The Most Popular Health Articles of 2018, a Scientific Credibility Review

News about health and medicine touch the lives of many people, therefore they often become highly circulated on the Internet. Many of these articles achieve viral status, but how many of these viral articles are actually scientifically accurate?

To find out, we conducted a study in collaboration with the Credibility Coalition to examine the scientific accuracy of health news articles. First, we compiled a list of articles with the highest number of social media engagements (comments, shares and likes) using data from Buzzsumo. The list gathers articles on health topics based on a query for various health-related keywords^[1] – including “vaccines”, “disease”, “health”, “virus”, “immune system”. We excluded articles about politics, policies and opinions from the final list of articles to be evaluated.

We then invited clinicians and scientists with the relevant expertise to assess the scientific credibility of the top 10 health articles in the list. Our review process, credibility criteria and definition of scientific credibility are detailed here. We were unable to find any reviewers for a few of the articles in the top 10, either because they became viral late in December or because no clinician/scientist wished to review them. (Note that they are still included in the list of the top 100 articles below.)

Credibility for the top 100 articles was assessed instead by Health Feedback’s science editors. As our editors do not have the domain knowledge required for all the top 100 articles, the strength of the credibility assessment is lower than that of the top 10 articles. However, they offer a good indication of whether the results of the first 10 articles also hold true for the first 100, which are arguably more representative of the broad diversity of popular health articles online.

Here are the top 10 articles which were reviewed by clinicians and scientists, ranked by popularity (Click for details on the evaluations for each article):
1) Federal Study Finds Marijuana 100X Less Toxic Than Alcohol, Safer Than Tobacco
2) Video shows difference between healthy lungs and those of a smoker
3) Benefits of Walking: 8 Ways Walking Regularly Improves Your Health
4) Everything You Know About Obesity Is Wrong
5) World Health Organization Officially Declares Bacon is as Harmful as Cigarettes
6) Have Cold or Flu Symptoms? Here’s How to Tell the Difference
7) Stem Cell Treatment Could Be A Game-Changer for MS Patients
8) How Cycling In Old Age Can Keep Your Immune System Young
9) Is everything you think you know about depression wrong?
10) Cause of polycystic ovary syndrome discovered at last

Overall credibility: Three quarters of the top 10 readers have interacted with misleading or false information

Of the 10 articles reviewed by scientists, only 3 articles achieved a high credibility rating (indicated by green and blue bars in the figure below) and 4 articles received a medium credibility rating (yellow bars), indicating that reviewers did not find major inaccuracies in these articles, but they do contain misleading information. The 3 articles with a high credibility rating were published by Time Magazine, a news outlet generally known for accurate and rigorous reporting.

Although these articles did not contain major scientific inaccuracies, reviewers still noted other issues that impacted credibility, such as lack of detail and context, overstatement of the significance of research findings, and misinterpretation of research findings. This illustrates the need for journalists to go beyond simply accurately describing results and research in health news. Presenting scientific findings in a balanced way and providing sufficient context helps readers to understand the full picture. Correctly interpreting the findings is also important to avoid erroneous conclusions. This can be a challenge if the journalist does not possess sufficient technical expertise. Obtaining comments from a study’s authors or independent experts can be helpful in addressing this issue.

3 articles received a very low credibility rating (represented by dark red bars in the top figure), indicating that these articles contained major inaccuracies. 2 were published in websites of dubious origin, while 1 was published by The Guardian (that article is an excerpt from a book, not written by a journalist).

This result is expected: sensational headlines (as exemplified by these 3 articles) are much more likely to attract social media engagements, as opposed to headlines in which a balanced tone is struck. Coupled with the fact that clickbait headlines have a tendency to be factually inaccurate^[2] (often involving exaggerations and logical fallacies), it is therefore not surprising that scientifically inaccurate stories tend to be more popular on social media than accurate stories. This also highlights a major concern in online credibility, as this means that the general public is more likely to come into contact with misleading information than accurate ones on social media.

1 article titled Everything You Know About Obesity Is Wrong received mixed reviews from clinicians and scientists. The main challenge in reviewing this article was its heavy emphasis on personal anecdotes and experiences in its content (although the author cited several scientific studies as well), making it difficult for reviewers to evaluate based solely on scientific evidence.

Topics of interest: Disease, exercise and food

The top article for 2018 focused on drug use (specifically marijuana, also known as cannabis), with more than 1 million interactions recorded. The high level of interest in this article may stem from various factors, such as marijuana’s potential therapeutic benefits in various medical conditions, as well as the fact that marijuana is a popular recreational drug. The article – which is highly inaccurate – suggests that marijuana is less harmful than alcohol, a view that will naturally find acceptance among an audience comprising of marijuana users. This bias may lead to indiscriminate sharing of the article, despite its misleading content. The clickbait headline alone would also draw many shares from non-users due to its sensational nature.

Among the rest of the top 10 articles, there were 6 articles on disease/disease treatment, 2 articles about the health effects of physical activity and exercise and 1 article about food and nutrition. Two of these articles suggest that everything known about a given topic (in this case, obesity and depression) is wrong, highlighting readers’ attraction to stories that reject current medical consensus.

The top 100 articles provided us with a broader overview of the general public’s interest in health and medicine, and a better sample of the credibility of online health news. As explained above, credibility for the top 100 articles was assessed by Health Feedback’s science editors instead of clinicians and scientists with the relevant expertise.

In this case, editors evaluated article credibility based on a set of criteria including, but not limited to, quality and diversity of primary sources (e.g. research papers, quotations by experts), as well as presence of rhetoric and emotional language. Generally, the article is deemed “credible if it helps readers become better informed (positive rating); it is not credible if it leaves them with a flawed, incomplete or inaccurate understanding (negative rating)”.

Overall credibility: More than half top 100 readers have interacted with problematic content

In terms of overall credibility, slightly less than half the top 100 articles achieved a high credibility rating. However, it is encouraging that there are a greater number of shares for highly-rated articles (45%) compared to poorly-rated articles (35%, see figure below). Highly-rated articles obtained a total of about 11 million shares, while poorly-rated articles obtained about 8.5 million shares. Articles in the neutral category received credibility scores that were borderline high or low. While some articles in this category may not be factually wrong, they may also contain problems such as exaggerations, misleading content and logical fallacies. Therefore, while not overtly inaccurate, neutral-rated articles still have a long way to go in terms of providing highly credible information to readers.

Considering that the number of shares for neutral and poorly-rated articles amount to almost half the total shares, this indicates that more work needs to be done to curb the spread of inaccurate health news. Much of the spread is facilitated by Facebook, which accounts for 96% of the shares of the top 100 articles, while Reddit accounts for 2% and Twitter 1%.

Topics of interest: Disease, food and vaccines make it to top 3

The top 100 articles were broadly classified into different topics of interest. The three main topics of interest were: disease and disease treatment (21 articles), food and nutrition (18 articles), and vaccines^[3] (17 articles).

In the case of articles about disease and disease treatment, 16 out of 21 articles received a positive credibility rating. Cancer was the subject of most articles. This strong interest was expected due to the rising burden of cancer worldwide. Another disease of note in this category was Alzheimer’s disease.

In the case of food and nutrition articles, only 5 out of 18 articles received a positive credibility rating. Content in this category was quite varied, but generally articles often took an extreme stand, often exaggerating the benefits and harms of various foods.

In the case of articles about vaccines, 12 articles received a positive credibility ratings. We observed that more than half of these articles were reporting outbreaks of vaccine-preventable diseases (mainly measles). These outbreaks were the result of declining vaccine uptake due to anti-vaccination movements. The fact that these articles are popular reflects the general public’s concern about this issue. Further underscoring this issue is the World Health Organization branding vaccine hesitancy – mainly due to the anti-vaccination movement – as one of the top threats to global health in 2019.

All 5 vaccine articles which received a negative credibility rating were anti-vaccine in nature, invoking conspiracy theories about public health authorities and pharmaceutical companies, as well as persistent myths about vaccines which have been disproven.

Among the top three topics, food and nutrition articles contained the largest percentage of negative credibility scores. One possible factor could be the type of news outlet behind these articles. Of the 13 articles which received a negative credibility rating, 9 came from what appeared to be lifestyle blogs or health-related websites of dubious origin. Articles published in these outlets may not undergo much scrutiny with regards to aspects such as accuracy and appropriate referencing, which in turn impacts the content quality. Our finding could also reflect on the type of audience that food and nutrition articles appeal to, although we do not have sufficient data to investigate this further.

On the other hand, articles about disease and disease treatment received the largest percentage of positive credibility ratings. Although 4 of the 21 articles originated from websites of questionable credibility (these 4 accounted for all the negative ratings in this category), the rest of the articles came from established news organizations, such as Time, The Atlantic, CNN and ABC News. This indicates again that well-established news sources are more likely to report science accurately, likely as a result of higher journalistic standards and stronger oversight over quality of sources and content.

These results show the importance of obtaining news from reputable sources, as opposed to sources applying minimal to no journalistic rigor.

