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The Unprecedented Reach of Social Media

On November 7, 2024

A Vast Reach

Social media has proven to be a more effective platform for spreading propaganda than traditional media due to its vast reach, the ability to target specific users, emotional manipulation, algorithm-driven amplification, and the speed at which information spreads. While print, broadcast, and other forms of media still play roles in shaping public opinion, they simply cannot compete with the scale, focus, and speed offered by social media platforms.

This shift represents a fundamental change in the dynamics of information spread. The power to shape beliefs and influence behavior is no longer concentrated in the hands of a few gatekeepers but is now accessible to anyone who understands how to leverage the tools of technology. As a result, the modern information landscape is more fragmented and volatile, making it increasingly difficult to distinguish between genuine information and propaganda.

Understanding these dynamics is essential for navigating the digital world, particularly as social media plays an ever-larger role in public discourse. Whether we can develop better strategies for recognizing and mitigating propaganda in this new environment remains to be seen, but it must be addressed if we are to preserve the integrity of public information.

Sheer Scale

One of the primary reasons social media is more effective at spreading propaganda than traditional media is its sheer scale. Platforms like Facebook, X (formerly Twitter), Instagram, and TikTok have billions of users globally. Information shared on these platforms can be instantly viewed, and reshared by a wide audience, allowing propaganda to spread virally within hours or even minutes. Unlike print or broadcast media, which require significant resources and distribution channels, social media allows anyone with an internet connection to produce and share content.

Targeting

Another critical advantage social media has over traditional media lies in its ability to micro-target specific individuals or groups. Social media platforms utilize algorithms that gather massive amounts of data on users’ behaviors, interests, and demographics. This data is then used to curate content with which users are most likely to engage, creating a personalized experience. While this system may enhance user satisfaction and increase time spent on the platform, it also can create filter bubbles producing highly effective propaganda.

Propaganda creators can design content that speaks directly to the fears, values, or biases of particular segments of the population. By targeting users who are already inclined to believe certain narratives, propagandists can reinforce pre-existing biases, creating echo chambers in which users themselves specifically choose content that reflects their preexisting ideas without encountering opposing viewpoints.

Emotional Manipulation

Social media platforms are designed to maximize engagement, and the most engaging content is often that which provokes strong emotional responses. Whether it’s outrage, anger, fear, joy, or sadness, emotionally charged content is more likely to be shared and spread than neutral or purely informative posts. This creates an environment in which sensationalism and emotional manipulation thrive, making social media fertile ground for propaganda. The old newspaper dictum, “If it bleeds it leads” has been carried to levels never imagined by previous generations of editors.

The Role of Algorithms

One of the most insidious aspects of propaganda on social media is the role of algorithms in determining what content users see. These algorithms are designed to prioritize content that keeps users engaged, often by promoting material that aligns with their existing beliefs or that provokes strong emotional reactions. In doing so, algorithms contribute to the spread of propaganda by ensuring that polarizing or misleading content reaches more people.

The Speed and Scale of Misinformation

Unlike print or broadcast media, where editorial processes and production timelines can act as natural checks on the spread of misinformation, social media operates in real-time. Users can share content instantly, without fact-checking or verifying sources. This speed makes it much easier for propaganda to spread before it can be debunked. By the time fact-checkers have corrected misinformation, it has already reached millions of people, many of whom may never see the correction.

The decentralized nature of social media makes it difficult to trace the origins of propaganda. Fake accounts, bots, and coordinated campaigns can obscure the sources of misleading content, making it harder for users to assess the credibility of the information they encounter. In traditional media, the source of information is typically clear, whether it’s a newspaper, a television network, or a radio station. On social media, the source of propaganda can be either disguised or entirely anonymous, or perhaps even fabricated by artificial intelligence, adding layers of complexity to the problem.

Hopefully this Brave New World of social media does not overwhelm the values that guide our country.

The Harmful Grip of Cigarette Smoking

By John Turley

On October 24, 2024

In Commentary, Medicine

Addiction, Health Risks, and the Benefits of Quitting

Cigarette smoking remains one of the leading causes of preventable death worldwide. In the more than 65 years since the US Surgeon General first required health warnings to be placed on cigarette packs, significant progress has been made in reducing the rates of smoking. In 1965 about 45% of US adults were smokers and today fewer than 12% smoke on a regular basis. Youth smoking rates have also declined dramatically. In recent years fewer than 5% of high school students report smoking on a regular basis. In my high school class (1966) the smoking rate was probably closer to 30%. As encouraging as these numbers are, there is no acceptable rate of smoking, and I hope those of you who don’t smoke will pass this article on to family or friends who do.

The Power of Nicotine Addiction

Nicotine, the primary addictive substance in cigarettes, is remarkably potent. When inhaled, it travels to the brain within seconds, where it stimulates the release of dopamine, a neurotransmitter that creates a feeling of pleasure and relaxation. Over time, the brain rewires itself, craving nicotine to maintain these pleasurable effects, leading to dependency.

The addictive nature of nicotine makes quitting extremely difficult, as withdrawal symptoms, including irritability, anxiety, difficulty concentrating, and intense cravings, can deter many smokers from quitting. Nicotine also increases heart rate and blood pressure, contributing to the stress-relief paradox: although many smokers feel cigarettes help them relax, the substance actually exacerbates stress on the cardiovascular system.

Smoking can be tied to our daily routines. Some people have commonly have a cigarette with morning coffee or after meals. Other people reach for a cigarette when they’re on the telephone. Social settings and peer influence can make quitting difficult. Attending social gatherings where smoking is common can reignite cravings. A smoker who decides to quit can feel surrounded by the temptations to resume smoking.

There are a number of other factors also that make it difficult to quit smoking. There’s a lack of immediate health benefits noted. Improvements like better lung function, reduced cancer risk or long terms outcomes are not noted right away. Some smokers fear weight gain more than they fear the effects of smoking and will delay any attempts at cessation because of that. Some smokers also feel frustration because after a few days without a cigarette they think “I don’t feel any better, what’s the point?”

