Jul 30 2009

Salon vs HuffPo

I have been critical of the Huffington Post’s anti-scientific editorial stance. Since the beginning of this online news source it has been a home to the anti-vaccination movement, featuring articles and blogs by David Kirby, Jenny McCarthy, Jim Carey, and RFK Jr. The health section of the the HuffPo is largely composed of credulous promotion of unscientific health claims and gross misinformation. In fact, this has led me to criticize the HuffPo’s de facto  “war on science.

Recently Dr. Rahul K. Parikh has written an excellent criticism of the Huffington Post for Salon.com. The full article is worth a read, but here are his main points.

He convincingly demonstrates that the anti-scientific editorial stance of the HuffPo comes directly from its founder, Arianna Huffington. She is hostile toward scientific medicine and enamored of so-called “alternative medicine.” Further, she has recruited health bloggers and editors in a scattered fashion, mostly on her personal whim, and has not taken care to provide even a balanced approach to health reporting, let alone a scientific or responsible one.

Her defense is typical and lame. She says that she is simply providing a variety of opinion. This is essentially the same lame defense put forward by Oprah when she was called out by Newsweek for promoting health nonsense. This defense is not only dismissive, it is dishonest. In both cases Huffington and Oprah were being criticized for their editorial filter of important health information. Their defense was that, in essence, they have no filter – they put it all out there to promote discussion. But in both cases this is patently not true – they disproportionately promote unscientific viewpoints.

Parikh also points out that there is a serious lack of quality control. It is the HuffPo’s own policy that if a factual error is pointed out for a blog entry the author will correct the error within 24 hours. That is a reasonable policy – and I find that most quality science bloggers do that. In fact I have specifically praised the role of commenters in science blogs – they help with fact checking and keeping us honest. The new journalism is more of a conversation, and often we recognize that our audience may be more expert on a topic about which we are blogging than we are.

But when it comes to health reporting on the HuffPo their own policy seems to be ignored. Parikh gives the example of Jim Carrey, who repeated the misinformation that vaccines contain ether and antifreeze. I and others have pointed out that this is factually incorrect – nothing but anti-vax propaganda – for a couple of years now. Yet Carrey never made the correction, and this lie remains part of the anti-vax “toxin gambit.”

I took a look today at the health section of the Huffington Post to see the nonsense de jour they are spouting. The lead article is by Dr. Mark Hyman, a proponent of “functional medicine.” My colleague, Wallace Sampson, does an excellent take down of functional medicine on the SBM blog. Essentially, it is a vague hand-waving justification for more bad science in medicine.

Interestingly, another article on Salon.com exposed the crankery of Mark Hyman:

Before I could change the channel, I heard Dr. Hyman make the following comments: “The way we think about disease, mental illness, and our brain aging, actually has nothing, nothing to do with how our body actually works … The way we think about disease is all wrong … the name of the disease tells us nothing about the real reason or the causes of them. Diseases don’t exist.

Diseases don’t exist? That is a pre-scientific notion contradicted by a couple centuries of medical science. What Hyman does is mix some cherry-picked scientific medical facts with pure speculation and misinformation, without distinguishing among them, and then present them as cutting-edge medicine.

In his latest article for the HuffPo he claims that underactive thyroid is an undiagnosed epidemic. He seamlessly mixes some reasonable statements with pure nonsense, and a misrepresentation of the evidence. For example, he states:

In fact, one study found that as people lost weight they released pesticides from their fat tissue.

This then interfered with their thyroid function and caused hypothyroidism. The toxins created a slow metabolism and prevented them from losing more weight.

The “study” he links to is not presenting any new evidence (it’s not an actual study), but rather is just speculating about a potential connection between weight loss and organochlorine plasma levels and thyroid function. The paper is filled with “mights” and “appears to” – but it is not presenting data. So Hyman is just citing speculation as if it is evidence for his speculation.

