How do you rank the reliability of information?
This spring, during the swine flu outbreak, I was searching the Web for news when a blog post on the Huffington Post caught my eye. Titled "Swine Flu: Protect Yourself and Your Loved Ones," its author, Kim Evans, offered a unique prescription for swine flu, one she believed could "save your life": deep-cleansing enemas.
"Most estimates are that the average person has ten or more pounds of stored waste just in their colon," Evans wrote. "In any case, many people have found that disease disappears when this waste is gone, and that when the body is clean it's much more difficult for new problems, like viruses, to take hold in the first place. And it's my understanding that many people who took regular enemas instead of vaccines during the 1918 pandemic made it out on the other side as well."
This is not exactly first-line advice on influenza prevention. There's no proof that a cleansing program will prevent influenza. In fact, Evans' notion contradicts basic germ theory. Influenza infection is transmitted through respiratory channels and not, like gastrointestinal infections, through contact with fecal matter. And even if people in 1918 did try to protect themselves with enemas -- Evans doesn't cite any historical record -- there's no evidence the practice saved anybody's life. Note to Evans: People did not have a choice between enemas and vaccines in 1918. The first influenza vaccine was developed in the 1940s.
The Huffington Post is one of the most valuable pieces of real estate on the Internet these days. It operates mostly as a news aggregation site (it has featured Salon stories) and throws open its doors to a wide range of bloggers, who cover everything from politics to entertainment. "When it comes to health and wellness issues, our goal is to provide a diverse forum for a reasoned discussion of issues of interest and importance to our readers," Arianna Huffington, the site's namesake founder, author, socialite and pundit, told me.
I would like to believe her. But when it comes to health and wellness, that diverse forum seems defined mostly by bloggers who are friends of Huffington or those who mirror her own advocacy of alternative medicine, described in her books and in many magazine profiles of her. Among others, the site has given a forum to Oprah Winfrey's women's health guru, Christiane Northrup, who believes women develop thyroid disease due to an inability to assert themselves; Deepak Chopra, who mashes up medicine and religion into self-help books and PBS infomercials; and countless others pitching cures that range from herbs to blood electrification to ozonated water to energy scans.
As a physician, I am not necessarily opposed to alternative health treatments. But I do want to be responsible and certain that what I prescribe to patients is safe and effective and not a waste of their time and money. A recent Associated Press investigation stated the federal government has spent $2.5 billion of our tax dollars to determine whether alternative health remedies -- including ones promoted on the Huffington Post -- work. It found next to none of them do. The site also regularly grants space to proponents of the thoroughly disproven conspiracy that childhood vaccines have caused autism. In short, the Huffington Post is hardly a site that promotes "a reasoned discussion," in its founder's words, of health and medicine.
Practically since its inception in 2005, the Post's health coverage has been the subject of scrutiny and criticism from physicians and medical experts. Steve Novella and David Gorski, both academic physicians, who run the blog Science-Based Medicine, have been at the forefront of the opprobrium. In a post this April, Novella declared that Huffington Post readers were being "fed demonstrable medical falsehoods and misinformation."
In May, Huffington hired Patricia Fitzgerald, who had previously blogged on the site, to serve as Wellness editor. In Huffington's words, Fitzgerald will add "another layer to the vetting process for posts dealing with medical, health, and nutritional advice." Fitzgerald, an acupuncturist with a master's degree in traditional Chinese medicine and a doctorate in homeopathic medicine, is the author of "The Detox Solution: The Missing Link to Radiant Health, Abundant Energy, Ideal Weight, and Peace of Mind." Her posts had praised actress Jenny McCarthy for healing her son's autism with "biomedical intervention," a menu of "detoxification, and removal of interfering factors, such as yeast, food allergies, viruses, bacteria, and heavy metals," restrictive diets, expensive nutritional supplements and chelation therapy -- all unproven.
Fitzgerald told me her mission "is to assist in providing interesting, informative and well-written pieces that support and inspire people looking to live healthier lives." She added, "I spend a considerable amount of time helping medical professionals used to writing for other medical professionals develop a style more accessible to a general audience. Every blog post on HuffPost is reviewed by our editorial team. I vet and offer input on some posts dealing with health advice."