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Notes & References

• 1 – The number of social media shares are from the Buzzsumo database as measured on December 31st 2018. It includes articles returned for queries of the following terms: “vaccine”, “vaccines”, “disease”, “diseases”, “health”, “healthy”, “virus”, “natural remedy”, “alternative medicine”, “homeopathy”, “anti-inflammatory”, “trans fat”, “trans fats”, “immune system”, “cardiovascular diseases”, “measles”.
• 2 – Zhang et al. (2018). A Structured Response to Misinformation: Defining and Annotating Credibility Indicators in News Articles. Companion Proceedings of the The Web Conference 2018. (This study by the Credibility Coalition last year found that clickbait headlines were strongly correlated with credibility ratings.)
• 3 – In the case of articles about vaccines, we included only articles dealing with vaccines for disease prevention, not disease treatment.

Flora Teoh, Science Editor, Health Feedback
A balanced view of the subject should have been provided – that is, both the known benefits and detriments should be discussed in an article. For readers to make better informed decisions, they need to be equipped with sufficient information to do so. But this article does not even mention the potential dangers of marijuana use at all, let alone warn about them, which can be harmful to others, such as an audience of impressionable age (e.g. teenagers).

This article is not written in a dispassionate, scientific style. It is written like an Op-Ed that is pushing a certain viewpoint, in this case the idea that cannabis is quite safe and has medical value. The headline of this article [“Federal Study Finds Marijuana 100X Less Toxic Than Alcohol, Safer Than Tobacco”] is based primarily upon a single study. Generally, the article describes the study accurately, but does not critique the study methodology. The study uses animal toxicology data to determine whether humans typically use close to the amount of the substance that is toxic in animals. This approach is not a rigorous way to determine the harms of a substance.

The basic finding that cannabis is less acutely toxic than other substances that humans misuse is accurate and widely accepted, but acute toxicity is only one way to characterize the harms of a substance. The article fails to point out that only very limited, low-quality evidence supports the use of cannabis for treating chronic pain. The article also fails to describe the potential harms of cannabis. Although it does not cause fatal overdose, it does cause intoxication and impairment, and driving under the influence is dangerous. Also, both acute and chronic use of cannabis cause cognitive impairment which can interfere with an individual’s safety and productivity. Thus, the article reads like a paean to cannabis and does not present a balanced view of its potential benefits which have yet to be conclusively demonstrated, and its known harms which have been well-documented.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
The article describes how the lung function of a heavy smoker is heavily compromised compared to that of a non-smoker. There is no question about the ill effects of smoking, but the article does contain some statements of questionable accuracy, such as “Because these lungs are COPD, cancerous lungs […]”. It is true that COPD raises the risk of lung cancer^[1], but it is not lung cancer itself.

• 1 – Raviv et al. (2010). Lung Cancer in Chronic Obstructive Pulmonary Disease: Enhancing Surgical Options and Outcomes. American Journal of Respiratory and Critical Care Medicine.

The article and the accompanying video highlight the dangers of smoking, which are real and significant. But the demonstration is not that scientific. The ability of lungs to expand depends on a number of factors and lungs inside your rib cage do not behave as they would in an open environment. Also, the most common damage from smoking, namely chronic obstructive pulmonary disease, results in hyper-inflated lungs, not lungs that have restricted filling.

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Flora Teoh, Science Editor, Health Feedback
This article claims that abortion was the highest cause of death worldwide in 2018. The headline and the tone indicate clearly that it is an anti-abortion piece. However, the article does not deal with science but with politics and policies, therefore it is not possible to assess it for scientific credibility.

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Flora Teoh, Science Editor, Health Feedback
The article describes various health benefits from walking. While any attempt to increase physical activity in people is a good idea, the article fails to provide links to the scientific studies it cites. It is possible to track down the original research articles it references by using keywords from the article – in that sense, its statements are backed up by some form of evidence, although of uncertain quality, as some studies have not been published yet. But the onus of such work is on the journalist, not the reader.

Some of the article’s conclusions are questionable. For instance, it says that walking “helps to boost your immune system: Walking at least 30 minutes a day was shown to increase the level of cells in the body’s immune system.” Having more cells in the immune system does not necessarily “boost” it. More cells in the immune system can be a good or bad thing, depending on several factors, such as which types of cells are involved in the increase.

Another statement which is also inaccurate is that “walking regularly can reduce the effects of 32 obesity-promoting genes in the human body.” There aren’t genes that promote obesity, merely variants of genes associated with increased risk of obesity.

Sharon Dunwoody, Professor in Journalism and Mass Communication, University of Wisconsin-Madison
While all these benefits of walking may be real, this article makes no effort to offer the evidence that lies beneath them.

REVIEWER’S COMMENT:

Carol Maher, Associate Professor (School of Health Sciences), University of South Australia
This article does offer the reader insights – particularly in that it cites credible research demonstrating the links between walking and various health outcomes (mood, disease prevention, weight loss, maintenance of mobility etc). Overall, the article is scientifically sound. My only criticism would be that the introductory paragraph is a little misleading in the way it presents jogging and gym work. Yes, walking has lots of great benefits, I don’t want to take away from that. However, walking isn’t equivalent to gym workouts and running. High intensity exercise, such as running or other vigorous activity that many gym goers do, has amplified health benefits compared with walking (i.e. it increases cardiovascular fitness and reduces disease risk even more than walking does). Also, strengthening exercises (that many people do at the gym) offers some different health benefits to walking (e.g. in terms of bone density, body composition, and reducing age-related declines). That is why most countries’ physical activity guidelines now specify that strengthening exercises should be undertaken in addition to aerobic exercise like walking.

The other minor limitation of the article is that it doesn’t give a clear indication how much walking someone should do, or how intense the walking should be. That is likely because there are no clear answers for these questions. 30 minutes a day isn’t a magic cut off. A little bit of walking is better than none, but more is better. More brisk walking will also be more beneficial than a gentle stroll. We also think that walking in continuous bouts (e.g. at least 10 minutes) is better than highly fragmented walking, although the scientific evidence isn’t completely clear on this.

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Flora Teoh, Science Editor, Health Feedback
The article reports on a study showing how too much screen time could adversely affect children’s mental health.
However, the article really needs to provide more links, especially to the original research study on which it is based, and to sources of information cited in the article. Having comments from an independent expert would have been useful.

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Flora Teoh, Science Editor, Health Feedback
The article describes the personal experiences of people living with obesity, and the psychological and emotional difficulties they face from society and especially physicians. Most scientific citations provided are for psychological and sociological studies (like surveys), not to biological research, therefore much of the article falls outside the scope of biology fact-checking.

Of the few statements about the biology of obesity, several are problematic since no citations are provided to support them, for instance:
1) “Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.”

2) “One effect of weight bias is that it actually makes you eat more. The stress hormone cortisol—the one evolution designed to kick in when you’re being chased by a tiger or, it turns out, rejected for your looks—increases appetite, reduces the will to exercise and even improves the taste of food.”

3) “And, in a remarkable finding, rich people of color have higher rates of cardiovascular disease than poor people of color—the opposite of what happens with white people. One explanation is that navigating increasingly white spaces, and increasingly higher stakes, exerts stress on racial minorities that, over time, makes them more susceptible to heart problems.”

While the central point of the article is about treating obese people with greater compassion (which I completely agree with), the author made the decision to use biological claims to support his conclusions, and for this reason, the article needs to be held to the same standard of scientific credibility in this regard, even if many people believe this misses the point.

REVIEWER’S COMMENT:

Personal stories and anecdotes make up the bulk of the article in a general discussion surrounding the biological and social causes of obesity. While the behavioral content may be more valid, references to biological, scientific content are inconsistent and vary in credibility.

One of the major contentious issues relates to discussion around the metabolically healthy obese, where the author fails to reference any of the meta-analyses showing that while this may be temporally true, the likelihood of future metabolic disease (e.g. diabetes) is still significantly higher in those who are overweight^[1]. In its critique of meal-replacement diets, there is no mention of the recent DiRECT trial in the UK^[2] which showed successful reduction in weight and Type 2 diabetes remission after a one-year follow-up^[3]. While the article rightly points out that Americans are eating less calories than 15 years ago, the size of this reduction (around 9%) is unlikely to translate to a meaningful difference in nationwide weight; a point which is ignored by the author.

Overall, the clickbait headline and controversial subtitle introduce an article which may be well-meaning but is misleading to the reader.

• 1 – Eckel et al (2018). Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study. The Lancet Diabetes and Endocrinology.
• 2 – International Clinical Trials Registry Platform (2018). Reversal of type 2 diabetes mellitus (T2DM) using non-surgical weight management with Low-Energy-Liquid-Diet and long-term maintenance, within routine NHS care. (ISRCT Identifier ISRCTN03267836). Retrieved from http://www.isrctn.com/ISRCTN03267836
• 3 – Lean et al (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
The article describes various health benefits of walking. Unfortunately no research is cited to back up any of its conclusions.

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Flora Teoh, Science Editor, Health Feedback
This article comments on the decision by the International Agency for Research on Cancer to classify processed meat as Group 1 compounds i.e. carcinogenic to humans, alongside tobacco. The article claims that this means “World Health Organization Officially Declares Bacon is as Harmful as Cigarettes”, which is NOT true, as already explained by the World Health Organization in an FAQ.

