Guns and Cancer

If you saw a stranger carrying a gun enter your neighbor’s house, would you get involved and call the police?  I think most people would agree that's the right thing to do. Recently, guns have been a main topic of conversation because of their most recent role in the senseless tragedy at the Sandy Hook school and the subsequent political efforts to make obtaining guns more difficult.  Major gun violence like Columbine and the DC Sniper always grip the national attention. Yet, according to statistics published for 2010, the death rate for guns in the US is about 1 in 10,000.  According to a 2004 report published by the Centers for Disease Control, there are over 100 more likely causes of death than guns. (See  http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf).  Nevertheless, gun violence remains one of the most hotly debated and media covered issues in our country.

Cancer, on the other hand, according to the American Cancer Society, is responsible for 25% of male deaths and 20% of female deaths. So why in our society is there relatively little discussion about preventing cancer? True, there are plenty of public efforts around early cancer detection like getting colonoscopies and mammograms. Pink lapels are everywhere, but it's not nearly enough. (See my blog on Cancer: Prevention or Detection? at http://mdprevent.blogspot.com/2013/05/cancer-prevention-or-detection.html) 

Yet, other than encouraging smokers to stop and people of all ages to avoid the sun, we barely scratch the surface of the cancer topic.  (By the way, speaking about the sun, except for those most prone to skin cancer, most people should get at least 15-30 minutes of direct sun each day at non-peak hours to naturally produce Vitamin D and melatonin. One interesting recent study showed that higher blood levels of melatonin were associated with a lower rate of diabetes.). 

So even though cancer is ubiquitous and everyone knows someone who has been diagnosed, treated, or passed from it, we as a society generally prefer to ignore the topic when possible. Why? As my wife likes to say, "it's just morbid to discuss it." I agree. Discussing cancer neither makes for good table-talk nor is it very popular topic at almost any other time.

It may be polite to avoid the topic, but is it smart? Is it time to overcome our distaste for the subject and bring it front and center?  Should we discuss it with friends and neighbors, our children and other relatives, co-workers, and even strangers? Should the halls of congress echo with debates on this topic greater than virtually any other? The answers depend on how much we value life and to what extent we are willing to go to preserve it.  What's the alternative? Continue to by and large avoid this difficult topic and in turn, sacrifice meaningful collective efforts to identify the major culprits.

The other question you may be asking is can and will such discussions change anything other than the mood of those involved? The scientifically valid answer of the moment is for some people, it simply won't matter. That's because scientists believe today that cancer is the result of damage to one's DNA and random mutations. In other words, some people are so genetically susceptible to developing cancer, that they cannot reasonably be expected to avoid all environmental triggers that have already and will continue to damage their DNA. Also, as far as researchers know right now, no one can completely avoid the random mutations that create cancer cells.

But for many, if not most, people, vigilance and caution could make a huge difference. For example, next on the list after smoking, being overweight is probably the most significant cancer risk factor. Obesity has recently become a hot topic, but mostly because of its effects on heart disease and diabetes, even though being overweight is the second greatest risk factor for cancer. Is it the extra weight, the type of food consumed, or the lack of exercise that creates the added risk? The answer is unclear.  Maybe it's all three. For example, a new study reveals the mechanism behind why exercise decreases a woman's risk for breast cancer. It is related to the changes to estrogen brought about by exercise. Exercise is good and women who exercise are less likely to develop breast cancer. When was the last time you heard that exercise prevents cancer?

When it comes to guns, we recognize their implicit danger. Guns take lives unexpectedly and can create peril at any time.  Most Americans agree that limiting the spread of guns is a necessity and a moral imperative. Unfortunately, efforts to limit gun access usually only affect law-abiding citizens and not those able to obtain firearms by criminal means.  In contrast, except in relation to children, and even in that regard the efforts are paltry, there is virtually little effort by citizen groups or the government to limit the hazards of chemically infested foods we regularly consume. 

Some isolated groups are waging campaigns. For example, the Environmental Working Group (ewg.org, a non-profit organization, has developed a list of fruits, vegetables, and other household mainstays with the highest pesticide and chemical residues.  However, the truth be told, the science showing a cause and effect relationship between these products and cancer is relatively limited and inconclusive. Is it limited because there isn't any link, because it doesn't exist, or because Big Food prevents it from seeing the light of day, I can't tell you. While the dangers may be real, they are unproven.

