This spring, during the swine flu outbreak, I was searching the Web for news when a blog post on the Huffington Post caught my eye. Titled "Swine Flu: Protect Yourself and Your Loved Ones," its author, Kim Evans, offered a unique prescription for swine flu, one she believed could "save your life": deep-cleansing enemas.
"Most estimates are that the average person has ten or more pounds of stored waste just in their colon," Evans wrote. "In any case, many people have found that disease disappears when this waste is gone, and that when the body is clean it's much more difficult for new problems, like viruses, to take hold in the first place. And it's my understanding that many people who took regular enemas instead of vaccines during the 1918 pandemic made it out on the other side as well."
This is not exactly first-line advice on influenza prevention. There's no proof that a cleansing program will prevent influenza. In fact, Evans' notion contradicts basic germ theory. Influenza infection is transmitted through respiratory channels and not, like gastrointestinal infections, through contact with fecal matter. And even if people in 1918 did try to protect themselves with enemas -- Evans doesn't cite any historical record -- there's no evidence the practice saved anybody's life. Note to Evans: People did not have a choice between enemas and vaccines in 1918. The first influenza vaccine was developed in the 1940s.
The Huffington Post is one of the most valuable pieces of real estate on the Internet these days. It operates mostly as a news aggregation site (it has featured Salon stories) and throws open its doors to a wide range of bloggers, who cover everything from politics to entertainment. "When it comes to health and wellness issues, our goal is to provide a diverse forum for a reasoned discussion of issues of interest and importance to our readers," Arianna Huffington, the site's namesake founder, author, socialite and pundit, told me.
I would like to believe her. But when it comes to health and wellness, that diverse forum seems defined mostly by bloggers who are friends of Huffington or those who mirror her own advocacy of alternative medicine, described in her books and in many magazine profiles of her. Among others, the site has given a forum to Oprah Winfrey's women's health guru, Christiane Northrup, who believes women develop thyroid disease due to an inability to assert themselves; Deepak Chopra, who mashes up medicine and religion into self-help books and PBS infomercials; and countless others pitching cures that range from herbs to blood electrification to ozonated water to energy scans.
As a physician, I am not necessarily opposed to alternative health treatments. But I do want to be responsible and certain that what I prescribe to patients is safe and effective and not a waste of their time and money. A recent Associated Press investigation stated the federal government has spent $2.5 billion of our tax dollars to determine whether alternative health remedies -- including ones promoted on the Huffington Post -- work. It found next to none of them do. The site also regularly grants space to proponents of the thoroughly disproven conspiracy that childhood vaccines have caused autism. In short, the Huffington Post is hardly a site that promotes "a reasoned discussion," in its founder's words, of health and medicine.
Practically since its inception in 2005, the Post's health coverage has been the subject of scrutiny and criticism from physicians and medical experts. Steve Novella and David Gorski, both academic physicians, who run the blog Science-Based Medicine, have been at the forefront of the opprobrium. In a post this April, Novella declared that Huffington Post readers were being "fed demonstrable medical falsehoods and misinformation."
In May, Huffington hired Patricia Fitzgerald, who had previously blogged on the site, to serve as Wellness editor. In Huffington's words, Fitzgerald will add "another layer to the vetting process for posts dealing with medical, health, and nutritional advice." Fitzgerald, an acupuncturist with a master's degree in traditional Chinese medicine and a doctorate in homeopathic medicine, is the author of "The Detox Solution: The Missing Link to Radiant Health, Abundant Energy, Ideal Weight, and Peace of Mind." Her posts had praised actress Jenny McCarthy for healing her son's autism with "biomedical intervention," a menu of "detoxification, and removal of interfering factors, such as yeast, food allergies, viruses, bacteria, and heavy metals," restrictive diets, expensive nutritional supplements and chelation therapy -- all unproven.
Fitzgerald told me her mission "is to assist in providing interesting, informative and well-written pieces that support and inspire people looking to live healthier lives." She added, "I spend a considerable amount of time helping medical professionals used to writing for other medical professionals develop a style more accessible to a general audience. Every blog post on HuffPost is reviewed by our editorial team. I vet and offer input on some posts dealing with health advice."