REVIEWER’S COMMENT:

Jana Anderson, Research Fellow, University of Glasgow:
The classification of processed meat as “Group 1” –carcinogenic to humans– means that the evidence is as strong as for other risk factors included in the Group 1 category, including tobacco. It does not mean that the risk is the same. While Cancer Research UK estimates that 19% of all cancers are caused by tobacco, processed meat is estimated to cause 3% of all cancers. The presentation of the facts in this article is therefore inaccurate, confusing and misleading to the readers.

The author misunderstood and misrepresented the report, which also led them to confuse the reader about the role of the World Health Organization (WHO) and discount its credibility. The WHO’s role is to direct and coordinate international health, and it is here to provide leadership on issues related to health. The WHO is a credible source that provides accurate information based on current evidence and it is trusted by decision-makers worldwide.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
The article describes the ways to tell if you have the common cold or the flu. The article includes comments from highly credible sources, such as family physicians and information from the Centers for Disease Control and Prevention. The information provided is thus accurate and also explained in sufficient detail – at least for the general public. As such, the article is not simply accurate but also highly useful for helping ordinary people prevent and manage the cold/flu.

REVIEWER’S COMMENT:

Simon Drysdale, Consultant and Senior Lecturer (Paediatric Infectious Diseases), St George’s, University of London:
Generally accurate. However, the main issue is that influenza viruses can also cause a “cold”, i.e. upper respiratory tract infection. A “cold” is a symptom/diagnosis whereas “influenza” is a virus that can cause symptoms such as a cold. There could be a better distinction by saying there are lots of viruses (flu, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), rhinovirus, coronavirus, etc.) that cause respiratory infections including “colds” and “chest infections”. Some of those influenza viruses can cause a more severe disease than others, although all of the viruses can result in severe disease or death – this varies a bit by population. For example, RSV is much more of a problem than flu in young infants.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
The article reports on the research findings of a study using stem cell transplantation to treat multiple sclerosis (MS). The biggest problem with the article is that it does not say which group did the study and where. Without knowing these details, it is virtually impossible to independently verify the research provided unless the reader was also at the conference/working with the research group (particularly since the research wasn’t published yet). Secondly, “stem cell” is a non-specific term – many different types exist, and it would have been helpful to explain which ones were used and why. Thirdly, having more comments from other sources would have been nice (but this is a minor point).

The article does explain how MS happens and its effects in a way that is easily understood by laypeople, with sufficient detail. It also provides some limitations of the study via comments by a named expert from the National MS Society. The article’s coverage is balanced, providing both beneficial aspects, as well as the potential downsides of this treatment, with fairly equal weight. Cited figures are quite accurate, when compared with estimates from the National MS Society.

Sharon Dunwoody, Professor in Journalism and Mass Communication, University of Wisconsin-Madison
While the study seems legitimate, the reporter’s characterization of it as potentially a “breakthrough” is not. The study appears to be the beginning of a long clinical road that will explore the possible benefits of the strategy more carefully. Since the study has not yet been subjected to peer review, I would have advised the reporter to hang on to it and to wait for further evidence.

REVIEWER’S COMMENT:

The article contains some inaccuracies and simplifications, but is overall accurate. It is not clear which article and whose scientific data it refers to. Such information should be mentioned in the article. The type of stem cells that were used for the procedure is also unclear.

Immune system renewal after hematopoietic stem cell transplantation has actually been demonstrated a long time ago by Muraro et al.^[1] The article’s description of the procedure itself, i.e. the sequence of steps, is incorrect (see Annotations below for more details). Despite the clearly very promising results, it would have been good to state that the development of treatments for MS has been quite successful in the last two decades. Hematopoietic stem cell transplantation is clearly a step forward – although this is not yet accepted by many neurologists. However, it is an invasive treatment with a certain (albeit small) risk of dying from complications (mostly infections) during the period when the “old” immune system has been destroyed, and new immune cells are not yet reconstituted.

• 1 – Muraro et al. (2005) Thymic output generates a new and diverse TCR repertoire after autologous stem cell transplantation in multiple sclerosis patients. Journal of Experimental Medicine.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
The article reports the research results of a group at the University of Birmingham, showing how ageing cyclists who regularly exercise have increased immune activity compared to inactive ageing individuals, suggesting that regular physical activity slows down immune system decline and promotes health. The article is based on a published study in a peer-reviewed journal, which has been linked in the article. It acknowledges that the study’s results – while encouraging – still require more work before more definitive conclusions can be reached, and generally uses balanced language, without exaggerations.

That said, the interpretation of the research findings is flawed. The article writes that: “Not only was T-cell activity higher in the active adults than the inactive men and women, but the cyclists were also producing the same level of T-cell activity as young adults in their 20s.” The original research article shows that findings are primarily numerical counts of certain types of T cells. Numerical counts on their own are not sufficient to indicate T cell activity. Secondly, this statement is also not completely accurate: “T-cells, which are known to help the immune system fight infections”. Many different types of T cells exist which serve different purposes. Some subtypes are even immunosuppressive, so they would actually dampen immune response against infections.

REVIEWER’S COMMENT:

Nicolette Bishop, Reader (School of Sport, Exercise and Health Sciences), Loughborough University:
The overall message of the article is correct – the study does show that active older people have markers of immune function that are similar to those who are 50 – 60 years younger. However, the following sentence is misleading: “Not only was T-cell activity higher in the active adults than the inactive men and women, but the cyclists were also producing the same level of T-cell activity as young adults in their 20s“. It suggests that T-cell activity was measured by the study’s authors – but it wasn’t – it was the number of the different types of circulating T cells involved in defense that was higher in the active adults than the inactive men and women, and similar to the young adults in their 20s.

To put it another way, the article is written in a manner that gives the impression that the function/defense processes of the cells were tested, which is not the case. The study looked at a comprehensive mixture of markers that essentially demonstrated that the level/availability of T cells was preserved in these very well-trained older cyclists to a similar degree seen in younger people. This is a very important finding as these cells are pivotal in viral defense, but this is not the same as ‘T cell activity’.

Therefore, while the overall message of the article is correct, the specific scientific detail is inaccurate.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
This article discusses current scientific thinking behind clinical depression and raises the possibility that clinicians may be treating the condition using the wrong approach, suggesting that most cases of depression are the result of feeling a lack of fulfilment in one’s life, instead of a chemical imbalance in the brain. While there are some grains of truth in this, the article is highly misleading in many ways.

The article has several problems which make its credibility questionable. Firstly, it never provides links to original sources where there are written quotes by experts. There are also no links to the research studies that it cites to support its findings. These two factors mean that verifying the claims is extremely difficult.

A response to Hari’s article by neuroscientist Dean Burnett which addresses some of its problems has been published.

REVIEWER’S COMMENT:

Raymond Lam, Professor (Department of Psychiatry), University of British Columbia
This article is an excerpt from a provocative book written by a lay person who is clearly anti-psychiatry, so there is no pretense of providing evidence (except cherry-picking evidence which supports his views) or a balanced viewpoint. It is full of wild exaggerations, oversimplifications and inaccuracies. Just a few include:
1. That the DSM-5 only includes symptoms for a diagnosis of depression – NOT TRUE. Symptoms are only one part of the criteria. Other criteria include significant functional disability or personal distress, and exclusion of other potential medical, psychological and social causes.
2. That all psychiatrists believe that depression is caused only by biochemical changes in the brain – NOT TRUE. All psychiatrists are taught a biopsychosocial model of illness, comprised of biological factors, psychological factors and social factors all working in a complex intertwined relationship (with each factor amenable to evidence-based treatments).
3. That the grief exclusion from the diagnostic criteria for major depressive episode was deleted in DSM-5 because psychiatrists did not want to consider that depression has social or psychological causes – NOT TRUE. See the previous point. Also, grief was taken out because it was not felt to be uniquely different from other types of “loss” or stresses that could be experienced by a person, for example, loss of employment, loss of a role such as retirement, loss of a relationship, etc. These types of severe stresses already need to be accounted for in the diagnosis and treatment of depression, so a special mention of grief was not necessary.
4. That all psychiatrists believe depression is caused by low serotonin and that antidepressant medications work by increasing serotonin – NOT TRUE. That theory was dispelled over 30 years ago and no one believes that there is a single cause for depression. The prevailing theory now is that antidepressant medications work by altering complex biochemical pathways that lead to formation of new brain cells and brain pathways, in effect to allow the brain to better compensate for stress.
5. That all psychiatrists only treat depression with medications – NOT TRUE. All psychiatrists are trained in psychotherapy and use supportive psychotherapy in management of depression. Many psychiatrists also deliver evidence-based psychotherapies (for example, cognitive behavioural therapy or interpersonal psychotherapy).

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Flora Teoh, Science Editor, Health Feedback
This is a press article on a new approach to immunotherapy developed by Stanford scientists. As this is a press article, comments are taken directly from the scientists who did the actual work, so one can presume that their comments are accurate at least with regards to the science. While there isn’t an independent source to give their take on the work, this is beyond the scope of press releases, so it’s not the fault of the article.

The article explains how this approach works in language that is easy for the layperson to understand. Necessary links to sources have been provided. However, mentioning potential downsides to this approach would have added some balance to the article, after all, no method is perfect.

