URAC Violators

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.

Accreditation Standards

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.

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

Deliberate Deception?

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.