An allergy is an inappropriate response by the body’s immune system to a substance that is not normally harmful. The immune system is the highly complex defenses mechanism that helps us combat infection. It does this by identify “foreign invaders” and mobilizing the body’s white blood cells to fight them. In some people, the immune system wrongly identifies a nontoxic substance as an invader and the white blood cells overreact and do more damage to the body than the invader. This the allergic response become a disease itself. Common responses are nasal congestion, coughing wheezing itching, hive and other skin rashes, headache and fatigue.
No one know why some people are allergic to certain substance however, allergies do run in families and it is also believe that babies are either re not breastfed are more likely to develop allergies. There may be an emotional cause to the problem as well, stress and anger, especially if the immune system is not function properly, are frequently contributing factors.
Food Allergy Self-Test
If you suspect that you are allergic to a specific food, a simple test can help you determine if you are correct. By recording your pulse rate after consuming the food in question, you can reveal if you are having an allergic reaction. Using a watch with a second hand, sit down and relax for a few minutes. When relaxed take your pulse at the wrist. A normal pulse reading is between 52 to 70 beats per minute. After taking your pulse, consume the food that you are testing for an allergic reaction. Wait fifteen to twenty minutes and take your pulse again. If your pulse rate has increase more than ten beats per minute omit this food from your diet for one month, and then re-test yourself.
For the purpose of this test, it is best to use the purest form of the suspect food available. This way you will know that whatever reaction you observe (or fail to observe) it is the responsibility of the food you consumed, and not the by-products that may have also been in the food.
There are several supplements that we recommend to help overcome food and seasonal allergies. If you suffer with allergies, talk to Dr. Mays and he can recommend what can help you.
Find more information about chiropractic and allergies @
www.oakhollowchiro.com
Monday, May 29, 2006
Soft Drinks Increase Weight, Linked to Type 2 Diabetes
The incidence of diabetes has risen sharply in the past several decades, paralleling the obesity epidemic. At the same time, soft drink consumption has seen a 61 percent increase in adults from 1977-97, and a 100 percent increase in children from 1977-78 to 1994-98. Researchers believe that in addition to contributing to obesity, sugar-sweetened soft drinks may increase diabetes risk by raising blood glucose levels due to their high concentration of high-fructose corn syrup.
Researchers performed separate analyses of diabetes and weight change on women participating in the Nurses’ Health Study II between 1991-1999. Women in the diabetes analysis were free of diabetes and other major chronic diseases at baseline. Anyone reporting a diagnosis of diabetes on a biennial questionnaire was sent a second questionnaire asking about diagnosis and treatment for the condition, and to distinguish between type 1 and type 2. Women in the weight change analysis were evaluated at baseline and in 1995 and 1999, providing complete dietary information, including soft drink consumption and weight.
Results: Women who reported an increased intake of sugar-sweetened soft drinks between 1991 and 1999 had significantly larger increases in weight and body mass index (BMI) than women who maintained their intake or who substantially decreased their intake. Greater soft drink consumption over that time period was also strongly associated with a progressively higher risk of developing type 2 diabetes. The association of soft-drink consumption to diabetes was significant even when weight gain and increases in BMI were taken into account.
According to the authors, higher consumption of sugar-sweetened beverages may increase the risk for type 2 diabetes by providing excessive calories and large amounts of rapidly absorbable sugars. The researchers also recommend that "public health strategies to prevent obesity and type 2 diabetes should focus on reducing sugar-sweetened beverage consumption."
Ditch the soda pop! To quench your thirst, try a glass of iced water with a slice of lemon or lime instead.
Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association, Aug. 25, 2004;292(8):927-34.
Researchers performed separate analyses of diabetes and weight change on women participating in the Nurses’ Health Study II between 1991-1999. Women in the diabetes analysis were free of diabetes and other major chronic diseases at baseline. Anyone reporting a diagnosis of diabetes on a biennial questionnaire was sent a second questionnaire asking about diagnosis and treatment for the condition, and to distinguish between type 1 and type 2. Women in the weight change analysis were evaluated at baseline and in 1995 and 1999, providing complete dietary information, including soft drink consumption and weight.
Results: Women who reported an increased intake of sugar-sweetened soft drinks between 1991 and 1999 had significantly larger increases in weight and body mass index (BMI) than women who maintained their intake or who substantially decreased their intake. Greater soft drink consumption over that time period was also strongly associated with a progressively higher risk of developing type 2 diabetes. The association of soft-drink consumption to diabetes was significant even when weight gain and increases in BMI were taken into account.
According to the authors, higher consumption of sugar-sweetened beverages may increase the risk for type 2 diabetes by providing excessive calories and large amounts of rapidly absorbable sugars. The researchers also recommend that "public health strategies to prevent obesity and type 2 diabetes should focus on reducing sugar-sweetened beverage consumption."
Ditch the soda pop! To quench your thirst, try a glass of iced water with a slice of lemon or lime instead.
Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association, Aug. 25, 2004;292(8):927-34.
Back Surgery May Be Worse Than No Surgery
Are you considering surgery for your back pain? Before you do, consider this: Research shows that many patients who undergo surgery for lower back pain often have subsequent surgeries for the same condition due to the failure of the initial procedure, which can contribute to further patient disability. Researchers sought to examine whether such patients had poorer general health than those with no history of spine surgery.
The study examined more than 18,000 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 through April 2000. Of those patients, 3,632 had a history of low back surgery. Data were derived from a first-visit questionnaire and the Short Form Health Survey (SF-36), both of which were completed by all patients when first evaluated for back pain.
Results showed that patients with a history of lumbar spine surgery fared significantly worse on areas such as physical functioning, general health and mental health compared to those patients with no prior history of spine surgery. "Previous back surgery is associated with significantly worse general health status than those without surgery among patients with low back pain..." the researchers wrote, further noting that "active rehabilitation intervention strategies designed to improve physical and mental well-being should be promoted, as they could have an impact on enhancing positive health outcomes."
If you suffer from low back pain -- or any kind of pain, for that matter -- think twice before considering surgery. Instead, consult your doctor of chiropractic for a treatment plan that will not only help reduce your pain but preserve your general health for the long term.
Hee HT, Whitecloud III TS, Myers L. The effect of previous low back surgery on general health status. Spine, Sept. 1, 2004;29(17):1931-7.
The study examined more than 18,000 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 through April 2000. Of those patients, 3,632 had a history of low back surgery. Data were derived from a first-visit questionnaire and the Short Form Health Survey (SF-36), both of which were completed by all patients when first evaluated for back pain.
Results showed that patients with a history of lumbar spine surgery fared significantly worse on areas such as physical functioning, general health and mental health compared to those patients with no prior history of spine surgery. "Previous back surgery is associated with significantly worse general health status than those without surgery among patients with low back pain..." the researchers wrote, further noting that "active rehabilitation intervention strategies designed to improve physical and mental well-being should be promoted, as they could have an impact on enhancing positive health outcomes."
