements? Perhaps some of this would be speculative and not wiki-worthy, but if relevant research has been done in this area, it would be interesting to reference. —The preceding unsigned comment was added by Tbbooher (talk • contribs) 05:14, 17 February 2007 (UTC).

I wonder whether the cats and dogs product really warrants mention as a "primary" product? In the absence of sales figures it is hard to say but by its very target market it would seem to be less important than a nutritional supplement for humans and not significant enough to mention.

Tbbhooer's question re food structure and its "gestalt naature" is a very interesting one. Juice, which is obviously "divorced from the structure" of the original food, has been shown to retain many of the health benefits of the original food, so the issue goes further than the simplistic issue of appearance ('macro' structure). The process of dehydration as a means of preservation for storage and successful reconstitution is evident in nature (in seeds) and in recent developments its viability is shown in sperm and tissue banks, so there would not appear to be in principle any reason to suggest that the concept is faulty on the basis of the product's "gestalt nature". It is not a unique idea but a novel application of an old idea.

On the other hand, look at most of what you eat and drink, e.g. breakfast cereals, bread, margarine, hamburgers, pizzas, a glass of wine, and you'll be hard put to it to find anything, apart from fruit and vegetables that is, which hasn't been processed in some other way, often merely to prolong its shelf life (usually for logistical rather than health reasons). Heat treatment, irradiation, pasteurisation, which leave the "gestalt nature" of food intact, have been shown to reduce its health benefits (e.g. enzymatic activity). TraceyR 07:38, 17 February 2007 (UTC)

TraceyR, great thoughts. Agreed this is an application of an old idea, I wonder how old. Where on Misplaced Pages/anywhere would we first find mention of the idea that the essence of food could be separated from its structure? What civilization/timeframe was the first to understand food and nutrition? Is there an article, branch of science which answers what in the composition in the food is transport material and what is nutritive. Have there been futurist movements which envision a world where we take one pill a day which is the perfect blend of nutrition. Certainly, current supplements, and even smoothies could fit into this category -- the whole concept of superfood. I see a development of slow food movement on one hand, which is closely tied to organic food type ideas and products like JP on the other hand which seem to be focusing on the chemical nature of food. (Not meant in any way to discredit the product or get the angry distributors edit-vandaling again, just some thoughts that might lead to an interesting link in this article or a new article altogether.) Tbbooher 18:58, 18 February 2007 (UTC)

The idea that JP focuses on the "chemical nature of food" is a misunderstanding, I believe. In fact, the opposite seems to be the case. This was why there was a long dispute about the use of "concentrate" and extract" earlier: the process by which JP is made is a physical one (i.e. juicing, then low-temperature dehydration); no "chemical" extraction process is involved, so the 'concentrate' is said to contain as much as possible of the nutrients of the original f&v (hence the "next best thing to f&v" claim, I suppose). Another misunderstanding is that this "superfood" is supposed to replace f&v in the diet, whereas JP is sold as a supplement. If these two points were generally understood I think that there would be a lot less criticism of the product. TraceyR 18:35, 20 February 2007 (UTC)

I have just tried the GNLD reference again - it still doesn't exist. I think that this reference should be deleted, for the same reason as before: it presents WP in general in a bad light if it contains references to non-existent sources and mitigates against "good article status" for this article if it stays in. Any objections to it being removed? TraceyR 14:53, 21 February 2007 (UTC)

It should be noted as inactive, not removed. Refer to previous discussion. Rhode Island Red 01:56, 22 February 2007 (UTC)

I see that the GNLD (Golden Neo-Life Diamite) 'article' (it seems to have been a marketing flyer) has been found on an archive site. I'm not sure that it meets the WP standards for being (a) research and (b) secondary. It certainly isn't a bona fide scientific source. Should it be used at all? I fear that allowing a marketing flyer to be cited in such a context might open the floodgates for all sorts of marketing copy to be used! Hardly advisable for "good article status".

I also wonder whether there might have been legal reasons for its removal from the original site, in which case there might be legal problems using it as a source. TraceyR 13:38, 23 February 2007 (UTC)

I notice that we are relying on the GNLD flyer (reference 4) to back up this sentence: "Four studies have indicated that the label's amounts are not entirely accurate". Since the claims made in the GNLD flyer are not even published in a technical report (much less in a refereed journal) we shouldn't use it as evidence for that. Perhaps we could use it just to point out that a competing supplement maker has questioned some of the label items on Juice Plus. I see that GNLD's scientific advisory board includes a number of people with good credentials. Perhaps if someone had the patience to track down their publications, it would turn out that some of GNLD's analyses are actually published. Citing one of those publications would be better than using the flyer (reference 4). EdJohnston 16:09, 23 February 2007 (UTC)

Infobox structure

Okay, I am now an expert on Misplaced Pages food templates, heh. There wasn't a category that listed them, so I made one, and have been chasing all of the 'pedia populating it: Category:Food templates. If anyone knows of something I missed, let me know.  :) In the meantime, I've taken the one that looked most appropriate for our needs: {{Foodbox}} and have modified it enough so that it seems to work. If we need more headings (like for additional vitamins), I can add them.

What I'm really not sure how to do though, is how to:

• Handle the differences between Orchard Blend and Garden Blend
• Adequately notate that these quantities are not USDA-confirmed, but are just off the label. And more importantly, how to adequately notate that some of the quantities have been identified to be incorrect.

For example, we could list it as:

Vitamin C: 80% (OB), 70% (GB), (study indicated actual percentages were 75%/40%)

Then again, that could get really wordy... What do other people think? --Elonka 00:13, 19 February 2007 (UTC)

I think we might be best off to include the Orchard Blend ingredients and %RDIs as well. They ingredient list might not look bad if is is simply integrated into the exisiting infobox . Also, have a look at my last comment about including the combined %RDI for the 4-capsule regimen. It's something else to think about. It could be added to the infobox or in the main text, or it might be unnecessary if we include the ingredients/%RDIs for Orchard Blend.

As to the question of the labeled amounts not being confirmed, Sloan Kettering used the following verbiage:

This product is regulated by the FDA as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.

We might be able to turn a phrase from that or I can dig around for the FDAs official statement about supplements not being certified to meet label claims. I know I have seen it somewhere. You're doing great Elonka so keep at it and I will help you fill in a few gaps when I get some more time over the next few days. Rhode Island Red 05:01, 19 February 2007 (UTC)

I was just noticing that we could save some real estate in the infobox by (a) fixing the break on the ingredient list so that it spans the full width of the column (b) removing the “source” section and instead footnoting to the reference list and/or listing just the batch/lot number (c) removing the picture. It looks good but if it came to a choice between a picture vs. information, I would probably favor the info. Perhaps the picture could instead be cropped a bit tighter to save a little more space. Rhode Island Red 05:20, 19 February 2007 (UTC)

Which of the ingredients have been considered to have been labeled most inaccurately? Is it a +/- 10% thing, or gross misrepresentation? I'm thinking that the best way to present it in the infobox, might be to list things as a range, like: "Vitamin C: 60-80%". --Elonka 18:56, 20 February 2007 (UTC)

Image needed

Right now we're using a pic from the NSA website as "fair use", but it's problematic to declare fair use on it since a free image could probably be created fairly easily. Could someone here with access to the actual product, snap a few photos? Like of the jars, of some individual capsules, etc. Then you can either send them to me and I'll upload them for you, or I'll talk you through how to upload your own images to Misplaced Pages or to the Commons. The trickiest part is the licensing issue, but as long as you're uploading your own pics, a simple GFDL or CC-by-SA license should do fine. --Elonka 18:58, 20 February 2007 (UTC)

Adverse effects

Since the material on adverse effects that Rhode Island Red has added is well-sourced, it's hard to argue against it. Just one line caught my attention:

These events resolved spontaneously and were deemed by the researchers to be unrelated to treatment .

