Quackwatch founder Stephen Barrett takes on health care reform myths

Stephen Barrett by nando Harry Lynch.jpg. . . or as Dr Barrett refers to it more accurately, Insurance Reform.
On Friday, Sarah Avery of the News & Observer reported on her interview with the now-retired Pennsylvania psychiatrist who started the Quackwatch.com website in 1996 following years of investigating fraudulent health practices.
From the Quackwatch Mission Statement:

Quackwatch is now an international network of people who are concerned about health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere. Founded by Dr. Stephen Barrett in 1969 as the Lehigh Valley Committee Against Health Fraud (Allentown, Pennsylvania), it was incorporated in 1970. In 1997, it assumed its current name and began developing a worldwide network of volunteers and expert advisors.

Avery reports that Barrett has been particularly effective in drawing attention to the quackery and dangers of chiropractors:

Call the American Chiropractic Association, mention Barrett’s name, and the response is a groan.
“Uhhhg,” said spokeswoman Caitlin Lukacs, “I’ll try to find someone to comment.”
No one called.
A Google search for chiropractors lends a possible explanation. Barrett’s Quackwatch page pops up as the fifth site listed out of 6.5 million, indicating it’s one of the most frequently visited among people looking for chiropractics.
He loves it.
“It’s good to be in the top 10,” he says and grins.


In his “retirement,” Dr Barrett and colleagues are now providing critical information to debunk myths about health care reform at Insurance Reform Watch. As Avery reports:

Now he has put together a health reform truth squad, a group of fellow retirees that includes a past admissions officer at Harvard University, a UNC-Chapel Hill academic, a doctor, two dentists, an economist and a one-time New York City insurance fraud investigator.
Their mission: to vet some of the wilder claims of those opposed to current health-care proposals and publish them on the Internet.
“Most of it is sheer baloney,” Barrett says.

In essence, Insurance Reform Watch is applying the same basic critical thinking tenets of Quackwatch to the health care debate:

John Hammond, a professor emeritus of pathology and lab medicine at UNC-Chapel Hill, says the group decided recently to go public with its findings as the debate grew more rancorous and certain assertions began to be repeated.
“All this garbage needs to be debunked,” Hammond says, pointing to one claim that older Americans will lose access to their doctors if more people are covered. “That’s so morally bankrupt you can’t even begin to consider it as a rational response.”

Beyond Avery’s article itself, the comment thread there is worth reading briefly as it deteriorates almost from the start with the accusations that since Dr Barrett is a registered Democrat and physician, he cannot be objective. Coupled with the “some alternative medicine works because Duke and UNC have acupuncturists on staff” and you’ve got all the makings of epileptic seizures for my colleagues, Orac and PalMD.
Welcome to our little slice of heaven, Dr Barrett. Bora Zivkovic and I look forward to coffee with you.
Watch Insurance Reform Watch as the site is updated during continued national debate on this topic.
Photo credit: Harry Lynch, News & Observer

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17 thoughts on “Quackwatch founder Stephen Barrett takes on health care reform myths

  1. “Call the American Chiropractic Association, mention Barrett’s name, and the response is a groan.”
    Yes, chiros are reflexive in spewing venom whenever he is mentioned. More than that, ca. 6 years ago PBS (Scientific American Frontiers) broadcast a program that featured the danger of chiropractic neck manipulation (strokes). The head of some chiro association wrote to PBS complaining that they had been misled by Dr. Barrett- who had no connection to the show! (Wallace Sampson, M.D., had been the consultant.)

  2. I meant to add the irony that, unlike me and despite the chiro hatred for him, Dr. Barrett thinks chiro can correct itself and be done rationally. Thus, he is only opposed to their irrational practices. However, there’s a joke that the difference between a rational chiro and a large pizza is the pizza can feed a family of four.

  3. On the surface with a quick glance Barrett’s “Quackwatch” is a noble endeavor by a group protecting patients from unsavory practices. But on just a bit deeper of inspection we find that the quackwatch group looks at healthcare and the protection of the public with one eye shut or at least jaundiced.
    With any reasonable view of healthcare the aspects of risk benefit ratios are essential to weed out valuable information versus slogans and propaganda. These risk benefit ratios could be:
    1. The risk of one procedure versus an alternative one.
    2. How much risk is allowable for the benefit possibly received by an intervention?
    3. What are the costs of one procedure versus an alternative one?
    Pulling back the proverbial curtain on the “Wizards of Quackwatch,” we find that when it comes to medical, pharmaceutical, or “non-alternative” healthcare they have no concern for the public’s best interest. In this arena high costs, low benefit, and high risks are ignored. The alternative healthcare methods that Barratt fights against routinely offer low risk or low cost, as discovered routinely in our emerging research evidence base.
    Why would the Quackwatchers not protect us against the medical, hospital, and pharmaceutical abuses that cost the public untold billions and cause deaths or disabilities many many magnitudes greater than the alternative healthcare they “champion” against?
    If we follow the money and where they focus their attention this group warrants deep profound concern and their motives dissected for all to see.