Not everybody who writes about health and medicine on the Huffington Post appears to cling to alternative treatments like detoxification and restrictive diets. Dr. Lloyd Sederer, a psychiatrist and medical director of New York's Office of Mental Health, and Dr. Sarah Lovinger, who blogs about health and the environment, have admirable public health backgrounds and seem to care about issues on the ground. Sederer, for example, recently posted a strong piece about mental health problems in soldiers returning from Iraq and Afghanistan, and Lovinger has been outspoken in her advocacy for healthcare reform.
But frequent visitors to the Huffington's Post "Living" site, home to its health and medical coverage, cannot avoid the preponderance of posts by enthusiastic champions of dubious treatments and therapies.
Evans epitomizes the Post's health bloggers. Her bio on the site describes her as "the author of 'Cleaning Up!' and the creator of The Cleaning Up! Cleanse, a powerful body cleanse that addresses deep levels of toxicity throughout the body and a common fungal problem, candida overgrowth." In other publications, Evans fixates on candida as the root of many medical problems, including cancer. While this theory is popular in the alternative health community, it is scientifically meaningless. It's true that candida overgrowth can cause relatively minor problems in healthy people taking antibiotics (vaginal yeast infections in women, thrush and diaper rashes in babies), and can cause serious systemic infections in those whose immune systems are compromised, such as HIV-infected patients. But there's no credible research or study that demonstrates chronic health problems or cancer can be cured by eliminating candida.
When I asked Evans to substantiate the views she has expressed on the Huffington Post, I had a hard time being persuaded by her answer. "First and really foremost, articles on the Huffington Post are typically about 15 paragraphs max and generally, they are not written for the medical or scientific community," she said. "My articles in particular are written for the average person, and the average person generally isn't interested in reading every study ever published or all of the research available to support an argument."
A more regular Huffington Post blogger is Dr. Srinivasan Pillay. According to his biography, Pillay is everything from a "psychiatrist" to "certified master coach" to "brain-imaging researcher" to "public speaker." Last March, Pillay wrote a piece, "The Science of Distant Healing," which began with the following question and bold claim: "There is much written about how our good intentions help others. But can your good intentions really reach someone who is not physically present, and how do we know this? In this column, I will present the current evidence that discusses this phenomenon and provide some explanations as to why distant healing has a place in modern scientific thinking." He went on to cite a "well-designed study" that proves that people, by using their thoughts, can heal (or harm) others who are sick in other locations.
Whatever that "well-designed" study may be (Pillay didn't specify, nor did he return my requests for an interview), the sum of the evidence suggests that distance healing is snake oil. Medical researchers at the University of Exeter in England looked at studies noting the health benefits of distance healing and found the research was hampered by serious flaws. Rigorous studies conducted by the University of Maryland School of Medicine have demonstrated that no difference exists between distance healing and placebo.
The Huffington Post's most famous unscientific stand is against childhood vaccines. From what seems like its first day on the Internet, the site has played host to the anti-vaccine movement, granting center stage to the movement's most prolific and outspoken proponents, such as author David Kirby, Jenny McCarthy's pediatrician Jay Gordon and detox advocate Dierdre Imus, wife of shock jock Don Imus. (It should be noted the site promoted Robert F. Kennedy Jr.'s 2005 article "Deadly Immunity," jointly published by Rolling Stone and Salon, which accused the Centers for Disease Control, and other health agencies, of covering up the links between autism and vaccines. The article was widely criticized by the medical community and required both publications to make numerous corrections of fact and analysis.)
As if the circus tent couldn't get any bigger, this April, the site posted a piece, "The Judgment on Vaccines Is In???" by actor and comedian Jim Carrey. In addition to the usual anti-vaccine platitudes -- blaming doctors for being in bed with drug companies; attacking people instead of data -- Carrey offered arguments apparently composed by Ace Ventura:
"I've also heard it said that no evidence of a link between vaccines and autism has ever been found. That statement is only true for the CDC, the AAP and the vaccine makers who've been ignoring mountains of scientific information and testimony. There's no evidence of the Lincoln Memorial if you look the other way and refuse to turn around. But if you care to look, it's really quite impressive."