Why would we be carrying this as an adverse effect if it's unrelated to treatment? Does anyone have access to the full text of the study?

That’s a totally reasonable question. In studies that monitor adverse events in subjects while taking a test agent, all adverse events are reported even if the investigators deem them to be unrelated to the treatment. This is because it’s usually impossible to know with certainty whether an adverse event has been caused by a test agent or some other unrelated factor, particularly for test agents that have unknown safety profiles, so any and all adverse events are reported. This uncertainty is reflected in the standard-use terminology “the investigators deemed…”, meaning that they are taking a best guess that the adverse event is unrelated to treatment but cannot say so definitively. Rhode Island Red 01:02, 25 February 2007 (UTC)

Also, when this section says 'Adverse effects... have not been rigorously monitored', it would be good if we included some definition of rigorous monitoring, so that the reader knows what we are talking about. EdJohnston 18:43, 24 February 2007 (UTC)

That’s another reasonable point. The relevant background information is that safety testing and adverse event monitoring/reporting are not required for dietary supplements. Rigorous safety studies, such as the kind required for drugs, track large numbers of subjects over relatively long periods of use and they employ careful study designs and surveillance methods to establish the safety profile and adverse events for the agent under investigation. Feel free to insert the appropriate verbiage if you feel taking a crack at it. Rhode Island Red 01:02, 25 February 2007 (UTC)

Turning the clock back - the article as re-written by Elonka was objective and met with a general support. It seems to me that Rhode Island Red is now trying to turn the clock back and turn the article into the less than balanced article that we had before (which led Elonka to invest her time and effort into the rewrite). Are we returning to the previous situation in which negative comment was permitted but positive comment dismissed as either not NPOV or because of what was deemed (usually by him) to be due to "conflict of interest". I had hoped that these "bad old days" were over. I'm disappointed by this trend. If "well-sourced" "adverse effects" are allowed, are well-sourced references to the "positive effects" to be permitted too? TraceyR 22:51, 24 February 2007 (UTC)

See above, Talk:Juice_Plus#Article_rewrite_section_break_.231, where Elonka asked for suggestions of what material to restore in the Adverse Effects section. We already have large sections on antioxidant and cardiovascular effects, in which positive effects are mentioned. Perhaps Elonka will give an opinion of how to proceed. EdJohnston 00:30, 25 February 2007 (UTC)

Adverse effects do not constitute “negative comment”. They are simply relevant facts without an inherent POV, positive or negative. Rhode Island Red 01:06, 25 February 2007 (UTC)

I agree, if such 'adverse effects' are well-documented and specific. If, as RIR says, "it’s usually impossible to know with certainty whether an adverse event has been caused by a test agent or some other unrelated factor" then such 'effects' have no place here. We don't want any "danger to fetus" 'effects' creeping back in, do we? Well, I don't. TraceyR 10:04, 25 February 2007 (UTC)

The word 'fetus' does not occur in the article at present, so 'danger to fetus' does not seem to be a very visible claim. Also the adverse effects section is rather short in terms of prose. On my monitor there are only eight lines in the 'Adverse effects' section. Do you have a specific concern with what still remains? EdJohnston 23:14, 25 February 2007 (UTC)

Ed, you'd have to scan back through the talk to check the interesting background to that remark. TraceyR 15:47, 26 February 2007 (UTC)

What is going on here?

I see that the reference to the "Virtual Franchise Owner's Manual (December 2002)" has re-appeared, in spite of a consensus (or so I thought) a short time ago that this was neither a generally available nor a secondary source. On this basis it was removed. Now it is back. With what justification? TraceyR 19:22, 26 February 2007 (UTC)

Propose we remove the Wake Forest consent form language (previous consensus, I think)

Earlier in this Talk page, there is an entire thread under 'Is a consent form a reliable source?' The most recent comment added to that thread was by User:Deckiller on 14 February:

Consensus appears to be in favor of removing the text. Logic dictates that the term "reliable" is a case by case basis; the most reliable source for an article is therefore a reliable source, unless it is so obviously questionable. Either way, claims with sources that don't seem to meet Misplaced Pages's general definitions of "reliable" need to have multiple sourcing to be certain. I don't see multiple sourcing here. Moreover, the claims are trivial. Keep the text removed. — Deckiller 01:05, 14 February 2007 (UTC)

If we accept Deckiller as correctly stating the Talk page consensus, then we would remove the following section from the article:

Heartburn, abdominal pain, diarrhea, gas with foul odor, and indigestion have been noted as very common risks associated with taking Juice Plus Orchard and Garden Blend, and nausea and vomiting as less common risks; in some cases these side effects may be serious and long lasting, persisting after use of the supplement has been stopped.

If you believe that User:Deckiller mis-stated the consensus, please continue the discussion here. My own reason for supporting Deckiller's view is that the scientific basis for adding those cautionary words to the consent form is, to us, completely unknown. Perhaps some doctor on the IRB got nervous, on the basis of his general medical intuition. It wouldn't be the first time that someone decided to stay on the safe side when there wasn't enough information.

So my bottom line is, I would remove everything based on the Wake Forest consent form language, unless somehow we can track down whatever studies led to that language being there (assuming such studies exist). Note that the stuff about risk to the fetus is already out, because Elonka didn't include it in her revised version. EdJohnston 22:15, 26 February 2007 (UTC)

I agree. Items previously removed after the establishment of a consensus and/or not included in Elonka's rewrite (which was accepted by most editors as a welcome and constructive effort) have been re-appearing in recent days. For example, why re-introduce previously deleted 'adverse effects', which are e.g. "deemed" not to have been caused by the product being tested anyway? What's going on? TraceyR 23:56, 26 February 2007 (UTC)

The issue previously raised about the Wake Forest document was specifically in reference to the effects of Juice Plus on the fetus, since it was suggested that the wording used was generic boilerplate. With regard to the other side effects, the wording in the source document was much more specific and was not boilerplate. It clearly identified certain side effects of Juice Plus as being very common and others as being less common. Those side effects were not the subject of our previous debate and no one had disputed that information. Furthermore, these side effects are similar to the same ones described by the manufacturer, so it does not appear that the statement is contentious in any way. Rhode Island Red 02:27, 27 February 2007 (UTC)

"Deemed" is standard terminology when reporting adverse events (AEs). Just try a Google search for "adverse events deemed". It is also typical to report all AEs regardless of whether or not they are deemed by the investigators to have been caused by the test agent, particularly for studies that not double-blinded, such as the one in question by Leeds et al., since the potential for bias exists.

As an aside, in most safety studies, it is not known conclusively whether a test agent causes a given side effect; the studies merely observe incidence and correlations in users and then report them. The cause and effect relationship only becomes apparent over time when a sufficient number of cases of a particular AE have been reported, and when a logical mechanism linking the AE with the test agent has been identified. But safety studies do not require a known cause/effect relationship as a prerequisite for reporting a given AE. Rhode Island Red 03:43, 27 February 2007 (UTC)

Are any of the remaining problems major?

