Multi-Author Medical Blogs – At the End it is all about Credibility

9 03 2011

Recently, Bertalan Mesko (Berci on Twitter) was asking his twitter followers whether they had a favorite Web 2.0 story.  Berci needed examples for his yearly “Internet in Medicine course” at the university of Debrecen.

Doctor Ves (drVes) and Berci discussed various examples of blogs that had grown in a way: a blog that branched from blog to most popular podcast/physician-radio host (Dr. Anonymous), Kevinmd.com starting from a solo blog with 2-line snippets to a HuffPost-style conglomerate, DiabetesMine becoming a group voice with increasing popularity and industry recognition and Dean Giustini’s start from blog to the openmedicine journal based on WordPress.

And while those are all great examples, I just wondered whether growth from single to multi-authored blogs is per definition “the best” and something one should strive for. Does growth in number of authors automatically mean: “growth” of the blog? And in what respect? Is sheer growth of traffic and a greater audience the most important?

This blog regularly had guest posts in the pasts and they were surely an enrichment. Shamsha Damani was the main contributor. Her welcomed posts were in line with the theme of this blog (evidence based medicine, library-related topics), but had a fresh new look at certain topics (see for instance Grey literature time to make it systematic and  Uptodate versus Dynamed. The post were written by Shamsha, but I reviewed them before publication. Because after all, I’m responsible for the blogs content.

Guest posts/co-authorships can help to post more often. Variety in topics, style and perspectives may  further engage the readership and enhance traffic.

All good things. However, there is a big BUT, the BUT of quality and consistency.

If the blog has a theme or a focus, all authors should more or less adhere to it. Writers can have different opinions and perspectives but these should not be in conflict with the basic principles. And it surely shouldn’t be nonsense!

Good examples of blogs where authors replenish each other while adhering to a basic style are: Life in the Fast Lane (focus: emergency medicine and critical care, education, web.20 & fun) and the Health Informaticists (pretty much the scope of this blog: EBM, health 2.0, knowledge management).

Another good example is Science Based Medicine, a multi-author skeptical blog. Last year however one author (Amy Tuteur) resigned after

….”it had become clear to both the editors of SBM and Dr. Tuteur herself that, although Dr. Tuteur had routinely been able to stimulate an unprecedented level of discussion regarding the issues we at SBM consider important, SBM has not been a good fit for her and she has not been a good fit for SBM“.

Splitting up can be a good decision in case of unresolvable differences in approach. It was remarkable however that part of the  readers (167 comments to the post) were sad about Amy Tuteur’s leave, because they found her posts stimulating and engaging. Some people like (literally) thought provoking posts, while others rather see thoughtful (and sometimes predictable) posts supported by evidence.

Posts that don’t fit in can pose great credibility problems, not only for co-authored blogs, but also for blogs with guest posts. The well known KevinMD blog, cited above because it has grown from a single to a multi-author blog, recently came under fire because of a controversial guest post. Two (almost) equally famous “skeptic” bloggers devoted an entire post to this mishap, Orac of Respectful Insolence:Say it ain’t so, Dr. Pho! Credulity towards alternative medicine on KevinMD” and Steven Novella at Neurologica Blog wrote That treatment is not based on science? Don’t Worry, says KevinMD.

In his guest post “Why alternative care seems to work“, Peter Weiss assumes that people don’t try (or are even unwilling(!) to try CAM, because they don’t know the working mechanism. Weis’s post is a credulous plea for CAM:

Don’t get so hung up on the explanation that you don’t believe in, that you’re unwilling to try a practice that might actually help you.  Just keep an open mind.  You don’t have to know everything about how things work; you just have to know that they work. Just like, do I really understand electricity or do I just know that if I turn the light switch, the light comes on?

Weis tries to prove his point by saying that a highly prescribed drug as Lunesta has no known working mechanism either. Besides that this is ludicrous comparison, it isn’t true either. We do have a clue as to how Lunesta works (albeit falsifiable like everything in Science). Furthermore, Lunesta is effective whereas there is no such evidence for acupuncture or chiropractic. So should we just go and try and see instead of making an informed decision on basis of evidence  and plausibility?

This post is unlike the critical voice we usually hear from Kevin Pho. Regularly he warns against overtreatment and unnecessary screening,  for instance.

Bloggers seldom critic each other, but this quack-like post has led Steven Novella to conclude:

Weiss’s post on KevinMD is very disappointing, and unfortunately indicates that the filter on that blog for guest posts does not appear to be adequate. I hope it does not indicate a shift in philosophy away from science-based medicine, which would be worse.

Orac is much harsher.  He even devotes two posts to the topic. In style with the blog title he rages a respectful insolent rant: he will remove Kevin MD from his blogroll and will cease to recommend Kevin’s blog as a reliable source of medical information.

