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Fake News in Medical Journals

“Fake News” is a real topic these days, but should those reading medical journals be concerned with it? Bloomberg has published an interesting, in-depth case study  involving Srinubabu Gedela, Ph.D., whose quest to stock his home town’s library with more research journals for his diabetes studies has grown into an “internet publishing powerhouse” claiming 1,000 open-access journal titles posting 50,000 articles annually.

Per a 2016 lawsuit, the Federal Trade Commission terms his companies a “predatory publisher duping professionals.” The medical journal industry is not a small one: a 2015 study in the journal BMC Medicine estimated revenue generated at $10.5 billion annually for traditional journals from global subscriptions.

Jeffrey Beall, librarian from the University of Colorado, Denver, has ended up at the center of the controversy, having been tracking publishers for the past few years who seem to publish articles with little to no peer review, the traditional cornerstone of the industry. Beall estimates that as many as 25% of the publishers of “scientific” journals could fall into the “predatory” category.  Check out this article in Bloomberg for more details.

 

Are Doctors Refusing to Operate on Smokers?

The Charlotte Observer published an article last month discussing why in some cases doctors are refusing to operate on patients who smoke. In recent years, research has shown that smoking inhibits the healing of wounds because it decreases blood flow. Studies have shown that smokers who have joint replacements have an 80 percent higher chance of needing repeat surgery than non-smokers. Surgeons are asking patients to quit smoking before performing these surgeries, and if they refuse to quit then surgeons are refusing to perform the operation. Overall, operating on smokers in some cases puts the situation at high risk with the potential that there may be expensive complications from the surgery which could “hurt the bottom line for physicians.”  According to the article, the refusal to operate until a patient is able to quit smoking is similar to refusing to operate on a patient who is overweight or has diabetes until they get those particular issues sorted out through weight loss or glucose control.

“The Biggest Loser” – After the Show

NBC’s reality television show “The Biggest Loser” is known for the incredible weight loss makeovers of its contestants – but what happens in the years after people appear on the show? A new article in The New York Times discusses Season 8 of “The Biggest Loser” where contestants lost hundreds of pounds on the show but in the years since had gained the weight back, in some cases ending up heavier than they were initially. A recent study of these contestants’ struggles has yielded surprising new discoveries about the physiology of obesity which is helping to explain why so many people are unable to keep off the weight they lose  “It is frightening and amazing,” said Dr. Kevin Hall, an expert on metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases. What shocked researchers is that as the years went by and weight was gained, the contestants’ metabolisms did not recover; in fact, they became even slower.

Read the New York Times article here. We also found the comments section to be a worthwhile scan.  

Sugar – Our #1 Food Villain

by Jen Jenkins, Market Analyst

Over the past several months we have often blogged on the topic of sugar and soda consumption and the possible detrimental effects both may have on human health. Sugar is quickly claiming the spotlight as the most villainous of foods that we consume, due to soaring rates of diabetes, obesity, and heart disease — all sugar-related disorders. Up until now, however, there has not been a study that truly proves sugar is a lone culprit in the rise of these chronic diseases. Dr. Robert Lustig is the reason we may now have, in his words, “hard and fast data that sugar is toxic irrespective of its calories and irrespective of weight.”

A new study developed by Dr. Lustig, out of the University of California, San Francisco, tested the effects of removing sugar from the diet of 43 children while keeping their weight and the amount of calories consumed exactly the same. Previous studies argued that it couldn’t be proven that removing sugar alone creates positive outcomes, since removing sugar also lowers calorie consumption and induces weight loss. To overcome this argument, Dr. Lustig made sure the children weighed themselves daily. If the children were losing weight, he had them eat more of the foods provided, to keep their weight the same. According to Dr. Lustig, after only 9 days “everything got better.”

Overall, their fasting blood sugar levels dropped by 53%, along with the amount of insulin their bodies produced since insulin is normally needed to break down carbohydrates and sugars. Their triglyceride and LDL levels also declined and, most importantly, they showed less fat in their liver. – Time

The main goal of this study was to look at sugar and how its negative effect on the body isn’t correlated with other diet concerns, calorie consumption, or weight loss. In fact, Dr. Lustig admitted that the diet the children were fed was far from ideal and still loaded with processed foods. Despite that, there were very noticeable improvements in the children’s health. Dr. Lustig is hoping these findings, along with new ones that continue to emerge, will encourage the U.S. Department of Agriculture to consider this new information on sugar when finalizing the updated Dietary Guidelines for 2016.

For more information on why not everyone is convinced by this new study and for other concerns expressed by experts, see this Time article.