Health Risks: Nicotine and Smoke by-products

Cigarette smoke contains over 7,000 chemicals, many of which are toxic. Among these are tar, carbon monoxide, formaldehyde, and heavy metals like cadmium and lead. Some chemicals are carcinogens, contributing to the development of cancer, while others damage tissues and organs in less visible but no less harmful ways.

Cardiovascular disease: Smoking increases the risk of heart attacks, strokes, and peripheral artery disease. It contributes to the buildup of plaque in arteries, restricting blood flow and forcing the heart to work harder. Among smokers greater than age 40, more than 50% develop cardiovascular disease and they’re more than twice as likely to die from cardiovascular events compared to non-smokers.
Congestive heart failure: Nicotine triggers release of adrenaline which increases both heart rate and blood pressure, putting more strain on the heart. Carbon monoxide from cigarettes binds to hemoglobin reducing the oxygen carrying capacity of the blood. Plaque buildup from coronary artery disease as well as myocardial fibrosis, scarring in the heart tissue, both lead to impaired cardiac function. Quitting smoking can significantly lower the risk of death from heart failure related complications.
Chronic obstructive pulmonary disease (COPD): Smoking damages the lungs, leading to chronic conditions such as emphysema and chronic bronchitis. Over time, lung capacity declines, making breathing progressively more difficult. Even with smoking cessation, lost lung function cannot be fully recovered. It is vitally important that anyone with pulmonary disease quit smoking as soon as possible.
Cancer: Tobacco use is responsible for roughly 80% of lung cancer cases. It is also linked to cancers of the mouth, throat, esophagus, pancreas, bladder, and cervix, among others.
Diabetes: Smoking increases the risk of type 2 diabetes by around 30 to 40%. Smokers with diabetes are much more likely to experience complications such as heart disease and kidney failure.
Reproductive health issues: Smoking affects fertility in both men and women. Pregnant smokers are at higher risk for miscarriage, preterm delivery, and having low-birth-weight infants.

The Benefits of Quitting Smoking

It’s never too late to quit smoking, and the benefits begin almost immediately after quitting.

Within 20 minutes: Blood pressure and heart rate start to normalize.
Within 12 hours: Carbon monoxide levels in the blood drop to normal, improving oxygen flow.
Within weeks: Lung function improves, and circulation begins to return to normal.
Within months to a year: Coughing and shortness of breath decrease, and the risk of heart disease drops significantly.
Within five years: Stroke risk drops to that of a non-smoker, and the risk of certain cancers is cut in half.
After ten years or more: The risk of lung cancer is about half of what it would have been had the person continued to smoke.

The Deceptive Appeal of Vaping

Unfortunately, the rise of e-cigarettes, also known as vaping, has emerged as an alternative to smoking among many people. E-cigarettes deliver nicotine through vapor rather than smoke. While they eliminate some of the harmful byproducts like tar and carbon monoxide, vaping is not without risks. Some vaping products contain toxic materials not contained in tobacco. Especially custom or self-blended cartridges for vape pens that may have carcinogenic or otherwise harmful additives not readily obvious to the user. Unfortunately, many adolescents and young adults who have never smoked cigarettes have developed a nicotine addiction through e-cigarette use.

Conclusion

There is no safe level of use of tobacco or other forms of nicotine. Quitting smoking improves quality of life, reducing the frequency of respiratory infections and improving overall energy levels. For long-time smokers, the prospect of reversing years of damage may seem daunting, but research consistently shows that health outcomes improve at any point, even decades after quitting. If I could give my smoking patients only one piece of medical advice it would be: “Quit smoking and quit now”. And I know how hard it is. I quit smoking 53 years ago and for many years afterwards it remained a daily struggle. But eventually, with the help and support of my family I was able to get past my tobacco cravings.

What Would Ronnie Think?

By John Turley

On October 21, 2024

In Commentary, Politics

Thoughts on Ronald Reagan and the Current State of the Republican Party

I think Ronald Reagan may have been the best president of the modern era. I know that will make my liberal friends cringe. Additionally, I have recently gained new respect for Clinton and Obama, and I know that will likewise make my conservative friends cringe. I’ve always considered myself to be more conservative than liberal. But I just cannot support the current direction of the Republican Party and now consider myself to be a “Recovering Republican”. I didn’t leave the Republican Party. The Republican Party left me. And I wonder “What would Ronnie think?”

Speculating on what Ronald Reagan might think of the modern Republican Party is risky and involves consideration of his political philosophy, policies, and the values he championed during his presidency from 1981 to 1989.

Key Points of Reagan’s Ideology:

Conservatism: Reagan was a proponent of traditional conservative values, emphasizing limited government, individual liberties, free markets, and a strong national defense. He likely would have been concerned about the confrontational form of conservativism espoused by many contemporary Republicans.
Optimism: He often conveyed a sense of optimism about America’s future, believing in the ability of the American people to solve their problems. He would have been concerned about current rhetoric designed to pit Americans against one another.
Bipartisanship: Reagan worked with Democrats on significant legislation, showcasing a willingness to compromise for the greater good. President Reagan and Tip O’Neill, Speaker of the House, believed that partisanship ended after 6:00 PM and should never be a barrier to friendship.
Focus on Issues: His presidency was marked by a focus on economic issues, such as tax cuts, deregulation, and a strong anti-communist foreign policy. He likely would have been concerned by the Republican Party’s current often favorable response to the totalitarian governments in both Russia and China.