I looked through the published data on this question and found that it is not clear at all. Plasma levels of organochlorine do increase in the short term during weight loss, but there is no long term data and there is every reason to think this is a temporary effect. Other data shows that plasma levels do not correlate with obesity itself, but rather with age.

However, I could find no studies making a convincing link to thyroid function in humans. This systematic review concluded that the evidence is mixed  – we cannot conclude from current evidence that there is a link. Yet Hyman concluded that “this study” shows the need for detoxification – when what he cited was not even a study, and the evidence absolutely does not support “detoxification” – forget the fact that most treatments promoted as detoxification have not been shown to remove actual toxins.

The rest of his article is as poorly argued – and it would take me far too long to counter each argument as I have above. He does give us an anecdote, however, about a patient with vague symptoms and inability to lose weight. He decided she has low thyroid:

So I treated her with a low dose of Armour Thyroid, which is a natural thyroid replacement.

What happened?

Well, she not only lost 20 pounds and improved her body composition, but her mood improved and all her other symptoms went away.

The assumption here is that she would not have responded the same way if she had not had low thyroid – but this is not a fair conclusion. Giving a patient thyroid hormones is kind-of like giving them a stimulant – it increases their metabolism, and they will have more energy and will lose weight. This is a non-specific result that does NOT confirm the diagnosis of hypothyroidism, as Hyman falsely implies.

The reason we don’t just give thyroid replacement to everyone who is overweight and depressed is because it is not safe. It can cause serious complications, like osteoporosis and heart arrhythmias. Ironically, Hyman is preaching lifestyle and balance, but then in this case he just gave a drug that probably threw his patient’s hormones out of normal balance.Actually, I can’t know because he did not disclose her TSH level.

The kernel of truth to Hyman’s article is that hypothyroidism is underdiagnosed. The American Association of Clinical Endocrinologists estimates that half of Americans with an underactive thyroid go undiagnosed. It is also true that the AACE in 2003 changed their guidelines. Prior to that a TSH level greater than 5.0 was considered hypothyroid. However in 2003 the AACE decided to lower the threshold to 3.04 in order to capture more patients with mild hypothyroidism.

Where to draw the line between “normal” and “abnormal” for such tests is always a tricky question, which has to do with specificity and sensitivity. Basically – do you want to have more false positives or false negatives. No test is 100%, so you have to accept some of both. Lower the threshold and you decrease the false negatives but increase the false positives. The AACE made the decision to reduce false negatives – to treat more people with milder hypothyroidism.

Of course, whenever you change the definition like this you change the numbers – so suddenly there were many more people meeting the definition of hypothyroidism. Also, it takes time for specialty recommendations like this to percolate through the medical profession. This is actually a legitimate complaint that I have about how continuing medical education is done in medicine. We need to find better mechanisms to update doctors on best medical practice.

So Hyman has a kernel of a legitimate point here, but he does not even emphasize it properly. Instead he gives the false impression that half of those with the new more liberal definition of hypothyroidism are going undiagnosed by their doctors. The truth is – some diagnoses are being missed, but many of those who are undiagnosed are so because they have not presented to their physician. That is why the AACE is advocating a public awareness campaign – to get people who may be hypothyroid into their doctor’s office.

Hyman uses the recent changes in diagnostic criteria and gaps in both physician and public education to then argue for a host of dubious and speculative tests and treatments which are not evidence-based. That seems to be the style for “functional” medicine – start with some legitimate physiology then speculate wildly, blame toxins and hormones, and treat in the absence of adequate clinical evidence.

And that also appears to be the standard for the HuffPo – allow anyone with a crank health claim that is sufficiently outside the mainstream or unscientific to have free reign, and then claim you’re just providing a range of opinions.

But as Dr. Parikh points out – reporting on science is not the same as reporting political opinion. There is a certain standard for factual correctness and responsibly representing the scientific consensus – especially when it comes to health care.

The Huffington Post is now the poster child for irresponsible health reporting online, and I’m glad that other media outlets are catching on and calling them on it.

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