Boeing’s Flight Plan for a New Era of Health Care

In the fall, 30,000 Puget Sound-area Boeing employees and retirees will be able to choose between two accountable care organizations (ACOs) for their personal and family health plan, a coverage option Boeing is calling the “Preferred Partnership.”

There were more than 600 ACOs nationwide at the start of the year, and they are being touted as a key strategy for curbing U.S. health-care costs.

The fundamental idea is that doctors and hospitals are rewarded for keeping and making patients healthy, rather than a “fee for service” approach where they earn more for prescribing lots of tests or scheduling appointments regardless of how a patient fares.

The contracts also include quality goals that matter to patients, such as the ability to schedule appointments in a timely manner and maintaining patient safety and satisfaction.

There are additional benchmarks tied to costs, including reducing readmissions to hospitals after treatments and effectively managing chronic conditions such as diabetes and heart disease.

Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, is hopeful the ACOs can help heal an inefficient health-care system. “There is so much waste,” Fisher said. “ACO arrangements are intermediate steps toward more fundamental reforms.”

Read more…

Size Matters

By Brian Grant MD

Actions that infringe on individual freedoms should be done cautiously and after careful consideration. Most laws and regulations infringe. Kids are forced to go to school, drivers are forced to obey speed limits, and we are not allowed to assault others. In the realm of health, we regulate drugs, force the use of seat-belts, regulate alcohol and tobacco and so on.

The New York Times article “In Fight Against Obesity, Drink Sizes Matter,” makes a compelling case for regulating the sale and sizes of sugared drinks. If we don’t, we may one day be seen in the same light as we now view the era of unregulated tobacco, unfortunate and overdue for change. The article describes the relative ineffectiveness of warnings and education on the dangers of tobacco, with ultimate behavioral change flowing from regulation, taxation, and bans.

But history has clearly shown that teaching people what is good for them is not enough. It must be accompanied by restrictions that curb unhealthy habits and environmental changes that foster healthier ones.

Cigarette smoking is a classic example. Myriad well-publicized reports documenting its hazards — even warnings on cigarette packs — did relatively little to get people to quit smoking and keep others from taking it up. It was not until smoking was banned in workplaces, restaurants, public buildings and transportation that smokers became social pariahs and millions gave it up.

Given the striking evidence that the current U.S. levels of consumption of sugary drinks is seriously contributing to type 2 diabetes and obesity, and the availability of benign options including water and artificially sweetened drinks, it would seem apparent that regulation and limits on these drinks is inevitable and appropriate.
Read More…

Risk Management: Why a Chef’s Job is Among the Riskiest

 By Vanessa Radatus

Photo credit: Food Network Kitchens/ Wiley, John & Sons, Incorporates

It may not be ranked among the most dangerous profession in U.S, but recent headlines about celebrity chefs and Food Network personalities have got us thinking that being a top chef should be ranked among the riskiest jobs.

Here’s some food for thought. Just this year, celebrity chef and cooking show host, Paula Dean, reluctantly announced that she was diagnosed with type 2 diabetes. Known for her Southern-style, often deep-fried, high calorie recipes, it came as no surprise to those who watch her show.

According to experts, a chef’s lifestyle poses many safety and health risks. Not only is a busy kitchen a dangerous place in general- with sharp knives, hot pans, slippery floors and sanitation issues- but a chef must also constantly taste the food they make leading to high-caloric intake, which can cause obesity, heart disease and diabetes like Paula Deen.

We often hear about high risk jobs like firefighters, police officers, and construction workers, but what if a celebrity chef or TV food host is injured, seriously ill and can no longer perform? How does that affect his or her income? And how does it affect the overall “brand” and the businesses that rely on their name? In a

 recent Risk Management article, “Chopped Chef,” they explain how insurance works for these high profile food connoisseurs.

The article lays it out pretty clearly, proving that a chef’s job is worth protecting, especially if a million dollar brand is involved: “Investors and corporate risk managers generally recognize how dependent these franchises are on the brand of their celebrity chefs. Their response is often to secure large blocks of key person life insurance to protect against an untimely death. But many often ignore the greater risk of injury and forgo disability coverage, which may be a mistake if you realize that replacing these individuals is not as easy as calling up a recruiting agency.”

For this reason, large corporations dependent on personalities such as Martha Stewart, Gordon Ramsay, Rachel Ray, etc, procure key person life and key person disability insurance  in order to protect the wide array of people invested: the company, the employees, the shareholders, the board of directors, production and merchandising partners, etc.