Yet, although I'm not trying to instill paranoia, I still think the principle of what you don't know may still harm you, may apply.  One cannot imagine much benefit to our body from the countless chemicals we consume.

That's why, caution is in order when consuming conventional fruits and vegetables. Although a major study from Stanford showed that such produce is no less nutritious than organically grown counterparts, soft-skinned conventionally raised produce is full of chemical contaminants. If unavoidable or the only type you can afford, then wash it thoroughly before eating.  Choose your household cleaning products carefully, opting for more environmentally friendly products when you can, and always protect your skin and  airways when using such products. Avoid, whenever possible, and otherwise limit consumption of all processed foods replete with a multitude and variety of potentially harmful chemicals.  

If you saw a stranger with a gun entering your neighbor's house, you would probably assume the worse. Just because you do, doesn't mean he intends harm to your neighbor. Yet, you would still be alarmed. So why are you any less cautious about the foods and products you come in contact with and allow to invade your body that are strongly linked to cancer and other diseases?

No one can promise you that you will crimp your own cancer development. With 50% of men developing cancer and 33% percent of women doing so, your odds of avoiding cancer are not great.  (I'm sorry for being morbid, but those are the facts.)  However, I can tell you with confidence after reviewing over twenty thousand related studies, that living a healthy lifestyle will shift the odds in your favor.

If you value your health and your life, isn't it worth the effort? Again, there are simple things you can do such as avoiding processed foods full of chemicals, taking precautions with cleaning products, and carefully washing your produce to remove as much residue as possible. Little things may actually matter. This may be one of those situations where you can actually create your own luck. Avoiding cancer is important because prevention really is preferable to cure.  Hippocrates knew this 2,500 years ago and it's even more true today. As Louis Pasteur once said, "Chance favors the prepared mind."

No one should experience the daily agony my relative must now bear.  Please heed my words and decrease the probability that you or a loved one will ever experience the same.  Bet on yourself and your loved ones.

Thoughts Are Not Facts: A Short Tale About Lycopene

A patient recently came to see me for an Annual Wellness Visit. This is a service paid for by Medicare that involves completion and review of a health risk assessment. As part of the process, I review the patient's list of supplements and advise if they are appropriate.

The patient told me that her doctor had recently sold her a bottle of lycopene to help alleviate her symptoms of urinary frequency, the need/urge to urinate more than usual.  Lycopene is a nutrient found in foods like tomatos and watermelon and is considered an antioxidant because it is beleived to neutralize free radicals.  IT is often associated with reducing the risk of prostate cancer, but studies are inconclusive.

In this particualr patient's cae, she stated that since starting the lycopene, her frequency of urination had decreased.  This was not conjecture or fanciful imagination. Her getting out of bed at night to urinate had definitely gone down.  As anecdotes go, this one seemed fairly relaible and good evidence of the power of lycopene to help. If this person had been asked to swear out testimony about the benefits of lycopene, she would have done so without hesitation

There was only one problem. Starting lycopene had nothing to do with why she had decreased her urge to pee.  First of all, I was suspicious because even if lycopene was responsible, its mechanism of action would not have made such a difference in such a short period of time.

More importantly, something else was going on. This patient usually took a diuretic pill for her blood pressure. A diuretic forces the kidneys to excrete more water and people who take them often complain of urinary frequency to the drug's effects.  As it turned out, around the same time that the patient started taking the lycopene, she had nearly depleted her diuretic medication and started taking it every third or fourth day instead of daily as required.  Under a reduced diuretic regimen, she was experiencing an obvious decrease in water expulsion.

The patient did not realize the overlay of this fact with her changed situation.  I made the connection for her. The mystery was solved. She now understood that the lycopene was not responsible.

Please don't get me wrong. I am not opposed to consumption of lycopene in fruits. In fact, friends, relatives, and even some strangers will tell you that I am a rabid fan of watermelon.  I can never get enough.  The only precaution I must take when eating watermelon is not too eat too much too late in the day or I will have to wake multiple times during the night to go to the bathroom.