If you suffer from low back pain -- or any kind of pain, for that matter -- think twice before considering surgery. Instead, consult your doctor of chiropractic for a treatment plan that will not only help reduce your pain but preserve your general health for the long term.
Hee HT, Whitecloud III TS, Myers L. The effect of previous low back surgery on general health status. Spine, Sept. 1, 2004;29(17):1931-7.
Saturday, May 27, 2006
When It Is Best to Buy Organic
If ever there were a time to splurge on organic produce, it is when you are buying strawberries. The reason? The scarlet beauties lack a rind or peel that can protect against pesticides. What's more, their porous surface allows chemicals to penetrate the flesh, so you cannot just scrub them clean. No organic strawberries nearby? You can still enjoy the juicy gems worry-free. Simply soak them in a solution of one pint water and 1/4 tsp. dish detergent for a half hour, then rinse. The detergent will ot affect the flavor, but the cleansing agents will neutralize any pesticide residue so you can savor the berries without a care.
UC DAVIS STUDY WITH MICE LINKS THIMEROSAL
Sacramento, Calif.) – A team of cell biologists, toxicologists and molecular bioscientists at the University of California, Davis, has published a study connecting thimerosal with disruptions in antigen-presenting cells known as dendritic cells obtained from mice. The study provides the first evidence that dendritic cells show unprecedented sensitivity to thimerosal, resulting in fundamental changes in the immune system’s ability to respond to external factors. The study was published online today and will be available in the July print edition of Environmental Health Perspectives, the peer-reviewed scientific publication of the National Institute of Environmental Health Sciences.
“This is the first time that thimerosal has been shown to selectively alter the normal functions of dendritic cells,” said Isaac Pessah, a toxicologist with the UC Davis School of Veterinary Medicine, director of the Children’s Center for Environmental Health and Disease Prevention and senior author of the study. “Dendritic cells play pivotal roles in overcoming viral and bacterial invaders by coordinating the immune system’s overall combat response.” One dendritic cell can activate as many as 300 T-cells – white blood cells that help find and kill external agents that attack the immune system – making them the most effective immune system activators.
The study shows how intricate connections between calcium channels in dendritic cells change when exposed to thimerosal. “The slightest fluctuation in how calcium channels ‘communicate’ can alter the growth, maturation and activation of dendritic cells,” explained Pessah. “Thimerosal dramatically alters how two key calcium channels, code-named RyR1 and IP3R1, found in dendritic cells function as a team by ‘garbling’ the normal signaling system between them.”
When thimerosal at a concentration as low as 20 parts per billion alters the fidelity of normal calcium signals, dendritic cells show abnormal secretion of IL-6 cytokine – a potent chemical signal that initiates inflammatory responses. Higher concentrations – 200 parts per billion – causes programmed death of dendritic cells, preventing them from maturing and doing their primary job of activating T-cells. Without proper feedback to guide its response, a normal dendritic cell can quickly become “a rogue, producing misinformation that could activate aberrant and harmful immune responses,” Pessah explained. “Even one rogue dendritic cell can activate many inappropriate immune responses.”
The research team conducted the study on cells cultured from a strain of mouse not particularly susceptible to immune dysregulation. Using fluorescent stains and powerful microscopes to study both immature and mature dendritic cells from bone marrow cultured under normal physiological conditions, the researchers discovered that extremely small levels of thimerosal interfere significantly with calcium channel function after just a few minutes of exposure. They also observed that immature dendritic cells are particularly sensitive to thimerosal.
Thimerosal is a cheap and effective mercury-based preservative. Its potential effects on embryonic neuron development led to its removal from many pediatric vaccines, however it is still used in influenza, diphtheria and tetanus vaccines, blood products and many over-the-counter pharmaceuticals. The concentrations of thimerosal used by the UC Davis researchers were comparable to those attained in childhood vaccinations containing the preservative.
Researchers and parents have previously proposed links between childhood vaccines and autism, a neurodevelopmental disorder that affects language skills and social interactions. In addition to being a direct neurotoxicant, the UC Davis study indicates that thimerosal may also be an immunotoxicant, leaving the immune system vulnerable to microbes and other external influences.
“Our findings do not directly implicate thimerosal as a single causative agent for triggering neurodevelopmental disorders such as autism,” Pessah said. “There is growing evidence that autism is several disorders that we now refer to as just one. There is also growing evidence that some children with autism have unique immune cell composition and responses to antigens. The results of our work provide a framework to test the hypothesis that the genetic background of some individuals may render them especially susceptible to thimerosal.”
Other experts also advise drawing no final conclusions regarding thimerosal and autism based on these outcomes.
“These findings should be interpreted cautiously. Although they suggest that thimerosal may affect dendritic cell function, the pathophysiological consequences of thimerosal remain unclear,” said David A. Schwartz, a physician and director of the National Institute of Environmental Health Sciences.
Since cell functions can differ across organisms, Pessah will next study dendritic cells isolated from the blood of children with and without autism to confirm if the intercellular changes are the same in humans. The initial mouse study was funded by the National Institute of Environmental Health Sciences and the UC Davis M.I.N.D. Institute. Joining Pessah on the scientific team were molecular bioscientists Samuel R. Goth, Ruth A. Chu and Gennady Cherednichenko and pathologist Jeffrey P. Gregg.
A copy of “Uncoupling of ATP-mediated Calcium Signaling and Dysregulated IL-6 Secretion in Dendritic Cells by Nanomolar Thimerosal” can be downloaded at http://www.ehponline.org/docs/2006/8881/abstract.html.
“This is the first time that thimerosal has been shown to selectively alter the normal functions of dendritic cells,” said Isaac Pessah, a toxicologist with the UC Davis School of Veterinary Medicine, director of the Children’s Center for Environmental Health and Disease Prevention and senior author of the study. “Dendritic cells play pivotal roles in overcoming viral and bacterial invaders by coordinating the immune system’s overall combat response.” One dendritic cell can activate as many as 300 T-cells – white blood cells that help find and kill external agents that attack the immune system – making them the most effective immune system activators.
The study shows how intricate connections between calcium channels in dendritic cells change when exposed to thimerosal. “The slightest fluctuation in how calcium channels ‘communicate’ can alter the growth, maturation and activation of dendritic cells,” explained Pessah. “Thimerosal dramatically alters how two key calcium channels, code-named RyR1 and IP3R1, found in dendritic cells function as a team by ‘garbling’ the normal signaling system between them.”
When thimerosal at a concentration as low as 20 parts per billion alters the fidelity of normal calcium signals, dendritic cells show abnormal secretion of IL-6 cytokine – a potent chemical signal that initiates inflammatory responses. Higher concentrations – 200 parts per billion – causes programmed death of dendritic cells, preventing them from maturing and doing their primary job of activating T-cells. Without proper feedback to guide its response, a normal dendritic cell can quickly become “a rogue, producing misinformation that could activate aberrant and harmful immune responses,” Pessah explained. “Even one rogue dendritic cell can activate many inappropriate immune responses.”