I just printed off two of the articles, trying to minutely answer some of the questions raised in this Talk page, and it suddenly occurred to me: I'm studying the primary sources! So my suggestion is: why not declare a truce on the scientific issues? If anyone else agrees, I'm prepared to declare the remaining issues negligible and leave the article as it is:

1. Stephen Barrett. Yes, some of the objections may be valid, but the articles of his that are cited are reasonably OK. He reminds us of the type of issues raised by multi-level marketing of something promoted for its claimed health benefits.
2. Reference 14 is from a publication called 'The Skeptic' which looks like an activist web site. The cited article may not be usable as a source for factual issues (per WP:RS). I'd put up with this, because if you read the cited article carefully, you probably won't be misled.
3. Reference 4, from GNLD International, provides a chemical analysis of Juice Plus which is not traceable to a journal article or even a technical report. It's basically a marketing flyer. So it should not be a factual reference about Juice Plus.
4. The 'Adverse effects' include a statement by the authors (Leeds et al, 2000) that they did not deem their subjects' minor illnesses to be due to administration of the supplement. What were they smoking? This is a non-placebo-controlled, non-blinded study that didn't even have a control group! So how could they possibly tell! OK, I'd even live with this because of the smart retort from Reference 14, mentioned above, which does restore balance.
5. Wake Forest (Reference 21). After the thousands of words of Talk discussion above, related to the Informed Consent Form of this study, I just looked at the full study protocol, available here and the full protocol has six pages of references. To be thorough, we should go through those references and see if any should be added to the article, and see if they justify the warnings about Juice Plus that our article had quoted from the consent form.
6. Are you beginning to see that this could be a lengthy process?

If you guys think that ALL of the minor issues should be ruthlessly hunted down and removed, I'd be willing to do that. (We'd probably lose up to 10 references). However the minor issues that remain are reasonably balanced, and the overall tone of the article I think is adequately neutral. Also it would probably be a struggle to get agreement on all the minor issues. So as an alternative, can we live with what's here now? I think that both RIR and Tracey would have to give opinions on this. And we'd have to agree that the material removed by Elonka would not be restored (except for what's already been done). What do you think? EdJohnston 03:03, 27 February 2007 (UTC)

I’m basically OK with the version we have now aside from a few minor issues raised previously that Elonka and I were in the process of addressing; none were particulalry controversial and they should be easy to work out by mutual agreement. As for the GNLD reference, the main problem I see is that it is quoted somewhat out of context. It might be appropriate to include it in Disputed Claims section, specifically described as an analysis reported by a competitor. I don’t advise pouring over the Wake Forest reference list; I am pretty darn sure that you find any studies in Juice Plus that are not already mentioned in our JP article. Rhode Island Red 05:46, 27 February 2007 (UTC)

The GNLD reference really has no place in a serious article (especially not in 'disputed claims') which is what we're striving for here - there is no research cited to back the claims and it is, after all, just a marketing flyer from a competitor. The Wake Forest consent form business was sorted out ages ago, I thought; it isn't specific to Juice Plus, but standard words they have to apply to anything being studied; if they did a study on organic apples they would have to include the same words. TraceyR 21:25, 28 February 2007 (UTC)

To reiterate, the previous consensus that was reached concerned the boilerplate disclaimer regarding fetal effects. The other side effects in the WFUSM document were described using more specific wording and, rather than being a generic disclaimer, the side effects are quite specific and similar to those described by NSA. Also, to be accurate, the document in question is not a “consent form”. It is a required submission to the IRB of WFUSM as a precondition for authorization to conduct the research.

As to the GNLD citation, there doesn’t seem to be any reason that should preclude its mention in the disputed claims section if it is appropriately described as originating from an analysis conducted by a competitor. GNLD claims that they conducted the analysis, they cited the methodology, they provided the detection limits for the compounds assayed, and they listed the results (i.e., no lycopene or lutein detected). It seems that it would be very suitable for the disputed claims section because it obviously disputes NSAs marketing claims. It may not meet our working definition of scientific research (i.e. published in a journal), and therefore would not be ideal for the Research section of the article, but it certainly seems to be a reasonable dispute of one of the Juice Plus marekting claims. It is also consistent with what other critics have stated (i.e. the product provides mainly added exogenous nutrients and there is no evidence that it provides any of the phytonutreint constituents of the source plant material). Rhode Island Red 01:53, 1 March 2007 (UTC)

New Juice Plus study available

I have just come across the following 'hot off the press' advance report:

Houston, MC (2007). "Juice Powder Concentrate and Systemic Blood Pressure, Progression of Coronary Artery Calcium and Antioxidant Status in Hypertensive Subjects: A Pilot Study". eCAM Advance Access. Oxford Journals. Retrieved 2007-03-01. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

I have extracted a few salient points; the whole text is available via the above link. It is just a pilot study (no control group, no placebo, only 51 (very brave?) subjects etc), partly financed by NSA, but it seems to confirm many of the positive findings from other studies, but some of the results are so significant (several with P < 0.001) that a study with a larger population would be extremely unlikely to produce very different results. When we have had time to digest the study, the article will need to be updated.

The abstract reads as follows:

Because micronutrients from plants may have beneficial cardiovascular effects, the hypothesis that an encapsulated juice powder concentrate might affect several measures of vascular health was tested in free living adults at low cardiovascular risk. Blood pressure, vascular compliance, lipid and antioxidant markers, and serial electron beam tomography (to calculate a coronary artery calcium score as a measure of atherosclerosis burden), were monitored in 51 pre-hypertensive and hypertensive subjects over 2 years. By the end of follow-up, systolic and diastolic blood pressure decreased significantly (–2.4 ± 1.0 mmHg, P < 0.05 and –2.2 ± 0.6 mmHg, P < 0.001), and large artery compliance improved significantly (1.9 ± 0.6 ml mmHg–1 x 100, P < 0.01). The progression of coronary artery calcium score was smaller than expected compared with a historical database (P < 0.001). Laboratory testing showed a significant decrease in homocysteine (P = 0.05), HDL cholesterol (P = 0.025) and Apo A (P = 0.004), as well as a significant increase in ß-carotene, folate, Co-Q10 and -tocopherol (all P < 0.001). The phytonutrient concentrate we utilized induced several favorable modifications of markers of vascular health in the subjects. This study supports the notion that plant nutrients are important components of a heart healthy diet.(all emphasis added)

Nuttritional intervention (and adverse effects):

Subjects were instructed to take three capsules of the phytonutrient preparation twice daily with meals. ... The phytonutrient preparation (Juice Plus+®, NSA, Inc., Memphis,TN, USA) is an encapsulated juice powder concentrate blend consisting primarily of fruits, vegetables and berries including: acerola cherry, apple, beet, bilberry, blackberry, black currant, blueberry, broccoli, cabbage, carrot, cranberry, Concord grape, elderberry, kale, orange, papaya, parsley, peach, pineapple, raspberry, red currant, spinach and tomato. Six capsules daily provided 7.5 mg ß-carotene, 276 mg vitamin C, 71 mg vitamin E and 780 mcg folate and about 63 kJ. Other than minor gastrointestinal complaints early in the study, there were no reports of adverse effects attributed to the phytonutrient preparation over the 24 months of follow-up.(emphasis added for those looking for the 'adverse effects' :-) )

Caveats cited in the study:

Limitations of this pilot study included the small sample size and lack of a placebo group. The comparison of change in coronary artery calcium score compared to the historical database is not optimal because of temporal differences of when that data were collected, along with other potential differences between this study population and the contributors to the database information. In addition, although some investigators have raised concerns about the reliability of the CR-2000 used to assess arterial compliance (42), others have disputed this opinion and finding the CR-2000 highly reproducible (46).