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Flora Teoh, Science Editor, Health Feedback
The article covers the recent US governmental report on climate change (Fourth National Climate Assessment), which describes the consequences of climate change in different aspects of life, such as the economy, health, and weather.

The article provides links wherever appropriate to original sources of information, which are scientifically verified and reliable. It also provides quotes from different experts on the subject. The topic is also explored with sufficient depth to be informative to the general public.

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Flora Teoh, Science Editor, Health Feedback
The article reports on the results of a research study showing how hyperbaric oxygen therapy can relieve symptoms of fibromyalgia.

The main problem with the article is that it does not provide any link or source about the study, only that it is by “Researchers from Tel Aviv University”. Googling the only quote in the article enables one to locate the original research article^[1] through another news article by Science Daily (which is actually much more informative, and which this article probably summarised or plagiarised, judging by its highly similar content).

Its quoted statistic on prevalence of fibromyalgia is more or less accurate, when compared to CDC estimates. The article describes the general symptoms of fibromyalgia fairly accurately, and also provides a statement about the current scientific understanding of the mechanism behind fibromyalgia. But it does not provide much detail about the research study itself, nor obtain comments from other independent sources.

• Efrati et al. (2015). Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial. PLOS One.

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Flora Teoh, Science Editor, Health Feedback
The article reports the results of a research study demonstrating the cause of polycystic ovarian syndrome, which was previously not known.

The article has provided a link to the original research article, which it describes quite accurately, and in appropriate detail for a general audience. It gives readers some background information on polycystic ovarian syndrome, and also discusses the mechanism behind the disease. Statistics quoted are quite accurate. In short, it is quite informative. But having discussed the potential benefit of cetrorelix treatment, the article could also have balanced things out by also discussing potential downsides and risks of cetrorelix treatment, which it didn’t do.

Roy Homburg, Head of Research (Homerton Fertility Centre), Homerton University Hospital:
This is, on the whole, an article that reflects the findings of the research published in Nature Medicine. A few points that did catch my critical eye: I think that the title overstates the position with the present level of knowledge and is too sensationalist. The ‘ovarian cysts’ stated to typically characterize PCOS are not cysts but follicles and this may be misleading. On the positive side, the quotes from Professor Robert Norman are spot on and accurately quoted (see Annotations below).

The clinical trial with cetrorelix which the scientists are about to perform will not work in my opinion, and stated here, may give false hope of an easy fix to many women. However, this is not the fault of Alice Klein who is merely quoting the original authors.

• READ THE FULL REVIEW

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Flora Teoh, Science Editor, Health Feedback
This article lists the benefits of taking a hot bath.

The article’s content is taken primarily from another article in The Conversation (which is more detailed and informative). Within the article itself, it does not provide any links to the original research (while the one by The Conversation does). Therefore, while the statements the article makes are true, in the sense that they are supported by scientific work, its complete lack of reference to the original sources means that it is not particularly useful as a reliable source of information.

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Flora Teoh, Science Editor, Health Feedback
The article addresses the myths and misconceptions surrounding the flu vaccine, in an effort to encourage more people to get vaccinated to prevent and reduce the disease’s spread.

The article provides many comments by relevant experts on the topic to address the public’s concern about flu vaccines and dispel the myths. Where necessary, links are also provided to reliable sources of information, such as the Centers for Disease Control and Prevention. Furthermore, the article discusses not just the benefits of the flu vaccine, but also acknowledges its limitations. Its coverage is balanced, informative and useful for people who are deciding whether to get vaccinated.

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Sharon Dunwoody, Professor in Journalism and Mass Communication, University of Wisconsin-Madison
The story is filled with both data and comments from credible sources. Assertions are dramatic but backed up by systematic evidence.

Flora Teoh, Science Editor, Health Feedback
The article reports on measles-related deaths in Europe as a result of the anti-vaccination movement. The article provides important information about measles epidemiology and complications from reliable information sources (such as the World Health Organization). Comments from relevant experts have also been included. As an article on public health, it provides reliable and accurate information on the subject, which is also informative and useful for the general public.

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Flora Teoh, Science Editor, Health Feedback
This article reports on the research findings of a study, which show that energy drinks can lead to narrowing of blood vessels and increase risk of heart attack and stroke. It’s true that excessive consumption of energy drinks has been associated with negative health effects. But the article does not provide much links to references for its claims in the article. Even the research study^[1] on which it bases its main claim is not cited either.

One inaccurate point it makes is in “the possible mechanism linking the high consumption of energy drinks to an increased risk metabolic syndrome.” The original research investigated cardiac functions; it did not mention metabolic syndrome at all, which is a different health problem.

• 1 – Higgins et al. (2017). Consumption of energy beverage is associated with attenuation of arterial endothelial flow-mediated dilatation. World Journal of Cardiology.

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Flora Teoh, Science Editor, Health Feedback
This article reports the successful conclusion of a clinical trial on a Lyme disease vaccine. Information on ticks and Lyme disease is generally accurate. Direct links to the the original research paper and trusted health information sources such as the CDC would have improved its credibility. The article could also have used more comments from independent sources who did not work on the vaccine.

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Flora Teoh, Science Editor, Health Feedback
The article covers a video by a gastroenterologist, purportedly showing how instant ramen noodles take a very long time to be digested, and then discusses how this poses a threat to human health owing to prolonged exposure to certain toxins present in the noodles.

While it is true that instant ramen noodles are processed food with little nutritional value, and therefore should not be a regular part of our diet, the article makes many unfounded assertions about instant ramen noodles that seem to be little more than fear-mongering. The article also fails sometimes to provide links to information sources (for instance its quote on benzopyrene). Where it does provide links to information sources, these sources are of questionable veracity and biased.

The main concern the article highlights is the toxic effects of tert-Butylhydroquinone (THBQ). However, TBHQ is not present in instant noodles at toxic levels in the first place, so the discussion of toxicity is merely scare-mongering, as the McGill Office of Science and Society has explained here.

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Flora Teoh, Science Editor, Health Feedback
The article discusses many ways onions can supposedly treat many health conditions. The article oversimplifies how the chemicals in onions could interact with the human body, and lacks adequate scientific evidence for its claims. Some of its claims may also cause harm, like using onions on cuts or ear infections, as it may prevent people from seeking medical treatment until their condition becomes too serious.

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Flora Teoh, Science Editor, Health Feedback
The article tells the story of a man who needed a liver transplant after a period of taking green tea supplements.
The scientific information provided is accurate. Its explanation of how green tea supplements could cause problems is well explained and detailed. It takes care to point out that green tea is generally safe, and that the risk of catechin liver poisoning is due to the much higher concentrations of epigallocatechin-3-gallate in supplements than is found normally in green tea brews. It also mentions that millions of people have taken green tea supplements safely. Thus, while it helps to warn the general public the dangers of taking too much green tea supplements, it is careful to balance this out with information about the general lack of harm from green tea consumption.

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Flora Teoh, Science Editor, Health Feedback
The article reports on a high number of measles cases in the US. It provides links to original sources, which are reliable and scientifically accurate (like the CDC and WHO). It provides people with adequate warning about the consequences of measles, and tells people how they can prevent it (by vaccination) and why vaccination is necessary.

The article mainly serves the function of simply reporting current news and is not a discussion of measles, the vaccine and its benefits and downsides. It is credible but does not add particular insight to the issue.

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Flora Teoh, Science Editor, Health Feedback
The article reports on a “quick-moving and potentially fatal virus” found in the U.S called the Powassan virus. The article does not provide sources for its statement. While it provides accurate information on preventing infection, it makes several inaccurate and imprecise statements about the disease itself, which hurts its credibility.

One inaccurate statement is:”The patients infected are likely to become susceptible to neurological damage due to inflammation of the brain, which can lead to both encephalitis and meningitis.” Many cases of Powassan infections are in fact asymptomatic (i.e. people don’t get sick), which means that it’s not dangerous in most cases. Another is: “Currently, approximately ten percent of cases have led to death”. This is misleading and scaremongering. According to the CDC, 10% of viral encephalitis as a result of Powassan infection are fatal, but not all of such viral infections result in encephalitis (see previous point).

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Flora Teoh, Science Editor, Health Feedback
The article reports on the findings of a research study showing how use of hand dryers spread bacteria significantly. It explains quite well how the study was done to a general audience, along with diagrams. Correct links to necessary sources are provided. The article reports findings accurately.

There are some points that could be improved on:
1) The article mentions that while UK restrooms using jet dryers had higher counts of pathogenic and drug-resistant bacteria on various aspects of the washroom environment, the same was not observed in the French and Italian hospitals. The first thought would be that the higher counts of bacteria are due to more than the use of jet dryers. This question isn’t addressed in the article, but the research paper does discuss how “differences in cleaning practices and methods used may be a contributing factor. The washrooms in the UK and Italy were cleaned three times per day and the washrooms in France were cleaned twice per day, with combinations of chlorine-releasing agents, limescale/grease removers, alcohol wipes, and a quaternary ammonium compound. Such differences were a limitation of our real-world study.”

