Bradfield Resident

Information. Issues. Insight. Investigation.

Tue 25 Aug 09 | To: Health On the Net Foundation | HONcode principles and the Australian Dental Association

Posted by bradfieldresident on 25 August 2009

Correction: Under the Principle 5 heading, “The AMA site” should read “The ADA website”. Correction emailed to the same HON address at 07:13 (+10).

From: Bradfield Resident <bradfieldresident@gmail.com>
To: honcodecomplaint@healthonnet.org
Date: Tuesday 25 August 2009 07:01 (+10)
Subject: HONcode principles and the Australian Dental Association

Health On the Net Foundation,

from a review the HONcode guidelines on the Health On the Net Foundation website (http://www.hon.ch/HONcode/Guidelines/guidelines.html), it appears that the Australian Dental Association’s site (http://www.ada.org.au), which currently displays a HONcode seal, does not respect the HONcode principles.

Clicking through to verify the HONcode certification (https://www.hon.ch/HONcode/Conduct.html?HONConduct282436), I find that the ADA site is presently undergoing an “annual review”.

A minor point here is that the seal image displayed on the ADA website (https://www.hon.ch/HONcode/Seal/HONConduct282436_s1.gif) – shows “HONcode Certified 09/2009”, and not a “REEXAM” seal as suggested might appear in your documentation (for example at http://www.hon.ch/HONcode/Patients/sample_certificate.html).

Seal-graphics aside, below are my reasons for thinking that the ADA site does not respect the HONcode principles.

Principle 1 – Information must be authoritative

All medical information presented on your web site must be attributed to an author and his/her training in the field must be mentioned.

This may be done on each of the pages with medical information or on an “Advisory Board” or “Editorial Board” information page.

The qualifications of the information provider (author, webmaster or editor) must be clearly stated (i.e. patient, Internet professional, medical or health professional).

If the information provider is a medical doctor, his/her specialty must be mentioned.
If the author is not a medical professional, this must be clearly stated on the web site.

The ADA site does not attribute authorship on individual pages and there does not appear to be any page (at least not obviously) designated as an “Advisory Board” or “Editorial Board” information page.

The site’s disclaimer page (http://www.ada.org.au/disclaimer.aspx), apparently last updated on 18 January 2004, states:

Information presented in the “Consumer Information” section was authored by the ADA Inc. Oral Health Education Committee. This Committee meets regularly and is responsible for reviewing and updating the “Consumer Information” section. All Oral Health Education Committee members are fully qualified and board registered dentists. In addition to this process, all information posted on the ADA inc website is reviewed and approved by the ADA Inc IT Manger/webmaster who also is a fully qualified and board registered dentist.

There does not appear to be any obviously designated “Consumer Information” section; I hazard a guess that this wording refers to some older version of the site. I have not seen any indication as to who makes up the “ADA Inc. Oral Health Education Committee”, nor who the “ADA Inc IT Manger/webmaster” is. This same disclaimer  even says that

The views and opinions expressed on this site are not necessarily those of the ADA Inc., the ADA State Branches or their affiliates.

so there is possibly content that is not authored by the ADA, and that the ADA doesn’t even agree with.

The qualifications and training of the anonymous group of authors is mentioned only as “fully qualified and board registered dentists”, without explaining what that means, nor even who or what the board is they are registered with. Perhaps, for the HONcode requirements, saying “registered dentist” is sufficient. If so, this should be clarified in the HONcode guidelines.

Principle 2 – Purpose of the website

A statement clearly declaring that the information on the website is not meant to replace the advice of a health professional has to be provided. E.g. of such a statement is ‘The information provided on [your web site] is designed to complement, not replace, the relationship between a patient and his/her own physician.’

A brief description of the website’s mission, purpose and intended audience is necessary.

Another brief description of the organisation behind the website, its mission and its purpose is also necessary.

The ADA site does not appear to offer a clear description of its mission, purpose and intended audience. Content apparently approaching this is found on the disclaimer page (http://www.ada.org.au/disclaimer.aspx):

The information contained in this online site is presented in summary form only and intended to provide broad consumer understanding and knowledge of dental health care topics.

Currently, the “About the ADA” section (http://www.ada.org.au/about/default.aspx) has broken links to content called “Overview” and “Functions”. The brief introduction on that page may be sufficient to describe the organisation, mission and purpose, though they are not obviously denoted as such:

Overview The Australian Dental Association is an organisation of dentists which has as its aim the encouragement of the health of the public and the promotion of the art and science of dentistry.

Functions There are Branches of the Association in all States and Territories. Membership is voluntary and over 90% of dentists in Australia are members.

Strategic Plan The Australian Dental Association Inc is a national association of dentists committed to promoting the art, science and ethical practice of dentistry, improving the oral health of the community and enhancing the professional lives of its members. To achieve this Mission for the period 2005 to 2008, seven major goals have been set.

Principle 4 – Information must be documented: Referenced and dated

All medical content (page or article) has to have a specific date of creation and a last modification date.

Date of last modification must also be included on every page describing ethical and legal information, author(s), mission, and the intended audience.