An extract from the discussion:

While the importance of antioxidants in the reduction of cardiovascular disease remains controversial, the parallel reduction of oxidative stress and other markers of vascular damage are reassuring. In this light, it is intriguing that a powder concentrate containing numerous phytonutrients, as opposed to tablets of single vitamins, was sufficient to attain the favorable surrogate results demonstrated. (emphasis added).

Summary:

In summary, this pilot study showed a favorable effect of an encapsulated juice powder concentrate, made primarily of multiple fruits, vegetables and berries, on several surrogate markers of cardiovascular disease. Additional placebo-controlled prospective studies will be required to confirm these findings.

— Preceding unsigned comment added by TraceyR (talk • contribs) 1 March, 2007. Oops! Thanks!

There are major problems with this study; in a nutshell they are: (a) the study was very poorly designed and executed (b) the results, for the most part, were unremarkable, and (c) there are disturbing conflict of interest issues. It is somewhat surprising that NSA is still sponsoring poorly designed, uncontrolled studies such as this one given that they have been researching the product for over a decade.

This study isn’t exactly hot off the press either. This data has been presented several times previously. It was published once as a research meeting abstract in May 2005 and again at a meeting of the European Nutraceutical Association in Feb 2006.version 1 (see page 9); version 2; version 3 No coauthors are mentioned in any of the latter 3 versions, just Mark Houston. In all of these reports, Juice Plus did not significantly affect systolic pressure, whereas in the new article a statistically significant 2.5% decrease in systolic pressure was reported. There are other discrepancies in the data presented in the various versions.

Study Design Issues

• The study was of the lowest possible design quality: an open label, non-randomized, non controlled, non-blinded study with no placebo group.
• The study’s participants were not excluded for taking concurrent antihypertensive medications. No details were given as to how many subjects were on such medications or how long they had been taking them. The blood pressure results reported would be much more likely to be due to antihypertensive meds than to Juice Plus.
• No attempt was made to control for or monitor the subjects’ diets, exercise, smoking or drinking. Changes in any of these factors could easily account for most of the results reported. It is in fact highly likely that the subjects had implemented lifestyle modifications to lower their blood pressure, since that would be the typical recommendation for someone with pre-hypertension/hypertension.
• Six subjects dropped out after the study had started and yet the data prior to dropping out were inappropriately included in the final analyses. This would not be permissible with a properly stringent study design.
• The study’s participants were misidentified as being hypertensive and pre-hypertensive. Hypertension is universally defined as BP greater than 140/90. The subjects designated as hypertensive in this study had average BPs of 139/85 and therefore were not actually hypertensive but pre-hypertensive. Similarly, the baseline blood pressure data for the so-called pre-hypertensive group shows that they were not actually pre-hypertensive; in fact, their average pressures were in the normal range (120/76). The title of the paper makes an even more egregious error in referring only to “hypertensive subjects”.
• The use of historical controls for comparisons of CAC, rather than a proper control group, is especially misleading given that the subjects in Houston’s study did not meet the definition of “hypertensive” yet presumably were compared to hypertensive historical controls. It is a faulty comparison because the historical controls in this case likely had more severe CV dysfunction than Houston’s study cohort.
• Juice Plus was taken not as the ususal 4-capsule regimen (2 each of Orchard and Garden Blend per day) but as 6 capsules, with a third product, Vineyard Blend, being taken in addition to Orchard and Garden Blend. The results, therefore, cannot be extrapolated to normal-use conditions.
• As an aside, such a poorly designed study would never be accepted for publication in a good journal, but it was accepted by this non-ranked journal, Evidence-based Complementary and Alternative Medicine (eCAM), for which the study’s lead author (Mark C. Houston of Nashville TN, home of NSA) has served as a reviewer. No scientist hopes for their research to be published in a journal like eCAM, even if they are in the complementary/alternative arena. It has minimal reach and a non-prestigious reputation and is not very stringent about the quality of articles published.

Results

• Nutrient Absorption: The reported elevation of blood levels of folate, beta-carotene, and vit E is not surprising because those vitamins are added artificially as fortifiers to the product. Absorption of these 3 nutrients has been reported previously in better designed studies, so the new data is unremarkable. KEY FINDING -- vitamin C was not absorbed.

• LDL/HDL: KEY FINDING -- Juice Plus led to a small but statistically significant reduction in good cholesterol (HDL), and a trend towards increasing levels of bad cholesterol (LDL). This data indicates a potentially adverse effect of the product on heart health. Total cholesterol levels were unchanged.

• Coronary Artery Calcium: The CAC score data is totally unreliable and essentially useless because the investigators used a historical database rather than a control group for comparisons. This is a critical flaw (see point 6 above).

• Blood Pressure: A slight decrease in systolic and diastolic pressure (2.4 and 2.2 mm Hg) was reported but the effect was so small that it could been due to a variety of uncontrolled factors, or to a gradual waning of the whitecoat effect effect -- a term that describes the phenomena whereby a patient’s blood pressure tends to go up in the presence of their physician due to general anxiety. Furthremore, the BP effect was not substantial enough to impact health outcomes (e.g. the prehypertensive subjects remained prehypertensive after taking Juice Plus for 2 years) and was much smaller than the effects typically obtained from lifestyle modifications or antihypertensive meds.

• Side Effects: The study did not describe any details of how side effects were monitored; therefore, it can be concluded that reliable, acceptable methods were not used to make such determinations. The authors did, however, note that the product caused gastrointestinal side effects, which they described as minor but in fact were severe enough to cause 3 subjects out of the initial 54 to dropout of the study prematurely. The reasons for 5 of the other 6 dropouts were not listed (contrary to convention), and therefore side effects could have been a cause.

• Other Effects: The data for other parameters showed trivially small or nonexistent effects. For example, Apo A decreased by 3.5% and homocysteine by 2.5%. These extremely small effects could be due to any number of factors that were not controlled for in the study and they are too small to be of therapeutic value. Glycosylated hemoglobin levels were unchanged.

Conflict of Interest

The article identifies NSA as a source of funding; however, Mark Houston seems to much have deeper ties with NSA/Juice Plus and a potential conflict of interest which was not disclosed (cf. ICMJE Guidelines p.75)

• Houston serves as the Medical Chair of the American Nutraceutical Association (ANA), an organization that largely represents the interests of the nutraceutical industry. The ANA has received funding from NSA in the past and held a Juice Plus research meeting in conjunction with an NSA distributor training conference in Phoenix in 2006. It is unclear whether the ANA receives other funding from NSA but it seems likely.
• Houston has been a speaker at Juice Plus sales training events and appeared in a Juice Plus promotional video in 2002 entitled The Science of Juice Plus. (see p.13)
• The ANAs partner organization, the European Nutraceutical Association (ENA), is run by Gerald Tulzer, Peter Prock, and Ingrid Keifer, all of whom have previously conducted or are now conducting Juice Plus research. Tulzer and Prock also serve as Juice Plus spokespersons and appear to have a direct financial interest in the product (and in all likelihood, so does Kiefer). Tulzer maintains a Juice Plus distributor site in Linz, Austria under the company name OEKO-BRAIN. Prock appears to be an employee of NSA
• The ENA is also supported financially by NSA .
• The ANA and ENA look unmistakably like NSA shell organizations for promoting Juice Plus, much like the Juice Plus Children's Research Foundation.