The research team conducted the study on cells cultured from a strain of mouse not particularly susceptible to immune dysregulation. Using fluorescent stains and powerful microscopes to study both immature and mature dendritic cells from bone marrow cultured under normal physiological conditions, the researchers discovered that extremely small levels of thimerosal interfere significantly with calcium channel function after just a few minutes of exposure. They also observed that immature dendritic cells are particularly sensitive to thimerosal.
Thimerosal is a cheap and effective mercury-based preservative. Its potential effects on embryonic neuron development led to its removal from many pediatric vaccines, however it is still used in influenza, diphtheria and tetanus vaccines, blood products and many over-the-counter pharmaceuticals. The concentrations of thimerosal used by the UC Davis researchers were comparable to those attained in childhood vaccinations containing the preservative.
Researchers and parents have previously proposed links between childhood vaccines and autism, a neurodevelopmental disorder that affects language skills and social interactions. In addition to being a direct neurotoxicant, the UC Davis study indicates that thimerosal may also be an immunotoxicant, leaving the immune system vulnerable to microbes and other external influences.
“Our findings do not directly implicate thimerosal as a single causative agent for triggering neurodevelopmental disorders such as autism,” Pessah said. “There is growing evidence that autism is several disorders that we now refer to as just one. There is also growing evidence that some children with autism have unique immune cell composition and responses to antigens. The results of our work provide a framework to test the hypothesis that the genetic background of some individuals may render them especially susceptible to thimerosal.”
Other experts also advise drawing no final conclusions regarding thimerosal and autism based on these outcomes.
“These findings should be interpreted cautiously. Although they suggest that thimerosal may affect dendritic cell function, the pathophysiological consequences of thimerosal remain unclear,” said David A. Schwartz, a physician and director of the National Institute of Environmental Health Sciences.
Since cell functions can differ across organisms, Pessah will next study dendritic cells isolated from the blood of children with and without autism to confirm if the intercellular changes are the same in humans. The initial mouse study was funded by the National Institute of Environmental Health Sciences and the UC Davis M.I.N.D. Institute. Joining Pessah on the scientific team were molecular bioscientists Samuel R. Goth, Ruth A. Chu and Gennady Cherednichenko and pathologist Jeffrey P. Gregg.
A copy of “Uncoupling of ATP-mediated Calcium Signaling and Dysregulated IL-6 Secretion in Dendritic Cells by Nanomolar Thimerosal” can be downloaded at http://www.ehponline.org/docs/2006/8881/abstract.html.
Wednesday, May 17, 2006
Relieving Back Pain the Natural Way
Back pain is the leading reason people seek out the services of a doctor of chiropractic for care. While spinal adjustments are the most popular method chiropractors use to treat back pain, they are by no means the only method. A review published by The Cochrane Collaboration has found that three herbs - devil's claw, white willow bark and cayenne - also are effective in treating low back pain, and that in some instances, they work just as well as prescription drugs.
In the review, scientists examined 10 other studies involving more than 1,500 people who suffered from acute, subacute or chronic low back pain. The review showed "strong evidence" that a 60 milligram daily dose of devil's claw was more effective than a placebo in the relief of back pain, and appeared to reduce back pain as much as a 12.5-milligram dose of Vioxx, a painkiller that was recently taken off of the market due to a number of adverse side-effects. A 240 milligram daily dose of white willow bark also had the same effect as a 12.5 milligram dose of Vioxx. Cayenne, which was tested as a type of plaster applied to the skin, reduced pain more than a placebo, and was just as effective as Spiroflor, a popular homeopathic gel.
Of course, it's important to note that while these herbs appear to be effective in treating back pain, they are not entirely without some side-effects of their own, at least in certain circumstances. Devil's claw, for instance, may cause an upset stomach, while white willow bark can reduce the effectiveness of blood-thinning medications. As such, people who are taking blood thinners or are sensitive to certain herbs may want to seek out other natural forms of back pain relief -- such as an adjustment from their chiropractor!
Gagnier JJ, van Tulder M, Berman B, et al. Herbal medicine for low back pain. The Cochrane Database of Systematic Reviews 2006, Issue 2. Article #CD004504. DOI: 10.1002/14651858.CD004504.pub3.
In the review, scientists examined 10 other studies involving more than 1,500 people who suffered from acute, subacute or chronic low back pain. The review showed "strong evidence" that a 60 milligram daily dose of devil's claw was more effective than a placebo in the relief of back pain, and appeared to reduce back pain as much as a 12.5-milligram dose of Vioxx, a painkiller that was recently taken off of the market due to a number of adverse side-effects. A 240 milligram daily dose of white willow bark also had the same effect as a 12.5 milligram dose of Vioxx. Cayenne, which was tested as a type of plaster applied to the skin, reduced pain more than a placebo, and was just as effective as Spiroflor, a popular homeopathic gel.
Of course, it's important to note that while these herbs appear to be effective in treating back pain, they are not entirely without some side-effects of their own, at least in certain circumstances. Devil's claw, for instance, may cause an upset stomach, while white willow bark can reduce the effectiveness of blood-thinning medications. As such, people who are taking blood thinners or are sensitive to certain herbs may want to seek out other natural forms of back pain relief -- such as an adjustment from their chiropractor!
Gagnier JJ, van Tulder M, Berman B, et al. Herbal medicine for low back pain. The Cochrane Database of Systematic Reviews 2006, Issue 2. Article #CD004504. DOI: 10.1002/14651858.CD004504.pub3.
Monday, May 15, 2006
Say "Yes" to Exercise, "No" to Surgery for Shoulder Injury
Shoulder injuries are common and often referred for treatment through surgical means. Researchers compared surgery vs. exercise training in patients suffering from shoulder pain to determine which has the more positive outcome. Shoulder pain in this study was defined as rotator cuff disease and nerve impingement.
Eighty-four participants were randomized into a surgical intervention group (41 patients) or physiotherapeutic exercise group (43 patients). All patients were evaluated before intervention and filled out a questionnaire regarding pain and impairment. The exercise group received 19, 60-minute sessions consisting of the application of heat, cold packs, or soft-tissue treatments, followed by muscle training and rotator cuff strengthening exercises.
Results: Both groups were evaluated at three, six and 12 months. Pain was measured using the Constant score totaling 100, which includes pain measured on a visual analogue scale, as well as measures in daily activity limitations, range of motion and shoulder strength. Before intervention, the exercise group Constant score was 34.8, while the surgery group was 33.7. After intervention, the exercise group Constant score improved to 54.8, 55.5, and 57.0 after three, six and 12 months, respectively, while the surgery group’s scores were 49.2, 53.8 and 52.7. After one year, 20 participants (10 in each group) reported a score of 80 or higher.
Although the researchers note some study limitations, they ultimately concluded that they "are now more reluctant to recommend surgery" for shoulder impingement.
Reference: Haahr JP, Østergaard S, Dalsgaard J, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis 2005;64:760-764.