While we might expect loose analogies and logic from a celebrity blogger, we might also expect them to take a little care with the facts. Carrey's piece contains multiple mistakes. He writes, for example, that vaccines contain "ether, and anti-freeze." They don't. Still, the post went up and generated thousands of comments, including many that pointed out Carrey's errors. Huffington states that the site's "policy calls for factual errors in blog posts to be corrected by the blogger within 24 hours of the error being pointed." Carrey's post appeared on April 22 and still hasn't been corrected.
Huffington has been in the public eye for decades as the author of over a dozen books on topics ranging from art to self-help to politics, as a radio talk show host, the wife (and now ex-wife) of a former U.S. GOP congressman who ran for Senate; an ex-California gubernatorial candidate, and now, and perhaps most successfully, the founder of the eponymous New Media juggernaut. In a 2008 New Yorker article, writer Lauren Collins suggested that Huffington was motivated not by money but by the quest to "command attention and to change minds." To that end, she has a long history of being "a budding celebrity contrarian."
Huffington's desire to be different became especially clear when I looked at her views about health. In her 2006 self-help book, "On Being Fearless," she provides her own definition of preventive care, one that's indistinguishable from Evans' blog post. "In today's world, where thousands of chemicals are being used all around us, it's essential both to protect against exposure and to maintain some kind of detox program," Huffington wrote. In the New Yorker, Collins revealed that Huffington has undergone "mercury detoxification, fire-walking, est, microdermabrasion, infrared saunas" and a long list of fad diets. In "On Being Fearless," she gave a description of her own experience with mercury detox, saying she was "stunned to find how much mercury I had in my body."
What Huffington may not know is the test used to determine the amount of mercury in the body is a sham, as proven by medical researchers at the Department of Environmental and Occupational Health, Emory University and other public health institutes. The test artificially elevates the levels of heavy metals in one's body, falsely leading one to believe that they've been poisoned by toxins. In fact, a doctor who routinely prescribed the test has been investigated and disciplined.
In an e-mail to me, Huffington touched on her long and winding road through alternative therapies, dropping the names of major universities (Harvard, Stanford, Johns Hopkins, UCLA) with centers for complementary and alternative medicine, where she has been a patient. But health coverage on the site goes beyond complementary medicine. In fact, the more I read the site, the more I realized its health writers were being chosen not in the name of diversity or on the basis of their qualifications. Rather, as Collins revealed in the New Yorker, they appear to be picked by Huffington on a whim.
One day, after having dinner with Charlie Rose, Huffington broke her ankle. "Rose recommended a foot and ankle specialist at the Hospital for Special Surgery, Dr. Rock Positano. He is now a contributor to Huffington Post," Collins wrote. "In the course of two days in May, Huffington invited the following people to be bloggers: someone she met at a book signing … a fifteen-year old lecture attendee; a bookstore owner; the Asperger's-afflicted teenage son of a radio d.j.; a woman, dressed exclusively in green, who was trying to stop insecticide spraying."
Huffington also relies on her Rolodex to make executive decisions. Recently she hired Dr. Dean Ornish to become the site's medical editor (a spokesperson for Ornish confirmed this). When I asked her how she chose him, she told me that the two of them have been friends for quite some time, which led to her offering him the job. Ornish, who will consult with Wellness editor Fitzgerald, will not be paid by Huffington.
If their mission is to indeed vet the health posts more vigorously, they will have their work cut out for them. One would expect a Huffington Post editor to insist health writers like Pillay support their unconventional claims with peer-reviewed research, published in reputable journals. Yet this is seldom the case. As a doctor and writer, but mostly as a consumer, I find this lack of substance callous. An editor should have demanded that Carrey correct his egregious mistakes about vaccines within the site's 24-hour policy. That same editor should have asked Evans to link to the relevant medical study when she claimed, "A study in 2005 found that newborns are being born with literally hundreds of chemicals in their bloodstream, many of them known to cause cancer." The story didn't link to a journal article but to
Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.
Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.
As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.
However, the government also is funding studies of purported energy fields, distance healing and other approaches that have little if any biological plausibility or scientific evidence.
Taxpayers are bankrolling studies of whether pressing various spots on your head can help with weight loss, whether brain waves emitted from a special "master" can help break cocaine addiction, and whether wearing magnets can help the painful wrist problem, carpal tunnel syndrome.
The acupressure weight-loss technique won a $2 million grant even though a small trial of it on 60 people found no statistically significant benefit — only an encouraging trend that could have occurred by chance. The researcher says the pilot study was just to see if the technique was feasible.
"You expect scientific thinking" at a federal science agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate nonsense."
Many scientists say that unconventional treatments hold promise and deserve serious study, but that the federal center needs to be more skeptical and selective.
"There's not all the money in the world and you have to choose" what most deserves tax support, said Barrie Cassileth, integrative medicine chief at Memorial Sloan-Kettering Cancer Center in New York.
"Many of the studies that have been funded I would not have funded because they seem irrational and foolish — studies on distant healing by prayer and energy healing, studies that are based on precepts and ideas that are contrary to what is known in terms of human physiology and disease," she said.
In an interview last year, shortly after becoming the federal center's new director, Dr. Josephine Briggs said it had a strong research record, and praised the many "big name" scientists who had sought its grants. She conceded there were no big wins from its first decade, other than a study that found acupuncture helped knee arthritis. That finding was called into question when a later, larger study found that sham treatment worked just as well.
"The initial studies were driven by some very strong enthusiasms, and now we're learning about how to layer evidence" and to do more basic science before testing a particular supplement in a large trial, said Briggs, who trained at Ivy League schools and has a respected scientific career.
"There are a lot of negative studies in conventional medicine," and the government's outlay is small compared to drug company spending, she added.
However, critics say that unlike private companies that face bottom-line pressure to abandon a drug that flops, the federal center is reluctant to admit a supplement may lack merit — despite a strategic plan pledging not to equivocate in the face of negative findings.
Echinacea is an example. After a large study by a top virologist found it didn't help colds, its fans said the wrong one of the plant's nine species had been tested. Federal officials agreed that more research was needed, even though they had approved the type used in the study.
"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.
Critics also say the federal center's research agenda is shaped by an advisory board loaded with alternative medicine practitioners. They account for at least nine of the board's 18 members, as required by its government charter. Many studies they approve for funding are done by alternative therapy providers; grants have gone to board members, too.
"It's the fox guarding the chicken coop," said Dr. Joseph Jacobs, who headed the Office of Alternative Medicine, a smaller federal agency that preceded the center's creation. "This is not science, it's ideology on the part of the advocates."
Briggs defended their involvement.
"If you're going to do a study on acupuncture, you're going to need acupuncture expertise," she said. These therapists "are very much believers in what they do," not unlike gastroenterologists doing a study of colonoscopy, and good study design can guard against bias, she said.
The center was handed a flawed mission, many scientists say.
Congress created it after several powerful members claimed health benefits from their own use of alternative medicine and persuaded others that this enormously popular field needed more study. The new center was given $50 million in 1999 (its budget was $122 million last year) and ordered to research unconventional therapies and nostrums that Americans were using to see which ones had merit.
That is opposite how other National Institutes of Health agencies work, where scientific evidence or at least plausibility is required to justify studies, and treatments go into wide use after there is evidence they work — not before.
"There's very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people's beliefs, even as a fad. And then pressure comes: 'It's being popular, it's being used, it should be studied.' It turns things upside down," said Dr. Edward Campion, a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine.
That reasoning was used to justify the $2 million weight-loss study, approved in 2007. It will test Tapas acupressure, devised by Tapas Fleming, a California acupuncturist. Use of her trademarked method requires employing people she certifies, and the study needs eight.
