Where Is the Bias?
A recent "research letter" published in the New England Journal of Medicine claims that search engines are more likely to list "partisan" websites for drug information and ignore what the authors see as "non-partisan" government sites.
The authors -- Edward Boyer et al. -- cite examples of what they call "harmful" recommendations which appear on these pages and claim that at every non-governmental site they visited, there are dangerous errors.
What they neglect to mention is that distortions of truth are at least as common on government sites, if not more so. Even worse, their own citations are deceptive and misleading.
For example, the first listing of "partisan" information in the NEJM letter is this quote from The Vaults of Erowid: "Most or all of the serotonin system [damage related to taking MDMA] may be prevented by taking Prozac (fluoxetine) 0-6 hours after taking MDMA." The Vaults, at least, has some rat research to back this idea -- but Boyer's group doesn't mention this.
Instead, they cite a paper published in the Annals of Emergency Medicine -- and claim that this paper shows that taking Prozac and MDMA simultaneously can lead to a potentially dangerous over-release of serotonin. However, a look at the actual Annals paper finds that it is titled "Death By Ecstasy: the Serotonin Syndrome?" meaning that there is controversy over whether this is what caused the death. And further, the death in question in the paper involves MDMA alone, not MDMA and Prozac!
If there was an actual case report about this combination, the authors surely would have cited it -- the fact that there is not suggests that while the question of whether Prozac is neuro-protective when taken with MDMA is still open, at least the combo doesn't seem to increase risk as the authors imply.
Another example: Boyer's group claims that the Ecstasy Info site gives dangerous information because it suggests drinking "lots of water to replenish body fluids" while taking MDMA. According to Boyer, however, water-drinking on ecstasy "carries the risk of water intoxication and hyponatremia leading to seizures, cerebral edema and death."
This is true -- but Boyer doesn't put the risk in context. There have been hundreds of deaths related to over-heating and dehydration on ecstasy -- but only two where people managed to drink so much water that it killed them. Most ecstasy sites use the word "replenish" deliberately -- they mean that users should make up for fluids lost through sweating from dancing, not add extra. They might not be providing clear enough information, but it's nonetheless a lot more than the government sites do. The official sites offer no information at all about reducing drug-related risks, just exaggerations and scare tactics.
For example, here's a quote from the National Institute on Drug Abuse's publication, "Marijuana: Facts for Teens.": "Since marijuana use can affect thinking and judgment, users can forget to have safe sex and possibly expose themselves to HIV, the virus that causes AIDS."
And, here's the government site Freevibe, on heroin: "Most users dissolve it in water then use a needle to inject it directly into a vein. Many users just snort the powder which is just as dangerous." Except of course, it isn't. The risk of overdose from snorting is much lower -- and snorting heroin (unlike smoking pot, it would seem!) carries no risk of HIV transmission.
There are numerous other examples, but the NEJM paper -- with its naive belief in unbiased government and "partisan" drug sites -- shows how far away we are from having a realistic debate on drugs in the U.S.
It also demonstrates how little the authors understand technology. The reason that the "partisan" sites rank higher on search engines is, of course, because most search technology (following the example of Google) now uses algorithms which take into account a site's popularity with other searchers. Government sites rank low because people interested in drugs don't find them useful.
In fact, the Office of National Drug Control Policy has essentially acknowledged that kids don't see the government as a disinterested source of drug information. That's why their anti-drug site Freevibe is Freevibe.com, not Freevibe.gov. -- and why they tried to slip anti-drug messages into television dramas and newscasts rather than using ads.