The Consultant Pharmacist is published by the
American Society of Consultant Pharmacists.


Information Access

Selected Web Site Reviews

In this department our goal is to provide you with systematic evaluations of Internet sites of potential interest to you and the clients you serve. We will also look at other communications technologies and discuss various techniques for getting the most out of those technologies.

Members of the American Society of Consultant Pharmacists—including Editorial Review Board members—and other health care professionals provide the reviews and their respective opinions on the sites presented in this column. Each review contains a statement on the audience the site is intended for, the purpose of the site, its most useful content, highlights and special features, limitations, and related sites. Independent submission’s of Web reviews welcome; please send to dbuerger@ascp.com.

Quackwatch.com

URL: www.quackwatch.com

Audience: The content is relevant for both consumers and professionals. Certain sections are labeled for health care workers, although most articles do not contain large amounts of scientific detail.

Purpose: This is a nonprofit organization whose purpose is "to combat health-related frauds, myths, fads, and fallacies."

Content: Quackwatch.com was begun in 1997 by Dr. Stephen Barrett, a consumer health advocate with over 45 publications, who has been working in this field since 1969. The home page is an indication of the founder’s blunt approach to debunking health claims and therapies not scientifically proven effective. Its table of contents fills seven printed pages and is divided into 14 sections. The site’s affiliations and income sources are clearly posted in the “Mission Statement” page. All articles published are dated.

Nearly all the articles published are linked from the extensive home page. These reports are typically in the form of referenced reviews that start with an introduction to the topic and then a point-by-point breakdown of the questionable therapy or practice. The site makes an effort to cross-reference keywords with other articles and link its citations to the Medline abstract from the National Library of Medicine. Those that do not contain citations are offered in the form of pearls or briefs. Many articles contain direct commentaries. Some of the home page links take the reader to compiled lists relating to a specific topic. For example, in “Dietary Supplements, Herbs, and Hormones,” Barrett cross-indexes 43 articles on questionable advertising to scientifically unsound therapies.

In the section titled “Questionable Products, Services and Theories,” Barrett (and a few others) attempt to expose several dozen popular therapies and practices, including acupuncture, aromatherapy, chiropractic, homeopathy, naturopathy, and osteopathy. Certain specific remedies are also denounced for their lack of credible scientific evidence. Such titles include “Chelation Therapy,” “DHEA: Ignore the Hype,” “Glucosamine for Arthritis,” and “The Herbal Minefield.” There are even two articles critical of pharmacists (see below).

In the “Questionable Advertisements” category, journal ads that make dubious claims for their products are countered for their inaccuracy. Many original ad illustrations are included. Notable celebrities such as Deepak Chopra are not immune to Barrett’s criticism in “A Few Thoughts on Ajurvedic Mumbo-Jumbo.” Barrett picks apart another popular Web site, “Ask Dr. Weil,” in an interview with Biography magazine. In it he exclaims, “. . . he says in one of his books that bloodroot, a caustic herb which burns your skin, can kill skin-cancer cells without injuring the surrounding normal cells. That’s absurd. It burns everything it touches.”

Other categories are dedicated to educating consumers about identifying health quackery and providing facts about popular nonstandard treatments.

Highlights or Special Features: Of interest to consultant pharmacists are two articles about pharmacy practice posted in September 1998 and April 1999. “Selling of Dubious Products” details the conflict of interest posed to retail pharmacies that sell products with questionable therapeutic benefit such as over-the-counter herbal and other “natural” products. In surveys, pharmacists responded poorly about their knowledge of these dubious products but said they continue to recommend and stock them. The conclusion by the survey’s author was simple: Alternative therapy products provide better profit margins. In a speech, David Kessler, MD, JD, former commissioner of the Food and Drug Administration questioned whether pharmacists “have given up their roles as health care professionals” or are simply “no longer in control of the store.” The second article, “Misuse of Compounding,” deals with the substitution of available prescription products with formulations prepared from bulk products. It states that some pharmacies will compound readily available commercial products because the ingredients may be less expensive. This raises ethical and legal concerns with Barrett.

The site is launching research projects and recruiting volunteers to report on certain areas of dubious health practice that will be targeted for scrutiny. An example is the Alternative Cancer Treatment Registry, where patients or professionals can submit their encounters with those making claims about the effectiveness of unproven methods. Lastly, for entertainment purposes, click on the “Cheers and Jeers” link. Excerpts of the harsh e-mails from defenders of the various treatments and practices criticized on the site are posted for all to read. Most of the foul language has been edited out, but their anger at Dr. Barrett is clear. It appears that Quackwatch.com uses the emotional reaction of its critics to substantiate its position.

Limitations: From a technical perspective, the site is poorly organized. The home page is used more like a document warehouse than a rational starting point. With the addition of dozens of forthcoming articles, readers will encounter some trouble finding what they want or discovering interesting topics. The site has a link to a search engine that helps somewhat, but the searches return line-by-line keyword results without displaying the title or context of the page.