The question remains as to what if anything in this study should merit inclusion in the Wiki article. That it does not meet minimal criteria for design quality and reliability? That it was company-funded and conducted by someone who has a fairly clear but undisclosed conflict of interest? That vitamin C was not absorbed? That it has adverse effects on HDL/LDL levels? That the effects on BP, homocysteine and Apo A were too small to be therapeutically useful and were more likely attributable to any number of uncontrolled factors rather than to Juice Plus? That it caused GI side effects of sufficient severity to warrant several subjects to drop out of the study? That it yielded useless data on arterial calcium based on comparisons with historical data rather than using a proper control group? That it misidentified the subjects in the study as being hypertensive? Rhode Island Red 20:14, 4 March 2007 (UTC)

Thanks for all the hard work.

• Just one point, though: it was a pilot study. Doesn't that mean that the objective was to assess whether it would be worth pursuing similar lines of investigation in a more rigorous study? So the list of things you mentioned (an open label, non-randomized, non controlled, non-blinded study with no placebo group) is interesting but not really relevant in this case. Obviously as a pilot it doesn't carry as much weight as a clinical study would. But didn't the study (as quoted in the extract above) point this out:

"Limitations of this pilot study included the small sample size and lack of a placebo group. The comparison of change in coronary artery calcium score compared to the historical database is not optimal because of temporal differences of when that data were collected, along with other potential differences between this study population and the contributors to the database information."

"Additional placebo-controlled prospective studies will be required to confirm these findings." TraceyR 21:41, 4 March 2007 (UTC)

• The point is that poorly designed studies like this one tell us almost nothing and carry almost no weight; they don't even provide enough information to determine whether more research is warranted. NSA continues to misrepresent such studies as evidence of the product's effectiveness. Poorly designed pilot studies are a worthwhile investment only from a marketing standpoint but they are junk science. It doesn’t cost significantly more to conduct well-designed studies, so it would appear that NSA and their hired researchers either don’t understand or aren't concerned about research quality. Rhode Island Red 00:15, 5 March 2007 (UTC)

• Oh yes, another point: there was a second source of funding that you omitted to mention (so it wasn't exclusively "company-funded" as you imply). TraceyR 21:41, 4 March 2007 (UTC)

• It’s arguable whether “company-funded” implies exclusivity but in any case, the implications of NSAs involvement remain the same regardless of whether another source contributed an unknown proportion of the funding. Rhode Island Red 00:15, 5 March 2007 (UTC)

• How can you possibly know that the "effects on BP, homocysteine and Apo A were ... more likely attributable (my emphasis) to any number of uncontrolled factors rather than to Juice Plus"? An interesting assumption, but where's the evidence one way or the other? TraceyR 21:41, 4 March 2007 (UTC)

• It is more likely because the influence of concurrent antihypertensive meds and lifestyle/dietary modifications was not controlled for. These are factors that are widely known to have a major influence on BP and other parameters of cardiovascular function. Also consider that (a) the study was so poorly designed that one cannot know that these minute effects were real and not just an artifact and (b) a study by Plotnick et al showed no effect on BP in normotensive subjects who took the same 6-capsule regimen of Orchard/Garden/Vineyard Blends. In fairness, the minute reduction (2.5%) in homocysteine levels could also have been due to the added folate in Juice Plus, since folate supplementation is known to reduce homocysteine levels. But interestingly, even though JP contains a fairly high dose of added folate, homocysteine levels were not substantially changed. Rhode Island Red 00:15, 5 March 2007 (UTC)

• And something else: only two subjects withdrew due to GI problems, not the three you mentioned; a minor point but salient enough to mention, perhaps. (I wonder what caused the GI problem - "more likely attributable" to something they ate?). Two or three other subjects withdrew because they were prescribed medication/treatments explicitly excluded from the study. Presumably the reasons for the other withdrawals were different, otherwise surely they would have been included one of the two categories listed. An assumption, but just as valid as yours. TraceyR 21:41, 4 March 2007 (UTC)

• Yes, it was 2 not 3 dropouts for GI side effects, a minor point but worth mentioning. The researchers said the GI distress was possibly due to Juice Plus but they didn't mention the possibility that it was due to something the subjects ate, let alone that this was a "more likely" explanation, as you suggest. I didn’t “assume” that the other 6 dropouts were related to side effects. I merely raised it as a possibility (i.e. “could”), since the causes for the mid-study dropouts were not listed (only those that withdrew before the first follow up visit). Normally, the causes for all dropouts would be listed, so the absence of such information is suspicious. The possibility remians that some of the 6 dropouts were caused by side effects. Rhode Island Red 00:15, 5 March 2007 (UTC)

• I'm not quite sure what the ANA and the ENA have to do with the study; is it enough to say that they "look unmistakably like NSA shell organizations" to insinuate that the author is in NSA's pocket? You'll have to produce more evidence for that, too. I imagine that NSA is one of the founding members of both organizations; I was unable to discover such details from the ANA website, but I did discover that Walter Willett, MD, DrPH (Chairman, Department of Nutrition, Harvard School of Public Health, and Professor of Medicine, Harvard Medical School, Boston Massachusetts) is on the editorial board of its journal. Is he (and the 26 other members of the editorial board) by association also in NSA's pocket? I hardly think so. TraceyR 21:41, 4 March 2007 (UTC)

• The main point is that Houston not only has received research funding from NSA but also has appeared in Juice Plus promotional videos and at Juice Plus distributor training meetings. He appears to be a paid consultant/speaker for NSA. This was not fairly disclosed in the article, as would be required. Even if all he had were a few dinners or travel expenses paid for by NSA, that would qualify as an undisclosed financial interest. The closeness of NSAs involvement with both the ENA and Houston’s ANA is very disturbing to say the least. At least two members of the ENAs executive committee are NSA employees and three of them have been involved in Juice Plus research. These kinds of relationships clearly qualify as a conflict of interest. A significant portion of the activities of the ANA and ENA involve Juice Plus, and they are both funded by NSA, so all in all, it doesn't seem too much of a stretch to call them shell organizations for NSA. At the very least we would have to agree that they cannot be counted on as reliable and objective sources for Juice Plus research.
• That' a straw man argument regarding Walter Willett and the other members of the board of ANAs journal JANA. I neither said nor implied anything about their potential involvement with NSA or Juice Plus. Willett's involvement with an editorial board of a journal isn't quite the same as Houston accepting research funds from NSA or appearing in Juice Plus promotional videos, magazines, and training seminars. Rhode Island Red 00:15, 5 March 2007 (UTC)

Small update on our usage of the GNLD reference

From Misplaced Pages:Attribution/FAQ.

An obsolete source is one that is out-of-date, or has been officially withdrawn or deprecated by its author(s) or publisher. Editors of articles on fast-moving subjects such as law, science, or current events should ensure they use the latest sources.

This should unfortunately give the coup de grâce to our reference to the GNLD flyer, since it's not on their website any more. Though it's rather interesting that they don't find any lycopene in the product. I'm sure if this is important it may eventually show up in some other study.

