When Web Sites Play Doctor

How to spot the snake oil on e-health sites

Nervous? Suffer from muscle aches? If some Web sites are to be believed, you may be harboring irksome parasites. Luckily for you, there's a solution: The Original Parasite Zapper, a battery-operated device that, together with certain herbs, will rid you of viruses, bacteria, and other pests. Just fork over $75, and you're on your way to being bug-free. Or maybe you've got more serious problems. With a few quick clicks of the mouse you'll find Web sites chronicling miraculous recoveries from cancer, diabetes, lupus, and a host of other ailments. For just $14.95, you can learn a self-healing method prescribed by the world's largest "medicineless" hospital, in China. Here, among other things, you will discover the secret to spontaneous remission of bladder cancer.

Cyberspace is awash in so-called e-health sites, spawned by consumers' unquenchable thirst for medical information. George D. Lundberg, editor-in-chief of a well-respected site called Medscape.com, figures there could be anywhere from 20,000 to 2 million such sites, including pages from university medical departments. Some dispense free advice, ranging from the genuinely helpful to the blatantly bogus. Others sell devices, services, and herbs that could cure you or kill you, depending on what other medications you might be taking.

ODDBALL. Telling the difference between helpful and harmful can be tough. Even some of the true oddball sites trumpet definitive studies, important-sounding journal articles, and degree-toting physicians, along with patient testimonials, photos, and charts. "There's a tremendous amount of quackery out there," says Dr. Stephen Barrett, a psychiatrist who runs Quackwatch.com, a site that strives to separate the good sites from the bad.

How do you determine what information is on the up-and-up? To begin with, consider the source. On sites run by the American Medical Assn. or the National Institutes of Health--to name just two--you're likely to find sound information that has been vetted by medical doctors. But don't look for that at the Chinese Association of Urine Therapy, a Taiwan organization that advocates drinking one's own urine to fight everything from cancer to baldness. Any validity to it? "There's no medical evidence to show that there's any benefit from the use of urine," says Dr. Anthony Atala, a urologist and associate professor of Harvard Medical School.

For many of these sites, the louder the marketing pitch, the lower the credibility. Sites organized to sell certain therapies usually give short shrift to others. Quackbuster Barrett also takes a hard line on all outfits that sell herbs, dietary supplements, and homeopathic products. Such sites usually fail to post warnings about who should not buy the products, he says, and "the information on these sites always contains unsubstantiated claims."

The claims can be downright dangerous. Take the case of a Chinese herb called ma-huang, which may help alleviate asthma and allergy symptoms, but is more commonly misused in weight-loss formulas and energy boosting compounds. The active ingredient, ephedrine, has been severely restricted in some states and has repeatedly come under heat at the Food & Drug Administration in the wake of more than 30 fatalities and hundreds of cases of serious side effects. And yet, the herb is available in bulk on the Legendary Ethnobotanical Resources' World-HerbShop.com Web site, where nary a warning can be found. The owner of the site, Luis E. Riesgo, argues that the research on ephedrine is not conclusive. "I would love to be able to offer correct information, but the truth of the matter is nobody has it," he says.

Even when sites post warnings, they may be played down. MotherNature.-com, for instance, alerts potential buyers about "the very public debate" raging over St. John's Wort, a popular antidepressant herb that interacts badly with several other medications. But it hastens to add that the stuff racks up about $140 million in annual sales, and that some studies have found it to be "an effective antidepressant that causes relatively few side effects." Jeffrey A. Steinberg, chief marketing officer for MotherNature.com Inc., says: "We don't purport to be physicians and we're not prescribing anything." He emphasizes that the site posts adequate warnings, and that visitors "really need to read the information."

Alternative medicine sites can be showcases for all sorts of cyber-silliness. At www.alternativemedicine.com, for example, you can hear about how the National Cancer Institute does not want to cure cancer. If alternative medicine still appeals to you, expect to find the most reliable information on sites linked to centers of traditional Western medicine. The National Center for Complementary and Alternative Medicines at the National Institutes of Health might be a good starting point. Here, news will hew to a higher scientific standard than at most alternative sites, in part because it is addressed to a skeptical audience of traditional doctors.

When it comes to mainstream medicine, there is no shortage of peer-reviewed data. The U.S. government, for instance, runs healthfinder.gov, which offers free access to health data on more than 1,000 topics, ranging from asthma to zinc deficiency. Michael Homan, president of the Medical Libraries Assn. also recommends MEDLINEplus, from the National Library of Medicine.

But don't rule out commercial sites altogether. Even if their main goal is to market a product, they may still aggregate and publicize legitimate research. Medscape.com and InteliHealth.com, for instance, offer current news along with links to medical data. On these sites, news about allergies, for example, will be clearly segregated from ads for medications or devices such as climate-control machines for allergy sufferers. And in theory, these sites are managed like leading newspapers and magazines, in which ads are not permitted to influence content.

ETHICAL CODE. One way users can reassure themselves on a site's credibility is to make sure the site operator adheres to various codes of ethics urged by recognized e-health organizations. Some sites, for instance, carry a logo from the Health on the Net Foundation (HON), a group that promotes objectivity and full disclosure policies in Web medicine. The Internet Healthcare Coalition, armed with a similar code, is also developing a certification system for sites. Both Medscape and InteliHealth, for instance, say that they abide by such codes.

Sadly, the Web makes it relatively easy to peddle junk science and useless products, so skepticism is a smart prescription. On the other hand, the technology makes it simple to check information from one site against another, so it's possible to differentiate sound medicine from snake oil. In the end, the best defense against e-quackery is making sure you know whom you're dealing with and exactly what they're pitching.

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