For all the praise the site has won from reputable reviewers and rating services, the presence of so many articles from one author (Dr. Barrett) leaves one sensing a lack of fair balance in his condemnation of many dubious health therapies. Steps to correct this are under way, as many reputable professionals have signed on to populate the site in their areas of expertise. A giant step toward true legitimacy would involve active peer review of the articles to be published, a logical transition for a site that relies on so much of the accepted medical literature as its foundation. Further, an area for academic counterpoint would be a good addition. As stated, Dr. Barrett often inserts his strong opinions directly into sections of an article already well supported by the literature. Although entertaining, this direct commentary may be viewed by some as less than professional medical writing and may be better reserved for its own section.

Related Sites: The success of Quackwatch has spawned two new sites from the author. Chirobase (www.chirobase.org) was established to provide information about chiropractic not readily found in the consumer literature. Its purpose is to encourage science-based practice and expose unfounded ones. The site also attempts to identify practitioners who provide sound patient care. MLM Watch (www.mlmwatch.org) was developed as a skeptic’s guide to multi-level marketing. Much of the criticism of Quackwatch.com stems from the claims made by product distributors in such organizations.

Reviewer: Bao-Anh Nguyen-Khoa, PharmD, Center for Health Information, Chesapeake, Virginia.

Ask Dr. Weil

URL: cgi.pathfinder.com/drweil

Audience: Consumers and health care professionals interested in alternative medicine.

Purpose: To answer a variety of questions posed by Web users regarding diet, fitness, and health care.

Content: The Ask Dr. Weil home page is set up mainly as a question-and-answer forum where readers can submit questions on a variety of health care topics to Andrew Weil, MD, a professor at the University of Arizona who specializes in alternative medicine, mind-body interactions, and medical botany. Weil is the founder of the Program in Integrative Medicine at the University of Arizona Health Sciences Center in Tucson, where he is training a new generation of physicians. He is the author of seven books, including his most recent best-seller, 8 Weeks to Optimum Health.

The page is regularly updated. Each day, Weil answers a new question, which can be viewed at the home page and is linked to an answer. Users can also access questions from the previous three days.

The page is divided into frames, with the title at the top of the page, an index on the left-hand side, and other contents listed on the right. The index lists sections for the Q&A library and the “Top 10 Questions.”

Under “Self Help,” there is a section on Weil’s “8-Week Program,” as well as the “Vitamin Advisor,” the “Herbal Medicine Chest,” a “Local Practitioners” section, and recipes. Under the section “Interact with Us,” items such as the “Free Bulletin,” “Community Boards,” a “Help” feature, and a site map with detailed descriptions of all site features are listed. There is also a link to a Q&A page operated by sex therapist Ruth Westheimer.

Highlights/special features: Weil answers questions on a variety of interesting health topics ranging from diet and herbal supplements to personal care products. The most popular questions of the month are listed in the “Top 10 Questions” section. Visitors can also browse through past questions or search the site for information on a specific topic. There are also hyperlinks to selected items on the answer pages (e.g., herb names, conditions). When the hyperlinked item is clicked, the user will be taken to another Web page with a description of the item.

The “Vitamin Advisor” walks the user through a series of personal questions (e.g., smoking status, age, gender, average alcohol intake, risk factors for cancer and heart disease), then recommends a list of appropriate vitamins and/or herbs based the information provided. This section also gives reasons for the vitamin recommendations, as well as possible vitamin side effects.

The “Herbal Medicine Chest” is broken down into sections by seasons (e.g., winter, summer) and contains information on indications, how the herb is available, herb-drug interactions, what to look for when buying, acceptable dosages, and warnings, if appropriate.

The “Local Practitioner” section will find a practitioner for a variety of alternative medicine areas such as acupuncture, biofeedback, and homeopathic medicine in a geographic area of the visitor’s choice.

The site also has a variety of free bulletin boards, “communities,” and planned events during which visitors can meet and chat with Weil.

Limitations: This site is definitely a different world for most western health care practitioners, with recommendations for herbal therapy, homeopathic remedies, and radical lifestyle changes. However, Weil’s answers are generally conservative and fairly balanced, and he always tells readers to refer to their personal physician when seeking information on treating serious medical conditions. As references are generally not given, it is unclear whether many of Weil’s recommendations have been studied in published, scientifically rigorous clinical trials, though it appears that most have not been. There is limited information on traditional medical therapies or drugs, though they are referred to occasionally. Weil is an author, and the site also offers information on his books and how they can be purchased—including a direct link to the Web site of Barnes & Noble.

This site contains a variety of interesting information on all types of herbal remedies, though there is not a comprehensive list of all herbs about which your residents and patients may inquire.

Health care practitioners may find this site interesting with regard to what is happening in the field of complementary alternative medicine.

Related sites: NIH: The National Center for Complementary and Alternative Medicine (http://nccam.nih.gov), Herbal Materia Medica (www.healthy.net/ clinic/therapy/herbal/herbic/herbs/index.html), The Alternative Medicine Homepage (www.pitt.edu/~cbw/altm.html)

Reviewer: Lisa F. Han, BS, Insight Therapeutics, LLC, Norfolk, Virginia.

The Consultant Pharmacist is published by the
American Society of Consultant Pharmacists.