Orac -and many of his readers are also displeased with Kevin’s response (where he does admit they are kind of right):

Orac,

I appreciate the critique. As readers of this blog know, I often post pieces here I don’t necessarily agree with myself to promote discussion and debate. Your concerns are certainly valid, and will be taken into consideration as I choose future pieces.

Best,
Kevin

Orac even spent a second post to show the ridiculosity of  teaching the controversy in medicine by “posting pieces you don’t necessarily agree with” . What annoyed people the most was the lack of a disclaimer or an informed comment.

Basically I agree that Kevin should select more critically* and if a bad posts slips through, he should retract, openly criticize, or at least (directly) comment to the post. Indirectly saying that you will be more careful next time is not enough, IMHO. Furthermore comments were closed very soon, not giving people ample chance to respond.

On the other hand, Kevin agrees with the critique on multiple occasions. Also, I do not think that he has only traffic in mind when he includes many guest posts. He invites readers to “Submit a guest post to be heard on social media’s leading physician voice”. In line with this, Kevin once rejected a nomination in the Medgadget blog contests, probably so that some lesser known blogger would get more recognition out of the awards (roguemedic.com). Furthermore, many of the guest posts are interesting and of high quality. Thus, hopefully, this is an exception.

Anyway, this incident illustrates a pitfall of multi-author or multi-guest blogs. Posts should not be in conflict with  the basic principles of the blog. This will be directly noticed by experts in the field and certainly by skeptics), who immediately pounce on any contradictory message. But eventually conflicting standpoints may also dismay or -even worse- confuse other readers (patients, lay people).

In the end blogging is not only about the traffic. It is about credibility. It is not even about your own reputation, it is about the credibility of medical blogs in general.

*************************************

*Earlier, in a short discussion on Twitter dr Ves pointed out: “Well, Kevin is the publisher and he decides what deserves to get in, readers decide whether to follow… Similar to newspaper”. He also stresses we can’t tell KevinMD what to publish. Which is true. However, Kevin Pho and other prominent medical bloggers have a great responsibility towards an audience consisting of people  who seek to be well-informed. Medical statements should be accurate and assumptions should be plausible.
By the way, even newspapers make corrections now and then.

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Worrying: WordPress shut down a Blog of a Student Critizing the Naturopath Christopher Maloney

21 02 2010

Last Thursday PZ Myers, author of the very successful science blog Pharyngula tweeted that Christopher Maloney was a quack” (see first tweet below). Prior to that tweet I’d never heard of Christopher Maloney.

I used to be rather indifferent about homeopaths and other people practicing CAM (Complementary and Alternative Medicine), thinking that it might help some people in some cases.

But examples of patients harmed (even to death) by alternative forms of healing are increasing. In the Netherlands we had two examples of well-known people dying of (curable) cancer after seeking help from alternative practitioners: Sylvia Millecam and the ex-wive of the politician Roel van Duijn. In addition, babies have died as a consequence of craniosacral therapy (see one  recent case in the NTVG (the Dutch Medical Journal) and the English translation of this case at the Anaximperator Blog here).

What is particularly dangerous about the alternative medicine movement is the way it is able to influence and/or mobilize people and media. Read for instance through Roel’s own words (and shiver) how his wife came under influence of macrobiotic healers and was convinced she could conquer the cancer by getting her “yin and yang” more in balance.
And what about the anti-vaccination movement? In our country the vaccination campaign against cervical cancer for teenage girls failed, because of negative publicity propagated via the Internet (and this is just one example).

CAM-movements are also very powerful in trying to silence their blogging opponents, mostly very esteemed journalists and scientist. Simon Singh, a British science writer, is currently being sued for libel by the British Chiropractic Association. Why? Because he wrote an article in the The Guardian “Beware the spinal trap” in which he states that The British Chiropractic Association happily promotes bogus treatments (which he substantiates). This resulted in Singh being sued for libel by the British Chiropractic Association.

Suing for libel is one foul approach to try to silence the anti-quack scientific writers. Another is trying to shut down the blog of those critical writers. These two approaches have been used by Christopher Maloney.

Maloney, as I learned from P.Z. Myers at Pharyngula:

“… is a naturopath in the state of Maine, where quacks like him get to call themselves “doctors”. These so-called “doctors” get to make recommendations like this, in which he disparages standard flu vaccines and suggests these useless prescriptions:

Parents waiting for vaccinations can provide their children with black elderberry, which blocks the H1N1 virus. A single garlic capsule daily cuts in half the incidence and the severity of a flu episode for children.”

