The American Nutraceutical Association: Under the Microscope
A look inside the ANA and its publication, JANA.
It’s a given that the nutraceutical segment only stands to benefit from solid clinical studies and honest marketing practices, among other things. Scientific journals and trade groups exist to respectively promote these tenets and, in the end, lend trustworthy credibility to a segment which, to some degree, is still hampered by an occasional “snake oil” claim that can cast a far-reaching cloud of mistrust or skepticism over healthcare practitioners and consumers alike.
Ten years ago, when such skepticism abounded among healthcare practitioners, Allen Montgomery, RPh, set out to change the way these professionals viewed nutraceuticals by educating them on the benefits and merits of the products. In 1997 Mr. Montgomery created the American Nutraceutical Association and subsequently, a publication, Journal of the American Nutraceutical Association (JANA), with the goal of educating health professionals.
Mr. Montgomery, who has a pharmacy background, made clear the fact that ANA was not a trade group with the goal of promoting the nutraceutical industry. “Sometimes it’s misinterpreted as a trade group, [but] we don’t try to promote this industry,” he explained. “Our members are healthcare professionals and we work toward providing educational programs on nutraceuticals for them.”
When he started ANA, Mr. Montgomery said “promotion” was the bane of the industry. “Ten years ago the products were based on marketing hype instead of science,” he said. “Our mission is to provide scientific-based information to healthcare providers. The industry is trying to sell products. The word promotion when it relates to science is inappropriate.”
During that time, said Mr. Montgomery, nutraceuticals were considered “voodoo science” within the university and healthcare communities. “When DSHEA passed, it related to what you could say and do with dietary supplements – so there were various levels of healthcare professionals selling products from their office, whether they were chiropractors or naturopathic doctors, or even MDs,” he said, alluding to the varying degree of information and misinformation impacting healthcare professionals at the time. “We put together a training program on DSHEA. I think we’ve had a little over 10,000 people take our training program – both healthcare professionals and non-healthcare professionals.”
The JANA Publication
Nine years ago, ANA created JANA to further furnish healthcare providers with the science of nutraceuticals. But JANA is not without its critics and criticisms. For starters, JANA is not listed in PubMed, the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature – considered by researchers and healthcare professionals to be the gold standard resource for credible scientific studies.
“We have not met the criteria of publication frequency to get it on PubMed,” admitted Mr. Montgomery, who added that ANA is working toward making JANA’s library of archives available for free online. “Our goal is the dissemination of science-based information on the safe, effective use of nutraceuticals. We’re not out there to create a journal as a competitor to JAMA, or the New England Journal; we’re simply providing a forum for healthcare professionals based on science.”
Mr. Montgomery said the journal’s submissions – a number of which are pilot studies -- come from academia. For instance, he pointed to an autism pilot study that came to the journal from the Autism Treatment Center in Dallas, TX, as well as a study comparing oral and injected beta-glucan from the University of Louisville Kentucky’s department of pathology. “A lot of them are early stage pilot studies with low numbers or animal models. For example, the autism study consisted of a small sampling of patients and is not intended to be the definitive word on the subject,” he said. “But getting that information into a mainstream journal is almost impossible for researchers. When you’ve got early stage [studies with] low numbers, scientists would say ‘that’s interesting but it needs to be validated in larger samples.’ That’s fine, but where do researchers go to get the initial information out into the public domain?”
Mr. Montgomery believes JANA is a good avenue for science-based, smaller sample studies of the “pilot” or “pre-mainstream variety.” These studies are important because they help move nutraceuticals to the next stage of research and get companies to provide grants for the next level of studies.
Anthony Almada, BSc, MSc, founder, president, and chief scientific officer, IMAGINutrition, Inc. and MetaResponse Sciences, unabashedly disputed JANA’s credibility. “The industry perspective [of JANA] is one that’s diminished over time—it is not a high tier nor impactful journal,” he asserted. “The rigor of peer review is very low, with many of the published articles being contributed by authors with few, if any, publications in mid- to high tier reviewed journals. The implementation of a disclosure of interest policy is much needed, as a notable number of the authors of articles do, arguably, have a conflict(s) of interest.”