Speculation on His Views of Today’s GOP:

Populism vs. Traditional Conservatism: Reagan might be concerned about the rise of populism within the party, which sometimes shifts focus away from traditional conservative principles. He valued ideological coherence over personality-driven politics.
Divisive Rhetoric: The modern Republican Party has seen an increase in divisive and confrontational rhetoric. Reagan was known for his ability to unite people and might disapprove of the factionalism that can alienate moderate Republicans and independents.
Economic Policies: Reagan’s foundational economic principles might resonate with today’s emphasis on tax cuts and deregulation. However, he also expressed concern over increasing national debt and the impact of tax cuts without corresponding spending reductions. He was a strong proponent of free trade and believed that it had benefitted the US economy by opening markets and encouraging competition and he played a significant role in establishing trade agreements that laid the basis for the North American Free Trade Act. In contrast, today’s Republican Party is more concerned with protectionist policies and tariffs and creating trade barriers which they believe will somehow benefit the country as a whole.
Social Issues: Reagan had a more moderate stance on certain social issues than some factions of today’s GOP. He might find the current approach to issues like immigration and LGBTQ+ rights more contentious than his more inclusive positions. He was slow to respond to the AIDS crisis but was not as overtly hostile to the issues as the current GOP. Reagan advocated a restriction of federal funding for abortions but did not back a total ban on abortions.
Foreign Policy: Given his strong anti-communist stance and emphasis on diplomacy, Reagan may critique some of the modern party’s more isolationist tendencies. He might also be concerned about the current positive approach towards totalitarian regimes.
Immigration: Reagan had a different approach to immigration than the current GOP. He backed the Immigration Reform and Control Act of 1986 which provided emergency amnesty for approximately 3,000,000 undocumented immigrants. Many of today’s Republicans would label Reagan’s amnesty program as a failure and certainly not one that they would be willing to repeat. Reagan’s policies were aimed at addressing the historic realities of immigration and included provisions for legalization which is currently opposed by most Republicans.

In summary, while Reagan might appreciate certain aspects of the modern Republican Party, such as a commitment to conservative economic principles, he would likely be critical of the divisive politics, populism, and the lack of bipartisan cooperation that he valued. Reagan’s views might resonate with traditional conservatives who still value free market principles. Likely though, they would face pushback from factions within the party that prioritize the nationalist policies. Many Republicans today see Reagan’s approach as outdated or incompatible with their current priorities which emphasize immediate economic protection over long term global engagement. This assessment is speculative, of course, and based on my interpretation of his beliefs and leadership style.

For a deeper dive into Reagan’s legacy, consider reading more from the Ronald Reagan Presidential Foundation (www.reaganfoundation.org)

What Would George Washington and Thomas Jefferson Think About Our Current Political Climate?

By John Turley

On October 16, 2024

In Commentary, History, Politics

In considering what George Washington and Thomas Jefferson might think of today’s political situation, it’s tempting to view their perspectives through the lens of nostalgia, believing that the founders had an idealistic vision that, if followed, would have prevented many modern problems. It’s impossible of course to know what they may have thought about our current environment. Certainly, such things as a 24-hour news cycle on cable television and social media would have been beyond their comprehension. While both men lived in a vastly different era, their writings and philosophies give us a sense of how they might respond to the polarization and tensions we witness today.

George Washington: A Warning Against Partisanship

George Washington was deeply concerned about the rise of factions in the United States. (Political parties as such were unknown at the beginning of our republic.) In his famous Farewell Address in 1796, he warned that factions could lead to division and weaken the unity of the country. Washington was worried that faction (party) loyalty would surpass loyalty to the nation, creating conflict between groups and impairing the ability of government to function for the common good. He feared that excessive partisanship would “distract the public councils and enfeeble the public administration,” leaving the nation vulnerable to foreign influence and internal discord.

If Washington could observe today’s political environment, he likely would be saddened by the partisanship which dominates political discourse. The gridlock, belligerent rhetoric, and divisiveness we experience today demonstrate the appropriateness of his concern. Washington would likely advocate for a return to greater civility, urging Americans to focus on the common good and to set aside factionalism for the sake of national unity. While political parties have become integral to our system, Washington would likely still press for cooperation, mutual respect, and compromise among all groups.

Thomas Jefferson: Liberty, Democracy, and the People’s Role

Thomas Jefferson, while more supportive of political parties than Washington, had his own complex views about governance. Jefferson believed in the power of the people to govern themselves and was a passionate advocate for liberty, democracy, and decentralization. He distrusted concentrated power, whether in government, or economic institutions, and feared that it could lead to tyranny. Jefferson was famously a champion of agrarianism and believed that widespread participation in the democratic process was the best defense against corruption and the loss of liberty.

Jefferson, while a proponent of states’ rights and individual liberties, might view polarization as a threat to democratic ideals if it stifles dialogue and compromise. He believed in the potential for free men to govern wisely, but would caution against the erosion of civil discourse that might follow the rise of extreme factionalism

Faced with the highly charged political debates of today, Jefferson would likely express concern over the increasing centralization of power in government, banks, and large corporations. He would, without doubt, be troubled by the outsized influence of money in politics.

Jefferson was also a firm believer in education as a cornerstone of democracy; he would stress the importance of an informed electorate, particularly in an age where misinformation can spread rapidly.

However, Jefferson was no stranger to political conflict, having played a central role in the fiercely partisan battles of his time. He understood the value of vigorous debate but would probably urge that such debate remain focused on the core democratic principles of liberty, justice, and equality rather than devolving into personal attacks.

Media and Civil Discourse

Of course, it is impossible to know what Washington and Jefferson would think about the current role of media, particularly social media which would be beyond anything in their experience. Washington felt strongly aggrieved by the attacks upon him in the newspapers of the time. He felt unfair attacks would undermine national unity. Jefferson, on the other hand, was a strong proponent of freedom of the press. He was also very adept at the use of newspapers to accomplish political means.

However, it is likely that both would caution against the dangers of misinformation and partisan bias to distort public perception. Most likely both would emphasize the need for a responsible press that distinguishes between fact and opinion and supports a healthy democracy. Both would be opposed to using false or misleading statements to influence the public.

Unity and Civic Responsibility

Despite their differences, both Washington and Jefferson would likely agree on one thing: the importance of unity and civic responsibility. They envisioned a country where citizens were deeply involved in a participatory government, contributing not just with votes but with informed, constructive dialogue. Washington would call for a spirit of national unity above party lines, while Jefferson would insist that the preservation of liberty relies on active and informed participation from the public.

Both founders would encourage a healthier, more cooperative political environment, one where differences are respected and not allowed to fracture the country. They would likely see today’s polarization as a threat to the very ideals they fought to establish, and both would urge Americans to remember their shared values.