All sources of the medical content must be given. You have to clearly indicate the recognized, scientific or official sources of health information quoted in your articles. If you used another website, a book, an article, a database or any other support, it has to be specified. You have to provide a precise link to the source, whenever it is possible and the references should be in relation with the content referred.

Note: – The last time the whole site was updated or the copyright date only, are not sufficient to comply with this principle. The ‘last update’ date should not be set to automatically display the current date.

-Depending on the website and its content, you may gather a bibliography instead of having a specific source for each medical article or page. This bibliography should clearly outline each reference to each medical subject.

Large swathes of (medical related) content on the ADA site are completely unattributed (authorship), without sources and not dated. This includes both “webpages” (usual HTML content) and linked PDF documentation. Very few dates appear for any of the content displayed on webpages. Even the copyright notice (on the disclaimer page) shows “2002”, two years prior to the apparent last modfication of that page. The FAQs section (http://www.ada.org.au/oralhealth/faqs/default.aspx) does have dates, though they appear to be mostly only “12/1/2001” or “1/1/2002”; perhaps batches of information were uploaded on a couple of dates and attributed to these dates (1 January seems an unlikely date given that it is a public holiday in Australia, but given that it is 7+ years ago the exact date isn’t so much an issue).

Of special concern are numerous medical claims made regarding the overall safety of products and chemicals, well outside of what I expect “dentistry” to cover, for which significant research findings have been made in recent years.

Principle 5 – Justification of claims

All information about the benefits or performance of any treatment (medical and/or surgical), commercial product or service are considered as claims. All claims have to be backed up with scientific evidence (medical journals, reports or others).

All medical information must be balanced.

All brand names have to be identified (with ® for example). Unless the purpose of the site is clearly stated to be the commercial platform of a particular product, it must include alternative therapies or products (including generics).

The AMA site makes numerous claims about products and treatments that, aside from on occasion appearing to be patently false or contradictory, are completely unjustified.

The site also repeatedly directs readers to, if not a specific brands of products, specific types of product, such as fluoride toothpaste, fluoride tablets, fluoride gels, fluoridated food products and additives, and even fluoridated water, without any “alternative therapy” offered for cleaning teeth and maintaining dental health.

As a simplificatioin, the product/treatment here is fluoride and its application/consumption. There are a number of documents provided on the website, for example, on the “Fluoride Resources” page (http://www.ada.org.au/oralhealth/fln/flresources.aspx) that might be intended as justification, however there is little or no association made between the majority of claims made in the rest of the site and these documents.

General safety claims are also made about mercury-containing dental amalgam as a type of product.

The medical information is certainly far from balanced. Concerns about harmful effects are, if mentioned a all, mentioned only briefly and in a significantly dismissive way, giving the impression that concerns have been raised only by an uneducated public, when in fact thousands of qualified dental and medical professionals around the world have very strong concerns about the potential harmful effects, and indeed questions about the efficacy of the use of fluoride in the first place. Documents on the website make claims for efficacy of “about half” and even “60%”, which are significant exaggerations at best. Statements such as “There is universal agreement between all the major public health bodies throughout the world regarding the benefits of water fluoridation” (“Fluoride – Nature thought f it first”, prefaced by a letter from the president of the ADA, at http://www.ada.org.au/app_cmslib/media/lib/0609/m16777_v1_fluoride%20-%20nature%20thought%20of%20it%20first.pdf) are grossly misleading (it is an undeniable fact that many countries do not support nor implement water fluoridation).

Summary

Details of the water fluoridation argument (and safety of mercury in fillings, etc) aside, it is apparent that the current ADA website does not respect a number of the HONcode principles – to an obvious and significant extent – and I imagine this to have been the case for a number of years, if not from the original review in January 2004. This example does not instill confidence in the credibility of the Health On the Net Foundation seal used for medical and health websites. I seek your explanation as to how a site reviewed numerous times with such glaring inconsistencies could be certified. I have not particularly listed examples of the inconsistencies since they appear on almost every page of the ADA website – if you cannot see them, I hold little hope for the HONcode’s reputation at all.

This complaint will be published online for public review and comment (at least at https://bradfieldresident.wordpress.com), and I intend to publish your response.

Bradfield Resident
Sydney, Australia

Tuesday 25 August 2009


Bradfield Resident
bradfieldresident@gmail.com
https://bradfieldresident.wordpress.com

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3 Responses to “Tue 25 Aug 09 | To: Health On the Net Foundation | HONcode principles and the Australian Dental Association”

  1. […] ago. I sent an email to honcodecomplaint@healthonnet.org on Tuesday 25 August — see a copy at https://bradfieldresident.wordpress.com/2009/08/25/to-health-on-the-net-foundation-honcode-principles… — and subsequently used your online compliance violation form on Friday 28 August (the […]

  2. […] when we find out there might be some problems and concerns around this highly-respected system.The Bradfield Resident blog published an interesting entry: …from a review the HONcode guidelines on the Health On the Net Foundation website, it […]

  3. […] when we find out there might be some problems and concerns around this highly-respected system.The Bradfield Resident blog published an interesting entry: …from a review the HONcode guidelines on the Health On the Net Foundation website, it appears […]

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