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Disclaim This —

September 7, 2012

I’m a pharmaceutical Luddite.

Or I was, until I married Veronica, who became my own personal Florence Nightengale.

Now, don’t get me wrong, I’ve been taking Paxil for ADD since I was 18, since I’m utterly insufferable without it (yeah, try to imagine how horrible that must be).

But in the rare instance when I’ve had a headache, I preferred to ride it out. When I was sick, I’d sleep it off. When I was sleepy, I’d either powered through or doze off.

I’m not sure what to chalk up my reluctance to self-medicate, but I suppose it could have something to do with the fact that I’ve always felt compelled to prove myself (shocked?).

With V’s help, I’ve come to accept the usefulness of this newfangled “medicine” that all the kids are talking about. Even so, medication isn’t the first thing that pops into my mind when I get a headache or a cold or fatigued. My first reaction is to let it run its course. Eventually, I either realize I’m being an idiot and take something, or else I whine about my condition in front of V, who reminds me that medicine exists.

In fact, this past week I’ve had a sudden, intense reaction to the surfeit of ragweed stemming from the drought. And even though my head throbbed with congestion and mucous, it still wasn’t enough to get me to take something on my own, which is a fairly common problem, apparently. In this particular case, my hesitance is partially due to my ongoing denial that I may have developed some seasonal allergies in the past few years and partially due to the belief that I had a cold, which I would ride out.

Finally, I gave in and have been taking Zyrtec the past few mornings and I feel much better. But it wasn’t before enduring a few days of congestion misery.

The only recent exception to my medicinal aversion is caffeine.

I don’t abuse caffeine. Not in the least. I actually drink less soda than I did three years ago. But every morning when I get to work, I make myself a chai tea, which has a negligible amount of caffeine. On days when I’m really tired (like right now), I’ll down a cup of iced espresso that I make with the pod coffee maker in our office. And for the rare completely-exhausted day, I might require three cups, but that’s a lot for me.

The only other time I require caffeine outside of work is when I take the eight hour round trip to pick up my son every third weekend. Since I am prone to highway hypnosis, I sometimes benefit from an energy drink, and the one I typically get — no paid endorsement here — is 5-hour Energy®.

The reason I like 5-hour Energy is that I hate the taste of every energy drink I’ve ever tried, including 5-hour Energy. I’m not that crazy about coffee either. I used to buy Starbucks Double Shots for the ride, but there’s the aftertaste of ginseng began to gross me out.

I look at 5-hour Energy as bad medicine, which I can down quickly, rather than force myself to drink a half-can of chemical juice disguised as fizzy fruit goodness.

So, if I were to ask my doctor about energy drinks, she would probably be okay with my limited usage, since small amounts of caffeine are essentially harmless.

But energy drinks aren’t without controversy, as some have called their proliferation a public health concern, in particular when combined with alcohol. As one study found, the combination of alcohol and energy drinks is particularly insidious among college-aged males:

For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found. Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity. [emphasis mine]

Then there’s the study that suggests that sugar-loaded energy drinks may contribute to obesity by increasing the user’s resting metabolic rate (RMR) and respiratory exchange ratio (RER). The RMR is how fast you burn energy while at rest and the RER is how much oxygen you inhale and carbon dioxide you exhale in a given breath. RER indicates whether a person is burning carbohydrates or fat at any given time. This dual increase, along with the supply of carbohydrates in some energy drinks, may contribute to an increase in calories:

Overall, the energy drinks caused a 12.1% increase in RMR and a 9.4% increase in RER. When the increase in RMR is used in conjunction with the change in RER (31), the energy drinks caused an increase of ~686 [calories] in energy coming from carbohydrate and a reduction in energy use from fat of ~445 [calories].

So, it’s probably wise to ask your doctor if energy drinks are safe for you, but I’ve never asked mine since I don’t drink enough caffeine to warrant concern. But on the off chance that you’re inclined to run every stimulant past your doctor, the makers of 5-hour Energy want you to know what your doctor would probably say:

Sounds like a fairly hearty endorsement, doesn’t it? Fuck my doctor, this lady asked 3,000 doctors, so case closed, right?

Well… not exactly.

You see, what stands out to me isn’t the data this woman provides, or the mountain of paper beside her that presumably contains the in-depth analysis of said doctors. No, what stands out to me is what she doesn’t say. Or, rather, the way 5-hour Energy strings together several unrelated sentences to create the impression that doctors love 5-hour Energy.

But let’s look at the text, shall we? Bold, green text are my thoughts:

We asked over 3,000 doctors to review 5-hour Energy and what they said is amazing. Amazing? What did they say, energy drinks cause teenage boys to become obnoxious binge-drinkers? Over 73% who reviewed 5-hour Energy said they would recommend a low calorie energy supplement to their healthy patients who use energy supplements. “A low calorie energy supplement”? Not 5-hour Energy specifically? Seventy-three percent. Wow, that’s almost half of all doctors! 5-hour Energy has four calories and is used over nine millions times a week. Which means it must be safe, amiright? Is 5-hour Energy right for you? It’s better than cocaine. Ask your doctor. Or your dentist. Whatever. We already asked 3,000. So fuck your doctor.

These are some pretty spurious claims, so I tried to find the survey referenced to read the raw data (including the questions asked), but have thus far turned up nothing.

Oddly enough, the most reliable information we get about this survey comes not from what this distinguished looking lady says, but from the disclaimers that appear beneath her. I’ve pulled them all and put them into one convenient graphic for you to review.

But for the sake of readability, let’s run through them here with bold, green text indicating my contributions in skepticism, snark and sarcasm.