Not everybody who writes about health and medicine on the Huffington Post appears to cling to alternative treatments like detoxification and restrictive diets. Dr. Lloyd Sederer, a psychiatrist and medical director of New York's Office of Mental Health, and Dr. Sarah Lovinger, who blogs about health and the environment, have admirable public health backgrounds and seem to care about issues on the ground. Sederer, for example, recently posted a strong piece about mental health problems in soldiers returning from Iraq and Afghanistan, and Lovinger has been outspoken in her advocacy for healthcare reform.
But frequent visitors to the Huffington's Post "Living" site, home to its health and medical coverage, cannot avoid the preponderance of posts by enthusiastic champions of dubious treatments and therapies.
Evans epitomizes the Post's health bloggers. Her bio on the site describes her as "the author of 'Cleaning Up!' and the creator of The Cleaning Up! Cleanse, a powerful body cleanse that addresses deep levels of toxicity throughout the body and a common fungal problem, candida overgrowth." In other publications, Evans fixates on candida as the root of many medical problems, including cancer. While this theory is popular in the alternative health community, it is scientifically meaningless. It's true that candida overgrowth can cause relatively minor problems in healthy people taking antibiotics (vaginal yeast infections in women, thrush and diaper rashes in babies), and can cause serious systemic infections in those whose immune systems are compromised, such as HIV-infected patients. But there's no credible research or study that demonstrates chronic health problems or cancer can be cured by eliminating candida.
When I asked Evans to substantiate the views she has expressed on the Huffington Post, I had a hard time being persuaded by her answer. "First and really foremost, articles on the Huffington Post are typically about 15 paragraphs max and generally, they are not written for the medical or scientific community," she said. "My articles in particular are written for the average person, and the average person generally isn't interested in reading every study ever published or all of the research available to support an argument."
A more regular Huffington Post blogger is Dr. Srinivasan Pillay. According to his biography, Pillay is everything from a "psychiatrist" to "certified master coach" to "brain-imaging researcher" to "public speaker." Last March, Pillay wrote a piece, "The Science of Distant Healing," which began with the following question and bold claim: "There is much written about how our good intentions help others. But can your good intentions really reach someone who is not physically present, and how do we know this? In this column, I will present the current evidence that discusses this phenomenon and provide some explanations as to why distant healing has a place in modern scientific thinking." He went on to cite a "well-designed study" that proves that people, by using their thoughts, can heal (or harm) others who are sick in other locations.
Whatever that "well-designed" study may be (Pillay didn't specify, nor did he return my requests for an interview), the sum of the evidence suggests that distance healing is snake oil. Medical researchers at the University of Exeter in England looked at studies noting the health benefits of distance healing and found the research was hampered by serious flaws. Rigorous studies conducted by the University of Maryland School of Medicine have demonstrated that no difference exists between distance healing and placebo.
The Huffington Post's most famous unscientific stand is against childhood vaccines. From what seems like its first day on the Internet, the site has played host to the anti-vaccine movement, granting center stage to the movement's most prolific and outspoken proponents, such as author David Kirby, Jenny McCarthy's pediatrician Jay Gordon and detox advocate Dierdre Imus, wife of shock jock Don Imus. (It should be noted the site promoted Robert F. Kennedy Jr.'s 2005 article "Deadly Immunity," jointly published by Rolling Stone and Salon, which accused the Centers for Disease Control, and other health agencies, of covering up the links between autism and vaccines. The article was widely criticized by the medical community and required both publications to make numerous corrections of fact and analysis.)
As if the circus tent couldn't get any bigger, this April, the site posted a piece, "The Judgment on Vaccines Is In???" by actor and comedian Jim Carrey. In addition to the usual anti-vaccine platitudes -- blaming doctors for being in bed with drug companies; attacking people instead of data -- Carrey offered arguments apparently composed by Ace Ventura:
"I've also heard it said that no evidence of a link between vaccines and autism has ever been found. That statement is only true for the CDC, the AAP and the vaccine makers who've been ignoring mountains of scientific information and testimony. There's no evidence of the Lincoln Memorial if you look the other way and refuse to turn around. But if you care to look, it's really quite impressive."