The moral of today's story is just because a patient (or you) think that a supplement is helping you, doesn't mean its true. It may be, but unless you have a scientifically valid way to verify it, you may be ignoring something else and wasting your time on unhelpful, if not potentially harmful, pills. You may even be experiencing a placebo effect or there may be other valid reasons for what you are experiencing. Be careful my friends.

Cancer: Prevention or Detection?

I recently spent a couple of days with my relative who is grappling with cancer.  It gave me plenty of time to reflect on what cancer represents.  Cancer is not only about the threat to our health and life; it is also about the physical and emotional agony it causes. No one should have to endure it.

On the plane back from the visit, I noticed an article in Delta's complementary airline magazine about the partnership forged between Delta and the American Cancer Society. The article spoke about the importance of cancer prevention and how it relates to cancer screening. To be fair, detection of cancer is really not prevention at all except if it is referring to prevention.of death. There is no doubt that certain detection tests like annually checking for blood in the stool and a digital rectal exam are helpful in finding cancer early and potentially avoiding another cancer caused death.  But detection tests do not prevent cancer.

In fact, there are very few things most people do or even doctors advocate to prevent cancer. The HPV vaccine is one rare example. Not smoking is another. Avoiding obesity has become a more common refrain. The question is, however, given the ravages of and pain and discomfort caused by cancer, which I just witnessed first-hand, why isn't there a greater focus on actual cancer prevention?

Recent studies have revealed the extent that gene mutations play in cancer development.  What continues to baffle researchers are the specific causes of these gene mutations. Is it hereditary or environmental? Is it fate or self-fulfilling?  I will not pretend to have the definitive answer because it is simply unknown. Yet, here is what we do know. Chemicals can cause gene mutations. This is a fact beyond a shadow of the doubt. We are exposed to chemicals in so many forms they seem unavoidable. They exist in our foods, on our foods, from the products we eat our food with, wrap our food, store our food, etc. They are in products we put on our bodies, and inhale on a daily basis. While they are ubiquitous, it doesn't mean we should take comfort in the old adage that "everything causes cancer so you can't avoid it and you shouldn't try.This type of outdated thinking is a mistake and displays serious denial of the risks of unrelenting exposure to dangerous chemicals.

So what's a person to do? What if you can't afford to buy organic, have to live where you work, can't eliminate all the chemicals in your house? The answer is do the best you can, but don't ignore the threat. No one can guarantee that your efforts will pay off any more than buying a lottery ticket is a sure thing. However, unlike a lottery ticket or placing a bet in a casino, making a conscious effort to limit your chemical exposure, particularly in your food, may spare you unimaginable pain and grief.

So take the time to read labels and if you don't recognize an ingredient, don't let the so called food pass through your pearly gates, your teeth. You may not be able for yet inexplicable reasons to prevent cancer, but don't let your ignorance be the cause of it.

I apologize for the solemnness of today's blog, but watching my relative suffer close-up makes me want to do everything and anything to spare others from the same fate. It's your health. It's your life. Please take control.

Be Nice To Your Bacteria and They May Return the Favor

Bacteria are everywhere; it is estimated that 10 trillion bacteria occupy our guts composed of 50 to 100 different strains. Yet, what most people know about bacteria is its relationship to illness. Who hasn't over the course of their lives been prescribed an antibiotic for one bacterial infection or another?

So bacteria are bad, right? Not always. Some people know that there are such things as good bacteria, referred to as probiotics. (For more on probiotics see my blogs, More On Probiotics at http://mdprevent.blogspot.com/2012/04/more-on-probiotics.html and What About Probiotics? http://mdprevent.blogspot.com/2012/03/what-about-probiotics.html). These 'healthy bacteria' are believed to live in our gut in a symbiotic relationship--we feed them and they perform some helpful functions for us.  But, some of the bacteria in our gut are dangerous and only pose a problem when they grow out of proportion of their usually small numbers. They are called opportunistic bacteria because they take advantage of opportunities to multiply when the normal state of affairs is altered. For example, although antibiotics kill certain harmful bacteria, they also destroy some helpful bacteria. This shifts the balance for control of the gut and allows some harmful bacteria to overgrow due to the decrease of the healthy bacteria that usually keep them at bay.