But Christopher Maloney is also dangerous in another respect. He tried to cut out a student*, Michael Hawkins, who criticized him, pointing out that “Naturopathic medicine is pure bull”, first by demanding the student to alter the blog post, next by asking WordPress to shut down the blog, which they did!!! (see FTSOS Fiasco)

This is the letter WordPress sent to Michael (see Pharyngula again); the picture below is from the Google cache http://tinyurl.com/ylbeshp (thanks Cryptocheilus, see comments)


And this is what you see when you search for: forthesakeofscience.wordpress.com:

That is a real spineless action and extremely unfair. I know so many sites and blogs that are spam or just contain a lot of abusive language. One such (Dutch) blog geenstijl.nl even won several blog wards.  Undeserved I think, but that is another issue.

WordPress shutting down a blog on request of a naturopath, who calls himself Dr. without having a true medical education (which seems allowed in the US State Maine). Without rigorous checking. That is creepy…..

Should I now fear the shut down of my blog criticizing WordPress?

Dear WordPress, the true power of blogging is that we, bloggers, can have a critical function in society, we can have  a voice. Blogging is almost identical to freedom of speech. When you shut down a blog of someone who is (rightly) criticizing something or someone you are endangering this process of debate, that scientists adhere to, but many CAM-proponents do not.

Shame on you WordPress. Shame on you!

———————————

Added: 2010-02-22:

* The blocking procedure was started by another quack:  Andreas Moritz. He admitted to getting WordPress to pull Michael Hawkins’ blog (source again Pharyngula).

If you want to read more on the dangerous nonsense Andreas Moritz is selling (i.e. cancer is a manifestation of “unresolved conflicts”) then you should read this article at Respectful Insolence (of “Orac”).

Below are some tweets about this WordPress/Maloney incidence in chronological order.

  1. PZ Myers
    pzmyers Christopher Maloney is a quack. http://bit.ly/aFJFNZ Spread the word.
  2. Laika (Jacqueline)
    laikas #Wordpress shut down a blog critiquing “Dr” Maloney (Quack) on his request. Shame on U WordPress! http://bit.ly/aFJFNZ (previous tweet also)
  3. Laika (Jacqueline)
  4. gimpy
    gimpyblog This is shocking and worrying for antiquack bloggers pls RT RT @laikas: #Wordpress shut down a blog tackling quack http://bit.ly/c3gsRF
  5. Elmar Breitbach
    ElmarBreitbach RT @gimpyblog: This is shocking and worrying for antiquack bloggers pls RT RT @laikas: #Wordpress shut down a blog tackling quack http:/ …
  6. trancegemini
    trancegemini RT @pzmyers: Christopher Maloney is a quack and WordPress censors Free Speech. #quack
  7. Liz Ditz
    lizditz Repeating @pzmyers http://bit.ly/bZBKLn Naturopath Christopher Maloney is a quack. http://bit.ly/bXsjT9 And WordPress lacks spine.
  8. Laika (Jacqueline)
    laikas RT @wordpressdotcom: WordPress.com is down, we’re working on restoring service now. @pzmyers what did you do? Witchcraft?
  9. Pamela
    timorousme So this infamous quack doctor had WordPress shut down the blog of a kid I know, and is threatening to sue: http://bit.ly/cDMC1E
  10. Chris Patil
    DoNotGoGently WordPress made a student who criticized a naturopath edit his blog – and then shut him down anyway. http://bit.ly/aFJFNZ

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Maloney is a naturopath in the state of Maine, where quacks like him get to call themselves “doctors”. These so-called “doctors” get to make recommendations like this, in which he disparages standard flu vaccines and suggests these useless prescriptions:

Parents waiting for vaccinations can provide their children with black elderberry, which blocks the H1N1 virus. A single garlic capsule daily cuts in half the incidence and the severity of a flu episode for children.





Complementary Medicine & Pharmacists

30 11 2009

I don’t know if the situation is the same in other countries, but in the Netherlands we can only get prescribed medications in pharmacies. Drugstores are only allowed to sell over-the counter (OTC) medicines.

Most Pharmacies have a small shop of 5 square meters (besides a large storage room). What surprises me is that the counter is not only full with non-allergic creams, and the shelves are not only filled with liquorice and plasters, but the counter and shelves predominantly display naturopathic and herbal “medicines”. In this flu-season there are even leaflets how to prevent flu with all kinds of naturopathic medicine. Dr Vogel’s Echinaforce “helps to augment your natural resistance, lowers the risk of flu and shortens the duration or decreases the severity of symptoms once you have the flu” (..”vermindert u de kans op griep en herstelt u sneller als u toch ziek wordt“). Apparently A Vogel.nl (via Biohorma) started a campaign in the Netherlands. At their website there is even an advertisement for an offer by an insurance company -OHRA- because it generously refunds homeopathic medicine. Biohorma also made a You-Tube video.
In contrast, in the US there is a disclaimer at the Echinaforce site:” These statements have not been evaluated by the Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure or prevent any disease.”