2) “In the UK restrooms, the notorious methicillin-resistant Staphylococcus aureus (MRSA) bacterium was found three times more frequently during jet dryer usage periods than paper towel periods. Bacterial species resistant to both penicillins and cephalosporins (known as ESBL-producing organisms) and species of pathogenic enterococci – a difficult-to-treat group – were found in significantly higher frequency and counts during these periods as well.”
Slightly more nuanced than that. Upon reading the original research article, this result is actually site-dependent, i.e. it depends on the site where samples were taken (e.g. sink, floor, door, air etc.) The finding that more MRSA S. aureus and ESBL-producing bacteria were detected is limited only to the floor.

3) “The most dramatic differences were seen between the surface of the jet dryer itself and the surface of the paper towel dispenser: In Udine, the dryer was covered in 100 times more bacteria, in Paris it was 33-fold higher, and in Leeds it was 22-fold.”
I think it may have been worthwhile mentioning the exact measurements of colony counts, because this gives the impression that the Italian hospital was dirtier than the rest. In fact, colony counts were lowest in Italy (0, 100), as opposed to France (9, 300) and the UK (9, 200); numbers: (paper towel use, jet air dryer use).

It should have been noted that the original study was funded by an organisation for paper towel industry (European Towel Industry), since this is a potential source of bias that needs to be acknowledged. At the same time, the article could also have written that in spite of this fact, the article was independently designed by the study authors and peer-reviewed by independent scientists not involved with the study or presumable the paper towel industry.

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Flora Teoh, Science Editor, Health Feedback
This article claims that two drugs, Neurontin and Lyrica, cause brain damage, based on a study by Stanford researchers^[1]. It also suggests that the media, the Food and Drug Administration and physicians are either ignorant about this fact or deliberately suppressing it. The article makes numerous claims without providing any evidence and displays a clear bias against health authorities and the medical establishment, in its use of words that portray these parties negatively. It is inaccurate, emotional and sensationalist.

• Eroglu et al. (2009). The Gabapentin Receptor α2δ-1 is the Neuronal Thrombospondin Receptor Responsible for Excitatory CNS Synaptogenesis. Cell.

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Flora Teoh, Science Editor, Health Feedback
This article claims that cannabis oil can help with COPD.

There’s no scientific evidence presented in the article to back up its claims. The websites it references and links to are of little to no credibility. It also exaggerates the risks of medications used to treat COPD.

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Flora Teoh, Science Editor, Health Feedback
The article reports on the presence of potentially cancer-causing chemicals in teenagers who use e-cigarettes. It describes the original research article accurately. Generally, the article provides links to information sources which are scientifically accurate and reliable (like the CDC and EPA), and discusses the potential harms of each chemical. It is credible and informative.

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Flora Teoh, Science Editor, Health Feedback
This article reports the death of an infant due to sudden infant death syndrome (SIDS) shortly after receiving vaccines. It portrays vaccines as dangerous, citing various studies and examples about how vaccinations have harmed children. The article completely fails to mention the essential fact that vaccines have prevented millions of child deaths resulting from childhood illnesses and their complications. It is clearly trying to sway opinion through appeal to emotion.

The article is rife with inaccurate information (listed below are a few of the problematic statements):
1) “However, building evidence indicates a link between the Dtap Vaccine and SIDS cited in this published study titled, ‘Possible temporal association between diphtheria-tetanus toxoid-pertussis vaccination and sudden infant death syndrome.’ ”
The cited study was published in 1983, 36 years ago! “Building evidence” ought to provide multiple recent studies. Those published in reputable journals report no evidence that DTaP causes SIDS.

2) “Several years ago, National Vaccine Information Center (NVIC) Advocacy Director, Dawn Richardson and Karen Schumacher went to the Travis County Morgue to go through autopsy reports of infants listed as SIDS deaths and looked at vaccination information. Perhaps another missing link to understanding SIDS?”
The National Vaccine Information Center is a known anti-vaccine organisation known for fearmongering and spreading misinformation about vaccines, and is far from being an unbiased source of information.

3) “A highly disproportionate amount of SIDS deaths clustered at 2, 4, and 6 months — which are the very times infants are vaccinated. If vaccines had nothing to do with these, the numbers should have been randomly spread throughout the first 6 months of life. Not so. I challenge the naysayers to go to any morgue in the country and to be honest and see what I’m talking about.”
Researchers haven’t found any link between SIDS and vaccines. The CDC has a page about this. This is the fallacy of post hoc ergo propter hoc.

4) “What is known is the US has a high infant mortality rate for an industrialized nation, and as a collective, we need to investigate why. As of 2017, out of 225 countries around the world, the US ranks 56th for infant mortality. Monaco, Japan, Iceland, Singapore, Norway, Finland, Bermuda, Sweden, Czechia, Hong Kong, and South Korea have the lowest infant mortality rates of the 225 countries listed.”
Those other countries listed also have mandatory vaccination schedules. Yet they have the lowest infant mortality rates. Clearly vaccines aren’t to blame for the problem in the US.

5) “According to the Journal Academic Pediatrics, “54% of children in the US experience one or more chronic health conditions,” or a neurodevelopmental disorder.”
The cited study never associated these health conditions to vaccines.

6) “Different vaccines are also given simultaneously during the same office visit – this hasn’t been tested for safety either!”
This statement isn’t true. See the CDC’s page on this.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the nutritional value of chicken feet, owing to the purportedly high levels of collagen. Collagen certainly has its use in the human body, but most of the article’s claims are unsubstantiated, such as “helps our body in absorbing calcium and protein” and “raise the production of red blood cells as it could make the structure of our blood vessels sturdier”, among others.

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Flora Teoh, Science Editor, Health Feedback
The article reports on the results of a study showing that women who live in greener spaces live longer. Its report on the results is accurate. Unfortunately, the article lacks a link to the original study^[1] and does not discuss mechanisms very much.

• 1 – James et al. (2016). Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women. Environmental Health Perspectives.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the increasing number of measles outbreaks owing to decreasing vaccination rate, and how the reduced rate of vaccination is the result of Andrew Wakefield’s discredited study suggesting a link between vaccines and autism. The article discusses parents’ fear of vaccines in a balanced manner. The discussion is also detailed enough to provide some insight to the general public. The article’s figures (e.g. for herd immunity) are fairly accurate. However, more links to primary sources of information would be nice.

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Flora Teoh, Science Editor, Health Feedback
The article claims that Japan has the lowest infant mortality rate in the world because it banned vaccines.

Japan never banned vaccines in the first place – it still has a vaccination schedule for children. There are also many inaccurate statements, a few of which are addressed below:
1) “As acknowledged by The Centers for Disease Control and Prevention (CDC). The National Vaccine Information Center estimates that less than one to ten percent of adverse reactions to vaccines are reported. Many of the numbers reported above could, therefore, be multiplied by one hundred to determine a more accurate amount of adverse reactions.”

There’s no basis for multiplying the numbers by a hundred to get a “more accurate” amount of adverse reactions. No medical intervention has zero side effects, and vaccines are no exception. However, the benefits from vaccines far outweigh the potential risks.

2) “Despite the fact that it has been blamed in vaccine courts for causing autism, vaccine supporters still deny the correlation between the MMR vaccination and skyrocketing rates of autism spectrum disorder”

That’s because there is no correlation between autism and vaccination. It has been disproven time and time again in many reputable studies. This is a scientific fact that cannot be changed by discussion in a courtroom.

3) “There is no knowing who will suffer side effects as a result of vaccination. [Proponents of vaccination] say the chance of suffering a side effect is 1 in a million. For parents, however, that one is everything.”

Vaccine researchers have acknowledged that vaccines can cause some side effects – these have been documented in studies. However, the fact is that the chances of serious, lasting damage is extremely small. Parents need to consider that the chances of suffering from childhood diseases and their serious long-term complications is much, much higher if they do not vaccinate their children, and weigh this up with the minuscule risks that come from vaccinations.

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Flora Teoh, Science Editor, Health Feedback
The article discusses the benefits of magnesium in treating depression, based on results by a 2017 study. The article correctly reports on the findings of this study, showing how a daily intake of 248 mg of magnesium resulted in improvement of depression symptoms. It is also true that antidepressants come with some problematic side effects.

That said, it is hard to say from the study whether magnesium works better than antidepressants, or that it can replace antidepressants (as suggested in the headline, which misinterprets the study). The patients in the study were all on different therapies (some on antidepressants, some on other therapies, while others had no treatment at all). A study with a more uniform population and a placebo group would be needed to make this comparison.

It would have been good if the article provided more links to other studies supporting its claims, such as magnesium’s effect on physical health. The article does over-sell magnesium’s health benefits somewhat – there are downsides to excess magnesium intake that it should warn people about, such as diarrhea and cramping, especially since it encourages the taking of magnesium supplements, .

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Flora Teoh, Science Editor, Health Feedback
The article reports the promising results of a study testing a vaccine against Alzheimer’s disease in mouse models, showing that “vaccinated mice experienced as much as 40% of their beta-amyloid plaques reduced and as much as 50% of their tau tangles diminished”. This is correctly reported. Also the article provides a good illustration of how the vaccine works, although in this sentence “The immune system is then catalyzed to produce antibodies to fight beta-amyloid”, the word “catalyzed” would be best replaced with the word “recruited” (catalysis has a particular scientific connotation that is inaccurate in this context).