“Chefs also can obtain coverage as a form of personal protection. This was the case for one high-profile celebrity chef in his mid-40s who was updating his financial plan when his new wealth adviser noticed that he failed to maintain disability income protection. With an annual income north of $2 million, the chef wanted to be able to maintain his lifestyle in the event of a disability. A policy was structured with a 90-day waiting period, followed by $100,000 per month of tax-free disability benefits. Coverage was underwritten protecting losses from both accident and illness utilizing a specific occupation policy form that covered the insured if he could not be an “on-air” personality. In all, nearly $15 million of future income was protected at a cost of around $40,000 annually.” Read More…

America’s Deadliest Diseases: How Your Diet May Put You at Risk

The food we eat may be the root to some of our nations most deadly health issues, according to the Wall Street Journal article “The New Science Behind America’s Deadliest Diseases.”

The article states that scientists have linked many diseases such as heart disease, cancer and Alzheimer’s to a condition known as chronic inflammation, and though the foods we eat can contribute to the cause they may also be one of the best medicines.

Here are foods that are proponents of chronic inflammation: How many of these foods end up on your plate each day?

  • Sugar: Sugar-sweetened beverages like soft drinks, fruit drinks and punches are one of the major sources of dietary sugars that many have overlooked. Do you know that drinking a can of Coke is as good as sucking ten sugar cubes?
  • Dairy: To lower your saturated fat intake, limit your consumption of whole and 2% milk; instead, opt for (organic) skim or 1% milk. Other ways to top your cereal include organic soy, almond, rice, hemp, hazelnut, or oat beverages.
  • Refined carbohydrates: Refined grains and products made out of them are almost everywhere. The common ones are: white rice, white flour, white bread, noodles, pasta, biscuits and pastries. A prime example is boxed cereals which contain substantial amounts of added sugar
  • Saturated fats: Feed-lot raised meat, lamb and pork. Opt for organic, naturally fed animals!
  • Trans-fats: Deep fried foods, fast foods, commercial baked goods and those prepared with partially hydrogenated oil, vegetable oils, margarine and vegetable shortening.
  • Alcohol: High consumption of  alcohol has been known to cause irritation and inflammation of the esophagus, larynx (voice box) and liver. Over time, chronic inflammation promotes tumor to grow and gives rise to cancer.

“Inflammation is the body’s natural response to injury and outside irritants. But when the irritants don’t let up, because of a diet of high-fat foods, too much body fat and smoking, for example, the immune system can spiral out of control and increase the risk for disease. Experts say when inflammation becomes chronic it can damage heart valves and brain cells, trigger strokes, and promote resistance to insulin, which leads to diabetes. It also is associated with the development of cancer,” according to findings in the Wall Street Journal article.

Here are some must eat foods that can reduce and fight chronic inflammation:

  • Oily Fish: Foods that are rich in omega-3 are key: Salmon, ahi tuna, sardines and other oily fish
  • Organic, free-range poultry and meat: Organic, free-range animals fed on a natural diet like grasses instead of grains and hormones contain more omega-3 fats, contain high amounts of protein and are lean. When you do eat red meat, choose lean cuts and limit to once a week.
  • Nuts: Nuts have long been linked with less coronary heart disease than other high-calorie foods. on some walnuts, pistachios or almonds. But measure a one-ounce serving (about one-fourth cup) to keep calories in check.
  • Berries: Cranberries, cherries, blueberries, strawberries, pomegranates, .as well as deep red and purple fruits are loaded with antioxidants and free radical-fighting  that are able to block the chemical pathways that create inflammation in the body as well as prevent cancer.
  • Vegetables: Broccoli, asparagus, carrots and many other deep orange and dark green vegetables are loaded with phyto-nutrients to prevent against inflammation as well as cancer and other diseases.
  • Oil and Spices: Olive oil, onion, turmeric, garlic and ginger have chemicals that act as a pain reliever and anti-inflammatory –just like ibuprofen.
  • Tea: All types (without sugar of course) have anti-inflammatory properties if you drink 4-5 cups a day.

Overall, a true anti-inflammatory diet is bright, colorful and fresh.

Are you up for the challenge? See how following an Anti-Inflammatory Daily Meal Plan can change the way you look and feel.

 

Breakfast:

  • Oatmeal sprinkled with strawberries, blueberries and cinnamon

Snack:

  • Grapes

Lunch:

  • Mixed-Green salad loaded with fresh veggies, including broccoli, onions, a sprinkling of walnuts or almonds and fresh-cracked pepper and an olive or canola oil dressing
  • Top your salad with grilled chicken
  • A slice of whole-grain bread or crackers
  • Unsweetened tea

Snack:

  • Cherries, walnuts

Dinner:

  • Grilled salmon with rosemary
  • Sliced fresh tomato drizzled with olive oil
  • Sautéed spinach with leeks and ginger
  • Brown rice
  • Unsweetened tea

Dessert:

  • Apple, sliced and sprinkled with cinnamon, cooked in the microwave or baked in the oven.

