“And I say that if a rhetorician and a physician were to go to any city, and had there to argue in the Ecclesia or any other assembly as to which of them should be elected state-physician, the physician would have no chance […]”
– Plato, Gorgias

Introduction

Critical, open, fact-based public discussion is essential to the proper functioning of modern, liberal democracies. When it works properly, such discussion promotes a widely shared understanding of the facts amon and enables constructive collective action.

The new social forces unleashed by the Internet are undermining critical, open, fact-based discussion, and the norms that safeguard it are enforceable to a much lesser extent than in the recent past. This is because the Internet has intensified competition among a new breed of media outlet for human attention; dominating the human attention economy is critical because it drives advertising revenue, which is the core business model of Internet content creators. As competition has intensified, the manipulation techniques used to increase engagement have in their own turn intensified and increased in sophistication. Perhaps the most powerful emotion leveraged to build media engagement and ensure human attention is outrage. The result is a proliferation of extreme and widely varying views driven by outrage, often conspiracy theories, all motivated by the need by content creators to maximize Internet advertising revenue.

In place of an information ecosystem that formerly produced a large degree of consensus about the nature of reality among the general population, the new information ecosystem promotes a splintering and polarization of that understanding of reality. This lack of shared understanding causes wasteful political conflict and paralyzes decision-making on some of the most important and pressing challenges of our time. This paralysis may in the final analysis prove deadly for individuals, societies, or even our very species.

Science and scientific communication are subtypes of critical, open, fact-based public discussion, and they too have been subjected to and fragmented by this very same trend. This includes not just the reception of science in the popular media but even what and how science is conducted and published in what were formerly some of the world’s most prestigious scientific publishing companies, including the British Medical Journal Publishing Group, Cell Press, and the Nature Publishing Group. The result is an increasing rejection of science by the public and a corruption of scientific practice from the inside of what were formerly science’s most hallowed professional journals.

Creativity, unorthodox thinking, and research questions that go against the grain of conventional wisdom in the research community are an important part of scientific progress. Likewise, vested economic and ideological interests can manipulate the scientific process and thereby post a major impediment to scientific advance, science-based public policy, and a scientifically literate and informed population. Society must therefore embrace, protect, and support innovative thinking and resist the manipulation of science by vested interests.

Yet, while individuals who self-publish on the Internet could in principle serve the role of independent watchdogs and/or self-styled Galileos challenging the desiccated dogmas of the scientific status quo, in practice the reality is quite different: the vast majority of such individuals, fraudulently taking on the mantle of challenger to a corrupt system, have promoted confusion, misinformation, and practiced grift on a massive scale. In the health sciences, the consequence of this trend has been to undermine medical care and public health via conspiracy theories about effective medical treatments and impede progress in public health policy by disrupting via misinformation the development of necessary consensus among policymakers. In short, while the Internet originally promised to democratize science and expertise, the outcome has been the proliferation of New York Times best-selling pseudoscientific manipulators and grifting quacks who work ceaselessly to further undermine an already dysfunctional public health system.

This grift has best been exemplified in the case of COVID-19. At the outset, the COVID-19 pandemic was used as fodder by unscrupulous and poorly educated online health experts to sell lies, conspiracy theories, and bolster reputations. On several occasions, this grift percolated to the highest office in the United States: the presidency. Throughout the pandemic, during press conferences before tens of millions of viewers, President Trump parroted inanities about COVID-19 trutherism, hydroxychloroquine pseudoscience, IV bleach treatments, mask denial, and more. This demonstrated just how pervasive and influential pseudoscience propagated over the Internet was in the United States: it was affecting policy at the highest levels, and it will continue to do so until something is done to change it.

The root cause prescription to “roll back” the wreckage of our information ecosystem is to legislate sweeping changes in how advertising over the Internet is regulated, or to abolish advertising on the Internet altogether. In the absence of such legislation, however, it is up to social media companies, media organizations, and individuals to work together to build a suite of new mechanisms and tools to combat, regulate, and ultimately reduce the current flood of misinformation that being used to wage war against our shared sense of reality and decency in the name of profit.

The following document lays out the criteria and algorithm that will be used to manage a misinformation database that tracks quackery, misinformation, and overhype in the nutrition and health space, to achieve some progress resisting some of the corrosive effects of the above forces.

Misinformation, hypesterism, and quackery (MHQ) rule list

The following will be subject to entry in the MHQ statement database:

1. A claim at odds with overwhelming evidence and consensus:
Example 1: “Dietary sugar is the cause of diabetes.”
Example 2: “LDL cholesterol does not cause heart disease.”
Example 3: “The HPV vaccine causes cervical cancer.”
Example 4: “Insulin is the cause of common obesity.”
Example 5: “A ketogenic diet cures cancer by starving it of glucose.”