The article could have expanded on the limitations of the study, such as the fact that results are from animal studies, and it remains to be seen if the same result happens in humans.

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Flora Teoh, Science Editor, Health Feedback
The article reports the findings of a global study on how sleeping more than a certain number of hours is linked to ill health and higher mortality.

The article discusses the results as well as the limitations and caveats quite thoroughly, although the headline is rather unfortunate. It gives the average reader the impression that sleeping too much causes ill health and mortality, when the causation is in the reverse direction: ill health may lead to greater fatigue and therefore longer sleeping hours. The article would be improved by including more links to primary information sources.

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Flora Teoh, Science Editor, Health Feedback
The article deals primarily with the personal experiences of cancer patients trying to obtain some vaccines against non-small cell lung cancer not available in the US and discusses the national policies that make it difficult for them to do so. The article also includes some science about the vaccine, but this makes up the smallest part of the article.

The article does a good job of presenting opposing views to the use of both vaccines, and discuss instances where they have worked and instances where they (presumably) did not. The article provides comments from various independent sources, comprising of experts either for or against the vaccine use in their patients. The description of how the vaccines work is accurate, more or less at an appropriate level for a general audience.

However, many figures and assertions are given in the article without providing links to the original research studies or sources. Also, one statement suggests that a patient has become “something of an expert on the subject”. Calling someone an expert on vaccines because they have gone through clinical trials is ambiguous and somewhat of an exaggeration.

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Flora Teoh, Science Editor, Health Feedback
This article is on a research study showing that the effects of childhood trauma persist into adulthood, leading to higher chances of psychiatric disorders, difficulty in making friends and holding jobs. It acknowledges both the strengths and weaknesses of the study. Necessary links to sources are provided.

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Flora Teoh, Science Editor, Health Feedback
This article talks about an alternative reason for getting vaccinated against the flu, which is protecting other people around us who are vulnerable. This aspect (herd immunity) isn’t often discussed in too great detail (often the focus is on protecting oneself), so it was good to see it addressed here. The author has provided statistics and evidence to back up his claim – it really puts into perspective why people should be concerned about the flu, and why they should get the vaccine.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the importance of getting enough sleep for children, and its beneficial effect on their mothers’ mental health. There are plenty of claims that are quite straightforward – the importance of sleep for health is well-established, but it would help the reader if links to the original studies were provided, as well as discussing how the studies were conducted and details about possible mechanisms.

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Flora Teoh, Science Editor, Health Feedback
The article claims that many cases of dementia are actually caused by drugs and vaccines, instead of being legitimate Alzheimer’s cases, and that this is actually a conspiracy by Big Pharma to sell more drugs and make more money off people.

It cites several legitimate information sources (such as research studies in reputable journals and a website linked to Harvard), but uses this information in a manner that draws erroneous conclusions meant to mislead the reader, such as the claim that the aluminium and mercury in vaccines cause cognitive decline. It is true that these compounds can be neurotoxic (like many other common chemicals), but not at the minuscule concentrations found in vaccines.

The study published in JAMA does indeed show that use of anticholinergic drugs are associated with dementia – a side effect that many other studies have found. However, no drug is free from side effects. Certainly, these findings show that people should be more aware of their medications, and communicate with their medical provider about any negative effects that they experience. But the unfounded fearmongering this article contains could cause people to suddenly stop taking their prescription medication without consulting their medical provider, which could be dangerous.

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Flora Teoh, Science Editor, Health Feedback
The article claims that a tetanus vaccine has caused sterility in young girls owing to the presence of human chorionic gonadotropin in the vaccine, and furthermore, that this was part of a deliberate attempt to sterilise Kenyan women. The article does not cite any research studies or scientific evidence to back up these claims. It is therefore impossible to verify, and will only stoke unfounded fears about vaccination.

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Flora Teoh, Science Editor, Health Feedback
This article reports recent and fascinating research findings showing that it is possible for paternal mtDNA to be transmitted to offspring.
The article is generally accurate about the properties of mtDNA. But I think it should be made clearer in the article that transmission of paternal mtDNA only occurs in very rare instances (in these cases, families with a history of mitochondrial diseases, so there is most likely some aberrant process involved in mtDNA transmission), and that the case reported in the study is one of the very few exceptions, and ought not to be seen as a common occurrence. For this reason, the headline is a bit too sensationalistic, as well as this statement “the finding may change the way we treat mitochondrial diseases and brings genetic testing for maternal ancestry into question”.

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Flora Teoh, Science Editor, Health Feedback
This article reports on a research study which showed that even small intake of alcohol results in health risks, and that the only way to reduce such health risks is not to drink at all. It’s an interesting finding, since there have been many studies showing the benefits of moderate intake of alcohol, such as wine, so the current result appears to contradict previous studies. More research is needed to understand why this discrepancy is present. The article does present views from opposing ends of the spectrum, which is good for presenting a balanced view. Links to information sources have also been provided.

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Flora Teoh, Science Editor, Health Feedback
This article highlights health problems associated with frequent and prolonged use of cleaning products, which is an important health issue to address for certain groups, such as cleaners and housewives. The research study is published in a reputable journal, and the article also cites another study which found similar results.

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Flora Teoh, Science Editor, Health Feedback
The article tries to sell cannabis as a cure-all for any disease, even cancer. Its coverage is clearly biased, since it does not mention any side effects of cannabis use, and it exaggerates the significance of scientific studies done in tissue cultures and laboratory animals. Whether cannabis can be used to treat cancer in humans has yet to be definitively determined, and clinical trials are required to assess this. Animal studies and in vitro tissue cultures provide reasons for further investigation in humans, but on their own they do not provide sufficient evidence for effects in humans. Some of its other sources are of dubious and questionable veracity.

The article claims that “with cannabis, suffering some kind of injury is nearly impossible” – this is untrue. Cannabis does have toxic effects, physical and psychological. Cognitive impairment arising from cannabis use can also result in accidents.

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Flora Teoh, Science Editor, Health Feedback
This article claims that aluminium build-up is a cause of autism because it triggers immune activation in the brains. Furthermore, it claims that the source of this aluminium is specifically from vaccines. This claim is founded on the basis of published scientific studies, many of which are not performed in a rigorous manner, or misinterpreted so as to fit the author’s beliefs, or just outright fraudulent.

The author tries to make a case for immune activation leading to interleukin-6 production being a cause of autism. This does not seem to be a logical link to make, because immune activation happens all the time, especially in young children as they easily catch various infections. Interleukin-6 is also produced during such infections, so if this cytokine is a cause of autism, how is it possible that only a minority of children are affected by the condition? Shouldn’t the majority, if not all children have it, because childhood illnesses are so common, and therefore immune activation is common? This paradox is not addressed by the article.

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Flora Teoh, Science Editor, Health Feedback
The article reports the research findings showing a link between the now-banned pesticide DDT and autism.
The article is accurate in reporting the results. It provides links to information sources and mentions a study that produced contradictory results, which gives a balanced perspective.

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Flora Teoh, Science Editor, Health Feedback
This article claims that ADHD is a fake disease invented by Big Pharma so they can sell more drugs and make more money – yet another conspiracy theory. The article says that the symptoms of ADHD are merely an indication of children not being able to get enough physical activity, and that these symptoms are normal. It completely ignores the fact that ADHD is defined by more than the expected restless or inattentive behaviour in children, as explained by the CDC.

Furthermore, the CDC does not recommend medications as the sole means of therapy. In fact, behavioural therapy and psychotherapy take precedence over medicating, since the medications could lead to side effects.

The article also suggests that the reason children are restless is because they do not get enough time for outdoor activity: “These states are also home to a lot of children who enjoy hunting and fishing. Jarvis reports that census data from Arkansas shows 89 percent of kids fish and 35 percent hunt. Similar survey data shows that in Kentucky, 86 percent fish and 31 percent hunt. “These were the closest indicators I could think of that Kentucky and Arkansas children are more interested in being outside and active than cooped up in a classroom,” he contends.”

These statistics were taken from a census focused on wildlife-associated recreation, with hunting as a predominant activity. It doesn’t look at the number of people involved in other common outdoor activities, such as hiking or playing sports. Drawing conclusions solely based on this census (which doesn’t give you the full picture) is going to be misleading at best.

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Flora Teoh, Science Editor, Health Feedback
This article reports on research showing how HIV-infected cells can be destroyed using metabolic inhibitors.
This is an interesting and novel approach, although the use of the word ‘cure’ is extremely premature. The experiments were performed ex vivo, i.e. outside a living thing, and so the cell environment is different. In vivo experiments and clinical trials will be needed to see if this approach is safe and works in humans. There also isn’t any discussion of potential drawbacks to such a treatment or its potential mechanisms of action.

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Flora Teoh, Science Editor, Health Feedback
The article talks about a research study which found that high levels of cortisol, a stress hormone, can lead to brain shrinkage. The article is generally accurate, discusses mechanisms and the details of the study, and is careful to state the study’s limitations. The article addresses the importance of stress relief for maintaining health during ageing. One minor point is that it should have provided the link to the research study.