All doctors surveyed identified themselves as primary care physicians. Or that they played a doctor on TV. Two surveys were conducted to determine the opinions of primary care physicians regarding energy supplements and 5-hour ENERGY: 1) an online survey of 503 participants and 2) an in-person survey by 5-hour ENERGY representatives of 2,500 participants (50% of those approached). Ah yes, online surveys are so reliable and respected, and the in-person survey reached out to 5,000 people, but only got half to respond. It makes me wonder what it was about this particular survey that drove particpation rates to have of those asked. Perhaps half the doctors feel uncomfortable reviewing a commercial product performed in a non-professional environment. In both, participants agreed to review materials regarding 5-hour ENERGY consisting of label and basic description of its ingredients. Basic ingredients = crystal meth. Of the 503 online and 2,500 in-person, over 73% said they would recommend a low calorie energy supplement to their healthy patients who use energy supplements. So, approximately 2,190 doctors said they would recommend a generic energy drink, so long as their patient is both healthy and already using energy drinks. It makes me wonder how many doctors wouldn’t recommend a generic energy drink for patients who aren’t already using them. Of the 73% of primary care physicians who would recommend a low calorie energy supplement to their healthy patients who use energy supplements, 56% would specifically recommend 5-hour ENERGY for their healthy patients who use energy supplements. So, of that 2,190 who already said they would recommend a low-calorie energy drink, just 56%, or 1,226, would specifically recommend 5-hour Energy. So, even among doctors who are okay with energy drinks, barely half would specifically recommend this brand. That’s 41% of the original 3,000. Of all primary care physicians surveyed, 47% would specifically recommend 5-hour ENERGY for their healthy patients who use energy supplements. Turns out of the original 3,000, there are about 184 doctors who would not recommend a low-calorie energy drink, but would recommend 5-hour Energy. Individual results may vary. No shit, Sherlock. These statements have not been evaluated by the Food and Drug Administration. Because if they did, they’d never stop laughing. This product is not intended to diagnose, treat, cure or prevent any disease. Except a shortage of circulating blood plasma awesomeness. No crash means no sugar crash. 5-hour Energy will not stop you from crashing your car, as some literalists seem to believe. 5-hour ENERGY contains no sugar. Just bull semen. Contains about as much caffeine as a cup of the leading premium coffee. So, really, why not just buy a cup of coffee, people. Limit caffeine products to avoid nervousness, sleeplessness and occasional rapid heartbeat. Oh, and cancer of the anus .

These are the games people play with research. Rather than admit that less than half the doctors surveyed would recommend 5-hour Energy, this spokeswoman weaves an unconvincing case for the healthfulness of its product. I guess it shouldn’t surprise me, given the history of disinformation coming out of the weight loss industry.

The most common, and misleading, claim to be found in obesity research is that patients on Program X lose a “significant amount of weight.”

Technically, it’s true, but only if you accept the definition adopted by almost all obesity and weight loss research teams. That definition typically states that losing between 5% and 10% of your starting weight is a “significant” amount. For me, that would be between 13 and 27 pounds.

Ask a lay fatty how much weight they’d have to lose in order to say they lost a “significant” amount of weight, and you get a completely different answer.

But this semantic juggling intentionally muddies both the research and the public perception. By skimming abstracts, a person could learn that  people do have success losing “significant amounts of weight,” but without digging into the numbers, that person may be left with a misleading impression of how much weight people can typically lose on a diet.

This is part of research literacy: paying attention to claims and hearing what the authors or endorsers don’t say, rather than what they do say. Have the courage to challenge someone who cites research, including myself, to back up their claims with data. Also, if you hear glowing reviews in a commercial, keep an eye out for the disclaimer, as this is where companies are forced by law to disclose the salient facts. In the 5-hour Energy commercial, notice how the small-print disclaimers clarify the woman’s claims, while in large print we’re assured that 73% of doctors love energy drinks.

It’s yet another subtle, sneaky way to make claims of success and acceptance without any actual proof

4 Comments leave one →
  1. Catgal permalink
    September 7, 2012 1:33 pm

    Perfect example of how data can be manipulated to say anything you want. When I first saw this commercial, I laughed. It reminded me of “4 out of 5 dentists surveyed, recommend Trident to their patients who chew gum”… Sound familiar?

  2. September 7, 2012 2:45 pm

    energy drinks are also the number one cause for isolated seizures among males of that age according to my neurologists. The ingredients in them, ESPECIALLY gurano (sp?) can cause adults to have a random seizure without having a seizure disorder. My brother is one of those people. He had ONE seizure, isolated, associated with energy drink use. here are some links:

    be careful yall

  3. kate217 permalink
    September 19, 2012 12:46 pm

    To me “over 73% said they would recommend a low calorie energy supplement to their healthy patients who use energy supplements” translates to “over 73% said that if their patients are going to drink that crap anyway, it’s better to consume fewer calories while they’re doing it.” (Full disclosure, I love regular Red Bull, and have found a couple of brands of energy drink at the dollar store that are yummy. I don’t drink them as much as I would if they were more affordable.)

  4. September 20, 2012 6:21 pm

    ok I have a confession to make I am a caffeine fiend and run pretty much on diet cola and coffee. I have done so since my teens i used the cover of drinking to avoid eating for years (didn’t work caffine makes my binge eating disorder worse oh the wonders of hindsight) and I now have a caffine addiction thats out of control….I also have major problems with my teeth. This junk research that gets sent out as gospel drives me bananas but how many people actually take these messages on board thats what worries me. Shannon you have done it again another brilliant article bravo

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