Eighty-four participants were randomized into a surgical intervention group (41 patients) or physiotherapeutic exercise group (43 patients). All patients were evaluated before intervention and filled out a questionnaire regarding pain and impairment. The exercise group received 19, 60-minute sessions consisting of the application of heat, cold packs, or soft-tissue treatments, followed by muscle training and rotator cuff strengthening exercises.
Results: Both groups were evaluated at three, six and 12 months. Pain was measured using the Constant score totaling 100, which includes pain measured on a visual analogue scale, as well as measures in daily activity limitations, range of motion and shoulder strength. Before intervention, the exercise group Constant score was 34.8, while the surgery group was 33.7. After intervention, the exercise group Constant score improved to 54.8, 55.5, and 57.0 after three, six and 12 months, respectively, while the surgery group’s scores were 49.2, 53.8 and 52.7. After one year, 20 participants (10 in each group) reported a score of 80 or higher.
Although the researchers note some study limitations, they ultimately concluded that they "are now more reluctant to recommend surgery" for shoulder impingement.
Reference: Haahr JP, Østergaard S, Dalsgaard J, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis 2005;64:760-764.
Headache Relief With Regular Chiropractic Care
Nobody likes headaches. They can strike with little warning and cause debilitating pain -- especially cervicogenic headaches (HA), which are defined as pain that originates in the cervical spine, or neck area, and refers up to the head.
Researchers investigated the effect of chiropractic treatment on HA in 20 randomized patients, specifically focusing on the relationship between the number of chiropractic treatments and pain relief. Participants were assigned to one of three treatment groups for comparison: Group one received a total of three office visits, one visit per week, for chiropractic manipulation; group two received a total of nine office visits, three visits per week, for chiropractic manipulation; and group three received 12 total visits, four visits per week.
Researchers discovered a correlation between the number of chiropractic visits and positive outcome in headache patients. "For HA pain, substantial differences were found between participants receiving 1 treatment per week and those receiving either 3 or 4 treatments per week," the researchers wrote. The researchers indicated that a larger clinical trial testing the relationship of HA and chiropractic treatment is warranted, and concluded that there are benefits to "9 to 12 [chiropractic] visits over 3 weeks for the treatment of HA/neck pain and disability. A larger number of visits than 12 in 3 weeks may be required for maximum relief and durability of outcomes."
If you suffer from headaches, your doctor of chiropractic can help. Make an appointment for a chiropractic evaluation today.
Reference: Haas M, Groupp E, Aickin M, et al. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. JMPT 2004;27(9):547-553.
Researchers investigated the effect of chiropractic treatment on HA in 20 randomized patients, specifically focusing on the relationship between the number of chiropractic treatments and pain relief. Participants were assigned to one of three treatment groups for comparison: Group one received a total of three office visits, one visit per week, for chiropractic manipulation; group two received a total of nine office visits, three visits per week, for chiropractic manipulation; and group three received 12 total visits, four visits per week.
Researchers discovered a correlation between the number of chiropractic visits and positive outcome in headache patients. "For HA pain, substantial differences were found between participants receiving 1 treatment per week and those receiving either 3 or 4 treatments per week," the researchers wrote. The researchers indicated that a larger clinical trial testing the relationship of HA and chiropractic treatment is warranted, and concluded that there are benefits to "9 to 12 [chiropractic] visits over 3 weeks for the treatment of HA/neck pain and disability. A larger number of visits than 12 in 3 weeks may be required for maximum relief and durability of outcomes."
If you suffer from headaches, your doctor of chiropractic can help. Make an appointment for a chiropractic evaluation today.
Reference: Haas M, Groupp E, Aickin M, et al. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. JMPT 2004;27(9):547-553.
Saturday, May 13, 2006
Using an Electric Toothbrush May Improve Oral Hygiene
You brush three times a day, floss after every meal, and see your dentist twice yearly, but if you aren't using an electric toothbrush, you might be cheating yourself. A recent review of several studies shows that some electric toothbrushes might help reduce plaque by 11 percent and gingivitis by 17 percent over manual toothbrushes.
The review included 42 studies and 3,855 participants, which compared manual, electric and battery-powered toothbrushes with various types of bristle arrangements and motions. The review of the literature concluded that regular brushing with powered toothbrushes containing circular bristle heads that rotate in alternating directions were better at removing plaque and reducing the risk of gum disease than brushing with manual toothbrushes alone.
Although electric toothbrushes may help reduce incidences of plaque and gingivitis, the researchers emphasize the importance of regular brushing "whether the brush is manual or powered" and further indicate that "the results of this review do not indicate that toothbrushing is only worthwhile with a powered toothbrush."
Reference: Robinson P et al. Manual versus powered toothbrushing for oral health. The Cochrane Database of Systematic Reviews 2005, Issue 2.
Yogurt Consumption Helps Reduce Weight, Body Fat
Recent studies have shown that calcium intake plays a role in weight loss, especially when the source of calcium comes from dairy products. To further assess this, researchers studied 38 otherwise healthy obese adults to determine if yogurt would induce calorie restriction, thereby accelerating weight and fat loss.
Study subjects were randomized into two outpatient regimented dietary groups for a period of 12 weeks. The yogurt-diet group's food intake consisted of 500 fewer calories per day than assessed at baseline; three 6-ounce servings of fat-free yogurt; and a calcium intake of 1,100 mg per day. The control group's diet consisted of 500 fewer calories per day than assessed at baseline; 0-1 servings of dairy products per day; 400-500 mg of calcium per day; and three servings of a sugar- and calcium-free, prepackaged flavored gelatin, as placebo. In both groups, calcium came from food sources. Body weight, body fat, fat distribution, blood pressure and circulating lipids were measured at baseline and at the conclusion of the 12-week study.
The researchers found that "all participants lost body weight and body fat due to the daily energy deficit of 500 kcal/day. However, both weight and fat loss were significantly increased by the yogurt diet compared to the control diet." The researchers note that lean tissue loss was reduced by 31 percent on the yogurt diet, while trunk fat loss was augmented by 81 percent on the yogurt diet vs. the control diet, resulting in "a markedly greater reduction in waist circumference," and the amount of fat lost from the trunk was higher in those on the yogurt diet.
Reference: Zemel MB, Richards J, Milstead A, et al. Dairy augmentation of total and central fat loss in obese subjects. International Journal of Obesity 2005;29:391-397.
Study subjects were randomized into two outpatient regimented dietary groups for a period of 12 weeks. The yogurt-diet group's food intake consisted of 500 fewer calories per day than assessed at baseline; three 6-ounce servings of fat-free yogurt; and a calcium intake of 1,100 mg per day. The control group's diet consisted of 500 fewer calories per day than assessed at baseline; 0-1 servings of dairy products per day; 400-500 mg of calcium per day; and three servings of a sugar- and calcium-free, prepackaged flavored gelatin, as placebo. In both groups, calcium came from food sources. Body weight, body fat, fat distribution, blood pressure and circulating lipids were measured at baseline and at the conclusion of the 12-week study.