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Flora Teoh, Science Editor, Health Feedback
This article claims that canola oil is bad for our health for several reasons, some of which are unfounded. It also makes several inaccurate statements. The article claims that it is the oleic acid which makes canola oil toxic, but oleic acid actually makes up most of the fatty acids in the human body’s fat deposits. It’s also the main fatty acid found in olive oil, which this article says is healthy.

Keshan disease is the result of selenium deficiency and an infection by a particular virus. It has nothing to do with oleic or erucic acid. There isn’t any scientific evidence showing that erucic acid hampers growth in children – also canola oil was modified to contain less than 2% erucic oil, which is considered safe.

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Flora Teoh, Science Editor, Health Feedback
This article claims that going to concerts will increase people’s longevity. I think it’s great to tell the general public about interesting ways to boost mental well-being, but the headline and content are clearly sensationalistic, inaccurate and misleading. According to the article, the study performed “psychometric testing and heart rate tests”. Such information on their own cannot tell us whether lifespan is increased, therefore the conclusion is unfounded. The study is also sponsored by a company that owns many music venues, which is a potential source of bias.

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Flora Teoh, Science Editor, Health Feedback
The article reports results of a study showing that increased exposure to perfluoroalkyl compounds levels led to changes in male hormones and reduction in penis length. The article summarises the research accurately, although the study was correlative in nature, and cannot inform us about causative factors.

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Flora Teoh, Science Editor, Health Feedback
The article talks about how moderate consumption of alcohol can prolong a person’s lifespan. The article reported the results accurately. It’s an interesting finding, although the information was collected via surveys mailed to participants, and the reliability of the information may not be very high – especially in an ageing cohort who may have memory issues. In this sense, the article does overstate confidence in the findings. The headline is also incorrect and the article does not link to research articles it cites.

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Flora Teoh, Science Editor, Health Feedback
The article discusses an interesting potential link between blood sugar levels and the risk of developing Alzheimer’s. It links to the studies it cites, and asks several experts about the subject. It is careful to distinguish between opinions and scientific findings, and also discusses alternative explanations. It was a good read.

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Flora Teoh, Science Editor, Health Feedback
The article is an opinion piece that promotes a low-carb and high-fat diet for better heart health. It is not clear from the article which research it refers to, but a Google search turned up this article^[1], which is most likely it. The research article actually concluded that high-carb diets lead to higher total mortality, but not an increased risk of cardiovascular disease or mortality. This conclusion runs counter to the opinion article’s central argument.

• Dehghan et al. (2017). Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. The Lancet.

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Flora Teoh, Science Editor, Health Feedback
The article talks about a mother’s negative experience with scented candles and claims that the candles pose a threat to human health due to soot production. It’s true that soot has negative health effects, but the headline is unnecessarily sensationalistic and inaccurate in claiming that manufacturers can’t/won’t tell people about the dangers of soot from scented candles. Even the article itself mentions that the warning about soot had been printed on the scented candle packaging.

UPDATE (20 Feb. 2018): APost has since revised their headline for the sake of greater clarity and explained that “they” refers to the infants, and not the candle manufacturers.

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Flora Teoh, Science Editor, Health Feedback
This article claims that a court decision has confirmed that Gardasil kills people. The article does not cite any scientific studies backing up its claims of Gardasil causing fatalities. It employs exaggeration and rhetoric that is meant to stoke emotional reactions from readers.

It cites the records from the Vaccine Adverse Events Reporting System as evidence that Gardasil is harmful. It does not take into account the fact that the system records ALL forms of complaints that physicians and patients believe were caused by vaccines, but may not actually be due to the vaccine after all. From the CDC: “Anyone who gives or receives a licensed vaccine in the U.S. is encouraged to report any significant health problem that occurs after vaccination. An adverse event can be reported even if it is uncertain or unlikely that the vaccine caused it” and “VAERS data contain both coincidental events and those truly caused by vaccines.” If anything, the numbers in VAERS are a significant over-estimate of harm from vaccines.

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Flora Teoh, Science Editor, Health Feedback
The article talks about the discovery of a new method of killing cancer cells, which could potentially lead to the development of a new form of therapy. The article is generally accurate, cites with the necessary links and discusses the mechanisms. It would have been good to also discuss potential downsides and to obtain some critique from an expert not involved in the study.

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Flora Teoh, Science Editor, Health Feedback
This article reports a study’s findings showing how treatment of chemotherapy and a cannabis-derived compound called cannabidiol (CBD) led mice with pancreatic cancer to survive nearly three times longer compared to those treated only with chemotherapy. The article is accurate in its summary of the study. The links to primary sources are provided.

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Flora Teoh, Science Editor, Health Feedback
This article discusses health benefits of dates. It doesn’t provide much details and does not cite any scientific studies for its claims.

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Flora Teoh, Science Editor, Health Feedback
This article reports on a research study that linked autoimmunity to a particular gut bacteria. This study is quite fascinating and interesting, as autoimmune conditions are understood to be highly complex diseases, yet the study has managed to link it to a single factor. This could potentially simplify understanding the disease mechanisms and therapy development. The article describes the research accurately. Primary sources have been linked to. It would have been good to have other scientists’ take on the subject though.

That said, the results should be interpreted with some caution, as the study was performed in mice and not humans. Furthermore, there are also many other possible mechanisms behind autoimmune disease, so the headline stating that this is the “root of autoimmune disease” is premature.

 

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Flora Teoh, Science Editor, Health Feedback
The article tells us how changing the way we bend forward can help us to avoid putting strain on our spine, thus preventing back pain. It’s a thought-provoking read about an everyday action we do without putting much thought into. The article gathered opinions from experts in the relevant fields, with the necessary links. It has acknowledged that there is a dearth of scientific studies that investigate this subject, so more work still needs to be done. It also discusses at some length the biological mechanism.

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Flora Teoh, Science Editor, Health Feedback
The article talks about how urine colour can be an indication of health. It’s generally accurate, but it does not provide any links to primary information sources.

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Flora Teoh, Science Editor, Health Feedback
This article reports research findings of a study by Stanford scientists, showing that diet quality (i.e. eating whole foods vs. processed foods) is more important towards sustained weight loss as opposed to quantity of calories. The article describes accurately how the study was performed, in detail. The links to the studies it cites are also provided. These findings would be very interesting for the general public, many of whom are concerned with losing weight (as expected, since obesity is a rapidly growing problem worldwide) for health and image reasons.

These findings also run contrary to current recommendations by health authorities on how to lose weight (which focuses on caloric restriction), and may help to change our approach towards achieving healthy and sustainable weight loss, which could be useful for many people.

 

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Flora Teoh, Science Editor, Health Feedback
This article reports the results of a study showing that a sedentary lifestyle increases mortality to the same or higher degree as smoking, coronary artery disease or diabetes. It is generally accurate in reporting the results, provides necessary links, and explores potential mechanisms. Some critique of the study or mention of its limitations would have been appreciated though.

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Flora Teoh, Science Editor, Health Feedback
This article reports study findings showing that coffee intake is associated with lower mortality, suggesting that coffee has beneficial effects on health. Its report of the results are accurate, although a more well-rounded approach regarding the health effects of coffee would have been better, because it does not dwell very much on the negative effects of high coffee intake (for instance, caffeine addiction can affect the quality of our daily lives, even if it doesn’t seem to affect our longevity). It also mentions studies about genes involved in caffeine metabolism, which have been suggested to influence coffee’s negative health effects (e.g. hypertension and heart attack), but doesn’t discuss possible reasons why the results of this study conflict with those of prior studies.

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Flora Teoh, Science Editor, Health Feedback
Thie article talks about the health benefits of okra. Some parts of it are true, for instance the high fibre content (since okra is a vegetable), but some of the other claims are exaggerated or unfounded, since there are no citations of relevant scientific studies (e.g. the Vitamin C stimulating the immune system to create more white blood cells, and potassium reducing clotting and atherosclerosis).

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Flora Teoh, Science Editor, Health Feedback
The article tells us about a study which found that preventing a certain enzyme from functioning can reduce beta-amyloid plaques from accumulating, which is believed to be the main mechanism behind Alzheimer’s. The report is accurate and it does discuss the caveats of the findings to avoid overstating their significance. However, the article did not link to the original study.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the potential for a condition called ‘popcorn lung’ to develop in e-cigarette users, owing the presence of diacetyl, which has been linked to this disease in popcorn factory workers. It is generally accurate in providing information about the disease. It also discusses the debate behind whether diacetyl actually causes popcorn lung, citing several scientific studies.

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Flora Teoh, Science Editor, Health Feedback
This article talks about a chickenpox outbreak and how it is linked to increasing rates of non-vaccination. The scientific information provided is accurate and the necessary links to primary sources have been included.

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Flora Teoh, Science Editor, Health Feedback
The article focuses on the painful experiences of a few women after receiving the “husband stitch” post-childbirth. The article acknowledges that there aren’t any scientific studies examining this problem, so it is virtually impossible to know objectively how often it happens, and the problems that arise from it. However, the article does obtain some comments from relevant experts.

