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David Bradley

I wasn't sure with all your bold and italics whether you were actually agreeing with what I said in my blog post or whether you thought my words were not credible simply because they were not published by Mayo or in a book.

In summary, I was not attempting to be derogatory towards either side: healthcare industry or patient advocates, simply to show that there are health problems and then there are health problems.

Brian Jackson

One more angle you didn't mention -- article placement in mainstream media by device companies. Typical scenario is that a device company is trying to push a new, technologically sexy product. They partner with a hospital/clinic/surgeon who sees an opportunity to promote themselves as cutting edge by offering this new device/procedure. They jointly pitch a story to a local science/medical writer, who doesn't have the background to critically assess the details, but who appreciates the material which is easy to package up into a news story.

I saw this recently with a spinal fusion device being promoted by orthopedists at Intermountain Healthcare together with the device manufacturer. The story implied, for example, that spinal fusion is beneficial in most people with chronic back pain.

Ajit Alles

This is a losing battle unless we are willing to ban direct-to-consumer advertising, which I personally believe we should do. The web is unregulated and democratic. You can't really blame the web by saying "it often makes it difficult for some readers to distinguish between good advice and bad advice in the medical domain." Websites that have the highest profile with slick graphics and easy maneuvering draw the biggest audiences. People watch TV without filtering the content, so why would they not do the same thing with websites? If it's out there it's true - an extension of "seeing is believing". Being a Sri Lankan, I see first hand examples of this with regard to reporting on the Sri Lankan conflict. The best way for reliable websites to attract more attention is to be ranked higher on Google.

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