The researchers found that "all participants lost body weight and body fat due to the daily energy deficit of 500 kcal/day. However, both weight and fat loss were significantly increased by the yogurt diet compared to the control diet." The researchers note that lean tissue loss was reduced by 31 percent on the yogurt diet, while trunk fat loss was augmented by 81 percent on the yogurt diet vs. the control diet, resulting in "a markedly greater reduction in waist circumference," and the amount of fat lost from the trunk was higher in those on the yogurt diet.
Reference: Zemel MB, Richards J, Milstead A, et al. Dairy augmentation of total and central fat loss in obese subjects. International Journal of Obesity 2005;29:391-397.
Friday, May 12, 2006
Childhood Weight May Predice Weight in Adulthood
It's no secret that obesity in America has reached epidemic proportions. Now, new research shows that children between the ages of 8-15 who are in the upper half of their normal weight range are more likely to become overweight or obese young adults than their leaner counterparts.
Researchers recorded the height, weight and blood pressure of 314 Massachusetts children, ages 8-15 years old at baseline, between 1978 and 1981. These values were measured in the same participants eight to 12 years later at follow-up. Participants averaged a mean body mass index (BMI) of 20 kg/m2 at the first childhood visit, with a "prevalence of at risk for overweight or overweight at the first childhood visit [at] 34 percent for girls and 32 percent for boys."
At follow-up, 48.3 percent of the boys and 23.5 percent of the girls were overweight or obese. High blood pressure was more prominent among the boys (12.3 percent) than girls (1.9 percent), as well. According to the authors, "children with a BMI between the national 85th and 95th percentiles for age and gender were classified as at risk for overweight, and those with a BMI > 95th percentile were classified as overweight." The authors considered BMI between the 50th and 84th percentile to be at the high end of a normal weight range.
The researchers concluded, "Although very lean children are unlikely to become overweight adults, we observed that children in the upper end of the healthy weight range (e.g., 50th to 84th percentiles) are at an elevated risk of becoming overweight or obese. Furthermore, boys in the upper end of the healthy weight range are at an increased risk of becoming hypertensive. These findings suggest that future interventions to prevent adult obesity and its complications should include not only overweight children but also children and adolescents as low as the 50th percentile of BMI for age and gender."
Reference: Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obesity Research Jan 2005;13(1):163-69.
Researchers recorded the height, weight and blood pressure of 314 Massachusetts children, ages 8-15 years old at baseline, between 1978 and 1981. These values were measured in the same participants eight to 12 years later at follow-up. Participants averaged a mean body mass index (BMI) of 20 kg/m2 at the first childhood visit, with a "prevalence of at risk for overweight or overweight at the first childhood visit [at] 34 percent for girls and 32 percent for boys."
At follow-up, 48.3 percent of the boys and 23.5 percent of the girls were overweight or obese. High blood pressure was more prominent among the boys (12.3 percent) than girls (1.9 percent), as well. According to the authors, "children with a BMI between the national 85th and 95th percentiles for age and gender were classified as at risk for overweight, and those with a BMI > 95th percentile were classified as overweight." The authors considered BMI between the 50th and 84th percentile to be at the high end of a normal weight range.
The researchers concluded, "Although very lean children are unlikely to become overweight adults, we observed that children in the upper end of the healthy weight range (e.g., 50th to 84th percentiles) are at an elevated risk of becoming overweight or obese. Furthermore, boys in the upper end of the healthy weight range are at an increased risk of becoming hypertensive. These findings suggest that future interventions to prevent adult obesity and its complications should include not only overweight children but also children and adolescents as low as the 50th percentile of BMI for age and gender."
Reference: Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obesity Research Jan 2005;13(1):163-69.
Thursday, May 11, 2006
Caffeine Increases Risk for Chronic Daily Headache
Before your reach for your next "cup-o'-jo," consider the consequences of excessive caffeine consumption. Caffeine has been shown to cause withdrawal headache, which may contribute to the development of chronic daily headache (CDH), or headache occurring at least 15 days per month.
To confirm such a hypothesis, researchers recruited population-cases and control subjects from three U.S. metropolitan areas as part of a study designed to address caffeine’s potential involvement in CDH. Control subjects reported two to 104 headache days annually (average: 30 days), while population-cases reported 180 or more headache days per year (average: 260 days). Current and past caffeine consumption was assessed by way of self-report.
Results: High caffeine exposure, defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter medication as a headache treatment, was associated with onset of CDH. Approximately one-fourth of case subjects reported taking pain medication of any type daily for headache in the previous three months.
According to the authors, “High medicinal or dietary caffeine consumption at the time of CDH onset (e.g., pre-CDH consumption) was a modest risk factor for CDH onset. Secondary analyses revealed that pre-CDH caffeine consumption might be an initiating factor in a subset of CDH sufferers, with the high-risk groups being women and those younger than age 40."
Still need a "pick-me-up" in the morning, but want to wean off caffeine? Try drinking green tea instead, which contains substantially less caffeine than coffee and has been shown to have a host of health benefits, including antioxidant and anti-cancer properties.
Reference: Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. A population-based study. Neurology, Dec. 14, 2004;63(11):2022-27.
To confirm such a hypothesis, researchers recruited population-cases and control subjects from three U.S. metropolitan areas as part of a study designed to address caffeine’s potential involvement in CDH. Control subjects reported two to 104 headache days annually (average: 30 days), while population-cases reported 180 or more headache days per year (average: 260 days). Current and past caffeine consumption was assessed by way of self-report.
Results: High caffeine exposure, defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter medication as a headache treatment, was associated with onset of CDH. Approximately one-fourth of case subjects reported taking pain medication of any type daily for headache in the previous three months.
According to the authors, “High medicinal or dietary caffeine consumption at the time of CDH onset (e.g., pre-CDH consumption) was a modest risk factor for CDH onset. Secondary analyses revealed that pre-CDH caffeine consumption might be an initiating factor in a subset of CDH sufferers, with the high-risk groups being women and those younger than age 40."
Still need a "pick-me-up" in the morning, but want to wean off caffeine? Try drinking green tea instead, which contains substantially less caffeine than coffee and has been shown to have a host of health benefits, including antioxidant and anti-cancer properties.
Reference: Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. A population-based study. Neurology, Dec. 14, 2004;63(11):2022-27.
To Fall or Not to Fall: That is the Question
Did you know that in-home injuries kill approximately 30,000 people in the United States each year and that one-third of home-injury fatalities are related to falls? Senior citizens are often most vulnerable to falls because balance and mobility decline as we age, but most of the time falls can be prevented.
The March issue of the Mayo Clinic Women's HealthSource newsletter highlights several precautions that can be taken in the home to avoid potentially fatal falls. These include keeping all areas of the home well lit, installing nightlights and having a flashlight available in the event of a power outage; arranging furniture to allow for easy movement; keeping porch steps and walkways in good repair; securing rugs and flooring with slip-resistant backing, and removing small throw rugs; ensuring that stairways are equipped with nonskid surfaces; and installing bars in the bathroom and shower, as well as using nonskid mats in the tub.
Falls are not a necessary part of aging! By taking a few precautions, most falls can be prevented and your home will be a safer place.
