Doctor Who?

Diagnosing Medical Fraud May Require a Second Opinion

Quackwatch.com— a skeptical psychiatrist's attempt to torpedo alternative and natural-health movements— scored a victory in late April when a government panel named it as a credible source for exposing fraudulent online health information. By so doing, the panel may have been, inadvertently or not, choosing sides in an escalating health e-commerce battle.

The Science Panel on Interactive Communication and Health, appointed by the U.S. Department of Health and Human Services, reached a rather obvious conclusion: Health information on the Internet can be inaccurate and misleading. Thus, consumers need to learn to separate the healthy wheat from the dangerous chaff. That is, Internet users need to guard against quacks.

"[Consumers] really need to be able to avoid quackery and bias. Bias can be as damaging as outright quackery," HHS Health Communication and Telehealth Staff Director Mary Jo Deering told Reuters.

But in today's divided health climate, a quack is in the eyes of the beholder. A touch therapist treating your third eye? Or a conventional doc who sprinkles around free pharmaceutical samples? The panel, composed of doctors, as well as representatives from HMOs such as Kaiser Permanente, insurers, and online health providers, considered but rejected the idea that the government should be in the business of quack exposing by regulating health information online.

"The panel decided that the most important thing is to have a voluntary standard for these Web sites," said HHS official Dr. Thomas R. Eng, who directed the panel's study. Eng unveiled vague guidelines and disclosure statements to help consumers determine the validity of sites. At the press conference, Eng named Quackwatch.com as a good site for uncovering fraudulent health information. But the mere mention of the site, posted by alternative- medicine opponent Dr. Stephen Barrett, raises the blood pressure of alternative advocates.

Barrett, a former psychiatrist in Allentown, Pennsylvania, doesn't sugarcoat his bitter pills. His site is a virtual hit list of therapies he finds too illogical to be tested for their validity. Chiropractic, acupuncture, homeopathy, vitamins and herbs, relaxation techniques, and preventive nutrition plans, as well as specific practitioners like Dr. Bernie Siegel, M.D. (author of Love, Medicine & Miracles and Peace, Love & Healing), Deepak Chopra (ayurvedic guru), and myriad others, are included in the quackery roundup.

Barrett, now a full-time journalist and book author and never a medical researcher, says he exposes underresearched, illogical therapies with little written about them. Yet he also says he examines reams of material to reach the conclusions published on his site, which are then often quoted as undisputed fact in the mainstream media.

Barrett depends heavily on negative research and case studies in which alternative therapies do not work, but he says that most case studies that show positive results of alternative therapies are unreliable. "It's easy to look at something like chiropractic, see what they're doing, and describe what they're doing wrong," Barrett says. He adds that he does not criticize conventional medicine because "that's way outside my scope."

Barrett believes most alternative therapies simply should be disregarded without further research. "A lot of things don't need to be tested [because] they simply don't make any sense," he says, pointing specifically to homeopathy, chiropractic, and acupuncture. He believes that consumers should rely solely on established medical groups and studies, and that anyone who wants to consider info on both sides is "waiting to be quacked in a major way."

"He seems to be putting down trying to be objective," says Peter Barry Chowka, a former adviser to the National Institutes of Health's Office of Alternative Medicine. "Quackwatch.com is consistently provocative and entertaining and occasionally informative," Chowka added. "But I personally think he's running against the tide of history. But that's his problem, not ours."

Chowka feels it is okay for HHS to mention Quackwatch.com as one of many sources. "But I have a problem when the federal government recommends a limited number of specific sites." The panel also recommended its own site: www.healthfinder.org, which includes advice on how to detect online health fraud (but does not mention Quackwatch).

Eng later backed away from his Quackwatch endorsement, saying consumers should question Barrett's site as well as those it targets. "The government doesn't endorse Web sites," Eng says. Still, he says, "[Quackwatch] is the only site I know of right now looking at issues of fraud and health on the Internet."

The Quackwatch debate illustrates a major rift in the health-care ranks as health entrepreneurs on both sides scramble for their share of health-oriented e-commerce. The Wall Street Journal reported last week that about 22.3 million adults, or nearly 40 percent of American adults online, looked for health info online in 1998, while drug companies spent $1.5 billion advertising prescription drugs directly to U.S. consumers. In late May, a $5 billion merger was announced between two Web-based health services: Healtheon Corp. and WebMDInc. This merger, backed by Microsoft, Intel, and Excite!, is bringing together doctors, insurers, and drug companies to sell and promote health services.

Yet corporate health sites have a battle on their hands: Many consumers are rejecting big-business medicine and opting for natural, less invasive, and nondrugged routes to wellness. And the Web is a grassroots way for consumers to decide for themselves.

"A power struggle has been going on for decades between those who have the power and the insurgents," Chowka says. "Give people the benefit of the doubt," he adds, calling for an end to "medical McCarthyism." "We no longer need a nanny state or a government-appointed watchdog to filter information to us." Yet Eng emphasizes that interactive media has a unique ability to "influence behavior change"— thus the need for caution. "They tailor information and interactions to the individual," he said of Web sites. "In print media, there is some kind of vetting. In interactive, anyone or their brother can slap a Web page together."

That, Barrett argues, is where his site comes in. Consumers, he says, aren't qualified to judge for themselves and must choose sides. "The consumer has to decide who to trust. I think I'm needed, and I'm qualified," he says.

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