The Word Wide Web is promoting a revolution in communication no less important than the development of movable type, radio or television. A vast amount of information is now available to anyone with access to a computer and a telephone line. This situation extends to medical and nutritional information, which can be obtained from numerous sources. Currently, 29% of U.S. citizens connect to the Internet and 70% of those on-line look for health information. Estimates in Fall 1999 are that, by the end of 2002, the majority of Americans will be on-line. Patients have access to as much or, sometimes, more information than their physicians. While the ability to obtain this information can assist patients, it can also be a source of serious problems due to the inability of most people to put issues in context and to distinguish competent from incompetent sources.
Searching for nutrition topics can be a daunting task due to the very nature of the Web. A mid-1999 estimate was that there were 800 million pages of information on the Web; no single search engine covers more than 16% of these pages [1]. Enter the term “nutrition,” and search engines return 260,000 to 2,400,000 hits. Pages that come up in the first 10 or 20 are likely to be accessed while those below are very unlikely to be read. A savvy webmaster can get his pages listed at desirable locations near the top of a list by incorporating the operative key words into hidden headers; indeed, some search engines are paid to list pages higher. The Web can be thought of as a vast library in which each page has been cut from its book and thrown into an enormous pile. Pages are changed, added or removed constantly without any announcements. Robot programs scour the Web daily trying to keep up with the many millions of pages of material.
Oliver Wendell Holmes said, “Knowledge and timber shouldn’t be much used till they are seasoned.” Complex issues of nutrition and health are enigmatic for the typical layperson. Therefore, those of us who deal with nutrition professionally should be all the more concerned with the misinformation and commercial exploitation that is common on the Web. The democratization of access to information on the Web works two ways. Consumers of information can find virtually anything they seek; suppliers of information have few, if any, restrictions and fewer obligations to provide accurate information. Although slick, commercial sites are multi-million dollar businesses, a Web site can be set up by anyone for a few dollars.
A Media Metrix, Inc., survey ranked the top five most visited health-related web sites in September 1999, based on unique visits, as: Drkoop.com (2.6 million), America Online Health Channel (2.5 million), Healthshop.com (1.3 million), Onhealth.com (1.3 million), and Drugstore.com (1.2 million) [2]. All of these sites provide information aimed at the general public. While most of the information on these sites is reliable, there is clearly a commercial slant to much of the nutrition information. Some sites have linked directly to vitamin-sales sites, while others provide information to induce the reader to purchase assorted supplements. Sites intended for health professionals include WebMD.com and Medscape.com. Some sites such as Intellihealth.com and Medem.com have separate sections for the professional and the layperson. Although some sites have been developed in collaboration with medical schools, most are strictly commercial ventures.
Nutrition misinformation abounds on countless sites that operate unchecked under freedom of speech protections and/or lack of oversight of this most recent frontier of communication. A favorite example, now defunct, was a site selling “silicaceous rods” claimed to kill all bacteria and viruses in foods stored in the refrigerator. These two-cent glass rods were sold for $40. Both individuals and organizations with a cause can use the Web as a pulpit to preach all sorts of misinformation. Common examples of this include the dangers of dairy foods, meat, carbohydrates and artificial sweeteners. Similarly, sites extol the virtues of paleolithic diets (even though we don’t know how to recreate one), raw food diets and numerous nutritional supplements without generally accepted levels of evidence. Pseudoscience often melds with conspiracy theories in this environment.
The U.S. Federal Trade Commission (FTC) has attempted some policing of commercial sites, but it is impossible for the FTC to have anything more than a symbolic effect. The FTC undertook Operation Cure.all in 1997 and 1998, identifying 800 Web sites that contained questionable promotions for products or services [3]. After e-mail warnings were sent to these sites, 28% of the claims were removed, or the sites had already stopped operating. Yet 72% changed nothing. The FTC instituted legal proceedings against four sites that made the most outrageous claims: a fat derived from beef tallow cured most forms of arthritis by permanently modifying the immune system; shark cartilage and Cat’s Claw were effective treatments for cancer, AIDS and arthritis; magnets to treat cancer, liver disease, arthritis and high blood pressure. These companies signed consent agreements not to make false or unsubstantiated claims in the future and are subject to fines of up to $11,000 per violation. If companies wish to ignore consent agreements, the consequences represent a very small expense when such companies can take in tens of millions of dollars.
Do we throw our hands up in despair? Certainly not. However, there is very little that can be done to shut down sites providing incorrect information or that intentionally mislead readers. It is our obligation to become familiar with the Web, to assist patients and the public in separating the wheat from the chaff, especially when testimonials extol the virtues of nutritional products without valid evidence of either safety or efficacy.
This issue marks the establishment of an on-line presence for the Journal of the American College of Nutrition. Beginning with this issue, titles and abstracts are being posted to the Web on the first day of each month of publication. These can be found at http://www.am-coll-nutr.org. No decision has yet been made concerning full text availability, and we are interested in readers’ opinions on this subject.
Disclosure: Dr. Klurfeld has a financial interest in the on-line nutrition information service, NutritionNewsFocus.com.
References
1. Lawrence S, Giles CL: Accessibility of information on the Web. Nature 400:107-109, 1999.
2. http://www.mediametrix.com/TopRankings/TopRankings.html Accessed Nov 24, 1999.
3. http://www.ftc.gov/opa/1999/9906/opcureall.htm Accessed June 24, 1999.
David M. Klurfeld, PhD, FACN
Editor-in-Chief