  4. That last comment is virtuosic in its seamless intermingling of the straw man argument and begging the question. But, while I may admire Charles’ style, I have to note a certain lack of substance. Has Quackwatch said anything unfair or untrue about any alternative treatment? Have the risks or drawbacks of any conventional treatment been minimized or whitewashed? Has any practice or institution been defended when it should have been criticized? And is there any sign of a conflict of interest among its contributors or supporters?
    As best I can tell: no, no, no and no.
    Charles is of course welcome to offer examples of misconduct at Quackwatch, but I bet he comes up dry. In essence, his complaint is that Quackwatch is pointedly critical of alternative treatments that do no good — or do actual harm. Sorry, but that is exactly what Quackwatch ought to be doing.

  5. Charles | September 8, 2009 3:23 PM wrote “The alternative healthcare methods that Barratt fights against routinely offer low risk or low cost, as discovered routinely in our emerging research evidence base.”
    Low risk and low cost are not proven. Chiropractors kill people (neck-snap leading to stroke). They also charge lots of money for unnecessary, “maintenance” procedures (which may also be lethal).
    Where is your “research evidence base?” Keep in mind, that quack literature does not count.

  6. Wow, naively didn’t realize this would become so charged so quickly. But I do suppose this is characteristic of the Quackwatch chronies. Here is a very very brief glance at the emerging evidence base I mentioned in my prior post.
    Let’s look at alternative conservative methods of care in relatonship to “traditional” methods for surgical interventions for lumbar disc herniations:
    “In our experience, recurrent lumbar disc herniation occurred in more than 10% of patients and was associated with substantial health care costs. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the health care costs and morbidity associated with this complication. Prolonged conservative management should be attempted when possible to reduce the health care costs of this complication.
    “Diagnosis and management of recurrent disc herniation were associated with a mean cost of $26 593 per patient, and the mean cost was markedly less for patients responding to conservative treatment ($2315) compared with those requiring revision surgery ($39 836) (P http://165.235.90.100/IMC/guidelines.html.
    6 Hoving JL, Koes BW, de Vet HCW, van der Windt AWM, Assendelft WJJ, van Mameren H, Deville WLJM, Pool JJM, Scholten RJPM, Bouter LM, Manual therapy, physical therapy, or continued care by a general practitioner for patient with neck pain: A randomized controlled trial. Annals of Internal Medicine 2002;136(10): 713-22.
    7. Korthals-de B, Ingeborg BC, Hoving JL, van Tulder MW, Rutten-van Molken MPMH, Ader HJ, deVetHCW, Koes BW, Vondeling H, Bouter LM, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: Economic evaluation alongside a randomized controlled trial, British Medical Journal 2003;326(7395): 911.
    8. Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW. The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain: A Prospective, Multicenter, Cohort Study J Manip Physiological Therapeutics. Jul 2007;30(6): 408-18.

  7. @Charles | September 9, 2009 12:39 AM
    McGirt et al 2009 compares two kinds of surgery, chiroquacktick is absent.
    Then you cite two (typically crappy) articles in JMPT; which is written by, and for, quacks. Let me help you- they are not randomized, controlled trials. Your magazine has not joined the twentieth century. One doesn’t look for gold in an iron mine.
    You cite more quack, and unrefereed or poorly refereed sources (yes, “Spine” is unreliable); including your fanzine “Dynamic Chiropractic” (DC). However, here is an article in DC that acknowledges that chiros cause strokes http://www.chiroweb.com/archives/23/04/18.html Also, look at this review by a chiro http://www.sciencebasedmedicine.org/?p=1037
    While there are a couple of your cites in which I am interested; given your overall lack of perspicuity, you should not hold out much hope. I probably just don’t remember rejecting them in the past.
    The next person you fleece, or cause a stroke, won’t be me.

  8. Yeah, just as I expected, the BMJ paper (2003) and the AIM paper (2002); I’ve seen them before, they do not refer to chiropracty. It is typical for your kind to try to attach yourselves to legitimate therapy that kinda sounds the same.

  9. So glad we can have a respectful scientific evidence based dialogue. When someone responds with some ethics and integrity to what I have shared I would be happy to dialogue with them. No matter how many times someone from Quackwatch signs in with different names the dialogue is always the same.
    You ask for evidence and then play the game of summarily dismissing peer reviewed pub med journals. You have the same tried and true things you use to support your position and ignore anything else. I am open to unbiased scientific well written literature. Anyone in the evidence based arena understands the limitations of randomized controlled trials.
    I am open to dialogue but your comments are just plain sillyness.
    Isn’t there anyone out there not from Quackwatchers that wants to have an educated dialogue and not use this blog as a public forum to spew their unscientific venom?