Conclusion

In short, George Washington and Thomas Jefferson, while men of their own time, had insights that are still relevant today. Neither man could have predicted the exact nature of modern politics, but their wisdom offers enduring guidance: political disagreements must not undermine the unity, liberty, and civic responsibility that are the foundation of the American experiment. We owe it to them not to lose the promise of the American Revolution.

Understanding Vitamins, Supplements, Herbal Preparations, Patent Medicines, and Homeopathic Medications

By John Turley

On October 4, 2024

In Commentary, Medicine

What you should know.

The cost of prescription medications is almost constantly in the news. It has even become a topic of debate in the current presidential elections. Americans spend over $500 billion annually on prescription medications. This includes drugs covered by insurance, and out of pocket costs and specialty drugs for chronic conditions.

But this is not the only expense Americans have for drug related health care items. Almost $90 billion a year is spent on nonprescription preparations.

The shelves of pharmacies, health food stores and convenience stores are lined with a vast array of vitamins, supplements, patent medicines, herbal preparations, and homeopathic medications. They are also available from hundreds of online sources, both reputable and of questionable origin.

Many people turn to these products in the hope of improving their health, boosting their immune systems, or addressing specific ailments. However, the development, testing, approval processes, and regulation of these products can be confusing, even for the most educated consumer. We will delve into each of these classes of health products, exploring how they are developed, tested, and regulated, and highlighting some potential drawbacks of which you should be aware.

Vitamins and Dietary Supplements

Development and Testing

Vitamins and dietary supplements include a broad range of products such as vitamins, minerals, amino acids, and other nutritional components. These products are typically developed through a combination of scientific research and commercial interest. Manufacturers may isolate nutrients from food sources or create them synthetically. Testing often involves ensuring that the products contain the stated ingredients in the correct amounts. However, unlike pharmaceuticals, these products are not usually subject to rigorous clinical trials to prove efficacy and safety before they are marketed.

Approval Process

In the United States, vitamins and dietary supplements are regulated by the Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act (DSHEA) of 1994. Under DSHEA, manufacturers are responsible for ensuring the safety and labeling of their products before they reach the market. However, the FDA does not approve dietary supplements before they are sold. Instead, the FDA can take action against any supplement that is found to be unsafe once it is on the market.

Drawbacks

One of the primary drawbacks of dietary supplements is the lack of pre-market approval, which means that the burden of proving safety is often on the consumer or the FDA post-market. This can lead to situations where unsafe or ineffective products remain on the market until sufficient adverse events are reported. Additionally, the quality of supplements can vary widely between manufacturers, and contamination with other substances is a known risk. Although, given the competitive nature of these products and the number of distributors, questionable products are usually forced out of the market early.

Herbal Preparations

Development and Testing

Herbal preparations include products made from plants or plant parts, used for their supposed medicinal or therapeutic properties. The development of these products is often rooted in traditional medicine practices, although modern herbal preparations may undergo some degree of scientific research. Testing for herbal preparations can vary widely; some are backed by clinical studies, while others rely on anecdotal evidence or traditional use.

Approval Process

The FDA considers herbal supplements as foods, not medicines. So, they are not subject to the same testing, manufacturing, and labeling standards and regulations as medicines.

This means they do not require pre-market approval by the FDA. However, in other parts of the world, such as Europe, herbal products may undergo more rigorous testing and regulation. All herbal products that display an intended use must be accompanied by a box warning stating: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnosis, treat, cure or prevent any disease.”

Drawbacks

The primary concerns with herbal preparations are the variability in potency and the potential for contamination or adulteration with other substances. Additionally, the lack of standardization in the preparation of herbal products can lead to inconsistent effects. Herbal supplements, unlike medicines, do not need to be standardized to make sure of batch-to-batch consistency. Some herbs can also interact with prescription medications, leading to adverse effects.

Homeopathic Medications

Development and Testing

Homeopathic medications are based on the principle of “like cures like,” where substances that cause symptoms in a healthy person are believed to cure similar symptoms in a sick person when taken in highly diluted forms. The development of homeopathic remedies typically involves diluting a substance repeatedly until little to no trace of the original substance remains.

While counterintuitive, homeopaths believe that a homeopathic medicine is more powerful the more times the active ingredients have been diluted. A 6X potency indicates that the drug has been diluted at a ratio of 1 to 10 for a total of six times. A C potency means the dilution ratio is 1 to 100. The higher the numeral, the lower the concentration of active ingredients in the medicine.

Testing in homeopathy is controversial, as traditional scientific methods, such as randomized controlled trials, often find no evidence that homeopathic remedies are more effective than a placebo. Some supporters claim that homeopathic remedies are developed for a specific patient making general testing irrelevant.

Approval Process

In the U.S., homeopathic medications are subject to regulation by the FDA under a different framework compared to dietary supplements. Historically, these products were allowed to be sold without pre-market approval as long as they were prepared according to the guidelines of the Homeopathic Pharmacopeia of the United States (HPUS) and the FDA’s Good Manufacturing Practices. All products are required to be clearly marked as “homeopathic”. In recent years, the FDA has increased scrutiny of homeopathic products, particularly those marketed for serious conditions, or containing potentially harmful ingredients, as well as those for eye conditions, and all homeopathic injectables.

Drawbacks

The major drawback of homeopathic medications is the lack of scientific evidence supporting their efficacy. Most scientific reviews and clinical trials have found that homeopathic remedies do not perform better than placebos. Moreover, because homeopathic products are so highly diluted, they are generally considered safe, but they may delay patients from seeking effective medical treatments for serious conditions.

Patent Medicines

History and Evolution

Patent medicines have a colorful history. They began in the 19th century and were popular into the early 20th century before evolving into the over-the-counter industry that we now know. This class includes many modern over the counter medications produced by reputable drugs companies and also medications of dubious quality and effectiveness produced in garages and basements.

In the late 19th and early 20th centuries, medicine wagons and medicine shows became popular vehicles for the promotion and sale of patent medicines. These traveling shows often combined entertainment with health claims, featuring acts such as music, magic tricks, and even wild west performances. At the center of the spectacle, a charismatic “doctor” or salesman would tout the benefits of their patent medicine—a proprietary formula claimed to cure a wide range of ailments.