The results of a healthy balance of gut bacteria has been long known.  It keeps the gut working properly and in many cases means normal bowel function. Some people think that by taking probiotics they are maintaining a healthy gut. Unfortunately, the science doesn't support that simply taking some probiotic, whether composed of a single strain of bacteria or a blend, whether containing hundreds of millions or even billions of colonies, really makes a difference in the face of the complexities and interactions among the 10 trillion various bacteria. The situation is simply far too complex for such a simple solution.

It's not that putting bacteria in the gut can't help.  Recent studies support that putting fresh feces from a healthy family member down a naso-gastric tube (a tube inserted through the nose that reaches the stomach) is actually the most effective treatment for a Clostridia Difficile (C. Diff) infection, which is a bacterial infection that often develops in response to someone taking too many or for too long, antibiotics.  This bacterial infection created by antibiotics often proves resistant to even more antibiotics taken to restore normalcy.  However, the healthy bacteria found in the fresh feces are able to overcome this 'bad' bacteria and restore the gut.  The idea may be unpleasant to you, but it works.

Recently, some new discoveries regarding the bacteria in our gut have been made. It's been long known that meat eaters have different bacteria in their gut then vegetarians, but the significance wasn't known.  It was recently shown that these bacteria are associated with increased risk of heart disease due to productive of a compound called TMAO. The studies show a relation to carnitine and lecithin in your diet. I won't bore you with the science other than to say that TMAO levels were found to be highest in those routinely consuming meat and eggs.  Another interesting study done in mice (human relevance unknown) showed that in obese mice who undergo gastric bypass surgery, the composition of their gut bacteria changes, probably as a result of change in diet. This has also been shown to be true in humans.  In the mice experiments, researchers took the new bacterial composition of strains from these no longer obese mice and injected them into obese mice. Guess what happened? The obese mice lost weight without surgery.

It's been debated for some time if the bacteria in an obese person are a result of the obesity or a causative factor. This mice study suggests it is causative and you can bet that some resourceful scientists are now researching if using the gut bacteria from patients post gastric surgery that have slimmed down or even bacteria from normally slim people can be used as an effective weight loss tool.  It is an exciting avenue of study and I am sure it will produce some exciting results in the not too distant future.

In the interim, limit your meat and egg consumption to one piece of beef no more often than once every two weeks and to no more than two egg yolks per week. Eliminating both altogether if you can isn't a bad idea either. In their place, get your healthy protein from wild fish like salmon and once a week chicken.  Your bacteria may not thank you, but it doesn't mean they are not grateful.

Everyone Needs Calcium. Where Should You Get It?

On February 15, I wrote a blog titled Calcium and Heart Disease: What's the Story? Here is the link if you want to review it.

http://mdprevent.blogspot.com/2013/02/calcium-and-heart-disease-whats-story.html.

That blog highlighted the possible dangers of taking calcium supplements and added that "the bottom line is everyone needs calcium and it is best and safest to get it from foods like broccoli, almonds, tofu, sardines, kale and other leafy vegetables, and almond milk. As I am not a fan of dairy, I don't recommend dairy products but Greek yogurt, etc. are also good sources of calcium."

I didn't spend  a lot of time in that blog discussing one of the other potential dangers of taking calcium supplements, which is the development of the most common type of kidney stone made from calcium oxalate. 

To mostly quote and sometimes paraphrase an article that appeared in MedlinePlus, here's the latest understanding of the role of calcium in kidney stones.

Scientists knew that getting lots of calcium from foods lowers the likelihood of kidney stones in those most at risk, but thought that it may only be true for calcium in milk.  Well a new study makes clear the benefit isn't just linked to milk products.

So first the good news. In a large new analysis, men and women who consumed the most dietary calcium from foods had about 20 percent lower risk of developing kidney stones than those who consumed the least calcium. The key takeaway is unlike calcium in pill form, don't avoid calcium in food as it is good for you.

