Efficacy of quality criteria to identify potentially harmful information: a cross-sectional survey of complementary and alternative medicine web sites.

BACKGROUND: Many users search the Internet for answers to health questions. Complementary and alternative medicine (CAM) is a particularly common search topic. Because many CAM therapies do not require a clinician's prescription, false or misleading CAM information may be more dangerous than information about traditional therapies. Many quality criteria have been suggested to filter out potentially harmful online health information. However, assessing the accuracy of CAM information is uniquely challenging since CAM is generally not supported by conventional literature. OBJECTIVE: The purpose of this study is to determine whether domain-independent technical quality criteria can identify potentially harmful online CAM content. METHODS: We analyzed 150 Web sites retrieved from a search for the three most popular herbs: ginseng, ginkgo and St. John's wort and their purported uses on the ten most commonly used search engines. The presence of technical quality criteria as well as potentially harmful statements (commissions) and vital information that should have been mentioned (omissions) was recorded. RESULTS: Thirty-eight sites (25%) contained statements that could lead to direct physical harm if acted upon. One hundred forty five sites (97%) had omitted information. We found no relationship between technical quality criteria and potentially harmful information. CONCLUSIONS: Current technical quality criteria do not identify potentially harmful CAM information online. Consumers should be warned to use other means of validation or to trust only known sites. Quality criteria that consider the uniqueness of CAM must be developed and validated.

Mechanistic studies of mouse skin tumor promotion by chrysarobin

Since the anthrone chrysarobin oxidizes and generates free radicals, investigations were conducted to assess a possible role for free radicals or reactive oxygen species (ROS) in skin tumor promotion by chrysarobin. Epidermal glutathione levels were not noticeably altered by chrysarobin, nor did a glutathione-depleting agent enhance promotion by chrysarobin. Multiple applications of chrysarobin increased lipid peroxide levels in mouse epidermis two-fold as compared with controls. The antioxidant $\alpha$-tocopherol and the lipoxygenase inhibitor nordihydroguaiaretic acid both inhibited production of lipid peroxides by chrysarobin. The antioxidants $\alpha$-tocopherol acetate and ascorbyl palmitate effectively inhibited promotion and promoter-related effects induced by chrysarobin. Since prooxidant states can lead to increases in intracellular Ca$\sp{2+}$, the effect of two Ca$\sp{2+}$ antagonists, verapamil and TMB-8, on chrysarobin-induced promotion and promoter-related effects were investigated. Both Ca$\sp{2+}$ antagonists inhibited promotion and promoter-related effects induced by chrysarobin, suggesting a possible role for intracellular Ca$\sp{2+}$ alterations in chrysarobin-tumor promotion. Since radical generating compounds are reported to possess the ability to enhance progression of papillomas to squamous cell carcinomas (SCCs), the effects of chrysarobin on papilloma development were tested. Growth kinetics and regression of papillomas generated with limited promotion with chrysarobin were similar to what was reported for the nonradical generating promoter 12-O-tetradecanoylphorbol-13-acetate (TPA) (Aldaz et al., 1991). To test the chrysarobin's ability to enhance progression of pre-existing papillomas to SCCs, tumors were generated by initiation with dimethylbenz (a) anthracene and promotion with TPA. Then mice were treated with chrysarobin, TPA or acetone for 45 weeks. When mice treated with chrysarobin were compared to mice treated continually with TPA with similar numbers of papillomas, the number of papillomas that progressed to SCCs was similar, suggesting that papilloma burden influences the progression of papillomas to SCCs, rather than radical production. In summary, the present study suggests that chrysarobin produces oxidative stress in mouse epidermis as indicated by the generation of lipid peroxides. Antioxidants inhibited production of lipid peroxides and tumor promotion by chrysarobin. Collectively, these data suggest a role for free radicals or ROS in tumor promotion by chrysarobin. ^

Effects of exogeneous p53 on growth suppression, apoptosis, and differentiation in oral cancer cell lines

The p53 gene is known to be one of the most commonly mutated genes in human cancers. Many squamous cell carcinomas of the head and neck (SCCHNs) have been shown to contain nonfunctional p53 as well. The use of p53-mediated gene therapy to treat such cancers has become an intensive area of research. Although there have been varied treatment responses to p53 gene therapy, the role that endogenous p53 status plays in this response has not been thoroughly examined. Because of this, the hypothesis of this study examined the role that the endogenous p53 status of cells plays in their response to p53 gene therapy. To test this, an adenoviral vector containing p53 (p53FAd) was administered to three squamous cell carcinoma lines with varied endogenous p53. The SCC9 cell line demonstrates no p53 protein expression, the SCC4 cell line displays overexpression of a mutant p53 protein, and the 1986LN cell line displays low to no expression of wild-type p53 protein as a consequence of human papillomavirus infection. After treatment with p53FAd, the cells were examined for evidence of exogenous p53 expression, growth suppression, alterations in cellular proteins, G1 growth arrest, apoptosis, and differentiation state. Each cell line exhibited exogenous p53 protein. Growth suppression was seen most prominently in the SCC9 cells, to some extent in the 1986LN cells, and little was seen with the SCC4 cells. WAF1/p21 protein was induced in all three cell lines, while PCNA, bcl-2, and bax expression was not significantly affected in any of the lines. Apoptosis developed first in SCC9 cells, next in 1986LN cells, with little seen in the SCC4 cells. The SCC9 line was the only line to show significant GI growth arrest. No significant differences were observed in the overall expression of differentiation markers, aside from increased keratin 13 mRNA levels in all three lines indicating a possible tendency toward differentiation. This study indicates that the endogenous p53 status of squamous cell carcinomas appears to play a critical role in determining the response to p53 adenoviral gene therapy. ^