Patent medicines of this era were largely unregulated, and their ingredients were often a secret. Some contained alcohol, opium, or other stimulants, which provided temporary relief or a placebo effect. Because there were few laws governing their production and sale, these concoctions could be marketed without scientific proof of their efficacy or safety.

Medicine shows traveled to rural and urban areas alike, attracting customers who had little access to conventional medicine, particularly those in remote regions. Unfortunately, these products were often ineffective or even dangerous. The rise of the Pure Food and Drug Act of 1906, which required the labeling of ingredients and restricted misleading claims, signaled the decline of these shows and the broader patent medicine industry.

A few of the original patent medicines stayed on the market until the late 20th century. The most famous of these was Carter’s Little Liver Pills which was touted for curing headaches, constipation, dyspepsia and biliousness. Lydia Pinkham’s Vegetable Compound which was sold for “female complaints “, is still on the market though it has been significantly reformulated. A number of medications on the market now could be considered as the descendants of early patent medicines, perhaps the best known of these is Geritol

Approval Process

Modern patent medicines fall into the category of over the counter (OTC) drugs. Preparation of these medicines must either follow a monograph established by the FDA (essentially a recipe book) or undergo New Drug Application (NDA) process. All patent medicines must comply with strict labeling standards and include accurate ingredient lists, dosage instructions, and warnings. Any health claims must be supported by scientific evidence.

Drawbacks

There are several drawbacks to over the counter (patent) medications. There’s a significant risk that people may intentionally take more than the recommended doses. This is particularly dangerous with some medications such as Tylenol which can lead to liver damage. People may use medications for a longer than the recommended period. They may also be used in an attempt to treat conditions for which they are not intended. They may mask symptoms of a more serious condition leading to a delay in seeking appropriate medical care.

Conclusion

Vitamins, supplements, herbal preparations, patent medicines and homeopathic medications each occupy a unique space in the health and wellness industry. While they offer consumers more choices in managing their health, the differences in how these products are developed, tested, and regulated are significant. As a consumer, it’s essential to be informed about these differences to make safe and effective choices.

I’d like to thank my friend Steve Kaplan, a Registered Pharmacist, who is also my coauthor for this post.

The Pot Predicament

By John Turley

On September 13, 2024

In Commentary, Politics

Recently, the Charleston City Council passed a bill to reduce the penalties for the possession of marijuana for personal use. This started me thinking about marijuana and its long intertwining with my generation. I first became aware of marijuana in my early teenage years, more than sixty years ago. At that time, possession of marijuana for personal use was a crime, as it still is in much of the country now, and it remains a federal crime. Soon after I became conscious of the whole thing, marijuana was incorporated into President Nixon’s war on drugs.

This is a war which sadly we continue to lose. This doesn’t stop us from pouring resources into a part of that war that doesn’t need to be fought. For as long as I can remember, we have continued to prosecute and imprison people who possess marijuana for their own use. I’m not going to discuss possession of marijuana for distribution, that’s a separate problem, one I think will take care of itself if we properly address marijuana for personal use.

Laws against personal use of marijuana remind me much of the failed experiment of prohibition. If people want something enough, they will find it regardless of what the law says. Most of the people imprisoned for personal possession of marijuana represented little or no threat to society as a whole and no one benefited from their imprisonment.

I know the arguments for and against. The health arguments on the pro side say it relieves glaucoma, chronic pain and anxiety. On the con side, there are arguments saying that it is addictive, it can cause cognitive delay and accelerate the development of psychosis. There have been many arguments surrounding marijuana as a gateway drug. I haven’t seen any convincing evidence that restricting personal use of marijuana makes any difference in use of other drugs. The only exception may be those cases where people become hooked on fentanyl or heroin that has been used to lace their marijuana.

My argument against laws criminalizing personal use is that they don’t work. We have spent millions, perhaps billions, of dollars and hundreds of thousands of law enforcement hours to enforce laws that in the long run have no real benefit.

I think it would make better sense to legalize marijuana for personal use. That way, like the alcohol and tobacco industries, it can be regulated with inspections and oversight activities. Customers would know it had not been contaminated with other dangerous drugs. It could also be taxed and distributed through businesses that would benefit from legitimate sale. The tax revenue could be used to fund drug treatment plans for our serious opioid crisis. That is the one war on drugs that we must win but in which we continue to fall further behind. Redirecting funds from marijuana enforcement to opioid treatment and enforcement will help save lives.

If personal use of marijuana is legalized, criminal distribution will rapidly fall away as there will be no profit. The street corner pot dealer will become a historical footnote, much like the prohibition era bootlegger.

I know some of you are thinking I must be an old hippie sitting around my living room smoking a joint and listening to the Grateful Dead. Even though I came of age in the Age of Aquarius, I’ve never tried marijuana and have no plans to do so whether it’s legalized or not. I have no objection to it, it’s just that as a younger man I preferred beer, as I got older, I migrated to wine and martinis, and now I’m too old to change.

The bottom line is this: we live in an age of limited resources, and we need to decide how we are going to utilize those resources. I would like to see us take those financial and human resources and utilize them to address the opioid and methamphetamine crises. We are currently wasting too many of these precious resources trying to enforce unnecessary and ultimately unenforceable laws against personal possession and use of marijuana. If we legalize personal possession, we will reduce crime and all but eliminate the illegal trafficking in marijuana.

That is my grumpy opinion.

A Book Report

By John Turley

On September 8, 2024

In Commentary, History, Politics

On Tyranny: Twenty Lessons From The Twentieth Century

Timothy Snyder

I don’t believe I have written a book report since I was a freshman in college. This is a small book that I believe is well worth your time to read. I mean small book quite literally. It’s about 4 1/2 inches by 6 1/2 inches and only about 126 pages of fairly wide spaced text. You can read the entire book in an afternoon and still have time left over. The book is also available as an audiobook, and it’s combined with Twenty New Lessons From Russia’s War On Ukraine. I got the audio book and listened to it as well. That will take about eight hours to complete.