The problem with the GNLD reference for me (apart from the facts that it is obsolete/withdrawn and from a non-neutral source) is that it just specifies several test methodologies without providing the evidence that tests were done! It looks impressive to quote such things, but where's the beef? TraceyR 00:43, 3 March 2007 (UTC)

By the way, thanks to TraceyR for the new reference, which could be very helpful. Since I don't come back to Juice Plus very often I haven't read the material yet. EdJohnston 22:33, 2 March 2007 (UTC)

Oops, I *did* look at the new study. It had 51 subjects, of whom 45 persevered to the end of the two years. Unfortunately there's no control group, no placebo, no blinding, no randomization, their diet was uncontrolled, and the selection of the participants certainly could have had an effect. (The measurement of benefit in calcium scores was by comparison to a historical database, which might contain sicker people than those enrolled in the study). The lowering of blood pressure seems good. Τhe investigators didn't notice any serious adverse effects, so that's good as well. EdJohnston 06:33, 3 March 2007 (UTC)

Good insights Ed. I noticed the same things and a few more serious problems with this study. I’m preparing a summary of the issues which I’ll post in the next day or two. The study did not describe an a priori experimental plan for monitoring side effects so any observations made about a lack of side effects must be considered anecdotal at best and, therefore, unreliable. Furthermore the authors noted that the product caused gastrointestinal side effects, which they described as minor but in fact were severe enough to cause 3 subjects out of the initial 54 to dropout of the study prematurely. The reasons for 5 of the other 6 dropouts were not listed. More to come…Rhode Island Red 15:26, 3 March 2007 (UTC)

Has consensus been reached that the GNLD reference should be removed? I have left two messages on their website since the issue arose here, asking for details about their statements, but have received no reply. Since the page has been withdrawn, the reference ought to go. TraceyR 22:40, 5 March 2007 (UTC)

I removed it from the article. EdJohnston 22:50, 5 March 2007 (UTC)

We had established that the article need not have an active link in order to merit inclusion and we did in fact have an archived link. Also, I had suggested that it could be used in the criticism section, and that section does require that the sources be published in journals exclusively. So are their any grounds for not including it in the criticism section? Rhode Island Red 03:22, 6 March 2007 (UTC)

The fact that it's not on line any more suggests that it's been withdrawn. Also calling it an 'article' is a stretch. It's a marketing claim that's no longer being made (like a TV commercial that used to run at one time). EdJohnston 03:56, 6 March 2007 (UTC)

I have a question, I just went looking for the notorious GNLD link, it wasn't up, so I googled GNLD, and guess what?!?! it a MLM, the thing that many incorrectly assume Juice Plus is, therefore we can assume that they would obviously be considered a "competitor" of Juice Plus since they sell "health" supplements, I think that's what they do, I couldn't even find product information unless I signed up-- but any way--if that link was active and allowed to be on a Wiki listing, wouldn't that open the window for every competitor of any/every company, person and product that is deemed Wiki-page-worthy to come up with their own "study" about that entity and say anything negative that they wanted to and then post it on Wiki, where it should be, is often is assumed to be valid, factual, non-biased and informativeand because it is on Wiki?Julia 06:45, 9 March 2007 (UTC)

The GNLD reference was removed a few days ago (see talk above). TraceyR 09:41, 9 March 2007 (UTC)

Thanks Tracey, I knew that, but I was just wondering about the bigger issue and precedent setting if in the sake non-biased editing we would want to even consider such a clearly biased competitor's "study" on this, or any Wiki page and want to see what others think! Julia 16:12, 9 March 2007 (UTC)

Environmental Nutrition reference

http://www.environmentalnutrition.com/pub/25_3/asken/150372-1.html and this reference, it is a reference? you can not access their "opinion" without creating an account AND providing payment info so that after 30 days of "free" access you then pay for it-- subscribing to their newsletter and pay $24. Do we want to have legitmate references listed if they are only accessible if you utilize a pay for opinion research listing? Just my thoughtsJulia 06:54, 9 March 2007 (UTC)

The publication Environmental Nutrition apparently has ISSN 0893-4452, and is in the collection at a number of libraries, according to Worldcat. So the publication itself has some respectability, and may be citable. The question in my mind is, is that reference any good? No authors' names are included in the reference, and we don't know if it's more like a scientific publication or an editorial. I wonder if the person who added that reference has access to the article, they could tell us something about it? --EdJohnston 20:24, 9 March 2007 (UTC)

Just to clarify the position on sources from sites which are not free or not open access, this is what the guidelines have to say about them:

Misplaced Pages, in the spirit of the GFDL, encourages referencing of freely available sources, when information is available from both credible free/open access sources (FOASs) and sources which require registration and/or payment (non-FOASs).

• If a FOAS is deemed to be less reliable than a non-FOAS, use of a non-FOAS is perfectly acceptable.
• Use of reliable FOASs available on the web is encouraged, as it enhances the credibility of Misplaced Pages if the reader can speedily verify the veracity of a given fact by use of an outside source with a simple click of the mouse.

There appears to be no objection in principle to using sources which are payable if there is no alternative source, but without paying to see the detail there is no way to come to a judgement about the quality of the material. But it does go against the spirit of wikipedia (using freely available sources).TraceyR 19:18, 10 March 2007 (UTC)

ConsumerLab reference

The ConsumerLab report seems to be similar, in that it is available (online) to subscribers only. The same source has recently (Jan. 2007) published a new multivitamin/multimineral product report, covering 39 products, which does not include Juice Plus. A search on 'multivitamin' didn't produce a hit for Juice Plus in 2006, so maybe the report currently referenced in the article has been replaced by the latest one. I had a look around the site and was unsuccessful in finding any references to NSA, NAI, Juice Plus, Juice, nor anything in their list of products tested. Is there still a valid source behind this reference? TraceyR 00:05, 10 March 2007 (UTC)

I haven’t checked the Consumer Lab website lately to see what they published in this year’s review or what else they have available, but I am looking at a copy of the 2006 report that I downloaded from the site last year and it bears the Consumer Lab copyright. The Consumer Lab report listed the following: “actual amounts” in a combination of one capsule of Orchard Blend + one capsule of Garden Blend: 6,300 IU beta carotene, 620 mg vitamin C, 19 IU vitamin E, 28 mg calcium, 0.5 mg iron, 6 mg magnesium, 45 mg potassium, 0.2 mg zinc, 0.04 mg copper, 3 mg phosphorus, 0.17 mg manganese, 2.8 mcg chromium. Based on this data, the 4-capsule regimen would provide the following amounts as percentage RDI: beta carotene 252%, vitamin C 2067%, vitamin E 127%, calcium 6%, iron 6%, magnesium 3%, potassium 3%, zinc 3%, copper 4%, phosphorus 1%, manganese 17%, chromium 5%.

The most notable finding was the massive vitamin C overload (1240 mg per 4 caps), which was more than 5 times the labeled amount (390% RDI, corresponding to 234 mg). Iron, calcium, beta carotene, and folate were at or near the amounts claimed on the label. Vitamin E content was 14% below the labeled amount. These 6 nutrients are known to be added to the fruit and vegetable powders in Juice Plus and are listed on the bottle label with the amounts as %RDI. As for the nutrients that are not listed on the Juice Plus label, the Consumer Lab assay showed very low amounts of magnesium, potassium, zinc, copper, phosphorus, manganese, and chromium relative to RDI.

