Questionable Research by the Juice Plus Children's Research Foundation

Questionable Research by the
Juice Plus Children's Research Foundation

Stephen Barrett, M.D.

According to its tax returns, the primary purpose of the Juice Plus Children's Research Foundation of Collierville, Tennessee, is "to initiate and/or support programs that advance the principle that improved nutrition leads to healthier lifestyle and overall better health in children." [1] Its primary project is said to be a study of people taking Juice Plus+ products. For fiscal years 1999 through 2004, the returns provide the following data:

	1999	2000	2001	2002	2003	2004	2005
Contributions, gifts, grants, and similar receipts	$212,133	$176,771	$188,039	$348,978	$27,200	$200,000	$394,889
Total participants enrolled	5,000+	15,000+	19,000+	40,000+	53,000+	65,000+	74,000+
Cost of enrolling participants	$67,046	$67,352	$68,391	$47,778	$48,887	$119,049	$96,786
Number of initial children's health surveys	4,000+	13,324	17,069	22,565	21,055	23,681+	32,761
Cost of processing initial children's health surveys	$12,092	$55,410	$98,574	$153,723	$186,366	$190,411	$269,584

The Foundation's Web site describes the research project this way:

The Juice Plus+^® Children's Health Study is a large-scale, multi-year health survey designed to help determine what effect adding Juice Plus+^® fruit & vegetable supplements to the family diet can have on the health and well-being of children ages 6-15. In the study, each child participant is paired with an adult participant, usually a parent. Child participants twelve years of age and younger are offered the choice of taking one Juice Plus+^® fruit and one Juice Plus+^® vegetable capsule per day, or two Juice Plus+^® fruit and two Juice Plus+^® vegetable chewables per day. Teenage participants thirteen and older are offered the same choice but with twice the amount of Juice Plus+^®. Adult participants take two Juice Plus+^® fruit and two Juice Plus+® vegetable capsules per day.

While the children in the study are provided free product by the Juice Plus+^® Children's Research Foundation, adults in the Study are required to purchase the Juice Plus+^® they use.

Each adult participant answers questions via written questionnaire regarding both his or her own experience and that of the child participant since starting to take Juice Plus+^®. Completed questionnaires are sent to the accounting firm Deloitte & Touche before being forwarded on to the Foundation for tabulation. Questionnaires must be submitted voluntarily to be included in the study results; there is no direct effort on the part of the Foundation to solicit responses [2].

The exact protocol for the study is not posted, but a 2002 report of "preliminary results" identified 17 questions for which the only responses were "more," "no change," or "less":

Have you seen any change in the amount of fruit or vegetables your child eats on average every day?
Have you seen any change in how often your child eats breakfast in the morning?
Have you seen any change in the amount of water your child drinks on average every day?
Have you seen any change in how often your child eats meals from "fast food" restaurants each week or any change in the number of carbonated soft drinks and/or high-sugar children's beverages your child drinks on average every day?
Has there been any change in the number and/or amount of over-the-counter medication(s) your child takes on a regular basis?
Has there been any change in the number and/or amount of prescription medication(s) your child takes on a regular basis?
Have you noticed any change in how often your child has visited a physician or clinic for "sick visits"?
Has your child been diagnosed as having any specific, on-going disease(s) or condition(s)? If yes, have you seen any changes in your child's disease(s) or condition(s)? Note: This reflects answers only from those respondents whose children had been diagnosed as having a specific, on-going disease(s) or condition(s). The most commonly cited ones were seasonal allergies, asthma, ADD/ADHD and food allergies.)
Has there been any change in the amount of school your child has missed for health-related reasons, including illnesses and doctor's visits?
Has there been any change in your child's academic performance in school?
Has there been any change in your child's ability to concentrate and pay attention in school?
Has there been any change in your child's self-image and self-esteem?
Have you seen any change in your child's level of participation in organized extracurricular sports/athletic activities?
Whether or not your child participates in organized extracurricular sports/athletic activities, have you seen any changes in your child's overall level of physical activity?
Have you seen any change in your child's level of participation in other organized extracurricular activities such as scouting, band or orchestra, school plays, chess, problem-solving competitions, etc.?
Have you seen any change in your child's level of participation in informal, personal hobbies or pastimes such as stamp collecting, amateur astronomy, painting, music, etc.?
Do you think your involvement in the Juice Plus+^® Children's Health Study has resulted in a change in your child's awareness of his or her own health and wellness? [3]

What's Wrong with this Picture?

Scientific research requires proper sampling techniques, the highest possible accuracy of measurement or observation, and appropriate statistical analysis of the findings. Controlled clinical trials offer the most credible evidence. These compare an experimental group of people who receive the treatment being tested and a control group of people who receive a different treatment or no treatment. For example, members of the experimental group may take a vitamin pill, while those in control group do not. Studies may be conducted "blind" or "double-blind" to minimize or eliminate the effect of bias on data collection and interpretation. In blind studies, the participants do not know which treatment they receive. In double-blind studies, neither the people administering the study nor the experimental subjects know who gets what. If separate treatment and control groups are used, care must be taken to ensure that they are comparable to begin with. Properly written reports include enough detail to enable them to be judged and be reproducible by others.

Juice Plus's 2002 "preliminary report" included no mention of the components needed to ensure meaningful research:

It does not mention a control group. If an improvement occurs, many factors could be responsible. A control group is needed because some of the reported items would normally improve as a child matures and learns new skills. For example, the amount of illness tends to improve with age because immunity develops in response to colds and other respiratory infections. Without a control group it would be impossible to know whether changes are due to taking Juice Plus+^® or to other factors.
The questions are vague, and many depend on subjective impressions rather than measurement of quantifiable data.
No mention is made about whether parents are supposed to keep records so they can rely on contemporary observations that would be more accurate than backward recall.
It can be assumed that parents want positive results to occur, which may bias what they report. That is another reason why blinding and a control group are needed for a valid test.
A proper report would list the number of participants that enter a study, the number that drop out, and the reason people drop out. This is necessary to ensure that important data are not overlooked. (For example, if people withdrew because a product made them ill, failing to tabulate their experience would make an experimental outcome more positive than it should be.)
The project description states that no effort will be made to solicit responses. I assume that means that parents will be be asked to submit their reports, but that no effort will be spent trying to maximize the percentage of respondants. That would make the data even less reliable because the people who report may differ fom those who don't.

No subsequent report has been published to Foundation's Web site, but it doesn't matter. The data gathered so far cannot possbly be used to draw valid conclusions. If Juice Plus+'s marketers want to test whether taking their product actually improves health, they would have to set up an appropriately controlled study to do the job. It is clear that Children's Health Study is nothing more than a gimmick to get families to buy Juice Plus+^® products.

References

Juice Plus Children's Research Foundation. IRS Form 990 (Return of organization exempt from income tax), 1999 through 2005. Downloaded from Guidestar Web site, 2004-2006.
About the research. Juice Plus Children's Research Foundation Web site, accessed on various dates from March 4, 2004 through August 20, 2006.
Preliminary results: Child Participant Summary. Juice Plus Children's Research Foundation Web site, archived Nov 22, 2002.

This article was revised on January 27, 2008.