Attacking Their HONor

Some Dispute Value of Logo Used to Verify Accuracy, Integrity Of Health Web Site Contents

You found a Web site touting a mysterious herbal product guaranteed to cure everything from baldness to jaundice through an eight-week, $160 regimen grounded in an esoteric California moon cult remotely based on Eastern mysticism. How can you tell if the health information is reliable?

Some calls are easy to make. You can safely assume statements like "tidal forces control hair loss" and "dermatologists don't want you to know" are suspect. But for those gray areas -- such as whether yoga, tai chi or herbal medicines are practical treatments for specific illnesses and conditions -- there's the HONcode, from the Geneva-based Health on the Net Foundation.

The HONcode is a set of ethical standards covering more than 3,500 Web sites based in 67 countries. These sites voluntarily adhere, at least in theory, to eight principles laid out by the foundation; once accredited, a site is permitted to display the HONcode logo. Clicking on this logo will take you to the main HON Web page (www.hon.ch) and automatically verify that the site is in compliance with the code.

Similar codes exist, but the HONcode is the most widely displayed and the oldest, having been created in 1995. The HONcode requires that information providers disclose potential conflicts of interest, provide credentials for authors relaying medical information, and reference the source of the information it presents.

"The HONcode is a way to improve the quality of information" on the Internet, said Celia Boyer, executive director of HON, which is funded by the Geneva Ministry of Health and the European Union. "Given the critical nature of health information and the unregulated environment of the Internet, Web surfers need all the help they can get. . . . We try to do the best we can." She gets by with a seven-member team.

It's a good system, but occasionally, in the field of complementary and alternative medicine (CAM), some groups either sugarcoat information or straight-out cheat, and Boyer said her group can't always keep up. For example, some Web sites display the HON code seal but were either never accredited or long-since discredited.

Stephen Barrett -- a retired psychiatrist and gadfly to the CAM community who is editor of the Quackwatch Web site -- has organized a campaign to improve compliance with the CAM code. He has contacted the responsible parties at even such credible sites as WebMD and the Mayo Clinic that pledge to uphold the HONcode but, in his view, aren't rigorous enough in their handling of alternative treatments. He says these sites' shortcomings may seem innocuous but ultimately promote quackery by describing dubious therapies without criticizing them.

The HON site itself provides a search engine for those seeking medical information, and search results are derived only from HON-validated web sites. Search for staples of quackery such as "touch therapy," "crystal healing" or "yogic flying" via the HON site, and the only reference that appears is an article uncovering touch therapy fraud. Type in "homeopathy," and you get a mix: links to Web sites presenting evidence of its possible efficacy and to other sites asserting that homeopathy is merely a placebo system.

Beyond the short arm of the HON, however, things begin to degrade. Healthfinder.gov is a U.S. government-funded clearinghouse of health information that displays the HONcode and links to more than 1,700 Web sites that are also largely in compliance with HON. While Barrett concedes that Healthfinder.gov is generally a sound site for health information, he said several of its links are questionable.

Search for "homeopathy" at Healthfinder.gov, and you will be offered a link to the National Center for Homeopathy, which wouldn't qualify for HON accreditation because it provides only positive results of homeopathic research and not the abundance of research showing homeopathy to be no more effective than a placebo. (And despite the name, this is not a government agency.) Search for "naturopathy," and you will be taken to the American Association of Naturopathic Physicians, which also doesn't display the HONcode and which contains information counter to mainstream scientific opinion.

Barrett said that a visitor to Healthfinder.gov will be presented a noncritical view of homeopathy and naturopathy -- and will encounter no information, for example, that explains that naturopathy is largely at odds with conventional medicine in that it doesn't promote immunization, doesn't recommend synthetic drugs and other proven therapies for cancer, and maintains that healing occurs by strengthening unquantifiable energy forces within the body.

Barrett said these examples show that, despite offering mostly legitimate information, some sites bearing the HONcode logo can make it difficult to discern fact from wishful thinking when describing complementary and alternative medicine.

"I don't think you should write balanced articles about unbalanced subjects," said Barrett. He points to such wording as "although controversial" or "is thought to work by," which implies there is rigorous scientific debate. "Controversial? I don't consider quack claims that clash with science as controversial. They're senseless."

Is this all just nitpicking? After all, scientists are finding that some alternative therapies might work for certain conditions. Acupuncture, which Barrett refers to as an unproven modality of treatment, has been shown in several published studies to be more effective than a placebo in treating postoperative and chemotherapy-induced nausea and vomiting.