"This is another piece of data to suggest that there's no role for dietary calcium restriction for kidney stones," said lead study author Dr. Eric Taylor, a kidney specialist at Maine Medical Center in Portland.  As stated earlier, most stones that form in the kidneys are made of calcium oxalate and past studies have found that eating calcium-rich foods - though not taking calcium supplements - seems to ward off stone formation."

Since most people typically got their calcium primarily from dairy products, "there was lingering doubt about whether some other component of milk might be responsible for the effect." To address this question, Taylor and his colleagues set out to see whether the results held true for calcium from non-dairy foods. To do so, they "analyzed data from three large studies that followed more than one million men and women, sometimes for decades, and included periodic detailed food questionnaires.
The researchers divided those participants into five smaller groups, based on how much calcium they consumed from dairy and other sources over as long as 20 years.

Only participants who were generally healthy and had never suffered from a kidney stone before dietary data collection began were included."

More good news. "For both dairy and non-dairy sources of calcium, people who consumed the most calcium were least likely to develop painful, symptomatic kidney stones - overall, their risk was 77 percent of that seen among people who ate the least calcium, Taylor's team reports in the Journal of Urology....

For non-dairy foods, people who consumed 250 milligrams of calcium a day - the amount in eight ounces of cooked kale or two sardines, for example - were twice as likely to develop a stone as people who got 450 milligrams daily.

Rates of kidney stones in the U.S. translate to the average person having a 6 percent chance of developing a stone during a lifetime. So, in the new study, low calcium consumption doubled that risk to 12 percent."

But here's the kicker. "Because most kidney stones are made of calcium oxalate, it might seem counter-intuitive to consume more calcium and end up with less in your kidneys, but there is theory about why it works...The real culprit is oxalate, not calcium. Oxalate is found in many foods including fruits, vegetables, nuts and chocolate, and calcium binds to it avidly. The more calcium in the digestive tract, she said, the more oxalate it can bind and take out of the body before the oxalate is absorbed into the bloodstream and ends up in the kidneys and bile duct.


Here's the bad news. Many patients don't understand this relationship and cut back on calcium anyway, which actually increases their risk, according to Dr. Mathew Sorensen, a urologist at the University of Washington in Seattle.
"I see patients every week, and most have cut back on their calcium intake," Sorensen told Reuters Health in an email. "It is one of the most important myths in the stones world that needs to be corrected."
Really excessive calcium levels aren't a good idea either, Sorensen said. He recommends patients keep levels moderate, around 1000 to 1200 milligrams per day."

So let's summarize.
1. You need calcium in your diet as it is one of the 15 essential minerals.
2. Dietary calcium binds oxalate in your intestinal tract to reduce oxalate's absorption into your blood stream, which reduces your risk for developing calcium oxalate kidney stones.
3. If you can avoid kidney stones and the sudden and very painful problems they cause, you should absolutely try to do so.
4. It is best to get your calcium from food in reasonable amounts as it is considered safe to get your calcium from dietary sources.
5. While milk and other dairy products are known sources of calcium, there are healthier alternatives such as almond milk, (Silk Brand, Unsweetened, is recommended) to get adequate calcium.
6. Calcium supplements remain a potentially dangerous source of calcium, whether or not taken with magnesium.

If you know of a doctor who continues to recommend calcium supplement pills, please ask him or her to review their information because it is out of date. Maybe you can even educate them. For me, an educated patient is my favorite type.

A Primer on Being Rich and Healthy

In the iconoclastic film, A Fiddler On the Roof, Tevye, the main character, a poor farmer, sings a song titled, If I Were A Rich Man. Some of the stanzas are notable for what they say about Tevye's perception of what it means to be rich.

Foremost, he sings that if he were rich, he "wouldn't have to work hard." Prized among his possessions would be "chicks and turkeys and geese and ducks." These fowls would signify wealth to the other townspeople. Finally, in describing what the wife of a rich man would look like, he says "about his wife, Golde, looking like a rich man's wife, With a proper double-chin. Supervising meals to her heart's delight."

Simply put, to Tevye, being rich means being fat, lounging around, and eating a lot. My, how things have changed.