Reference: Press release. Tips to avoid falls at home. Newswise. March 11, 2005. www.newswise.com.
Saturday, May 06, 2006
Tai Chi for Health
Tai chi is an ancient practice that combines breathing techniques, meditation and body movements performed in slow-motion. Although first taught as a form of self-defense, tai chi is now practiced by millions of people worldwide as a means of reducing stress, promoting balance and flexibility, and enhancing well-being.
A recent study examined the role tai chi can play in treating heart failure. In the trial, 30 patients with chronic stable heart failure (average age 64) were randomized to receive either "usual care" (consisting of drug therapy and diet/exercise counseling), or usual care plus 12 weeks of tai chi training. Tai chi training consisted of a one-hour tai chi class held twice weekly. To measure changes between groups, the researchers incorporated a variety of tests, including a quality of life questionnaire and an exercise capacity test.
At the end of 12 weeks, patients in the tai chi group had significantly improved quality of life scores compared to the usual care-only group (an average of 25 points higher among tai chi patients). In addition, patients in the tai chi group were able to walk longer distances without difficulty, and had lower levels of B-type natriuretic peptides (an indicator of heart failure) than usual care-only patients. The researchers concluded that tai chi "may be a beneficial adjunctive treatment that enhances quality of life and functional capacity in patients with chronic heart failure who are already receiving standard medical therapy."
Reference: Yeh GY, Wood MJ, Lorell BH, et al. Effects of tai chi mind-body movement therapy on functional status on exercise capacity in patients with chronic heart failure: a randomized controlled trial. American Journal of Medicine Oct. 15, 2004;117(8):541-548.
Friday, May 05, 2006
Natural Relief for Anxiety
RECOMMENDED READING: Keeping you aware of the latest resources that will provide the information you need to make wise decisions about your health.
This month's featured title is Natural Relief for Anxiety by Edmund J. Bourne, PhD, et. al. Natural Relief for Anxiety explores the whole bodyÕs response to stress in a down-to-earth, nonjudgmental way, and describes how relief from mild to moderate anxiety can be achieved through holistic means. The text emphasizes how specific physical and lifestyle factors take their toll on the body, which can subsequently result in anxiety, and describes how the elimination of such factors can lead to peace of mind, mental clarity, and physical and emotional wellness.
Click here to read the complete review.
This month's featured title is Natural Relief for Anxiety by Edmund J. Bourne, PhD, et. al. Natural Relief for Anxiety explores the whole bodyÕs response to stress in a down-to-earth, nonjudgmental way, and describes how relief from mild to moderate anxiety can be achieved through holistic means. The text emphasizes how specific physical and lifestyle factors take their toll on the body, which can subsequently result in anxiety, and describes how the elimination of such factors can lead to peace of mind, mental clarity, and physical and emotional wellness.
Click here to read the complete review.
Thursday, May 04, 2006
Doctor's Behaving Badly
==========================================================================================
BL Fisher Note:
It is no wonder M.D./Ph.D. researchers find themselves in a credibility gap. We have put them on a pedestal for far too long, creating an elitist class which considers themselves entitled to special entitlements and protection from ethical constraints.
For far too long, the American public has been worshipping at the feet of those who practice science and medicine, naively assuming men and women who gravitate toward the healing arts are somehow exempt from human flaws that tempt them to cut corners or exploit others for profit, career advancement and fame. It has been a costly mistake to allow scientists and doctors to police themselves because we have based our entire health care system on a collective trust they are always telling the truth.
Transparency, accountability and justice are three values which will help keep the scientific research process and those who operate it truthful. The public should have full access to all scientific data and analysis used to proclaim a medical intervention is safe and effective for human use. Those who accept responsibility for proclaiming a medical intervention safe and effective should be held accountable if they are not truthful. And those who are harmed by a medical intervention which has been falsely proclaimed to be safe and effective should be able to access the civil court system to seek justice.
htp://www.nytimes.com/2006/05/02/health/02docs.html?ei=5088&en=989fce7c62c8e
849&ex=1304222400&partner=rssnyt&emc=rss&pagewanted=all
The NY Times
May 2, 2006
The Doctor's World
For Science's Gatekeepers, a Credibility Gap
By LAWRENCE K. ALTMAN, M.D.
Recent disclosures of fraudulent or flawed studies in medical and scientific journals have called into question as never before the merits of their peer-review system.
The system is based on journals inviting independent experts to critique submitted manuscripts. The stated aim is to weed out sloppy and bad research, ensuring the integrity of the what it has published.
Because findings published in peer-reviewed journals affect patient care, public policy and the authors' academic promotions, journal editors contend that new scientific information should be published in a peer-reviewed journal before it is presented to doctors and the public. That message, however, has created a widespread misimpression that passing peer review is the scientific equivalent of the Good Housekeeping seal of approval.
Virtually every major scientific and medical journal has been humbled recently by publishing findings that are later discredited. The flurry of episodes has led many people to ask why authors, editors and independent expert reviewers all failed to detect the problems before publication.
The publication process is complex. Many factors can allow error, even fraud, to slip through. They include economic pressures for journals to avoid investigating suspected errors; the desire to avoid displeasing the authors and the experts who review manuscripts; and the fear that angry scientists will withhold the manuscripts that are the lifeline of the journals, putting them out of business.By promoting the sanctity of peer review and using it to justify a number of their actions in recent years, journals have added to their enormous power.
The release of news about scientific and medical findings is among the most tightly managed in country. Journals control when the public learns about findings from taxpayer-supported research by setting dates when the research can be published. They also impose severe restrictions on what authors can say publicly, even before they submit a manuscript, and they have penalized authors for infractions by refusing to publish their papers. Exceptions are made for scientific meetings and health emergencies.
But many authors have still withheld information for fear that journals would pull their papers for an infraction. Increasingly, journals and authors' institutions also send out news releases ahead of time about a peer-reviewed discovery so that reports from news organizations coincide with a journal's date of issue.
A barrage of news reports can follow. But often the news release is sent without the full paper, so reports may be based only on the spin created by a journal or an institution.
Journal editors say publicity about corrections and retractions distorts and erodes confidence in science, which is an honorable business. Editors also say they are gatekeepers, not detectives, and that even though peer review is not intended to detect fraud, it catches flawed research and improves the quality of the thousands of published papers.
However, even the system's most ardent supporters acknowledge that peer review does not eliminate mediocre and inferior papers and has never passed the very test for which it is used. Studies have found that journals publish findings based on sloppy statistics. If peer review were a drug, it would never be marketed, say critics, including journal editors.
None of the recent flawed studies have been as humiliating as an article in 1972 in the journal Pediatrics that labeled sudden infant death syndrome a hereditary disorder, when, in the case examined, the real cause was murder.
Twenty-three years later, the mother was convicted of smothering her five children. Scientific naïveté surely contributed to the false conclusion, but a forensic pathologist was not one of the reviewers. The faulty research in part prompted the National Institutes of Health to spend millions of dollars on a wrong line of research.
