The major problem is that it’s not clear which of the story’s sources we should trust: the independent experts pointing out the lack of human studies, or the company spokesmen touting their products’ effectiveness in the lab. Both are given about equal time, and there’s no clear indication that one view should trump the other. Better discussion of the evidence quality would have helped readers reach the appropriate conclusions.
This week a PR firm sent out a news release stating, “Enzymes are Trending in the News.”
People are increasingly captivated by the idea that their food may be causing them harm. This goes beyond longstanding worries about the adverse effects of “junk” food, and involves growing concern that everyday foods may trigger a whole host of health problems due to “toxic” ingredients (e.g. gluten, high-fructose corn syrup, etc). The popular culture around cleansing has grown such that an increased uptake of remedies such as enzymes by the public is not surprising. But which of these concerns are real and which are based on nonsense? And how do we differentiate effective remedies from those that are modern snake oil? Quality health journalism can help readers answer these important questions.
The study does not discuss the costs of any of the products mentioned. You could say, “well it doesn’t amount to very much,” we suppose. But 70% of the nearly 1,900 stories we’ve reviewed fail to adequately discuss cost. It all adds up. We think it’s an important item to include in any story about claims for health care interventions.
The story lacks precision in describing the benefits of some products that have actually been studied in human tests (e.g. lactase and Bean-o), but then gives too much detail about products that have only been tested in lab studies. Does anybody care that a pill results in “60% [of] large gluten molecules broken down in a half-hour and 75% at 90 minutes” in a test tube? No. We care what happens inside people’s bodies and whether the products produce actual symptom relief. It’s particularly upsetting that the story concludes with a plug for these test tube benefits, when a few paragraphs earlier we are told that the products have never been tested in human trials.
The story makes a half-hearted attempt here. It says that new over-the-counter enzymes are made by fungi and haven’t been tested in humans. And it suggests that anyone with a fungal allergy should “use the products with caution.” It also passes along a company spokespersons’ observation that “only occasional side effects” are reported by customers taking one of their supplements.
But the company phone line is hardly an accurate tool for assessing possible harms and side effects of these products. And vague warnings about possible allergic reactions don’t qualify as useful information for decision-making. If there are safety concerns with any of these products, the story should have spelled them out more clearly and described what the risks are.
There are some notes of caution sprinkled throughout the piece. For example:
“there are not high-quality, well-designed studies” that prove [the products] work in humans
since the enzymes can work slowly, he says he is skeptical the capsules will work fast enough for many patients, who experience symptoms in minutes or hours.
But for every such caveat, it seems, there is a quote from a company spokesperson touting how effective the new products are in lab tests:
Both companies say lab tests show their enzymes do what they are expected to do. For example, says Jeremy Appleton, a naturopathic doctor at Schwabe, proteases are tested to make sure they efficiently break down proteins.
Such tests provide very little assurance as to how the products will perform inside a human stomach or whether they will provide actual symptom relief. The story should have done a better job of communicating this, or, better yet, left out these comments entirely.
The story should also have done a better job explaining what kind of evidence supports the established enzyme products, lactase and Bean-o. The story cites “doctors” and “published human trials” as the evidence that these products work–not good enough for a satisfactory rating.
We’ll flag the story for casually throwing around the term “gluten sensitivity,” which the story says can produce “symptoms such as stomach aches, joint pain, fatigue and headaches.” These are generalized complaints that are unlikely to be caused by gluten, and we think this description will help feed the public’s (largely unfounded) fear that gluten is a harmful substance that should be avoided. While some researchers now believe that certain people do experience adverse effects from gluten that are not a result of celiac disease (i.e. “gluten sensitivity”), the number of people affected is most certainly tiny compared to the number of people who think they are sensitive to gluten. The story makes gluten sensitivity sound like a garden variety ailment, when in fact it’s an uncommon and poorly understood phenomenon–if it even exists at all.
A few different independent experts raise concerns about the quality of the evidence supporting these products, their effectiveness, and their potential to cause harm. And the story seems to identify relevant commercial relationships that represent a conflict of interest. This was the major strength of the story; but as noted above, we think these sources could have been put to better use.
The story at least gave a nod to Lactase and Beano products, but it doesn’t address other common-sense approaches that may help treat gas and bloating: avoiding the foods that give you trouble, avoiding fat-rich meals, eating smaller meals, etc.
The study provides the names of products that are available over the counter. Readers should be able to use this information to track down the products if they want to buy them.
The story explains that newer enzyme products are following in the footsteps of established enzymes that have been around for years.
There is enough original reporting that we can be sure the story wasn’t based on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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