I’m calling this a book report rather than a book review because I want to tell you what’s in the book rather than what I think about it so that you can form your own opinion. First, I’ll give you an overall impression. It’s thought provoking and raises issues of concern to us today. You may not agree with it. I don’t agree with everything that he said. I found some of his 20 lessons to be redundant because I thought he was stretching to get 20 lessons for the 20th century. I also found one or two of them to be painfully obvious. What follows is just a summary of the book. Read it and e-mail me or call me if you’d like to discuss it. I will send the book to the first person who asks for it, but only if you promise to pass it on when you’re finished.

Doctor Snyder is a professor of history at Yale University. He specializes in Central and Eastern Europe and has spent considerable time in Ukraine. He’s the author of 15 books and reads five European languages and can converse in ten.

Preface

The book begins with a preface in which Doctor Snyder establishes the importance of historical awareness. He describes the failure of some 20th century European democracies and their descent into authoritarian rule. He uses these examples to illustrate how democracy cannot be taken for granted. He makes the argument that democracy is fragile and must be defended. He further argues that even in the United States, the continuation of our democracy is not a given and we must fight for freedom and maintain constant vigilance over our democratic processes.

Each of his twenty lessons is contained in a separate chapter, varying from a few pages to a single sentence.

The Twenty Lessons

Do Not Obey In Advance: Many authoritarian regimes have achieved their power from the people’s willingness to conform without being forced. Do not comply with unjust policies that are not being actively enforced.
Defend Institutions: Democratic institutions such as courts, the press, and unions are an important part of a free society. We must support and defend them against attacks and subversion.
Beware The One-Party State: A multiparty system is crucial for the survival of liberty. The rise of a one-party system often precedes the decline of democratic government.
Take Responsibility For The Face Of The World: The use of symbols in public spaces matters. Authoritarian regimes can shape public perceptions by co-opting national symbols and using them to create division rather than unity. Be vigilant for and challenge symbols of hate and remove these symbols from our public spaces.
Remember Professional Ethics: Professionals, especially those in law, medicine, education and government service must uphold ethical standards, even when pressured to conform to the aims of authoritarian regimes. Their integrity is vital for maintaining democracy.
Be Wary of Paramilitaries: Resist the rise of unofficial armed groups that support authoritarian figures. Such groups may eventually take the place of the legally constituted police and military services. “When the men with guns who have always claimed to be against the system start wearing uniforms and marching with torches and pictures of a leader, the end is nigh. When the pro-leader paramilitary and official police and military intermingle, the end has come.”
Be Reflective If You Must Be Armed: If you are part of law enforcement or the military, refuse to participate in unjust actions or repressions of the population. Ensure that those who bear arms do so with a deep sense of responsibility and ethics and a great regard for the value of democracy.
Stand Out: Authoritarian regimes thrive on compliance. Demonstrate opposition publicly and show visible descent and encourage others to show resistance whenever possible.
Be Kind To Our Language: Be precise in your use of language and avoid repeating the phrases made popular by authoritarian leaders. Independent thinking is facilitated by the careful use of language. Manipulation of language is a powerful tool for the control of the population.
Believe In Truth: Truth is the linchpin of justice and democracy. Uphold and defend objective truths. Reject the false narratives or “big lies” spread by authoritarian regimes. Make every attempt to shed light on their falsehoods regardless of how often or loudly they proclaim them.
Investigate: Seek out reliable sources of information. Support independent journalism. Identify, evaluate and encourage trusted sources. Do not accept any claims by the authoritarian regime without your personal verification. Remember critical thinking is important to resisting manipulation.
Make Eye Contact and Small Talk: Build personal connections within the community to foster solidarity and resilience. Visible civic involvement demonstrates unity and a commitment to democratic principles.
Practice Corporal Politics: Participate in protests, marches, and public events. Physically demonstrating support and civic engagement shows a strong commitment to democratic principles.
Establish A Private Life: Protecting your privacy from surveillance is essential. Authoritarian regimes often invade personal spaces to control and manipulate individuals.
Contribute To Good Causes: Support organizations and causes that defend democracy and human rights. Both financial and moral support will strengthen resistance.
Learn From Peers In Other Countries: Understand how some nations have succumbed to authoritarianism while other nations have resisted it. Learn from their experiences and strategies.
Listen for Dangerous Words: Be alert to the use of language that demonizes opponents or glorifies violence. Such rhetoric often precedes more severe actions against targeted groups. Be sensitive to efforts to convert the population to harmful ideologies through repeated derogatory speech.
Be Calm When The Unthinkable Arrives: Stay composed in moments of crisis and resist the urge to act impulsively. Authoritarian leaders often attempt to exploit chaos to seize power. Be alert for such attempts and be ready to counter them.
Be A Patriot: True patriotism involves defending democratic values and principles, not blind loyalty to a leader or party. Waving flags and shouting slogans is not patriotism. Defending democracy is the true mark of a patriot.
Be As Courageous As You Can: “If none of us is prepared to die for freedom, then all of us will die under tyranny.” (That is the total of this lesson; perhaps the most important one of all.)

Epilogue

The book concludes with an epilogue entitled History and Liberty. In the epilogue Doctor Snyder discusses his theories of the Politics of Inevitability and the Politics of Eternity.

The Politics of Inevitability is the belief that history naturally progresses in a linear forward direction typically towards a better future. It assumes that liberal democracy and capitalism will inevitably spread across the world leading to a more prosperous and freer global system. Human forces are seen as predictable and human activity is often downplayed. People who live under the politics of inevitability tend to believe that the current state of affairs will persist because it represents the end point of political and economic evolution.

The Politics of Eternity, on the other hand, rejects the linear progression of history and emphasizes a cyclical view. It supposes that nations are perpetually threatened by external forces. It glorifies a supposed golden age of the past that is idealized and mythologized. It views current politics as a struggle to return to that idealized past.

I found his discussions to be more theoretical than practical. I can see aspects of both in most current societies. I invite you to please read this and I would love to discuss it. I may be missing something in his presentation of inevitability and eternity.

In Conclusion

If you are concerned about the survival of democracy, read this book.