Leeds et al. (2000) reported the amounts (in 4 caps) of magnesium (70 mg), zinc (4 mg), manganese (1.8 mg), and chromium (48 μg) based on information provided by the manufacturer. The amounts of these nutrients reported in the Consumer Lab analysis (per 4 caps) were much lower: 0.4 mg zinc, 12 mg magnesium, 0.34 mg manganese, and 5.6 mcg chromium. Rhode Island Red 06:12, 10 March 2007 (UTC)

Did you have to pay a download fee to get the report? Using the current 30 day subscription plan, it now costs $10 per download made during that time.

The article reference is to "Consumerlab 2006", which is somewhat vague - is it still available there?

Does the report give any information e.g. about how the assay was performed and by whom?TraceyR 08:28, 10 March 2007 (UTC)

(a) Yes, I had to pay for it.

(b) I don’t know if it is still available.

(c) Yes, they provided information about how the assay was perormed and by whom. Here is a relevant excerpt: “As described below, products were tested for their amount of selected index elements (see below), their ability to disintegrate in solution (excluding chewable and time-release products) and lead contamination. Each product was tested for at least one index element in each category shown below. The first element within each category was selected unless not claimed in the product, in which case, the next claimed element was selected. Products were analyzed for their vitamin and mineral index elements using the USP (United States Pharmacopeia) methods for Oil- and Water-soluble Vitamins and Mineral Tablets in an independent laboratory. Disintegration of non-chewable and non-time release formulations was analyzed utilizing USP (United States Pharmacopeia) <2040> recommendations entitled "Disintegration and Dissolution of Nutritional Supplements." Analyses for lead were performed using an atomic absorption/graphite furnace method or ICP-MS (Inductively Coupled Plasma-Mass Spectroscopy). All testing was conducted in independent laboratories which the identities of the products were not disclosed." Rhode Island Red 15:29, 10 March 2007 (UTC)

I have just received email confirmation from ConsumerLab that their latest (2007) report on Multivitamin/Multimineral supplements (which does not cover Juice Plus) replaced their previous 2006 report, which is no longer available on their website for download. Presumably this means that it can no longer be cited as a source, because is it (a) out-of-date and (b) withdrawn by its author/publisher. Any objections? TraceyR 14:29, 12 March 2007 (UTC)

From Misplaced Pages:Attribution/FAQ.

"An obsolete source is one that is out-of-date, or has been officially withdrawn or deprecated by its author(s) or publisher. Editors of articles on fast-moving subjects such as law, science, or current events should ensure they use the latest sources."

Yes, I object strongly. CL issues their report annually and just because they have issued a new report for 2007 on a new set of vitamins does not mean they have officially withdrawn or deprecated the previous 2006 report or that the 2006 data on Juice Plus can rightly be said to be “out of date”. The 2007 report did not test Juice Plus so there is no new data that supplants the previous report on Juice Plus. The Wiki rule that was cited refers to fast moving changes in subjects like science but that does not apply in this case, since the 2006 data on Juice Plus has not been updated or replaced in the new report. The source in question was not withdrawn; it is simply no longer available online.Rhode Island Red 14:56, 12 March 2007 (UTC)

Julia Havey, there is no Wiki policy that requires sources to be available online. Please consult the policies and guidelines instead of offering your own misinterpretations of what is and is not allowed on Wiki. Your own biography page Julia Griggs Havey cites mostly sources that are not available online, so you can certainly remove them if you are so concerned about offline references. As a seller and spokesperson for Juice Plus, you are violating WP:COI and should not be arguing for deletion of sources that are critical of the product nor should you even be participating in this discussion. I also find your comment about “Red’s roost” to be needlessly inflammatory. Please stop making such comments and excuse yourself form this discussion. Rhode Island Red 15:53, 13 March 2007 (UTC)

More straw men?

Rhode Island Red recently drew attention to this rhetorical device (Straw man argument) and set me thinking about some of the sources currently cited in the article which, perhaps unwittingsly, use it.

The one which immediately springs to mind is the Stephen Barrett criticism of the Juice Plus Childrens' Research Foundation survey. He first claims that it is doing scientific research (a "straw man" of course, because the Foundation doesn't claim to be doing scientific research) before claiming that "it isn't science". This is obviously incorrect and should not be cited. Given Barrett's record, it is hard to believe that this is done unwittingly, but let's be charitable and assume that he wan't aware of the mistake he was making.

Other examples, perhaps unwittingly, fall into a different trap: members of the scientific and medical communities are familiar with pharmaceuticals and judge Juice Plus by the same standards. As has been mentioned here often enough, a concentrate made from fruit and vegetable juice is not a pharmaceutical, so Juice Plus should not be judged by the same criteria. Some critics are possibly unaware that they are using "straw man" arguments. Barrett falls into this trap too, as one would expect, but he is not alone there. It would take quite a bit of work to locate the "offenders", of course. Perhaps the Sloane-Kettering remarks fall into this category?

Nor is Juice Plus a conventional multivitamin/multimineral supplement, which confuses the issue even more, especially when it is criticised with respect to RDI percentages. Normal multivitamins contain some of the recognised 13 vitamin and some trace minerals, and their manufacturers know exactly how much of each is present because they choose and add them to the mix. As has been stated here often enough, Juice Plus contains small amounts of (naturally occurring) phytochemicals, but it would be impossible to quantify and list them all (if for no other reasons than that the label wouldn't be big enough, and that not all have been identified and catalogued as yet by the scientific community). As a recent study has shown, very small amounts of natural phytochemicals acting in synergy can have a greater effect than very large doses of isolated and/or synthetic substances. See Nature 405, 903-904 (22 June 2000), where 100g of apple (including the skin) containing 5.7 mg of vit. C were shown to be as effective as 1500mg of isolated vitamin C (260+ times as effective and certainly safer). Comparing Juice Plus with 'normal' isolated vitamins is incorrect, all the more so in the light of recent research showing isolated vitamins to be potentially dangerous. TraceyR 15:56, 12 March 2007 (UTC)

TraceyR, are you a Juice Plus distributor? Rhode Island Red 16:33, 12 March 2007 (UTC)

Julia you have once again incorrectly interpreted Misplaced Pages policy. Have you ever actually read those policies? You have a clear WP:COI and should not even be commenting on this page. Merely asking a question as to whether someone has a COI is not a violation of Wiki policy, particularly when someone’s edits are consistently in the direction of deleting or arguing for removal of content that is critical of or reflects badly upon Juice Plus. Rhode Island Red 14:14, 13 March 2007 (UTC)

Julia Havey, as a Juice Plus distributor with a COI, has no place in this discussion. Ranting and uncivil behavior does not help to improve the Juice Plus page and does not belong here.Rhode Island Red 20:15, 13 March 2007 (UTC)

The comments from Julia Havey, the Juice Plus distributor/spokesperson, are painfully inconsistent and not constructive. On the one hand, Julia Havey called for the removal of a citation (an important one that happens to reflect poorly on Juice Plus) which is no longer available online but meets the eligibility criteria for inclusion, while at the same time turning a blind eye to the fact that her biography page is based on several sources that are not and never were available online. That is inconsistent.

By the same token, Julia Havey criticized me and accused me of a personal attack because I had asked another editor if they were a Juice Plus distributor, and then posed exactly the same question back to me. This is also inconsistent. However, the question of whether someone sells Juice Plus is relevant because if they did, they, like Julia, would have a COI and should not be involved with the Juice Plus article or this discussion, particularly if they have a slant towards non-NPOV editing and comments.