It involves pressing on specific points on the face and head — the inner corners of the eyes are two — while focusing on a problem. Dr. Charles Elder, a Kaiser Permanente physician who runs an herbal and ayurvedic medicine clinic in Portland, Ore., is testing whether it can prevent dieters from regaining lost weight.
Say a person comes home and is tempted by Twinkies on the table. The solution: Start acupressure "and say something like 'I have an uncontrollable Twinkie urge,'" Elder said. Then focus on an opposite thought, like "I'm in control of my eating."
In Chinese medicine, the pressure is said to release natural energy in a place in the body "responsible for transforming animal desire into higher thoughts," Elder said.
In a federally funded pilot study, 30 dieters who were taught acupressure regained only half a pound six months later, compared with over three pounds for a comparison group of 30 others. However, the study widely missed a key scientific standard for showing that results were not a statistical fluke.
The pilot trial was just to see if the technique was feasible, Elder said. The results were good enough for the federal center to grant $2.1 million for a bigger study in 500 people that is under way now.
Alternative medicine research also is complicated by the subjective nature of many of the things being studied. Pain, memory, cravings, anxiety and fatigue are symptoms that people tolerate and experience in widely different ways.
Take a question like, "Does yoga work for back pain?" said Margaret Chesney, a psychologist who is associate director of the federally funded Center for Integrative Medicine at the University of Maryland.
"What kind of yoga? What kind of back pain?" And what does it mean to "work" — to help someone avoid surgery, hold a job or need less medication?
Some things — the body meridians that acupuncturists say they follow, or energy forces that healers say they manipulate — cannot be measured, and many scientists question their existence.
Studying herbals is tough because they are not standardized as prescription drugs are required to be. One brand might contain a plant's flowers, another its seeds and another, stems and leaves, in varying amounts.
There are 150 makers of black cohosh "and probably no two are exactly the same, and probably some people are putting sawdust in capsules and selling it," said Norman Farnsworth, a federally funded herbal medicine researcher at the University of Illinois at Chicago.
Even after a careful study, "you know one thing more precise and firm about what that agent did in that population with that outcome measurement, but you don't necessarily know the whole gamut of its effectiveness," as the echinacea study showed, Briggs said.
The center posts information on supplements and treatments on its Web site, and has a phone line for the public to ask questions — even when the answer is that not enough is known to rule in or rule out benefit or harm.
"I hope we are building knowledge and at least an informed consumer," Briggs said.
On the Net:
Federal agency: http://www.nccam.nih.gov
It was my understanding that Wakefield's research was flawed in the sense that he specifically recruited certain patients. I do know about the conflict of professional interest. Still, there is evidence of bowel issues with ASD individuals; my own 6 year old finally potty trained last summer after years of encopresis (we had several trips to the pedi gastro at Emory). In fact both boys tested positive to high levels of resistant yeast in their digestive tract as well.
Did Wakefield merely stumble upon yet another common condition amongst Autism and link it? Perhaps! However, I believe he also did find evidence of the measles virus in said patients....why would this be?
But there are also proven alternative medicinal aids too; the only thing that swept out the yeast from my boys' guts was caproyal (medicinal food). My mother's migraines have diminished considerably since she used acupuncture. Glucosamine has also helped with the mild-moderate arthritis in her knee
Likewise it has been proven that high levels of omega 3 oil (epa above 800mg) can help with depression, bipolar as well as other mood disorders. (I wouldn't recommend it as monotherapy though, it can be enough to lessen the need for a second or third med).
Then there are the scams; here is a link to a great friend's research and outing of some horrendous scams that target the most desperate and disadvantaged, (I wonder if such scams would be as broad if the current way the US practices medicine; all for profit).
You may have to trawl around her blog but there are multiple sacms she has researched.
There is a difference between foods or supplements that have a method of action.
If we used "anecdotal evidence" of everyday people and ghost writers for the pharmaceutical industry, and wrote a book titled "Know your pharma sources", then people might start to get it. But who's got enough money to push such a book? By push, I mean the pharma industry's meaning of the word "market".
Besides, what will motivate the ghost-writers to speak up and tell the truth?