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Flora Teoh, Science Editor, Health Feedback
This article talks about how a third of early deaths could be prevented if people stopped eating meat. The main problem with the article is that it comprises of a lot of claims and assertions without citing the necessary scientific evidence. No studies have been linked to in the article, although these statements have been made by relevant experts, and therefore (presumably) are not inaccurate. Also, the article clearly advocates for veganism and vegetarianism without discussing the challenges and potential downsides of switching to these diets.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the increasing number of measles cases worldwide, and how the anti-vaccine movement is the main driver behind this observation in wealthy countries. The scientific information provided is accurate but it does not provide links to information sources.

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Flora Teoh, Science Editor, Health Feedback
Another article that talks about how restroom hand dryers spread bacteria, supported by a different study. It reports the study’s results accurately and explains how the study was done, as well as discusses potential mechanisms.

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Flora Teoh, Science Editor, Health Feedback
This article warns people about the myths perpetuated by the anti-vaccine movement, and how the decreasing rates of vaccine uptakes has led to more cases of measles. The scientific information is accurate. Providing more links to primary information sources would help.

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Flora Teoh, Science Editor, Health Feedback
This article promotes kid-free holidays for mothers as a way of improving their mental well-being. There’s very minimal science being discussed (just a few short quotes by a psychologist) – this is more of an opinion piece.

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Flora Teoh, Science Editor, Health Feedback
This article serves as a public health warning about increasing number of measles cases owing to reduced vaccination rates, and reminds people to get vaccinated if they have not done so, as the complications from measles are potentially fatal. The information provided is accurate.

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Flora Teoh, Science Editor, Health Feedback
This article claims that having pizza for breakfast is fine, and is actually better than eating a bowl of cereal, because science says so. It’s certainly true that depending on the toppings on the pizza, one can get a better variety of nutrients. However, the article should have acknowledged that this by no means indicates that pizza is healthy, but simply the least bad option between the 2 bad options of pizza and cereal. This article is overselling the health benefits of pizza a little.

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Flora Teoh, Science Editor, Health Feedback
The article makes many claims about the purported health benefits of moringa leaves and ginger. It does not cite scientific evidence or experts to back up its claims, and relies on Ayurvedic medicine (considered “alternative medicine”) as an information source.

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Flora Teoh, Science Editor, Health Feedback
This article warns people about the presence of various heavy metals in different brands of protein powders, based on a study by the Clean Label Project. While it is true that high levels of heavy metals such as arsenic and lead cause serious health problems, the Clean Label Project study actually found very small amounts in these protein powders – the highest level detected in a powder as reported by CLP was 79.6 μg/kg (far below the toxic dose of 1 mg/kg/day). Of course, the less of such substances we consume the better, but trace amounts of many chemicals can be detected in almost any substance, so the article’s conclusion based on such information is unfounded and merely stokes unnecessary fear.

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Flora Teoh, Science Editor, Health Feedback
This article discusses a popular diet for many people trying to lose weight commonly called keto. It debunks several of the myths involved in doing a keto diet, and highlights the difficulty of achieving actual ketosis, as well as the risks involved in the diet. It explains the scientific mechanisms behind its arguments, cites the opinions of several experts in the field, and provides links to the studies it cites.

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Flora Teoh, Science Editor, Health Feedback
This article claims that measles infections can still be transmitted by those who have been vaccinated against it, and that therefore the measles vaccine is useless. It claims there is a “voluminous body of contradictory evidence from epidemiology and clinical experience” for this, although it cites none of the relevant scientific studies.

While the measles vaccine has never been claimed to be 100% effective at preventing measles, its prevention rate is still extremely high, as shown by reputable studies. Yet the author seizes on only one study showing that one person in 88 had transmitted the measles infection to four others despite prior vaccination, as incontrovertible proof that the measles vaccine is absolutely useless, and that vaccinated people are the ones responsible for measles outbreaks instead of the non-vaccinated. This is an utterly baseless conclusion. Its other claims are also similarly subjected to the same wilful ignorance about vaccines and how they work.

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Flora Teoh, Science Editor, Health Feedback
This article discusses the decreasing vaccination rates in many parts of the world and how this could be behind the growing number of measles outbreaks. The article links the reduction in vaccine uptake with anti-vaccination movements and rightwing populism. The article dwells predominantly on the politics and policies of vaccination, so there is little scientific information to assess.

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Flora Teoh, Science Editor, Health Feedback
The article’s central argument is that marijuana use does not cause driving impairment, based on the results of a study. This is a serious mischaracterisation of the study’s conclusions. It was made clear that driving under the influence of marijuana does lead to impairment, even if not the same kind as that of alcohol: “Drivers with only alcohol in their systems showed impairment in all three areas while those strictly under the influence of vaporized cannabis only demonstrated problems weaving within the lane.”

The article also claims that marijuana “makes them drive safer or slower.” This is not a logical conclusion to make. If marijuana use leads to impairment, like alcohol does (even in a different manner), and alcohol is well-known to increase the likelihood of road accidents, how can marijuana produce an opposite effect? It concludes that this “should deter any attempts to deploy instant roadside tests for THC-blood levels.” It’s not true that this means rapid roadside tests for marijuana shouldn’t be used, but that other biochemical techniques need to be developed for rapid and accurate detection.

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Flora Teoh, Science Editor, Health Feedback
This article reports a study’s findings that showed hugs are good for psychological well-being during interpersonal conflict. It reports the study’s findings accurately, cites the original research study and several others, discusses potential mechanisms as well as limitations.

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Flora Teoh, Science Editor, Health Feedback
This article warns people with certain medical conditions to avoid ginger for various reasons. It did not cite any scientific studies to support its claims. There is some scientific basis for the first claim: ginger does contain natural blood thinners, so it is possible that an excess amount of ginger intake might interfere with blood clotting. However, the rest of the claims have not been supported by scientific studies to date.

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Flora Teoh, Science Editor, Health Feedback
The article reports the news of a measles outbreak in a US primary school, which has been attributed to the large number of religious vaccination exemptions among the students. The article has linked to the primary sources (e.g. from which it cites its statistics). The scientific information provided is accurate, and it provides quotes from the relevant experts.

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Flora Teoh, Science Editor, Health Feedback
This article reports on “a new set of health guidelines, released by the World Cancer Research Fund”. The main problem is that there is no link to primary sources about these guidelines, so it’s hard to verify its main claim. There is also no supporting evidence produced for the rest of its claims.

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Flora Teoh, Science Editor, Health Feedback
This article reports a study’s findings showing how the body’s immune system can be recruited to destroy spontaneously forming tumours. It describes the findings accurately. The article provides the link to the original study, as well as links to some explanatory information from reliable sources. It also discusses the caveats and limitations of the study.

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Flora Teoh, Science Editor, Health Feedback
The article reports research findings linking autism to inflammation as a result of certain types of gut microbiota.
The article has linked to the original study. It also describes how the research was done, as well as the biological mechanisms involved. It states some of the study’s limitations.

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Flora Teoh, Science Editor, Health Feedback
This article reports on a study’s findings showing how exercise prevents decline of the immune system (this is the same research article we reviewed here). The article reports the research findings accurately (using T-cell levels), although this statement “They followed 125 long-distance cyclists, some now in their 80s, and found they had the immune systems of 20-year-olds” is too broadly applied. It is true that the T cell status is similar, but the immune system comprises of many more cells than T cells. Discussing caveats and limitations of the study would have improved the article.

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Flora Teoh, Science Editor, Health Feedback
This article reports a case of stroke in a child as a result of chickenpox infection, which he caught from an unvaccinated sibling. This highlights the serious complications from chickenpox (which many people are not aware of) and discusses why vaccination is important. The article has linked to the original case study and includes comments from several different doctors.

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Flora Teoh, Science Editor, Health Feedback
This article reports news of the recall of a drug called Advil, which is commonly used in children to treat fever, because of a mislabelling that could lead to overdoses. In general, the article does a good job of sticking to the facts instead of fearmongering (except perhaps its opening paragraph). It has cited several sources such as the Food and Drug Administration as well as established news outlets.

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Flora Teoh, Science Editor, Health Feedback
This article is about a research study showing how inactivating a single gene in mice allowed them to eat as much as they wanted without gaining weight. This is claimed to be a potential treatment for obesity, which is an important modern-day problem. The description of the research findings is fairly accurate. The article’s headline is an exaggeration and highly misleading, since the study was only done in mice, and it is hard to predict the effect when the system is mimicked in humans. The article also needs to provide a more detailed discussion of the caveats and limitations of the study.

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Flora Teoh, Science Editor, Health Feedback
The article reports the findings of a study (which it has linked to) showing that fertility rates in developed countries are declining, and discusses the potential problems countries could face if they are unable to replace their population. It looks at the problem from several perspectives as well, and includes comments from relevant experts.

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Flora Teoh, Science Editor, Health Feedback
This article is about a study that found a link between the Epstein-Barr virus and several other diseases (many of which are autoimmune). The article has cited and linked to the original study. The description of the study is generally accurate. More discussion of the study’s limitations would have been welcome.

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Acknowledgements

Many thanks to the Credibility Coalition for supporting this project and to our reviewers for their contributions!