Stephen Barrett, M.D.
|URAC, is an independent nonprofit organization based in Washington, D.C. Organizations that meet its Health Web Site Accreditation Program standards can display the URAC Accreditation Seal. Its annual fee for accrediting Internet-based companies ranges from $3,800 for companies with up to $1 million in annual sales to $8,000 for those with annual sales of $75 million or more. In March 2004, URAC's Web site listed 45 Web sites that it had accredited.|
URAC's program includes 53 standards that cover disclosure; health content and service delivery; linking; privacy; security; accountability; policies and procedures; and quality oversight. The standards are important, but they do not ensure that the health information on the site is reliable. Standard WS 13 states that "The Web site does not make claims of therapeutic benefit without reasonable support." However, the health content section also notes:
The URAC Health Web Site Accreditation Program is not designed to guarantee a minimum level of quality for health content or service delivery. However, the practices and mechanisms described in this section (and elsewhere in these standards) are important components of a quality Web site program.
As the site further explains:
Does URAC guarantee the content of a Web site it accredits?
No. URAC reviews the process that a health Web site uses to develop health content. However, URAC accreditation is not a guarantee of the reliability of health information on a Web site.
If URAC does not guarantee content, how does it promote health content that is credible and reliable?
By reviewing the processes the Web site uses to develop content, and checking that the Web site has research or other data to back up it health claims, URAC promotes quality health information.
Can health Web sites post content on alternative forms of medicine and still be URAC accredited?
Yes. As long as a Web site supports its health information with research or other reliable data, it can be URAC-accredited.
What does URAC look for in editorial policies to ensure that quality content is the outcome?
According to URAC Standards, the editorial policy must include the qualifications of content authors, and the process for content approval.
Put another way, it doesn't appear to matter whether the scientific community would regard the information as preposterous as long as the site's material is written by people with credentials, has references posted at the end of the articles, and has people with credentials review what is written. Or does it? In March 2004, I decided to find out by calling URAC's attention to misleading information on many of the sites it has accredited.
Consumer Health Interactive
At least 22 URAC-accredited sites violate Standard WS 13 by making invalid claims for "alternative" and "complementary" methods. Most of these have identical misinformation supplied by Consumer Health Interactive.
- AdvancePCS Health & Wellness Channel
- Anthem Blue Cross & Blue Shield
- Anthem Blue Cross & Blue Shield of Colorado
- Anthem Blue Cross & Blue Shield of Connecticut
- Anthem Blue Cross & Blue Shield of Indiana
- Anthem Blue Cross & Blue Shield of Kentucky
- Anthem Blue Cross & Blue Shield of Maine
- Anthem Blue Cross & Blue Shield of Nevada
- Anthem Blue Cross & Blue Shield of New Hampshire
- Anthem Blue Cross & Blue Shield of Ohio
- Anthem Blue Cross & Blue Shield of Virginia
- Blue Cross & Blue Shield of Minnesota
- Blue Cross Blue Shield of Massachusetts
- Horizon Blue Cross Blue Shield of New Jersey Health and Wellness
- Horizon Healthcare Consumer Health Information
- Premera Blue Cross
- Principal Financial Group
- Wellmark BlueCross BlueShield
Dozens of articles on these sites make unsupportable claims. Searching for "homeopathy," for example, yields more than 30 such articles. including one by a homeopathic manufacturer who states:
Homeopathy, like chiropractic, works bioenergetically to correct dysfunctions or nerve interferences. Remarkably, homeopathy has the ability to correct nerve interferences throughout the whole body -- even in places where the hands of the chiropractor cannot! Homeopathy empowers the chiropractor to be the doctor of the whole nervous system and get the broad spectrum of results the founding fathers of chiropractic declared they would.
Many articles that accurately describe standard treatment throw in an "Alternative Treatment" paragraph which falsely claims that homeopathic treatment is effective against whatever the article discusses. The conditions include arthritis, bursitis, emphysema, endometriosis, gallstones, high blood pressure, kidney stones, multiple sclerosis, pneumococcal pneumonia, and urinary tract infections.
Chelation therapy is a series of intravenous infusions containing disodium EDTA and various other substances. It is falsely claimed to be effective against cardiovascular disease, autism, and many other diseases and conditions. The article about chelation therapy regurgitates these claims and sums up the negative evidence by calling chelation "controversial." The article fails to mention that (a) the theory behind chelation is senseless; (b) well-designed studies have demonstrated that it doesn't work against cardiovascular disease; (c) although chelation therapy is appropriate for some cases of heavu metal poisoning, chelation therapists don't use the standard protocol; and (d) the primary proponent group is under a court order not to advertise that chelation therapy is effective against cardiovascular disease. The article also states that, "However, a pooled analysis from the results of over 70 studies showed positive results in all but one," but it neglects to mention that the "positive studies" were either too small or too poorly designed to prove anything.