The information contained  at www. MCNTalk.com  is provided for informational purposes only and is not meant to substitute for advice from your doctor or health-care professional. This information should not be used for diagnosing or treating a health problem or disease, or prescribing any medication. Always seek the advice of a qualified health-care professional regarding any medical condition. Information and statements provided by the site about dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. MCNTalk  does not recommend or endorse any specific tests, physicians, third-party products, procedures, opinions, or other information mentioned on the Site. Reliance on any information provided by MCNTalk  is solely at your own risk.

A Mathematical Challenge to Obesity

From The New York Times, in a conversation with Carson Chow, an investigator at the National Institute of Diabetes and Digestive and Kidney Diseases:
Question: Did you ever solve the question posed to you when you were first hired — what caused the obesity epidemic?

Answer: “We think so. And it’s something very simple, very obvious, something that few want to hear: The epidemic was caused by the overproduction of food in the United States.”

Beginning in the 1970s, there was a change in national agricultural policy. Instead of the government paying farmers not to engage in full production, as was the practice, they were encouraged to grow as much food as they could. At the same time, technological changes and the “green revolution” made our farms much more productive. The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day.

Chow has a number of other interesting, practical comments:

  • The conventional wisdom of 3,500 calories less is what it takes to lose a pound of weight is wrong. The body changes as you lose. Interestingly, we also found that the fatter you get, the easier it is to gain weight. An extra 10 calories a day puts more weight onto an obese person than on a thinner one.
  • Also, there’s a time constant that’s an important factor in weight loss. That’s because if you reduce your caloric intake, after a while, your body reaches equilibrium. It actually takes about three years for a dieter to reach their new “steady state.” Our model predicts that if you eat 100 calories fewer a day, in three years you will, on average, lose 10 pounds — if you don’t cheat.
  • Another finding: Huge variations in your daily food intake will not cause variations in weight, as long as your average food intake over a year is about the same. This is because a person’s body will respond slowly to the food intake. Read more…

Who’s really to blame for child obesity?

From time to time MCNtalk has touched on the subject of childhood obesity. Per this article in The Philadelphia Inquirer,  the subject is meriting serious attention, with dramatic solutions being discussed.

Should morbidly obese children be taken from their parents and put into foster care? This was the question discussed in a commentary piece last month by obesity expert David S. Ludwig of Children’s Hospital Boston and lawyer Lindsey Murtagh of the Harvard School of Public Health. They explored this solution at a time when the rates of obesity in U.S. children over the last 30 years have tripled.

“In severe instances of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and parents’ chronic failure to address medical problems,” wrote Murtagh and Ludwig.

But, they added, “the decision to pursue this option must be guided by carefully defined criteria . . . with less-intrusive methods used whenever possible,” and the two are quick to point out that “morbid obesity” is the key point: Imminent risk – where children are really in lethal situations – is the only reason children can be removed from parental custody.

Bill Lawhorn, a supervisor of Court Appointed Special Advocates in Philadelphia, says that, in more than 30 years with the child-welfare system, he has never seen a case of removal based solely on obesity and that to do so would be a logistical challenge.

“Child welfare is hard-pressed to respond to adjudicate matters of abuse and neglect, let alone dietary concerns and lifestyle, or following through on healthy choices,” Lawhorn said.

Reporting laws in a handful of states, including Pennsylvania, could possibly make removals happen, though. Such laws require that doctors contact child services if they think chronic parental neglect has resulted in morbidly obese complications – like failing to comply with doctors’ orders for weight-related diabetes and sleep apnea.

But placing blame solely on parents would be shortsighted, according to Daniel Taylor, a pediatrician at St. Christopher’s Hospital for Children in Philadelphia and the founder of the Children’s Advocacy Project, known as Cap4Kids. Decades of societal neglect are actually to blame for our obesogenic generation, he said, citing the areas of food-industry regulation, investments in safe outdoor play, and portion-control regulation as elements that have been ignored.

Clearly the root causes need to be found and addressed; lifespans in the United States are seriously lagging behind rates in other developed nations, with obesity being one of the main culprits for the gap. Obesity and its complications are a major social, emotional, and economic drain on Americans. Perhaps removing children from their homes is not the actual solution, but it does frame the discussion in drastic terms: which is probably how it should be framed.