I recently published an article in which I described the following “troubling example”:

In June 2004, if you went online to learn about ?cholesterol,? you might have typed that word into Google, the world?s most heavily used search engine. Google would have quickly returned a list of more than five million websites containing the word ?cholesterol.?

The first ten websites would appear immediately before you; the remaining five million would take progressively more time and patience to find. The eighth result would be a page within MedlinePlus. This is an elaborate website created by the National Library of Medicine, a department of the United States government that has an annual budget of US $250 million, a mandate from Congress to inform the public about medical issues, more than a century of experience, and a highly professional staff of scientists and librarians. …

Somewhat higher up on the Google listing, at number five, was a site written by Uffe Ravnskov , MD and PhD, who described himself as the ?spokesman of THINCS, The International Network of Cholesterol Skeptics.? His site announced: ?The idea that too much animal fat and high cholesterol are dangerous to your heart and vessels is nothing but a myth. ? If you think this is written by another internet crackpot, take a look at Dr. Ravnskov?s credentials and the reviews of his book??which was for sale on the site.

I am not competent to judge whether Dr. Ravnskov?s claims about cholesterol or his own credentials are accurate. However, it is remarkable that an individual with a low-budget website?registered to the ?.nu? domain, which belongs to the New Zealand protectorate of Niue in the South Pacific?should be able to beat the National Library of Medicine of the United States in the competition for prominence on Google.

Dr Ravsnkov has, understandably, sent me an email complaining of his treatment in my article. I went back to his personal page and the Thincs website. To me, they raise interesting, complex, and ambiguous issues. Indeed, I meant to explore those issues in my article, although I confess that my tone was disparaging toward Dr. Ravnskov. These are the points that “trouble” me:

1) None of us can tell directly whether “animal fat and high cholesterol are dangerous to your heart and vessels.” We all rely on trusted authorities. People like me are completely dependent on others’ expertise. But even a scientific specialist in this field would have to trust the instruments he or she used and the reliability of past research. So the issue is not whether Dr. Ravnskov’s argument is right (I’m not qualified to judge that), but rather whether we should trust him or the medical orthodoxy that he is challenging.

2) In general, there are some good reasons to trust medical orthodoxy. Scientific method makes sense. Randomized, double-blind, clinical trials really are the “gold standard” of research. Not only that, but academic and government-paid researchers are supposed to work for institutions with integrity that reward truth and not profit. It worries me that anyone can create a website and say anything at odds with the medical establishment, and potentially convince lots of people to ignore the standard advice.

3) On the other hand, it is perfectly plausible that all those white-coated folks at NIH could be wrong about a particular topic. “Group-think” could have set in. Worse, they could have been more or less corrupted by the pharmaceutical companies that are making huge amounts of money from anti-cholesterol drugs. Newspapers and medical journals are full of distressing stories about distorted medical research.

4) Dr. Ravnskov’s websites look a little amateurish, and they advertise a book that he is selling. They list articles and other books in support of his position; but many are not peer-reviewed. Facts like these are sometimes taken as signs that a website is untrustworthy. However, some of the articles he cites are peer-reviewed. More importantly, the conventional signs could be misleading. Maybe Dr. Ravnskov’s sites look amateurish because they are low-budget; and they are low-budget because he has integrity. Maybe MedlinePlus isn’t more reliable, just more slick.

4) I feel that if I were worried about cholesterol (which I’m not, especially), then I could look into the issue and decide which sources are really credible. I could take the time to read the links on Medline and on Dr. Ravnskov’s page, and I believe I could make decent judgments. However, I (arrogantly) assume that I have better-than-average skills in the interpretation of research. How should we tell a 9th-grader to sort out reliable and unreliable claims?

All of this underlines the deep importance of ethics in medical research. I would quickly dismiss a critic of medical orthodoxy if it weren’t for all those stories about financial conflicts-of-interest.