Dr. Google Will See You Now (Revised)

By John Turley

On September 3, 2024

In Commentary, Medicine

There are few words that cause more trepidation among doctors than having a patient start off a visit by saying, “I was reading on the internet”. It’s not that we don’t want our patients to be well informed; a knowledgeable patient is an important part of successful health care. It is what we call the therapeutic alliance.

What we worry about is what they may have been reading on the Internet. There is a lot of good information available, and I always encourage my patients to learn as much as they can about their own health issues. There are many professionally researched and peer reviewed medical websites. They include such commercial sites as Medscape and WebMD. They also include patient advocacy sites such as the American Diabetes Association and the American Heart Association. And, of course, there are the government sites such as the Centers for Disease Control and the National Institutes of Health. All these present the best available science and benefit from rigorous research and review.

That is not to say that they won’t change. Science evolves and knowledge improves. What is our best knowledge now may at some point in the future be proven wrong. However, your best chance of getting solid information is on these well documented sites.

What I worry about are the undocumented or unverified websites that provide what can best be called rumor or conspiracy. Any time a patient tells me,” I was reading on the Facebook page “The Truth About….,” I cringe. Any Facebook page entitled “The Truth About…” is unlikely to contain much truth.

False information takes on a life of its own on the internet. The big lie almost always buries the truth. Long after the article that was the basis for a false claim linking the MMR vaccine with autism was withdrawn by the British medical journal The Lancet, and long after the physician who wrote the article was found by the British General Medical Council to have falsified the data and long after he lost his medical license, the study is still quoted by many anti-vaccine people as being a fundamental truth.

Even when the authors of such false information repudiate it, people still believe it. It becomes part of the legend that “they” forced the author to remove it. No one ever explains who “they” are or why “they” want to keep the public in ignorance. Of course, there is never any source documentation or research reference.

The websites espousing false medical information may be second in number only to those espousing false political information. At times it seems that the more outlandish the claim the more readily their adherents will believe it. It doesn’t even seem to matter that this type of information is frequently published anonymously. You would think the readers would wonder why a person in possession of such great knowledge would refuse to take credit for it. They will frequently require you to make a purchase or enter a credit card number before you’re allowed in on the secret. Clear references from reliable sources are almost always absent. If they do refer to reliable sources, check and make sure their claims are actually backed up on the site they reference.

How do you evaluate reliable medical websites? First, they should have clear authorship; the site should identify the author(s) and their credentials. There should be frequent updates. Health information should be current. You should look for a publication or review date. There should be clear citations as reliable sites will provide references for their information. The site should be objective in tone; the content should be balanced and should not be focused on selling you something. And finally, reputable sites will have clear privacy policies on how they handle user data.

In summary, I want all my patients to be well informed and take an active interest in their health care. I encourage you to Google any medical questions you have. Just be sure that what you are reading is accurate and verified and scientifically based. Are the authors, their qualifications, and their affiliations clearly identified? Are reliable references cited? Has the article been peer reviewed by experts in the field? Is the article little more than a cleverly prepared sales pitch? Don’t allow conspiracy theories and “crackpot science” to have a detrimental effect on your health.

If in doubt, ask your doctor. If you don’t trust your doctor to give you factual information and prefer to consult with anonymous pseudo medical websites, then perhaps it’s time to find a new doctor. But please, think twice before disregarding the advice of someone whose entire professional life is dedicated to your good health.

Understanding Medical Care Guidelines

By John Turley

On August 7, 2024

In Commentary, Medicine

An important discussion to have with your physician.

Trivia question: What are medical guidelines? Are they rules we must follow or are they simply suggestions or are they something in between?

As we get older and have more frequent visits to the doctor, we are bound to hear one of them say, “according to the guidelines”. To understand how the guidelines apply to you, it is important to know how and why they are developed. You also need to know if there are ever times when you shouldn’t follow them.

At the end of this article, I’ll tell you about my experience with one specific guideline, and how strictly following it possibly could have led to a bad outcome for me. But first, let’s learn a little more about medical guidelines.

Medical care guidelines, also called clinical guidelines, come in two general classes. There are guidelines for preventative care and guidelines for the management of disease processes.

Guidelines have several goals. They are intended to improve public health by recommending evidence-based preventive and treatment measures to help reduce the incidence and severity of disease and improve overall public wellbeing. They’re designed to optimize resource utilization by preventing unnecessary treatment and screening tests. They are also intended to reduce health care disparities by ensuring that all recommended treatments are widely available and are based on the most up-to-date evidence so that health care across the nation is at a uniformly high level of quality.

Sources of Guidelines

Preventative care guidelines have to do with such things as cancer screening, cardiovascular health, vaccinations and immunizations, and lifestyle improvement such as diet and exercise recommendations. Disease management guidelines are developed to ensure the best possible treatment for diseases such as hypertension, diabetes and pulmonary disease.

Guidelines are developed by physician groups such as the American College of Physicians and the American Academy of Pediatrics. They are also developed by advocacy groups such as the American Cancer Society and the American Diabetes Association. Government organizations such as the Centers for Disease Control and Prevention and the National Institutes of Health also develop and promulgate medical care guidelines.

The United States Preventative Services Task Force (USPSTF) is an independent panel of experts in prevention and evidence-based medicine. They issue recommendations on a wide range of preventive services including screenings, counseling and preventative medications. The USPSTF rates medical care recommendations from Grade A, those with a high certainty of substantial benefits, all the way to Grade D, those services that are not recommended due to having no benefit or having harm that outweighs benefits. Their recommendations can be viewed at www.uspreventiveservicestaskforce.org.

Preventative care guidelines

Preventive care guidelines are designed to help identify and mitigate potential health issues before they become significant problems. They help to ensure adequate screening for significant disease processes. They are also designed to help avoid unnecessary screening which may lead to unnecessary treatment and cost.

Preventative care guidelines include such things as mammogram recommendations, colonoscopy recommendations, blood pressure and cholesterol screening, and prostate cancer screening. Preventative care guidelines also include recommendations for vaccinations both for children and adults. Recommendations on diet and the use of vitamins and supplements are one area where the guidelines seem to change frequently.