While we might expect loose analogies and logic from a celebrity blogger, we might also expect them to take a little care with the facts. Carrey's piece contains multiple mistakes. He writes, for example, that vaccines contain "ether, and anti-freeze." They don't. Still, the post went up and generated thousands of comments, including many that pointed out Carrey's errors. Huffington states that the site's "policy calls for factual errors in blog posts to be corrected by the blogger within 24 hours of the error being pointed." Carrey's post appeared on April 22 and still hasn't been corrected.
Huffington has been in the public eye for decades as the author of over a dozen books on topics ranging from art to self-help to politics, as a radio talk show host, the wife (and now ex-wife) of a former U.S. GOP congressman who ran for Senate; an ex-California gubernatorial candidate, and now, and perhaps most successfully, the founder of the eponymous New Media juggernaut. In a 2008 New Yorker article, writer Lauren Collins suggested that Huffington was motivated not by money but by the quest to "command attention and to change minds." To that end, she has a long history of being "a budding celebrity contrarian."
Huffington's desire to be different became especially clear when I looked at her views about health. In her 2006 self-help book, "On Being Fearless," she provides her own definition of preventive care, one that's indistinguishable from Evans' blog post. "In today's world, where thousands of chemicals are being used all around us, it's essential both to protect against exposure and to maintain some kind of detox program," Huffington wrote. In the New Yorker, Collins revealed that Huffington has undergone "mercury detoxification, fire-walking, est, microdermabrasion, infrared saunas" and a long list of fad diets. In "On Being Fearless," she gave a description of her own experience with mercury detox, saying she was "stunned to find how much mercury I had in my body."
What Huffington may not know is the test used to determine the amount of mercury in the body is a sham, as proven by medical researchers at the Department of Environmental and Occupational Health, Emory University and other public health institutes. The test artificially elevates the levels of heavy metals in one's body, falsely leading one to believe that they've been poisoned by toxins. In fact, a doctor who routinely prescribed the test has been investigated and disciplined.
In an e-mail to me, Huffington touched on her long and winding road through alternative therapies, dropping the names of major universities (Harvard, Stanford, Johns Hopkins, UCLA) with centers for complementary and alternative medicine, where she has been a patient. But health coverage on the site goes beyond complementary medicine. In fact, the more I read the site, the more I realized its health writers were being chosen not in the name of diversity or on the basis of their qualifications. Rather, as Collins revealed in the New Yorker, they appear to be picked by Huffington on a whim.
One day, after having dinner with Charlie Rose, Huffington broke her ankle. "Rose recommended a foot and ankle specialist at the Hospital for Special Surgery, Dr. Rock Positano. He is now a contributor to Huffington Post," Collins wrote. "In the course of two days in May, Huffington invited the following people to be bloggers: someone she met at a book signing … a fifteen-year old lecture attendee; a bookstore owner; the Asperger's-afflicted teenage son of a radio d.j.; a woman, dressed exclusively in green, who was trying to stop insecticide spraying."
Huffington also relies on her Rolodex to make executive decisions. Recently she hired Dr. Dean Ornish to become the site's medical editor (a spokesperson for Ornish confirmed this). When I asked her how she chose him, she told me that the two of them have been friends for quite some time, which led to her offering him the job. Ornish, who will consult with Wellness editor Fitzgerald, will not be paid by Huffington.
If their mission is to indeed vet the health posts more vigorously, they will have their work cut out for them. One would expect a Huffington Post editor to insist health writers like Pillay support their unconventional claims with peer-reviewed research, published in reputable journals. Yet this is seldom the case. As a doctor and writer, but mostly as a consumer, I find this lack of substance callous. An editor should have demanded that Carrey correct his egregious mistakes about vaccines within the site's 24-hour policy. That same editor should have asked Evans to link to the relevant medical study when she claimed, "A study in 2005 found that newborns are being born with literally hundreds of chemicals in their bloodstream, many of them known to cause cancer." The story didn't link to a journal article but to Newsweek, which was referencing a study of newborns and chemicals by the Environmental Working Group, a nonprofit.