Fraud, flawed articles and corrections have haunted general interest news organizations. But such problems are far more embarrassing for scientific journals because of their claims for the superiority of their system of editing.
A widespread belief among nonscientists is that journal editors and their reviewers check authors' research firsthand and even repeat the research. In fact, journal editors do not routinely examine authors' scientific notebooks. Instead, they rely on peer reviewers' criticisms, which are based on the information submitted by the authors.
While editors and reviewers may ask authors for more information, journals and their invited experts examine raw data only under the most unusual circumstances.
In that respect, journal editors are like newspaper editors, who check the content of reporters' copy for facts and internal inconsistencies but generally not their notes. Still, journal editors have refused to call peer review what many others say it is — a form of vetting or technical editing.
In spot checks, many scientists and nonscientists said they believed that editors decided what to publish by counting reviewers' votes. But journal editors say that they are not tally clerks and that decisions to publish are theirs, not the reviewers'.
Editors say they have accepted a number of papers that reviewers have harshly criticized as unworthy of publication and have rejected many that received high plaudits.
Many nonscientists perceive reviewers to be impartial. But the reviewers, called independent experts, in fact are often competitors of the authors of the papers they scrutinize, raising potential conflicts of interest.
Except when gaffes are publicized, there is little scrutiny of the quality of what journals publish.
Journals have rejected calls to make the process scientific by conducting random audits like those used to monitor quality control in medicine. The costs and the potential for creating distrust are the most commonly cited reasons for not auditing.
In defending themselves, journal editors often shift blame to the authors and excuse themselves and their peer reviewers.
Journals seldom investigate frauds that they have published, contending that they are not investigative bodies and that they could not afford the costs. Instead, the journals say that the investigations are up to the accused authors' employers and agencies that financed the research.
Editors also insist that science corrects its errors. But corrections often require whistle-blowers or prodding by lawyers. Editors at The New England Journal of Medicine said they would not have learned about a problem that led them to publish two letters of concern about omission of data concerning the arthritis drug Vioxx unless lawyers for the drug's manufacturer, Merck, had asked them questions in depositions. Fraud has also slipped through in part because editors have long been loath to question the authors.
"A request from an editor for primary data to support the honesty of an author's findings in a manuscript under review would probably poison the air and make civil discourse between authors and editors even more difficult than it is now," Dr. Arnold S. Relman wrote in 1983. At the time, he was editor of The New England Journal of Medicine, and it had published a fraudulent paper.
Fraud is a substantial problem, and the attitude toward it has changed little over the years, other editors say. Some journals fail to retract known cases of fraud for fear of lawsuits.
Journals have no widely accepted way to retract papers, said Donald Kennedy, editor in chief of Science, after the it retracted two papers by the South Korean researcher Dr. Hwang Woo Suk, who fabricated evidence that he had cloned human cells.
In the April 18 issue of Annals of Internal Medicine, its editor, Dr. Harold C. Sox, wrote about lessons learned after the journal retracted an article on menopause by Dr. Eric Poehlman of the University of Vermont.
When an author is found to have fabricated data in one paper, scientists rarely examine all of that author's publications, so the scientific literature may be more polluted than believed, Dr. Sox said.
Dr. Sox and other scientists have documented that invalid work is not effectively purged from the scientific literature because the authors of new papers continue to cite retracted ones.
When journals try to retract discredited papers, Dr. Sox said, the process is slow, and the system used to inform readers faulty. Authors often use euphemisms instead of the words "fabrication" or "research misconduct," and finding published retractions can be costly because some affected journals charge readers a fee to visit their Web sites to learn about them, Dr. Sox said.
Despite its flaws, scientists favor the system in part because they need to publish or perish. The institutions where the scientists work and the private and government agencies that pay for their grants seek publicity in their eagerness to show financial backers results for their efforts.
The public and many scientists tend to overlook the journals' economic benefits that stem from linking their embargo policies to peer review. Some journals are owned by private for-profit companies, while others are owned by professional societies that rely on income from the journals. The costs of running journals are low because authors and reviewers are generally not paid.
A few journals that not long ago measured profits in the tens of thousands of dollars a year now make millions, according to at least three editors who agreed to discuss finances only if granted anonymity, because they were not authorized to speak about finances.
Any influential system that profits from taxpayer-financed research should be held publicly accountable for how the revenues are spent. Journals generally decline to disclose such data.
Although editors of some journals say they demand statements from their editing staff members that they have no financial conflicts of interest, there is no way to be sure. At least one editor of a leading American journal had to resign because of conflicts of interest with industry.
Journals have devolved into information-laundering operations for the pharmaceutical industry, say Dr. Richard Smith, the former editor of BMJ, the British medical journal, and Dr. Richard Horton, the editor of The Lancet, also based in Britain.
The journals rely on revenues from industry advertisements. But because journals also profit handsomely by selling drug companies reprints of articles reporting findings from large clinical trials involving their products, editors may "face a frighteningly stark conflict of interest" in deciding whether to publish such a study, Dr. Smith said.
BL Fisher Note:
It is no wonder M.D./Ph.D. researchers find themselves in a credibility gap. We have put them on a pedestal for far too long, creating an elitist class which considers themselves entitled to special entitlements and protection from ethical constraints.
For far too long, the American public has been worshipping at the feet of those who practice science and medicine, naively assuming men and women who gravitate toward the healing arts are somehow exempt from human flaws that tempt them to cut corners or exploit others for profit, career advancement and fame. It has been a costly mistake to allow scientists and doctors to police themselves because we have based our entire health care system on a collective trust they are always telling the truth.
Transparency, accountability and justice are three values which will help keep the scientific research process and those who operate it truthful. The public should have full access to all scientific data and analysis used to proclaim a medical intervention is safe and effective for human use. Those who accept responsibility for proclaiming a medical intervention safe and effective should be held accountable if they are not truthful. And those who are harmed by a medical intervention which has been falsely proclaimed to be safe and effective should be able to access the civil court system to seek justice.
htp://www.nytimes.com/2006/05/02/health/02docs.html?ei=5088&en=989fce7c62c8e
849&ex=1304222400&partner=rssnyt&emc=rss&pagewanted=all
The NY Times
May 2, 2006
The Doctor's World
For Science's Gatekeepers, a Credibility Gap
By LAWRENCE K. ALTMAN, M.D.
Recent disclosures of fraudulent or flawed studies in medical and scientific journals have called into question as never before the merits of their peer-review system.
The system is based on journals inviting independent experts to critique submitted manuscripts. The stated aim is to weed out sloppy and bad research, ensuring the integrity of the what it has published.
Because findings published in peer-reviewed journals affect patient care, public policy and the authors' academic promotions, journal editors contend that new scientific information should be published in a peer-reviewed journal before it is presented to doctors and the public. That message, however, has created a widespread misimpression that passing peer review is the scientific equivalent of the Good Housekeeping seal of approval.
Virtually every major scientific and medical journal has been humbled recently by publishing findings that are later discredited. The flurry of episodes has led many people to ask why authors, editors and independent expert reviewers all failed to detect the problems before publication.
