Sunday, June 9, 2013

Link Spamming and IBD


Scamming the search results


Google is the still the primary search engine most of us use to find useful information on the Web.  Their PageRank algorithm is generally effective – promoting pages that have more links to them, and ordering search results based on the popularity of the results.  Unfortunately, this means that popular pseudoscientific ideas can show up higher in the rankings than legitimate articles and studies on a particular topic.  While this affects all searches for any topic, in this post I’ll look at some of the most common searches related to IBD and examine the top Google results.

Inflammatory Bowel Disease.  This term is probably the most reasonable in terms of results.  The top 10 are all legitimate medical providers (e.g. the Mayo clinic), information aggregators (e.g. Wikipedia), or government sources (the Centers for Disease Control in the US). 

Crohn’s.  The first link is to the Crohn’s and Colitis Foundation of America – the leading advocacy group for those that suffer from IBD.  There are a few links to Wikipedia, WebMD, and other several provider sites, but there is one link that has poor information in the top 10:

Fox News, a bastion of accurate journalism (sarcastic note), has an article titled “Curing Crohn's? Man says he found way to beat incurable disease”.  While the article itself is fairly balanced overall and talks about an individual that went into remission after maintaining a healthy diet and being on 6-MP, the first half implies that the patient got better due to things like “krill oil, garlic, cat’s claw and probiotics”, before providing a medical opinion:

“He got better because of the 6MP,” Kummer told FoxNews.com, “and he took it for a long time. We have an objective measure of him getting better, and he felt good, so he stopped taking it – and he continued to feel good. But, that’s the mechanism of the drug.”
And
Meisel did go off all medications, and although he realizes he fundamentally cannot be ‘cured’ of an incurable disease, he and Kummer can agree he is in remission – for now

The highly suggestive and inaccurate headline (bordering on negligent) makes implications about cures for Crohn’s, despite covering nothing of the sort.

Ulcerative Colitis.   As with Crohn’s disease, searching for UC provides links to solid medical sites and basic information portals.  Fortunately, none of the first-page links appear to be to any questionable cures or charlatan sites.

What happens when we add the word cure (this is an expected term that the newly diagnosed would put in)? 

Crohn’s Cure.  All appears to be similar with the addition of the word cure – the same articles above appear (including the Fox News article), but there is one additional article that looks unusual at first glance at cureforcrohns.co.uk.  The title is a bit frightening, and the summary appears to imply someone claiming to have cured Crohn’s disease with diet.  Going to the site, however, shows a fairly balanced account of one individual that does not claim to have been cured.  The site is from the mother of a 16 year old boy who is in drug-free remission that she attributes to removing lactose from his diet.  While this constitutes no proof whatsoever of the effectiveness of removing lactose (it is a single account, has no experimental value, and there are no secondary details), the site does look at Mycobacterium Avium Paratuberculosis (MAP) as a cause for Crohn’s disease in a relatively objective manner.  MAP is potentially linked to Crohn’s (this will be the subject of a future post),, and there is some correlation between the two found in multiple studies, but it tends to attract followers who overstate the evidence.  (2)

Ulcerative Colitis Cure.  Uh-oh.  The very first link is to an Ayurveda-based “medical” site claiming to have a cure for Ulcerative Colitis in the form of Ulcerin.  The site claims:

Approximately 85% patients, who never had a remission with 5-aminosalicylic acid, 5-ASA, and mesalazine (Brands-Asacol; Mesasal; Pentasa; Salofalk) and steroid therapy, became symptoms free with the addition of these compounds. Many patients were thinking of surgery, because they were advised Colectomy (total removal of large intestines) before my treatment. Many (approx. 85%) patients went in remission. This success gave me lot of satisfaction in my life.

Reading further, however, there is a caveat added:

After treatment only a few patients could be subjected to investigations like colonoscopic or Sigmoidoscopic and Histopathological examination due to the lack of facilities in my center.

The site has questionable links (you need to get a phone call back to make a payment) and the drug they are selling has no efficacy nor even safety (or minimum toxicity) information available.  I’ll take a deeper look at this product and Ayurveda-based medicine in future posts also.  For now, anyone purchasing from this site and taking the medicine is taking quite a risk.  (3)

 I suspected this site has moved to number 1 through manipulation of the Google algorithm, and I was not disappointed.  The site is primarily linked from forums related to Crohn’s disease.  The forums generally consist of a member that has signed up, linked to the site on the available boards with a “Found this miracle cure” posting, then dropped off.  This has all of the hallmarks of a quack attack (where the proprietors of a website create multiple identities claiming to be cured, post a link to a quack medicine they are selling, then disappear).  The remaining sites appear to be valid, as with Crohn’s disease.  

IBD Cure.  The number 4 link on IBD is similar to the above-mentioned questionable links.  Curezone provides a basic overview of IBD (that is fairly well done), but then trails off into irresponsible territory, citing toxins and a water cure.  It goes into colon, kidney, and liver cleansing, containing dangerous methods like the coffee enema, covered previously, as part of the regime. 

A closer look at the site shows that their regime is used to cure everything from fibromyalgia to cancer – any time a site claims to cure disparate diseases that should be considered a clue.   Their cure protocol has no research backing it up (there is no clinical trial where their protocol is evaluated against another or against a control), and several steps have known side effects that are dangerous.  This one looks like it took a slightly different approach to jump up in the rankings – the site itself consists of tons of internal reference links, allowing each page to jump higher in the listings.   Fortunately, the site appears to have been covered by skeptical sources as well: http://quackfiles.blogspot.com/2004/10/quacksites-most-unreliable-health.html

The remaining IBD Cure links seem to be legit (not generated by link spamming) as well.

Summary


Overall, at least compared to other search terms, the prime links associated with IBD, Crohn’s, and Ulcerative Colitis are mostly legit sites.  A few questionable sites snuck in – mostly due to link spamming as noted above, but they are still in the minority.  As a community, we can keep them out by linking to legitimate medical sites, and by doing our homework when we come across them and not taking their results at face value.

Bottom Line


·         Google rankings are fairly robust, but can be manipulated by dedicated individuals.
·         Fortunately, very few of the top 10 sites related to Crohns and UC appear to have been link manipulated.
·         If you want to know why a site is ranked so high, try using the “link:” prefix in Google to find out who linked to it.
·         Simply typing the name of a site followed by “quack” into Google can also lead to interesting debunkings if the content is fraudulent.  As with the site itself, though, the “debunk” site should be providing documented research backing up there assertions.


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