When I asked Fitzgerald about why the site granted so much credence to the vaccine-autism link, her response left me unimpressed: "When it comes to hot-button topics like this one, I think it's important to present as many viewpoints as possible -- and that is what we have tried to do on HuffPost." It's hard to see a diversity of viewpoints, though, in Imus, Kirby, Carrey, RFK Jr., Gordon and Fitzgerald herself, who all maintain that childhood vaccines contributed to autism.
If the site is now making an effort to feature all sides of a health debate, it's not apparent to Ken Reibel. Two months ago, Reibel, founder of the blog Autism News-Beat, and a parent of a child with autism, contacted the Huffington Post to express his dissatisfaction with its anti-vaccine bias. He was invited to blog by Jonah Peretti, a co-founder of the Post. However, neither Fitzgerald, Ornish nor anybody else has followed up with Reibel, and so he has not been able to post on the site. To its credit, the Huffington Post did run a recent post by UCLA pediatrician Harvey Karp defending vaccines (predictably the piece drew the ire of the Post's audience and Gordon, who harshly criticized Karp).
Arthur Allen, who has written regularly for Salon and Slate, blogged on Huffington Post to respond to Kirby's anti-vaccine posts. Allen told me he was dismayed by his experience at the site. "There is zero oversight of anything at HuffPo as far as I can tell," he said. "HuffPo seems like a place to dump any opinion you have you don't mind not being paid for. That tends to be people with agendas, including PR types." Allen hasn't written for the site since 2007. "I like to do careful reporting, and that takes time," he said.
One thing that the site's club of health bloggers seem more than ready to do is to defend themselves or their friends in the face of criticism. Take Chopra's recent post defending Oprah Winfrey against reports, including my own, that she dispenses bad medical advice on her show. Chopra doesn't defend the credibility of Oprah's experts or provide proof to support the health views and advice of Suzanne Somers and Northrup. Instead, he litters the piece with attacks on doctors and the medical establishment. "Scientific medicine by and large ignores wellness, prevention, and alternative medicine in general," he writes. "On a daily basis doctors don't deal in these things; few take courses in medical school centered on them."
It's hard for me to agree with Chopra's sentiment. Most primary care doctors I work with and know advocate for and offer preventive care to our patients. Further, they do not routinely ignore or get defensive about alternative medicine -- though, justifiably, they do view it with skepticism, given the lack of evidence for much of it.
The Huffington Post's poor science raises the question of what are the ethics of heath and medical writing and blogging? I posed the question to Dr. Robert Lamberts, a primary care physician, who writes the well-respected blog Musings of a Distractible Mind. When I asked him about the rules (formal or informal) of science blogging, he told me that health writers and bloggers expect one another not just to provide a clear perspective, but also to make sure that they disclose any potential conflicts of interest, citing appropriate sources and changing inaccuracies when pointed out. That seems like a more than reasonable expectation, yet the Huffington Post does none of these things with diligence. "I do have problems with people without medical backgrounds ... becoming medical experts and influencing people to their opinions like they are political opinions," he told me. "This is the problem with the whole immunization 'debate.' It is not being done between medical professionals, but instead is being handled like it is a political discussion -- trying to convince people based on emotions rather than facts."
Not long ago, Huffington praised President Obama for stating he wanted to ensure "that scientific data is never distorted or concealed to serve a political agenda and that we make scientific decisions based on facts, not ideology." But Huffington has distorted science and facts to serve a health agenda. In correspondence with me, she insisted her site doesn't "impose an editorial litmus test favoring one discipline over another." In the end, though, a sincere editorial process is about more than offering a range of disciplines. It is about holding writers accountable for the fairness and accuracy of their messages. And right now fairness and accuracy in health and medicine take a back seat to sensationalism and self-promotion on the Huffington Post.