  10. Charles, I can assure you that both Joe and jre are not associated with Quackwatch, they are real people with whom I have had e-interactions with for over three years. There is no toying with multiple IP addresses as I have access to this information in the comment tagging information via Moveable Type. They raise very critical points, particularly the fact that all peer-reviewed literature is deserving of post-publication criticism.

  11. Dear Abel Pharmboy,
    “They raise very critical points, particularly the fact that all peer-reviewed literature is deserving of post-publication criticism.”
    I am not sure where you have studied raising critical points on post peer-reviewed published literature but in the scientific circles I have traveled the past 30 years the following is not the way:
    “Then you cite two (typically crappy) articles in JMPT; which is written by, and for, quacks. Let me help you- they are not randomized, controlled trials. Your magazine has not joined the twentieth century. One doesn’t look for gold in an iron mine.
    “You cite more quack, and unrefereed or poorly refereed sources (yes, “Spine” is unreliable)…” [Joe]
    The whole scientific process is founded on being open, being eternally critical, and attempting to resist biases. Summarily dismissing quality respected journals after asking for evidence is not any scientific process but is quite characteristic of the Quackwatch group.
    Let’s see another “critical point” that was raised by Joe was “Yeah, just as I expected, the BMJ paper (2003) and the AIM paper (2002); I’ve seen them before, they do not refer to chiropracty. It is typical for your kind to try to attach yourselves to legitimate therapy that kinda sounds the same.” [Joe]
    Again this is typical of the Quackwatch mantra. Anyone in the field of manipulation which can include osteopaths, manual therapists, physiotherapists and chiropractors know that the chiropractic profession has the most extensive training in spinal manipulative therapy of all the groups. So if a study discusses manipulative therapy in a positive light someone with greater training would not only be expected to attain a similar response but, to any reasonable mind, would expect even better results.
    And even one more “critical point” that was raised by Joe supporting your contention that “the fact that peer-reviewed literature is deserving of post-publication criticism.”
    “The next person you fleece, or cause a stroke, won’t be me.” [Joe]
    The general consensus of the published peer reviewed literature has clearly shown NO causal relationship between cervical manipulation and stroke. The fact there is a coincidental one was discussed by the Cassidy study in Spine [1]. This focused on the fact that primary care allopathic (non-manipulation) and chiropractors (manipulation) both had patients with the same incidence of stroke. Their findings determined that the reason was because patients with an impending stroke will have head or neck pain and seek care for this pain.[1].
    The present call to the chiropractic profession and any healthcare provider treating patients with head or neck pain is to be aware of the signs of patients with red flags (# 1 & 2) indicating an impending stroke so they can be immediately referred to an emergency room, as well as yellow flags (#3 &4) which indicate co-treatment with an allopathic physician may be needed.
    These types of signs include but are not limited to:
    1. Patient dizziness, drop attacks, blurred vision, difficulty speaking, swallowing, or walking, along with nausea, numbness, and nystagmus. Also any grouping of these signs with a patient having had a history of an infection [2,2], particularly an upper respiratory tract infection should heighten alertness for the doctor.
    2. If a patient says “I have a pain in my neck and/or head unlike anything I have ever had before.” Also we will need to increase any investigation if the patient has posterior head pain that is “throbbing, steady or sharp.”
    3. We need thoroughly to investigate young women patients who report a new onset (within the past year) of probable migraine with visual aura, who smoke, and take oral contraceptives [4].
    4. Blood laboratory analysis showing increased levels of c-reactive protein [5,6], homocysteine [7,8], and LDL versus HDL [9] warrant dietary modifications and exercise as well as in unresponsive cases of allopathic cotreatment.
    Mr. Pharmboy if these are the types of “real people” with whom you “have had e-interactions with for over three years,” I would be careful with what information you are gleaning from them and how much credence you offer these interactions. Their comments have nothing to do with, “peer-reviewed literature … deserving of post-publication criticism.” They seek to be nothing but inflammatory and venomous.
    1. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.
    2. Forster K, Poppert H, Conrad B, Sander D. Elevated inflammatory laboratory parameters in spontaneous cervical artery dissection as compared to traumatic dissection: a retrospective case-control study. J Neurol. 2006 Jun;253(6):741-5. Epub 2006 Mar 6.
    3. Guillon B, Bethet K, Benslamia L, Bertand M, Bousser MG, Tzourio C. Infection and the risk of spontaneous cervical artery dissection. A case-control study. Stroke 2003; 34(e):79-81.328.
    4. MacClellan LR, Giles W, Cole J, Wozniak M, Stern B, Mitchell BD, Kittner SJ. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke. 2007 Sep;38(9):2438-45. Epub 2007 Aug 9.
    5. Tanne D, Benderly M, Goldbourt U, Haim M, Tenenbaum A, Fisman EZ, Matas Z, Adler Y, Zimmlichman R, Behar S, C- Reactive Protein as a Predictor of Incident Ischemic Stroke Among Patients With Preexisting. Cardiovascular Disease. Stroke. 2006 Jul;37(7):1720-4.
    6. Cao JJ, Thach C, Manolio TA, Psaty BM, Kuller LH, Chaves PH, Polak JF, Sutton-Tyrrell K, Herrington DM, Price TR, Cushman M. C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the Cardiovascular Health Study. Circulation. 2003 Jul 15;108(2):166-70.
    7. Cui R, Moriyama Y, Koike KA, Date C, Kikuchi S, Tamakoshi A, Iso H; JACC Study group. Serum total homocysteine concentrations and risk of mortality from stroke and coronary heart disease in Japanese: The JACC study. Atherosclerosis. 2007 Dec 27;
    8. Tanne D, Haim M, Goldbourt U, Boyko V, Doolman R, Adler Y, Brunner D, Behar S, Sela BA.. Prospective study of serum homocysteine and risk of ischemic stroke among patients with preexisting coronary heart disease. Stroke. 2003 Mar;34(3):632- 6.
    9. Amarenco P, Steg PG. The paradox of cholesterol and stroke. Lancet. 2007;370:1803- 1804.