Treatment guidelines

Treatment guidelines provide a roadmap for managing specific medical conditions. These recommendations encompass diagnostic procedures, therapeutic interventions, and follow-up care to ensure optimal patient outcomes.

Treatment guidelines include recommendations for such things as initiation of blood pressure management and diabetes management. They provide recommendations for diagnostic modalities and specific medications and dosages.

For example, treatment guidelines include blood pressure levels at which medication should be started, the goal of treatment and specific medication, depending on what other medical conditions the patient may have. Similarly, there are blood glucose management recommendations for diabetics that are tailored to specific patient populations. The use of bronchodilators and pulmonary rehabilitation and oxygen therapy for lung diseases are also the subject of a series of guidelines. Treatment guidelines continually evolve as new medications are developed and our understanding of disease processes improves.

Understanding the variability in guidelines.

While the guidelines developed by the various organizations share a common goal of improving patient care, their methodologies and focus areas can differ, reflecting diverse perspectives and priorities within the medical community. There’s not a single set of guidelines that are fixed across all specialties. While the various guidelines are generally in agreement, some may have slightly different recommendations for such things as the onset and aggressiveness in treating hypertension or diabetes. There may be variations in the guidelines for diagnostic testing such as mammograms or colonoscopies. For example, the USPSTF recommends biennial mammograms for women aged 50 to 74, whereas the American College of Surgeons advises annual mammograms starting at age 45 and transitioning to biennial screening at 55. The discrepancy lies in differing interpretations of the balance between benefits and harms of more frequent screenings.

Some guidelines may also become outdated, not reflecting new medications or new treatment plans. Even where there are variations, all guidelines strive to be evidence based, patient centered, and up to date.

Additionally, guidelines need to be individualized to meet the needs of each patient. The overall guidelines are based on the most effective health care for the population as a whole. Some patients may require specialized screening or treatment. For example, women who have a family history of early onset of breast cancer or of genetic mutations may require screening at an earlier age or more frequent screening. Men with a family history of prostate cancer at a young age or of a particularly aggressive prostate cancer may require earlier screening including biopsies or may need screening beyond the age that general guidelines recommend screening is no longer necessary.

My Experience

Several years ago, I received a diagnosis no one wants to hear. Cancer! Prostate cancer to be specific. Thanks to two skilled urologists, I’ve been cancer free for five years.

But it might not have had a happy ending. Please indulge me and let me tell you my story. I think it will be worth your time.

It starts with the PSA, the prostate specific antigen. This is something every man over 40 should know about and every man over 50 should consider getting checked.

So, what is the PSA? It is a protein that is produced by both cancerous and normal cells of the prostate gland. It can be elevated by prostate cancer but it can also be elevated by prostatitis (an infection of the prostate) or an enlarged prostate (benign prostatic hypertrophy). It is checked through a simple blood test your family doctor can order as part of your annual work up.

What are the recommendations for the PSA? The USPSTF has the following three recommendations: (1) consideration of annual screening for men aged 55 to 69 with no family history of prostate cancer; this should be a shared, informed decision between the patient and his physician; (2) for men who have a significant family history of prostate cancer consideration should be given to screening beginning at age 40; (3) for men over 70 years old they recommend against screening for prostate cancer. Please note the phrase “consideration of screening”. This is not a firm recommendation.

A PSA test can have false positives that may lead to unnecessary biopsies or surgery. Only about 25% of men who have a prostate biopsy are found to have cancer. Although, it is important to recognize that a prostate biopsy does not test the entire gland. It takes samples from several areas of the prostate. It is possible, though unusual, that a cancer could be missed in the biopsy process

Additionally, most prostate cancer is very slow growing. Most men who have prostate cancer later in life will generally die of something else before they would die of prostate cancer. However, a small percentage of men will have a high-grade prostate cancer that can progress rapidly and cause their death.

I’m going to use my personal experience as a way of explaining why it is important to have a discussion with your physician about guidelines. The week before my 70th birthday I went in to get my annual physical. In our clinic we have a “birthday panel”, a set of blood tests that we draw for people annually for their physical exam. I had not planned to have my PSA checked since it was not recommended by either the USPSTF or the American Academy of Family Physicians for 70-year-olds. However, it had slipped my mind that a PSA was part of our “birthday panel”.

My PSA came back slightly elevated. Since it was a very minor elevation, I followed the guidelines and waited six months and repeated it. At that time, it increased only a small amount. The guidelines suggested repeating it again in six months. I have to admit though, I have never been a wait-and-see kind of guy. I scheduled an appointment with a urologist.

The urologist and I discussed the options. He told me that the elevation was slight, and we could wait and repeat it in 6 months or if I wished we could do a biopsy. I decided on a biopsy and then after receiving the biopsy results and having further discussions, I eventually decided on surgery. It was my decision, as it should be, made in consultation with my physician and my family.

The post-operative pathology report said that there was a high-grade carcinoma that apparently had been missed by the biopsy. It had extended beyond the capsule of the prostate. Fortunately for me it had not metastasized and had not spread to the lymph nodes, nor had it extended beyond the fat layer surrounding the prostate. Had I followed the guidelines and waited another year or even six months for a repeat biopsy, it is possible that the outcome may have been different.

What’s the bottom line?

Does my experience mean that the guidelines should be ignored? Far from it, I made an informed decision, in conjunction with my physician, on what was best for me. Additionally, I have followed the guidelines in the management of my hypertension and high cholesterol.

Healthcare guidelines are essential in promoting preventive care and effective treatment and in helping clinicians provide high-quality, evidence-based care. But the guidelines are just that, guidelines they are not “set in stone” rules for healthcare. It’s important for you to discuss your health care with your physician. Be an informed health care consumer. Ask how the guidelines are being used to manage your health care and how they may be affected by your family history or personal history. You and your physician should be involved in joint decision making. Your individual plan will generally follow the guidelines while having some variation based on what is the best care for you. And that’s what the guidelines are all about, making sure we are able to provide the best possible health care for all of our citizens.

A Thought For Today

By John Turley

On August 1, 2024

In Commentary

A lie doesn’t become truth, wrong doesn’t become right, and evil doesn’t become good, just because it’s accepted by a majority.

–Booker T. Washington