He also discussed the journal’s use of advertising. “The presence of advertising for finished goods—mostly supplements—with many lacking independent randomized controlled trials to support the efficacy claims also diminishes the distinction and impact of the publication,” he said. “JANA is very reminiscent of what was once the Journal of Optimal Nutrition (funded by TwinLab) and Alternative Medicine Review, owned by Thorne Research, a marketer of dietary supplements to health practitioners. It [JANA] strikes me as an easy to obtain publication acceptance, quasi-science publication that happens to be a ‘peer-reviewed’ journal.”
“The strength of any journal is how quickly they can get new research results out there, and I don’t know if that’s always their [ANA’s] focus,” commented Daniel Fabricant, Ph.D., vice president of scientific affairs, Natural Products Association (NPA). “Granted, they are telling another story, helping the industry on a science front, but at the same time it seems that a lot of the studies that might be appropriate for a journal like that -- on nutraceuticals and dietary supplements -- wind up making their way to other journals.”
“A lot of mainstream journals shun the nutraceutical world and the studies that they are involved in,” countered Mr. Montgomery. “We provide a forum for scientists that are conducting pre-clinical studies.”
“I respect what they’re doing, but you don’t see the top tier studies there and those are the studies that really need to be communicated to the healthcare practitioners for them to have a better understanding of the amount of science that’s out there,” said. Dr. Fabricant. “They’ve got to start making inroads with researchers. And they’ve got to start appealing to people designing larger studies if they’re going to have a larger impact.”
On the upside, ANA’s conference agendas are gaining momentum. ANA has collaborated with the Foundation for Care Management to provide two annual continuing medical education conferences that have featured lectures from scientists around the world regarding the prevention of osteoporosis, probiotics, diabetes and childhood obesity. “These are all intended for the clinical practice, not the academia level,” noted Mr. Montgomery. “Our predominant members are healthcare professionals in integrated or complementary practices, or traditional practices who are interested in complementary and integrated medicine.” Mr. Montgomery estimated that at least 5000 people have participated in the association’s CME programs.
ANA’s Spring Continuing Medical Education Conference (April 19th, 2008 at the Wyndham Hotel in Phoenix, AZ) is titled “The Role of Nutraceuticals, Diet and Nutrition in Disease Prevention,” and features the renowned Tieraona Low Dog, MD, director of education for the Program in Integrative Medicine and clinical assistant professor, Department of Medicine, University of Arizona College of Medicine. Her lecture, “Living in the Balance: Strategies for Optimal Health,” will review the evidence of safety and benefit for dietary supplements commonly recommended for health, the scientific evidence for mind-body approaches to pain, anxiety and depression, and review the scientific evidence for nutritional approaches for the prevention of cardiovascular disease and common cancers.
The conference will also feature presentations from John Landrum, Ph.D., professor of chemistry and associate dean, University Graduate School Florida International University Miami, FL, (“The Role of Nutrition and Dietary Supplements in Preventing and Treating Age-Related Macular Degeneration (AMD): Guidelines for the Clinical Practice”); Manfred Lamprecht, Ph.D., Institute of Physiological Chemistry Medical University of Graz Graz, Austria (“Oxidative Stress, Antioxidants and Exercise: Guidelines for the Clinical Practice”); and Bernd Wollschlaeger, MD, clinical professor, Dept. of Family Medicine, University of Miami School of Medicine, medical director, Aventura Family Health Center, North Miami Beach, FL (“Nutrients and Genes: Nutrigenomics and Personalized Health Care).
While Dr. Fabricant admits he’s never attended an ANA conference, he said he was encouraged by ANA’s Spring Conference speaker lineup. “Tieraona Low Dog is a terrific speaker,” he said. “The more they can meet with people like that and have people like that at their seminars, it’s good for them. Tieraona’s obviously a healthcare provider so it’s great to have that interface there.
“At the same time,” he added, “the medical world isn’t just healthcare providers. There’s a big globe out there and a lot of researchers. There’s got to be a way to include more research because this is where a lot of the questions originate, not on the practitioner side.”
“I did my Ph.D. at college of pharmacy and I used to teach pharmacists -- and there was always a battle between the clinical pharmacists and some of the researchers who have done a lot of work on the natural products side. That’s one of the things I think they [the ANA] have had some success with, is that they’ve really helped to combat some of the misinformation that’s out there,” Dr. Fabricant concluded. “That’s really great. I get the feeling that that’s the battle they want to fight. And the best way to do that is through high-impact studies.”