2. A claim or work not supported by currently available evidence:
Example 1: “A plant-based diet reverses heart disease.”
Example 2: “Omega-6 fatty acids cause inflammation in humans.”
Example 3: “A diet consisting entirely of beef is the proper human diet.”
Example 4: “Phytochemicals cause adverse health effects.”
Example 5: “Weight-neutral approaches cause the greatest weight loss.”

3. A claim about science or clinical practice based on anecdotal evidence:
Example 1: “I lost 50 pounds on a ketogenic diet. Therefore, there must be something wrong with science that suggests that ketogenic diets are at best only slightly better than other diets for weight loss.”
Example 2: “I treated my bipolar disorder with a ketogenic diet. Therefore, a ketogenic diet should be used to treat bipolar disorder.”
Example 3: “Margaret’s metastatic cancer regressed and disappeared on a vegan diet. Therefore, a vegan diet cures cancer.”

4. A claim that uses a citation that does not support the claim:
Example: “Garlic supplementation was shown in this paper to reduce the incidence of cold.” Paper is cited which reports no change in incidence of cold upon garlic supplementation.

5. A claim that overhypes science:
Example 1: “Sauna was shown in this prospective observational study to reduce the incidence of death by 30%. Wow!” Paper is then cited which shows such a result, but all discussion of published scientific literature containing extensive and potentially fatal criticisms of the paper is never discussed.
Example 2: “Sulforaphane prevents cancer by activating NRF2. Wow, take sulforaphane!” All discussion about research showing that NRF2 activation can enhance tumor growth is omitted.
Example 3: “Resveratrol produced dramatic health benefits in mice in my experiments.” The repeated failure by large scientific teams to replicate these findings costing millions of dollars is never discussed.

6. A claim that misrepresents facts:
Example: Ancel Keys cherrypicked his Seven Country Study to give him the result he wanted rather than being impartial to whatever the evidence would say.

7. A potentially dangerous health protocol requested or given, hypothetical or otherwise, that is supported by weak or non-existent human evidence (such as epidemiology, case studies, anecdotes, animal studies, or cell culture studies):
Example 1: “I take: Resveratrol – 1g/daily; Nicotinamide Mononucleotide (NMN) – 1g/daily; Metformin (prescription drug) – 1g/daily”
Example 2: “If you, or someone you cared about deeply, is diagnosed with cancer, how would you use your alternative dietary therapy to treat it?”
Example 3: “I eat only meat and ignore LDL to treat my diabetes.”

8. Any of the above claims accompanied by a disclaimer that “this is not medical advice.” [i.e., any disclaimer that misinformation should not be interpreted as medical advice that will be interpreted as medical advice by many is inherently dishonest.]
Example: “Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.” Page then goes to discuss dietary therapies for cancer that are unsupported or contradicted by clinical evidence.

9. Providing a blogging, podcast, book, or speaking platform on which any of the above take place.
Example: John makes a claim about insulin and weight gain that is demonstrably false in a video on dietdoctor.org, which is run by Bob. Both John and Bob are independently added to the MHQ database, under the claim made by John.

10. Belonging to an organization whose official stance violates any of the above.
Example: Jason, Tom, Fred, and Mark are publicly listed as belonging to The International Network of Cholesterol Skeptics (THINCS), a science denialist organization whose official publications claim that statins are harmful and that blood cholesterol plays no role in heart disease. Jason, Tom, Fred, and Mark are each independently added to the MHQ database, under each claim made by the official publications of THINCS.

11. Claiming that one is providing the comprehensive, scientific “truth” about a given health or nutrition topic, without providing a methodology for systematically selecting and evaluating the evidence on the topic one is writing or speaking about. [It is impossible to provide the scientific truth about something if one does not systematically and impartially evaluate the evidence.]

Misinformation, hypesterism, and quackery (MHQ) procedure

Upon reporting MHQ using the submission form available here and being verified as a legitimate violation of one or more of the above rules by a member of the editorial staff, a form email with the rule violation will be sent to the offender, and rule violation will be documented in the Preliminary List. The offender will then have one week (seven days) to provide public clarification of the violation, on the same platform used to communicate the violation or the largest platform otherwise available to the offender. Staff will be notified over email of the clarification by the offender, and the offender will provide a hyperlink. If the offender provides adequate clarification or reversal so as to demonstrate that the rule is no longer being violated, the violation will be moved to the Resolved List with clarifying statement included, where it will remain without further action being taken. If adequate clarification or reversal is not provided to show that the rule is no longer being violated within one week, then the statement will be moved to the Unresolved List, a video will be recorded, and the statement’s score will be aggregated in the Summary Sheet to provide a sum MHQ score for that individual. If adequate clarification or reversal of the statement is provided in the future, the statement will be moved from the Unresolved List to the Resolved List, and the statement score will be removed from the aggregate MHQ score for the individual on the Summary Sheet.

