Terra Sigillata

There are responsible ways to present medical information and irresponsible ways. I will say at the outset that I have no ethical issues with discussing complementary and alternative medicine (CAM) with cancer patients, as long as the information presented is based in fact.

ResearchBlogging.orgSo it was no surprise to me and actually quite alarming to read a recent report suggesting that while only 1 in 20 breast cancer websites offer incorrect information, CAM-focused websites were 15 times more likely to contain inaccurate or incorrect information. The study to which I refer will appear in the 15 March issue of Cancer (and has just appeared online if you have access to the journal; abstract here.)


Investigators at Houston’s M.D. Anderson Cancer Center and Hospital and the University of Texas School of Health Information Sciences at Houston (SHIS) identified 343 websites based on querying 5 search engines for 15 breast cancer-related keywords and 3 website characteristics. The sites were then evaluated for 15 quality criteria. The results (from the abstract) were:

The authors found 41 inaccurate statements on 18 webpages (5.2%). No quality criteria or website characteristic, singly or in combination, reliably identified inaccurate information. The total number of quality criteria met by a website accounted for a small fraction of the variability in the presence of inaccuracies (point biserial r = -0.128; df = 341; P = .018; r2 = 0.016). However, webpages containing information on complementary and alternative medicine (CAM) were significantly more likely to contain inaccuracies compared with pages without CAM information (odds ratio [OR], 15.6; P < .001).

Holy cow! Fifteen times more likely to contain inaccuracies??? I can’t wait to see the original paper to discover the types of inaccuracies contained therein.

Buried in the M.D. Anderson press release, however, was a statement from the authors that the academic and medical credentials of the website author(s) bore no relation to the quality and accuracy of information provided. This issue speaks to a topic discussed quite often at Science-Based Medicine and my blog colleagues Orac and Dr RW (the latter of whom coined the term “quackademics” to denote unsubstantiated CAM practices conducted and promoted at otherwise highly respected academic medical centers.).

Far too many professionals with legitimate credentials are now promoting dubious practices under the guise of “complementary and alternative medicine.” I’m all for health freedom and, after all, I have spent 15 years of my life working on anticancer therapies from plants, marine creatures, and microorganisms. But I am sorely disappointed that my MD and PhD colleagues are putting their names behind inaccurate information on, of all places, websites for the breast cancer patient.

Kudos to Funda Meric-Bernstam, MD and her colleagues on bringing this issue to light.


Bernstam, E.V., Walji, M.F., Sagaram, S., Sagaram, D., Johnson, C.W., Meric-Bernstam, F. (2008). Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer. Cancer DOI: 10.1002/cncr.23308

Comments

  1. #1 Joe
    February 12, 2008

    FYI

    The “American Cancer Society’s Guide to Complementary and Alternative Cancer Methods” second edition is due out next month. It is more useful than the title suggests; because when they comment on cancer treatments, they also discuss non-cancer claims and comment on the validity of other uses.

    Thanks for the post.

  2. #2 Joshua Zelinsky
    February 12, 2008

    I don’t unfortunately have access to this article at the moment but I’m curious about whether one gets this result if one doesn’t include statements that are inaccurate because they make CAM related claims. That is, are the websites with CAM claims are more generally unreliable or CAM claims causing their higher level of unreliability under this study?

  3. #3 Abel Pharmboy
    February 12, 2008

    Very good points, Dr Zelinsky. Once I get the primary publication we can perhaps discuss these distinctions.

  4. #4 Ian Musgrave
    February 12, 2008

    Able wrote:

    I can’t wait to see the original paper to discover the types of inaccuracies contained therein.

    Unfortunately, they don’t give this type of data. There is also no way from the paper to find out if CAM sites were more prone to error than non-CAM sites that mentioned CAM.

    However Walji M,Sagaram S,Sagaram D, et al. Efficacy of quality criteria to identify potentially harmful information: a cross-sectional survey of complementary and alternative medicine web sites. J Med Internet Res. 2004; 6: e21 is somewhat more illuminating.

    We found that most CAM Web sites were potentially harmful either by displaying statements which could cause harm, or by omitting vital information. However, our data suggest that available technical quality criteria fail to identify potentially harmful information online.

    We found that one quarter of CAM Web sites present information that may cause physical harm if acted upon. These sites encouraged consumers to avoid conventional therapy, presented information on products that may be directly toxic, or presented information on products that may cause interactions with conventional medications.

    So it looks like CAM sites are likely to have potentially harmful or misleading information. Perhaps a discrete enquiry to the authors might be helpful?

  5. #5 Abel Pharmboy
    February 13, 2008

    Prof Musgrave – thanks as always for the insightful comments. I was able to come by the complete article this morning and share your disappointment that the specific content of the 41 inaccurate statements was not listed. Indeed, I shall take your advice and contact the authors. Interestingly, this was the senior author’s insight as noted in the press release:

    “[T]here are times patients read about treatments that clearly do not apply to them, which can increase their level of anxiety or expectations for a treatment that they are not a candidate for. Of course, one also worries about patients who go online and then ultimately do not seek out any treatment despite it being necessary.”

    For readers, I should note from the paper other topics were inaccuracies were noted with an odds ratio of greater than 1.4: of course, sites discussing CAM had a 15.6-fold higher risk of at least one inaccurate statement, those discussing psychology 3.21-fold, breast reconstruction 2.1-fold, risk factors 2.1-fold, and diet/nutrition 1.4-fold. So in comparison, sites discussing CAM were far, far more likely to include inaccurate statements than even the second ranking associated topic.

  6. #6 Zuska
    February 14, 2008

    Wow, great – and worrisome – post. I hope you’ll post again if you get more info from the author about the specific inaccuracies.

  7. #7 Doug Alder
    February 15, 2008

    My wife just finished being treated for in situ breast cancer. While waiting for surgery she spent a lot of time on the net searching for information in order to make the best decision for her circumstances. I could not believe how contradictory and outright false some of that information was. I hope for their conscience’s sake they actually believe what they say because as far as I’m concerned anyone putting false information on cancer on the net is morally, utterly reprehensible.

  8. #8 kanser
    March 10, 2008

    The “American Cancer Society’s Guide to Complementary and Alternative Cancer Methods” second edition is due out next month.

  9. #9 murat
    June 26, 2008

    Are you kidding me? The synergetic effects of removing one cell of an eight cell stage are staggering. Am I getting this right?

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    September 13, 2008

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