Other Violative Sites
- Aetna InteliHealth contains many articles about "alternative therapies" that are overly promotional and misleading. The information, which is prepared by Natural Standard, a Harvard-based group that bases reports on published scientific papers but does not take plausibility into account in its evaluations. Thus it almost never says that something doesn't work. In addition, it does not take into account that some positive reports are falsified, and it uses weasel words to tone down negative evaluations. Applied kinesiology is a pseudoscience based on the anatomically and physiologically impossible notion that muscle-testing enables the practitioner to determine "weaknesses" of organs throughout the body that "correspond" to nutrients placed under the tongue. Instead of acknowledging that this is nonsense, Natural Standard concludes: "High-quality scientific research of applied kinesiology is limited. Some studies suggest that muscle responses are not related to underlying diseases, and others report that diagnoses made by applied kinesiology practitioners are not consistent and may not accurately reflect nutritional status. Because of weaknesses in available research, the effectiveness of applied kinesiology remains unclear." An honest assessment would state that properly designed studies have found no relationship between muscle responses and underlying disease and that the diagnoses made by practitioners have nothing whatsoever to do with nutritional status.
- American Specialty Health repeats proponents claims without placing them in proper perspective. Its article on adrenal extracts, for example, states: "The extracts are used to support adrenal function and are claimed to help a person deal with stress." The article fails to define "stress" or mention that in 1978 the FDA banned the marketing of adrenal extracts as drugs because their low potency poses a significant potential hazard. The American Specialty Health site also sells dozens of homeopathic and dietary supplement products with unsubstantiated claims.
- HealthAtoZ, at the time URAC accredited it, contained many articles with false or unsubstantiated claims for homeopathy, vitamins, and various other "alternative approaches." One article about homeopathy, for example, stated: "Acute homeopathic prescribing is thought to benefit a wide range of ailments. These include altitude sickness, Bell's palsy, the common cold, allergies, coughing, dengue fever, dysentery, earaches, migraine headaches, fever, food poisoning, grief, influenza, motion sickness, shock, sore throat, surgical complications, and reactions to vaccinations and drug therapy. Acute remedies may also be prescribed to treat insect stings, animal bites, and problems related to poison oak and poison ivy. It may be further employed in treating injuries including black eyes, burns, bruises, concussions, cuts, damaged tendons and ligaments, dislocations, fractures, herniated discs, nosebleeds, puncture wounds, sprains, and strains." Three of the site's medical advisors who looked at articles I sent them said that they had not seen them before and were shocked at how bad they were. One reviewer mentioned that although he had provided advice on some articles, he had never looked at the site. In response to prodding from me and a warning from an official of the Health on the Net Foundation (overseer of the HONcode), HealthAtoZ removed all (more than 100) of the articles I complained about. Unfortunately, after HON finished its review, most of the bad articles were restored.
- WebMD Health contains many staff-generated articles that promote nonsensical "alternative" methods, including homeopathic treatment of earaches and cancer. Colonic irrigation is senseless and has killed people. But instead of telling the truth, an article states that it "has yet to gain the endorsement of any mainstream medical organization." WebMD also includes an extensive collection of articles from Healthwise that fail to adequately criticize what they describe. Its chelation therapy article, for example, states that, "Chelation therapy has also been used by some health professionals to treat atherosclerosis and/or coronary artery disease, although there is inadequate current scientific evidence that proves this treatment is effective. Some believe that EDTA binds with calcium deposits (the part of plaque that obstructs the flow of blood to the heart) in the arteries and then the calcium deposits are 'cleaned out' of the arteries by the EDTA, reducing the risk of heart problems. This treatment is controversial, and research results have been inconsistent." An honest presentation would say there is no logical reason to believe EDTA chelation is helpful against cardiovascular problems and that the "inconsistent results" consist of poorly designed studies that claimed benefit and well-designed studies that found none.
The flaws that I report above follow a consistent pattern. Some articles appear to be written by knowledgeable people who deliberately downplay adverse findings. Others are written by proponents who use weasel words or weak disclaimers to give the appearance of "balance." Despite many hours of searching the sites, I found no statement that any "alternative" or "complementary" treatment should be avoided because it doesn't work or lacks a scientifically plausible rationale. Responsible medical writing should advise people to stay away from methods that don't work. I did not find a single statement to that effect on any of the sites mentioned in this article. It will be interesting to see whether URAC cares.
This article was updated November 1, 2004.