Frequently Asked Questions

Q. What does MHQ mean?
A. MHQ stands for misinformation, hypesterism, and quackery.

Q. Why not just focus on statements of MHQ and exclude the names of sources? In other words, why not focus on science, not people?
A. The popular diet and health industries revolve around the credibility of popular names, authors, gurus, and organizations. For most of those unfamiliar with the science, the credibility of particular sources of information is the only way to gauge the credibility of the scientific message. Unfortunately, as the very point of this project suggests, such credibility in the public eye has very little relationship to the true scientific credibility as might be established in the scientific community. This project is an attempt to make the public credibility that many popular health experts enjoy more closely match their true scientific credibility and thus provide the lay public with a better understanding of the true quality of information coming from such experts.

This is somewhat different from what occurs in the scientific community. In the scientific community, while credibility is important, the role of “the facts themselves” or “the data” is substantially greater: one does not win scientific arguments by who one is but by what one shows. In the popular nutrition and health industries, on the other hand, marketing, rhetoric, business acumen, etc. play the overwhelming role in establishing credibility–to the point where many individuals who systematically make claims that are not true are highly regarded in otherwise respected popular publications. As mentioned, the goal of this project is to provide a mechanism that can neutralize some of the influence of marketing, rhetoric, business acumen, etc.

This is done in two ways. For sources/experts who consistently misinform the public, this database will in detail show exactly how they do so and give them a score based on the extent and dangerousness to which they do, thereby reducing their credibility commensurate with the low quality of information that they release. Second, this database will promote sources of information that are reliable, thereby increasing the credibility of those sources commensurate with the high quality of the information that they release.

Q. I notice that Science Communicator X is on the summary sheet and has a non-zero Aggregated MHQ Score. Why is this if Science Communicator X is such a great communicator and puts out such high-quality information?
A. In order to be unbiased and impartial, all reported statements that are MHQ must be recorded on the Preliminary List, if they are vetted by the editorial staff accordingly. In truth, virtually everyone will produce some MHQ eventually, including the architects and maintainers of this database. This is why the Preliminary List and notifications are critical: whether someone has a non-zero Aggregated MHQ score is entirely up to those who produce MHQ and can always be achieved by correcting or clarifying MHQ.

Q. What is the Summary Sheet?
A. The Summary Sheet details both reputable sources of online health, nutrition, and fitness information, as well as sources that made statements of MHQ that have been reported and added to the Unresolved List. The summary sheet will include an Aggregated MHQ Score for each source, which is a proxy for reliability of that source.

Q. What is the Aggregated MHQ Score?
A. Each statement in the Unresolved List will be weighted by dangerousness, with three dangerousness rankings: Mostly Harmless, Possibly Dangerous, and Dangerous. Statements that are Mostly Harmless will count as 1, Possibly Dangerous as 2, and Dangerous as 3. The score for each reported MHQ statement from a given source will then be aggregated into a total Aggregated MHQ Score for that source, and this score will be listed on the Summary Sheet. For example, a source with two reported MHQ statements on the Unresolved List, one of which is Dangerous (3) and the other Mostly Harmless (1), will receive a score of 4.

Q. How do we evaluate Dangerousness?
A. Mostly Harmless- statements about matters of fact that are wrong, misleading, or overhype but in such a way without any real practical intent or consequence
Possibly Dangerous- statements about matters of fact that are wrong, misleading, or overhype that mislead the audience into actions that are potentially dangerous (e.g. fad diets)
Dangerous- statements about matters of fact that are wrong, misleading, or overhype that mislead the audience into actions that are definitely dangerous according to overwhelming consensus (e.g. refusing life-saving medical care)

Q. What is the Preliminary List?
A. The Preliminary List will contain for one week all recent reports of statements of MHQ that have been vetted by the editorial staff. During the week on the Preliminary List, the violator will have the opportunity to issue clarifications or corrections.

Q. What is the Unresolved List?
A. The Unresolved List is where all reports of MHQ on the Preliminary List go if they have not received adequate clarification or correction within one week of notification. All statements on the Unresolved List will have their scores aggregated, and this score will be listed by the source in the Aggregated MHQ Score in the Summary Sheet.

Q. What is the Resolved List?
A. The Resolved List is where all reports of MHQ go that have received clarification or correction such that it is clear that MHQ is not being communicated or has been disavowed. Reports of MHQ from the Preliminary List can be moved to the Resolved List if addressed within one week. Reports of MHQ from the Unresolved List can be moved to the Resolved List if addressed at any time. Statements moved to the Resolved List will not be included in the Aggregated MHQ score in the Summary Sheet.



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