The publication process is complex. Many factors can allow error, even fraud, to slip through. They include economic pressures for journals to avoid investigating suspected errors; the desire to avoid displeasing the authors and the experts who review manuscripts; and the fear that angry scientists will withhold the manuscripts that are the lifeline of the journals, putting them out of business.By promoting the sanctity of peer review and using it to justify a number of their actions in recent years, journals have added to their enormous power.
The release of news about scientific and medical findings is among the most tightly managed in country. Journals control when the public learns about findings from taxpayer-supported research by setting dates when the research can be published. They also impose severe restrictions on what authors can say publicly, even before they submit a manuscript, and they have penalized authors for infractions by refusing to publish their papers. Exceptions are made for scientific meetings and health emergencies.
But many authors have still withheld information for fear that journals would pull their papers for an infraction. Increasingly, journals and authors' institutions also send out news releases ahead of time about a peer-reviewed discovery so that reports from news organizations coincide with a journal's date of issue.
A barrage of news reports can follow. But often the news release is sent without the full paper, so reports may be based only on the spin created by a journal or an institution.
Journal editors say publicity about corrections and retractions distorts and erodes confidence in science, which is an honorable business. Editors also say they are gatekeepers, not detectives, and that even though peer review is not intended to detect fraud, it catches flawed research and improves the quality of the thousands of published papers.
However, even the system's most ardent supporters acknowledge that peer review does not eliminate mediocre and inferior papers and has never passed the very test for which it is used. Studies have found that journals publish findings based on sloppy statistics. If peer review were a drug, it would never be marketed, say critics, including journal editors.
None of the recent flawed studies have been as humiliating as an article in 1972 in the journal Pediatrics that labeled sudden infant death syndrome a hereditary disorder, when, in the case examined, the real cause was murder.
Twenty-three years later, the mother was convicted of smothering her five children. Scientific naïveté surely contributed to the false conclusion, but a forensic pathologist was not one of the reviewers. The faulty research in part prompted the National Institutes of Health to spend millions of dollars on a wrong line of research.
Fraud, flawed articles and corrections have haunted general interest news organizations. But such problems are far more embarrassing for scientific journals because of their claims for the superiority of their system of editing.
A widespread belief among nonscientists is that journal editors and their reviewers check authors' research firsthand and even repeat the research. In fact, journal editors do not routinely examine authors' scientific notebooks. Instead, they rely on peer reviewers' criticisms, which are based on the information submitted by the authors.
While editors and reviewers may ask authors for more information, journals and their invited experts examine raw data only under the most unusual circumstances.
In that respect, journal editors are like newspaper editors, who check the content of reporters' copy for facts and internal inconsistencies but generally not their notes. Still, journal editors have refused to call peer review what many others say it is — a form of vetting or technical editing.
In spot checks, many scientists and nonscientists said they believed that editors decided what to publish by counting reviewers' votes. But journal editors say that they are not tally clerks and that decisions to publish are theirs, not the reviewers'.
Editors say they have accepted a number of papers that reviewers have harshly criticized as unworthy of publication and have rejected many that received high plaudits.
Many nonscientists perceive reviewers to be impartial. But the reviewers, called independent experts, in fact are often competitors of the authors of the papers they scrutinize, raising potential conflicts of interest.
Except when gaffes are publicized, there is little scrutiny of the quality of what journals publish.
Journals have rejected calls to make the process scientific by conducting random audits like those used to monitor quality control in medicine. The costs and the potential for creating distrust are the most commonly cited reasons for not auditing.
In defending themselves, journal editors often shift blame to the authors and excuse themselves and their peer reviewers.
Journals seldom investigate frauds that they have published, contending that they are not investigative bodies and that they could not afford the costs. Instead, the journals say that the investigations are up to the accused authors' employers and agencies that financed the research.
Editors also insist that science corrects its errors. But corrections often require whistle-blowers or prodding by lawyers. Editors at The New England Journal of Medicine said they would not have learned about a problem that led them to publish two letters of concern about omission of data concerning the arthritis drug Vioxx unless lawyers for the drug's manufacturer, Merck, had asked them questions in depositions. Fraud has also slipped through in part because editors have long been loath to question the authors.
"A request from an editor for primary data to support the honesty of an author's findings in a manuscript under review would probably poison the air and make civil discourse between authors and editors even more difficult than it is now," Dr. Arnold S. Relman wrote in 1983. At the time, he was editor of The New England Journal of Medicine, and it had published a fraudulent paper.
Fraud is a substantial problem, and the attitude toward it has changed little over the years, other editors say. Some journals fail to retract known cases of fraud for fear of lawsuits.
Journals have no widely accepted way to retract papers, said Donald Kennedy, editor in chief of Science, after the it retracted two papers by the South Korean researcher Dr. Hwang Woo Suk, who fabricated evidence that he had cloned human cells.
In the April 18 issue of Annals of Internal Medicine, its editor, Dr. Harold C. Sox, wrote about lessons learned after the journal retracted an article on menopause by Dr. Eric Poehlman of the University of Vermont.
When an author is found to have fabricated data in one paper, scientists rarely examine all of that author's publications, so the scientific literature may be more polluted than believed, Dr. Sox said.
Dr. Sox and other scientists have documented that invalid work is not effectively purged from the scientific literature because the authors of new papers continue to cite retracted ones.
When journals try to retract discredited papers, Dr. Sox said, the process is slow, and the system used to inform readers faulty. Authors often use euphemisms instead of the words "fabrication" or "research misconduct," and finding published retractions can be costly because some affected journals charge readers a fee to visit their Web sites to learn about them, Dr. Sox said.
Despite its flaws, scientists favor the system in part because they need to publish or perish. The institutions where the scientists work and the private and government agencies that pay for their grants seek publicity in their eagerness to show financial backers results for their efforts.
The public and many scientists tend to overlook the journals' economic benefits that stem from linking their embargo policies to peer review. Some journals are owned by private for-profit companies, while others are owned by professional societies that rely on income from the journals. The costs of running journals are low because authors and reviewers are generally not paid.
A few journals that not long ago measured profits in the tens of thousands of dollars a year now make millions, according to at least three editors who agreed to discuss finances only if granted anonymity, because they were not authorized to speak about finances.
Any influential system that profits from taxpayer-financed research should be held publicly accountable for how the revenues are spent. Journals generally decline to disclose such data.
Although editors of some journals say they demand statements from their editing staff members that they have no financial conflicts of interest, there is no way to be sure. At least one editor of a leading American journal had to resign because of conflicts of interest with industry.
Journals have devolved into information-laundering operations for the pharmaceutical industry, say Dr. Richard Smith, the former editor of BMJ, the British medical journal, and Dr. Richard Horton, the editor of The Lancet, also based in Britain.
The journals rely on revenues from industry advertisements. But because journals also profit handsomely by selling drug companies reprints of articles reporting findings from large clinical trials involving their products, editors may "face a frighteningly stark conflict of interest" in deciding whether to publish such a study, Dr. Smith said.
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