I freely admit that I have no financial interest in Juice Plus or any competitive interest with any other product, and thus have no COI. My interest in the subject is purely academic, and while it is true that I have shown an interest in the subject of Juice Plus, there is no basis for saying that I have conflict of interest as outlined in WP:COI.

I reluctantly raise these issues despite the fact that they do not directly pertain to the discussion of improvements to the Juice Plus page. But in the interest of maintaining a high level of quality for the article, those who are selling Juice Plus (or are employed by any of the companies involved with selling or marketing it) should not be contributing to this article or discussion, and they most certainly should not be engaging in sideline heckling of those of us who do not have a COI and do belong here.

On a final note, Julia Havey, the Juice Plus distributor and spokesperson, should be aware that Misplaced Pages user pages are not to be used for promoting Juice Plus, so in keeping with WP:UP, that information (i.e. “I also am a distributor for Juice Plus and passionately stand behind the product”) should be removed from your user page. Rhode Island Red 00:34, 14 March 2007 (UTC)

Link to Wise Study Violates Copyright

The link to the study by Wise et al. , which was added by TraceyR to the reference section, links to a Juice Plus distributor’s website, and the version of the article in question is not an official reprint from the journal. Linking to this article would unfortunately constitute a violation of the publisher’s copyright.

Misplaced Pages’s official policy WP:C states the following:

“If you know that an external Web site is carrying a work in violation of the creator's copyright, do not link to that copy of the work. Knowingly and intentionally directing others to a site that violates copyright has been considered a form of contributory infringement in the United States (Intellectual Reserve v. Utah Lighthouse Ministry). Linking to a page that illegally distributes someone else's work sheds a bad light on Misplaced Pages and its editors.”

If a link exists to a version that does not violate copyright, that link shld be substututed. Otherwise, the exiting link should be removed. Rhode Island Red 14:37, 14 March 2007 (UTC)

These types of things are easy to fix; there's no need to provide an online source for every reference, its just convenient. Citing the journal entry properly is enough for its use as a reference. Shell 19:50, 14 March 2007 (UTC)

Agreed. Link has been removed. Rhode Island Red 00:56, 15 March 2007 (UTC)

Why so negative?

I don't understand why the tone of the Juice Plus page is so negative. It seems like the people who wrote this initial article took a very suspicious stance towards Juice Plus and they have jealously guarded their slanted look on the product ever since. Why is it important to write about someone who complained to the BBB about a slogan Juice Plus had? Even if Juice Plus had to remove the slogan, why is this relevant? I don't think the product is nearly as controversial as the article would have you think. It is recognized, used and recommended by hundreds of doctors throughout the world. I don't sell Juice Plus but I have used it for over five years. I haven't had as much as a cold since I started taking it. I'd like to see a more impartial view of a product with less sensationalistic negativity. Thank you. Citizen Don 04:48, 2 April 2007 (UTC)

Since this appears to be your very first edit on Misplaced Pages, you may be unfamiliar with our policies about reliable sources, and finding references to back up controversial claims. This article had a further problem that it was nominated on our Conflict of Interest noticeboard. The nominator pointed out that User:JuliaHavey, a Juice Plus distributor, was very active in editing the article. After much discussion we arrived at a version that many of us believe is neutral. If you have scientific citations to share with us about Juice Plus we would be eager to have them, but personal experiences are not considered valid material for the encyclopedia. EdJohnston 05:26, 2 April 2007 (UTC)

Ed, I think that we should at least consider the views of someone coming fresh to the article - there seems to be a tacit assumption that anything positive offends the Neutral Point of View policy, whereas negative 'slant' is somehow considered to be 'neutral' - which of course it isn't. TraceyR 22:25, 3 April 2007 (UTC)

Ed, to clarify, I did very little editing on the article, and none after it was pointed out to me that I should not do so due to my confict of interest. I have been active in commenting on the discussion page but am not going to take part in discussion of changes to the page, again out of respect for Wiki COI policy. However, if my name is going to continually mentioned, I will defind my position. The article, in my opinion, is not neutral, by any definition. Anyone with no prior knowledge of Juice Plus would leave the Wiki article with a negative opinion of the product. Per wiki policy, that should not be the case, a person should arrive neutral and leave neutral--just with knowledge of the facts. FYI, one study referenced here as 'negative' actually had favorable outcome for Juice Plus in regard to what the study was researching, however the section where the researchers wrote what was NOT effected is ALL that is quoted here, even though the study was not about those issues and despite the fact that other studies conducted using longer studies focused on other health issues did show favorable outcome FOR Juice Plus.Juice Plus is not a supplement but the whole food nutrition of many different fruits and vegetables encapsulated--read the lable; it reads "nutrition facts" not supplement facts, it was it is, a FOOD. It is not a MLM but rather a franchise business. But those facts don't appear anywhere on the neutral article.Julia 23:02, 3 April 2007 (UTC)

Hi Julia. I didn't intend any slur on your reputation as an editor, since a conflict of interest is merely a technical matter, and you did (properly) recuse yourself.

Does anyone have a citation for a government decision allowing Juice Plus to be a sold as a food? Or at least, a pointer to the requirements? EdJohnston 00:43, 4 April 2007 (UTC)

Ed, I didn't take it as a slur, however my name keeps getting cited and therefore when I am entered into a discussion I will comment, but only when I am brought into the conversation and again, not regarding any deletion or content issues. If you would like, I can email or snail mail you information on Juice Plus. Julia 02:11, 4 April 2007 (UTC)

Juice Plus is regarded and regulated as a dietary supplement in accordance with the 1994 Dietary Supplement Health & Education Act and 21 CFR Part 101 of the U.S. Code of Federal Regulations. Rhode Island Red 03:12, 4 April 2007 (UTC)

Rhode Island Red, both link you gave don't work. One said page not found at the HHS site, the other went to a 'page not found' internet page. Is there a current link? Thank you.Julia 03:32, 5 April 2007 (UTC)

Thank you for the correction.Julia 03:35, 5 April 2007 (UTC)

Ed, thanks for the response. I understand there have been efforts to establish a neutral tone to the article but it doesn't read like that. It reads like it came from a multilevel marketing watchdog website. The article basically says that Juice Plus purports to be healthy for you but this can not be proven. With the vitamin content alone I think we establish that Juice Plus is good for you. If I read this article before I started taking Juice Plus I wouldn't have tried the product. There are many people who could benefit from Juice Plus and they are being driven away. I think Juice Plus can save lives so I find this article discouraging. It looks like this negativity towards the product emanates from how the product is sold (multilevel marketing or franchise business, whatever, I don't sell it) and it clouds people's perception of the product. I don't even know where I would begin in rewriting it but I think it needs substantial changes. Thanks again. Citizen Don04:05, 11 April 2007 (UTC)

The article basically says that Juice Plus purports to be healthy for you but this can not be proven. I believe that's a fair summary. It seems reasonable that more studies should be done, since Juice Plus could be more beneficial that what is so far established. Until the studies are done, I'm not sure how much it is reasonable to change the article. As you can see, it's very heavily referenced. If you think the article makes negative statements that can't be justified, please give us examples. EdJohnston 13:25, 11 April 2007 (UTC)

1. "CCCWFU #60A02 Protocol Amendment #12" (PDF). Institutional Review Board, Comprehensive Cancer Center of Wake Forest University. 2006-19-17. Retrieved 2007-02-11. {{cite web}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)