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April 22, 2019

Counteracting Health Misinformation: A Role for Medical Journals?

Author Affiliations
  • 1Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
  • 2Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  • 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA. 2019;321(19):1863-1864. doi:10.1001/jama.2019.5168
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    4 Comments for this article
    "Alternative" Pseudomedicine
    Raymond Whitham |
    Formerly reputable universities and medical schools have increasingly incorporated untested examples of alternative practices (eg homeopathy, Reiki, naturopathy) into their institutions, which appears to legitimize them in the public's eye. I'd like to see more diligence in choosing their modes of therapy and stick to evidence-based medicine. Medical science demands proof - patients deserve proof.
    Richard Bedlack, MD PhD | Professor of Neurology, Duke University
    I wanted to tell you about an example of physicians and scientists working together on the problem you describe.

    There is a program started in 2009 called ALS Untangled (www.alsuntangled.org). It includes a virtual bulletin board where patients submit alternative and off-label treatment (AOT) ideas for amyotrophic lateral sclerosis (ALS), and vote for the ones they are most interested in. Patients have now submitted more than 400 AOTs; several have received more than 1,000 votes. A team of 120 clinicians and scientists from across 10 different countries invented and crowd-sourced standard operating procedures including
    a “Table of Evidence” that facilitate objective review of AOTs. Using this infrastructure, we have now published reviews of 49 different AOTs. Through an agreement with the journal Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, these are made free open access so patients never have to pay to read them. ALSUntangled reviews comprise 8 of the top 10 most downloaded articles in the history of this journal. Some have more than 30,000 downloads, and collectively they have more than 100,000 downloads. We recently started short podcast summaries of our reviews and these are already getting hundreds of listens each month.

    Through a collaboration between ALS clinicians, scientists and a medical journal, ALSUntangled is helping patients to better understand AOTs, and make more informed decisions about them.
    Promote Science-Based Medicine
    Steven Zeitzew, M.D. | West L.A. Veterans Administration Healthcare Center
    If the public should be guided by science, so should the top medical schools, all of whom now teach, promote, and profit by selling unscientific medical treatment in the guise of integrative medicine. So should the Veterans Administration, Medicare, and Medicaid, who all pay for unscientific medical treatment. Physicians ought to make recommendations for medical treatment based upon the best available science. Government regulations allow some drugs, such as herbal supplements and homeopathics, to be sold without first requiring the same evidence of safety and efficacy we require for pharmaceuticals. We should have the same standards of safe manufacture, honest labeling, and sufficient scientific evidence of safety and efficacy for all bottles of pills. Exempting alternative medicine from regulation deceives patients because the bottles of pills are sold side-by-side with medications with evidence for efficacy, safety, and clean preparation.
    Who Is To Blame?
    Helmut Beierbeck, Ph.D. |
    The rise in the use of "alternative medicine" is indeed a serious matter. The problem isn't so much that the "alternative" treatment might be harmful, but rather that the patient might forego effective professional medical care. What explains this distrust of mainstream medicine? The fact that the medical/pharmaceutical complex has lost credibility. There has simply been too much negative publicity, too many law suits. Journal editors are well aware of this. Why else would authors be required to report potential conflicts of interest?