  12. In my previous post, I dismissed your citations, with reasons for doing so. I did not just discount your quack literature, in several cases I explained why I did so. In particular, many cases you offered citations that were not relevant to chiro.
    It is not my business to sort through articles that you hope will pass the tests of legitimate research. Let me cut to the chase- your ref. #9 concerns “cholesterol and stroke”; are you suggesting that chiro influences cholesterol?
    Don’t dump irrelevant articles, do cite studies that you think are compelling. So far, you have failed on both fronts.

  13. Dear Joe,
    I must admit I am not familiar with blogs and the jokes they can become. I suppose you just looked at the references and ignored what I had written. If you had read what I had written you would have noted that in the course of an examination of a patient that along with patient history – cholesterol HDL/LDL ratios, homocysteine and c-reactive protein levels are all yellow flags regarding stroke issues.
    By the way I completely dismiss everything and anything you have posted so far because they have absolutely no substance, are pathetic attempts to deflect issues, and refrain from respectful scientific dialogue.
    You can have the last comment since I am no longer checking this blog for anything.

  14. Mr. Pharmboy if these are the types of “real people” with whom you “have had e-interactions with for over three years,” I would be careful with what information you are gleaning from them … They seek to be nothing but inflammatory and venomous.

    Well, I would like to speak for my own reality (of course, I would say that even if I were not real).
    As to Quackwatch, I have no connection. I noticed the site in the mid-1990s, when I was researching claims made for miracle foods such as Blue-Green Algae. Everything I found on Quackwatch turned out to be readily confirmed by independent and reliable sources. Since then, I have gone back to Quackwatch many times, and have never found anything there that struck me as untrue or unfair. So, yes — my impression of Quackwatch, formed over more than twelve years, has been very positive.
    Now, I hold no brief for or against chiropractic, but I did sense a certain … ummm … hostility in Charles’ first comment that made me wonder if he is not, perhaps a disinterested seeker after truth. I also objected to the style of argument, e.g.

    Why would the Quackwatchers not protect us against the medical, hospital, and pharmaceutical abuses that cost the public untold billions and cause deaths or disabilities many many magnitudes greater than the alternative healthcare they “champion” against?

    — which seems to assume a whole bunch of facts not in evidence.
    Speaking of evidence, I did a cursory search on PubMed for “cervical manipulation stroke” and found many of the same articles cited above. Conspicuous by its absence in those papers Charles has cited is Miley et al. 2008, which concludes

    Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. Ultimately, the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy.

  15. Why would the Quackwatchers not protect us against the medical, hospital, and pharmaceutical abuses that cost the public untold billions and cause deaths or disabilities many many magnitudes greater than the alternative healthcare they “champion” against?

  16. I just came across your blog while doing a bit of a search on said Mr Barrett ( I say Mr as he may no longer be a doctor ).
    As usual there is much argument, so insted of getting riled up myself I thouhgt I’d draw your attention to others posts on Mr Barrett
    http://campaignfortruth.com/Eclub/190707/quackbusterbusted.htm?in_article_id=460896&in_page_id=1774
    http://www.quackpotwatch.org/
    http://www.raysahelian.com/quackwatch.html
    And a short 402 page list of health frauds not mentioned on his sites, that really should be!
    http://www.garynull.com/articles/BigPharma102009Final.pdf
    Happy reading
    Chris

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