According to the British Telegraph, a leading London newspaper, "Over the last century – for the first time in history – an odd phenomenon has emerged in developed societies: the richer you are, the more likely you are to be thin. Wallis Simpson nailed the phenomenon several generations ago, when she said, "You can never be too rich or too thin."

George Orwell noticed a related phenomenon in 1937, in The Road to Wigan Pier:

"The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food. A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn't… When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don't want to eat dull, wholesome food. You want something a little bit 'tasty'. There is always some cheaply pleasant thing to tempt you. Let's have three pennorth of chips! Run out and buy us a two-penny ice-cream!"

But the British are not the only ones experiencing this sea of change, As Americans struggle with an obesity epidemic and related illnesses often referred to as "diseases of affluence" such as heart disease, diabetes, and cancer, a paradox has emerged. Today, it appears that it is the truly more affluent who seem to have a better handle on the effects that food has on one's health and are in the position to make better lifestyle choices. Buying organic fresh produce and wild salmon imported from Alaska, balancing work-life demands, taking time to stay physically fit or indulging in a personal trainer or even a gym in your own home seem to be only the domain of the wealthy.

Unlike in ancient times when wealthy landowners and monarchs like Henry the Eighth could satisfy their every gastronomical craving by feasting on the beasts of the land and in turn, develop their characteristic double chins and pompous bellies consistent with their coveted status, the smart money now sees the world differently. Living a healthy lifestyle now seems to cost more, not less. Those with money or those who value health are taking the smart steps to live longer and healthier lives.

It would seem like a disturbing paradox, if it were true, but it's not. The truth is that most anyone can make the choice to avoid fast food and sweets, stay physically fit, work on friendships, etc. Money helps, but it's not the end to end all. Okay, so if you don't have the budget for organic, you will have to eat conventional fruits and vegetables over the pricier stuff. That's not a big deal because they are both equally nutritious. There are always farmer markets and farming cooperatives about that offer fresh produce at affordable prices. Walk whenever you can. Do jumping jacks and sprints if you can't afford a gym membership. Don't believe everything you think is a fact. It's not. Smile more. When people ask you how you are doing, answer absolutely fantastic. Believe it.

Yes, it may be easier to do all these things when you are rich, but don't be fooled for a second that money offers any guarantees. There are still plenty of overweight wealthy people whose money has failed to increase their intelligence or decrease their illnesses. These people, who are none the smarter for their fatter wallets, continue to ignore the daily warnings and consume what they please with reckless disregard to consequences.

So the question for you is simple: Which would you prefer? To be a rich person who can afford to live a healthier lifestyle but chooses not to or a not so rich person who has the smarts to do so? It's not that you can't have both money and smarts, but just recognize what's more important. You see money can't buy you health (doctors don't make you healthy) any more than it can buy you happiness. Whether you have lots of money or not, the most priceless asset will always be your health.

Therefore, please indulge me as I rewrite a few of Tevye's stanzas to reflect how a rich man should really be:

"If I were a rich man,

Ya ha deedle deedle, bubba bubba deedle deedle dum.

All day long I'd biddy biddy bum.

If I were a wealthy man.

I wouldn't have to stop being physically active

Ya ha deedle deedle, bubba bubba deedle deedle dum.

If I were a biddy biddy rich,

Yidle-diddle-didle-didle man.

I'd fill my yard with organic kale, nuts, berries, and avocados

For the town to see and smell.

And each aroma would delight the senses

As if to say "This is what it means to stop and smell the roses like a wealthy man."

If I were a rich man,

Ya ha deedle deedle, bubba bubba deedle deedle dum.

All day long I'd biddy biddy bum.

If I were a wealthy man.

I wouldn't have to stop being physically active.

Ya ha deedle deedle, bubba bubba deedle deedle dum.

If I were a biddy biddy rich,

Yidle-diddle-didle-didle man.

I see my wife, my Golde, looking like a rich man's wife

With a slender figure, positive demeanor, and looking well slept.

Distributing meals to the homeless to her heart's delight.

I see her helping others and bringing joy to those around her.

Oy, what a happy mood she's in.

Laughing with and smiling at people, day and night.

If I were a rich man,

Ya ha deedle deedle, bubba bubba deedle deedle dum.