There is no evidence that Echinacea prevents flu (see Cochrane Review and de Volkskrant [Dutch newspaper referring to clinical trials]), although it is not excluded that it helps for the early treatment of colds in adults.

Isn’t such a promotion of ineffective stuff a bad advice considering we have  a real flu-epidemic, and given the inverse relationship between pediatric vaccination and CAM usage (see Respectful Insolence)?

It is quite confusing, however, because Echinacea is advertised as an homeopathic medicine, whereas it seems a herbal medicine (not diluted ad infinitum). To date there is no evidence that homeopathy ‘works’. All 6 published Cochrane systematic reviews with ‘homeopathy’ or ‘homeopathic’ in the title conclude that there is little or no evidence that it works beyond the placebo-effect.

During the recent The House of Commons Science and Technology Committee meeting calling in homeopaths and scientists to discuss evidence for the alternative therapy Prof. Dr Ernst (with experience as a homeopath) said: “I have supplied a list of systematic reviews of homeopathy. There are two dozen. None in that list were positive.” (see this excellent summary of the meeting by Ian Sample). For the entire memorandum of Dr Ernst see here.

Besides that the clinical trials are ineffective, the whole theory is incompatible with the laws of physics and chemistry.

Nevertheless:

  • There is a lot of homeopathic research going on, i.e. funded by the NHS (National Health Sevice) in the UK and the NCCAM (National Center for Complementary and Alternative Medicin, NIH) in the US.
  • In the UK homeopathic medicine is endorsed by the MHRA (Medicines and Healthcare products Regulatory Agency)
  • CAM is booming business (£1.5bn industry in the UK)
  • CAM is covered by insurance companies.
  • CAM is sold and sometimes advocated by pharmacists.

Thus all over the world people are buying these ineffective homeopathic medicines while believing they ‘work’, or at least cause no harm. However, while homeopathic medicines may not harm themselves, they may cause harm if they are used in place of proven treatment for any life-threatening illness.” Indeed the WHO has warned people with conditions such as HIV, TB and malaria not to rely on homeopathic treatments (BBC NEWS 20 August 2009

For me it is incomprehensible, that pharmacists who are trained in pharmacology and chemistry (at the University Level), just sell those ineffective costly water-dilutions and advocate them directly or indirectly by putting them on the shelves, providing ample leaflets and brochures and giving positive “advise”. What could be the reason for doing that other than ignorance or MONEY?


Recommended Reading:

Photo Credits

  1. Pharmacists mortar and pestle http://commons.wikimedia.org/wiki/File:PharmacistsMortar.svg
  2. Homeopathic Medicine on the shelves http://www.flickr.com/photos/caseywest/ / CC BY-SA 2.0
    (this photo has nothing to do with the subject)
, but all kind of complementary medicine (CAM).
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Friday Foolery [1]: On Homeopathy, Nutritionists and Toothiologists

21 08 2009

Widely referred to on twitter, shown on the blog of drShock, and already cited in 2008

But for those who do not know the Irish standup comedian Dara Ó Briain or his Homeopathy & Nutritionists vs Real Science!” here is the video:

Some great oneliners:

  • (Hé but) “Science knows it doesn’t know anything, otherwise it would stop … That doesn’t mean you can fill in the gaps with whatever fairytales”
  • “Homeopathy is water… You can’t overdose on us, but you can fucking drown in it”
  • “A dietitian is to a nutritionist as a dentist is to a toothiologist”

What does Dara Ó Briain mean with the latter?

Holford Watch, a (naughty) blog against about the “media nutritionist” Patrick Holford explained a while ago:

A ‘dietitian’ is a protected title, they need to be educated to a high level, etc., while anyone can call themselves a ‘nutritionist’. Dara drew a comparison with dentists: you have to meet certain, fairly stringent, criteria to call yourself a dentist or dietitian; anyone, though, can call themselves a toothiologist or nutritionist.

However, that Nutrionist is not a protected term is not entirely true. The title “nutritionist” is protected in Quebec, Alberta and Nova Scotia, as I learned from Wikipedia and Weighty Matters, the blog of Yoni Freedhoff, a Canadian Family doc and founder of Ottawa’s Bariatric Medical Institute.

Yoni is also not very fond of Nutritionists either. At his blog I found the (Funny Friday) video below about this profession. Made by Mitchell and Webb.

I also came across a video about homeopathy made by the same British comedians. Awesome.

Have a great weekend and be sure to take some Bach Flower Therapy to prevent your hangover. And remember, to take cocktails shaken not stirred with 1 ppm alcohol!

References:

Shaken, not Stirred

Image by el patojo via Flickr

More Friday Foolery:


Dara Ó Briain: a dietitian is to a nutritionist as a dentist is to a toothiologis

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