All day long I'd biddy biddy bum.

If I were a wealthy man.

I wouldn't have to stop being physically active.

Ya ha deedle deedle, bubba bubba deedle deedle dum.

If I were a biddy biddy rich,

Yidle-diddle-didle-didle man.

As far as I'm concerned, the greatest wealth is our health. If you don't believe me, just ask someone with failing health what they would give up to restore their health. Their answer will be priceless.

 

When Is A Medical Study Reliable? It's Getting Harder To Tell.

Whether you are new to my blog or a faithful reader, you should know of one of my favorite made-up Latin sayings, which is Caveat Lector, “Let the reader beware.” You may think my railing against the written word  conveys a certain level of paranoia about the attempts of others to mislead us by giving inaccurate and misleading reports. If so, the old rephrase, “just because you are paranoid, doesn't mean they are not out to get you,” comes to mind.

So it is bittersweet to share an article that appears in today's New York Times, titled Scientific Articles Accepted (Personal Checks, Too). I say bittersweet because it is sweet that I can offer confirmation of the need for one to be circumspect when reviewing scientific studies, and even more diligent when reading stories prefaced on such studies. On the other hand, it is bitter because of the invasion of baseless Journals offering worthless studies that can only further exacerbate the degree of confusion of the average person as to what advice to follow and which to ignore.

The Times article states in reference to scientists being duped into presenting at a conference that feigned legitimacy, “Those scientists had stumbled into a parallel world of pseudo-academia, complete with prestigiously titled conferences and journals that sponsor them. Many of the journals and meetings have names that are nearly identical to those of established, well-known publications and events. 

Steven Goodman, a dean and professor of medicine at Stanford and the editor of the journal Clinical Trials, which has its own imitators, called this phenomenon “the dark side of open access,” the movement to make scholarly publications freely available. 

The number of these journals and conferences has exploded in recent years as scientific publishing has shifted from a traditional business model for professional societies and organizations built almost entirely on subscription revenues to open access, which relies on authors or their backers to pay for the publication of papers online, where anyone can read them.

Open access got its start about a decade ago and quickly won widespread acclaim with the advent of well-regarded, peer-reviewed journals like those published by the Public Library of Science, known as PLoS. Such articles were listed in databases like PubMed, which is maintained by the National Library of Medicine, and selected for their quality.

But some researchers are now raising the alarm about what they see as the proliferation of online journals that will print seemingly anything for a fee [bold added for emphasis]. They warn that non-experts doing online research will have trouble distinguishing credible research from junk [bold added for emphasis]. “Most people don’t know the journal universe,” Dr. Goodman said. “They will not know from a journal’s title if it is for real or not.”

One ambitious soul has taken to creating a list of dubious journals. According to the Times, "Jeffrey Beall, a research librarian at the University of Colorado in Denver, has developed his own blacklist of what he calls “predatory open-access journals.” There were 20 publishers on his list in 2010, and now there are more than 300. He estimates that there are as many as 4,000 predatory journals today, at least 25 percent of the total number of open-access journals.”

Folks, it is getting tough out there for credentialed scientists and legitimate doctors to know which Journals to trust. I can only imagine the pain for those less educated. The proliferation of misinformation is growing, creating a crisis of confidence regarding reliable scientific studies, even for the more savvy among us.

One of the readers of my blog, named Helen, likes to respond every so often to something I wrote.  She will often share what she believes to be "facts.” She is undoubtedly an avid reader because she will commonly refer to one source of information or another.  Try as I may to convince her that the facts she offers are often inaccurate, that her sources may be questionable, and therefore her information, unreliable, she insists that she is right and our disagreement is merely a difference of opinion.  I hope the story in the Times sounds a cautionary alarm for Helen that just because someone publishes something somewhere, it doesn't mean it is reliable. 

For the rest of my readers, I promise that I will try to stick to the facts. I say that with the caveat that it is getting harder to know what the facts are when misinformation seems to be dropping like bombs during a blitzkrieg.  So Helen if you are reading this, stop pretending that you know "the facts” because you read them somewhere on the internet. To paraphrase Mark Twain, “don't take advice from a health website, you could die from a misprint.”