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The black-capped chickadee, seen here, is well known for its strong episodic memory. Dmitriy Aronov hide caption

The "barcodes" powering these tiny songbirds' memories may also help human memory

April 5, 2024 • Tiny, black-capped chickadees have big memories. They stash food in hundreds to thousands of locations in the wild – and then come back to these stashes when other food sources are low. Now, researchers at Columbia University's Zuckerman Institute think neural activity that works like a barcode may be to thank for this impressive feat — and that it might be a clue for how memories work across species.

The "barcodes" powering these tiny songbirds' memories may also help human memory

"One second doesn't sound like much, but in today's interconnected world, getting the time wrong could lead to huge problems," geophysicist Duncan Agnew says. Here, an official clock is seen at a golf tournament in Cape Town, South Africa. Johan Rynners/Getty Images hide caption

Negative leap second: Climate change delays unusual step for time standard

March 30, 2024 • We're nearing a year when a negative leap second could be needed to shave time — an unprecedented step that would have unpredictable effects, a new study says.

A researcher holds up a sandy De Winton's golden mole. Nicky Souness/Endangered Wildlife Trust hide caption

Once lost to science, these "uncharismatic" animals are having their moment

March 29, 2024 • Historic numbers of animals across the globe have become endangered or pushed to extinction. But some of these species sit in limbo — not definitively extinct yet missing from the scientific record. Rediscovering a "lost" species is not easy. It can require trips to remote areas and canvassing a large area in search of only a handful of animals. But new technology and stronger partnerships with local communities have helped these hidden, "uncharismatic" creatures come to light.

Once lost to science, these "uncharismatic" animals are having their moment

The country's two biggest reservoirs are on the Colorado River. Water levels at Lake Powell have dropped steeply during the two-decade megadrought. Justin Sullivan/Getty Images hide caption

The Colorado River rarely reaches the sea. Here's why

March 28, 2024 • More than half of the Colorado River's water is used to grow crops, primarily livestock feed, a new study finds. The river and its users are facing tough decisions as the climate warms.

A post-reproductive toothed whale mother and her son. David Ellifrit/Center for Whale Research hide caption

Most animals don't go through menopause. So why do these whales?

March 22, 2024 • Across the animal kingdom, menopause is something of an evolutionary blip. We humans are one of the few animals to experience it. But Sam Ellis , a researcher in animal behavior, argues that this isn't so surprising. "The best way to propagate your genes is to get as many offspring as possible into the next generation," says Ellis. "The best way to do that is almost always to reproduce your whole life."

A cicada perches on a picnic table in front of Nolde Mansion in Cumru Township, PA in May 2021. New research shows that these insects urinate in a surprising way. Ben Hasty / MediaNews Group/Reading Eagle via Getty Images hide caption

Scientists studied how cicadas pee. Their insights could shed light on fluid dynamics

March 20, 2024 • Cicadas, and the way they urinate, offer a 'perfect' lab for understanding fluid dynamics at very small scales, researchers say

Workers at the U.S. Embassy in Havana leave the building in September 2017. New research out of the National Institutes of Health finds no unusual pattern of damage in the brains of Havana syndrome patients. Emily Michot/Miami Herald/Tribune News Service via Getty Images hide caption

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In havana syndrome patients, nih scientists find no physical trace of harm.

March 18, 2024 • The mysterious ailments that became known as Havana syndrome left no physical evidence of injury or disease, according to two government studies.

This close-up of the Verona astrolabe shows Arabic and Hebrew markings. Federica Gigante hide caption

This medieval astrolabe has both Arabic and Hebrew markings. Here's what it means

March 16, 2024 • This discovery sheds new light on the rich history of scholarship and intellectual exchange between Muslims, Jews and Christians during a time of Muslim rule in medieval Spain.

Flares burn off methane and other hydrocarbons at an oil and gas facility in Lenorah, Texas in 2021. New research shows drillers emit about three times as much climate-warming methane as official estimates. David Goldman/AP hide caption

Oil and gas companies emit more climate-warming methane than EPA reports

March 13, 2024 • Oil and gas drillers are releasing more climate-warming methane than the government estimates, a new study shows.

This type of staghorn coral ( Acropora pulchra ) appeared to benefit from the presence of sea cucumbers ( Holothuria atra ), a new study finds. Terry Moore/Stocktrek Images / Science Source hide caption

This often-overlooked sea creature may be quietly protecting the planet's coral reefs

March 13, 2024 • The pickle-shaped bottom feeders may reduce the amount of microbes on the seafloor that could potentially sicken coral, scientists suggest

Millions of people are affected by long COVID, a disease that encompasses a range of symptoms — everything from brain fog to chronic fatigue — and that manifests differently across patients. The Washington Post/The Washington Post via Getty Images hide caption

What we know about long COVID — from brain fog to physical fatigue

March 13, 2024 • "Long COVID has affected every part of my life," said Virginia resident Rachel Beale said at a recent Senate hearing. "I wake up every day feeling tired, nauseous and dizzy. I immediately start planning when I can lay down again." Beale is far from alone. Many of her experiences have been echoed by others dealing with long COVID. It's a constellation of debilitating symptoms that range from brain fog and intense physical fatigue to depression and anxiety. But there's new, promising research that sheds light onto some symptoms. NPR health correspondent Will Stone talks with Short Wave host Regina G. Barber about the state of long COVID research — what we know, what we don't and when we can expect treatments or even cures for it. Have more COVID questions you want us to cover? Email us at [email protected] — we'd love to hear from you.

Maria E. Garay-Serratos holds a framed photograph of her mother, who died after suffering decades of domestic violence. Scientists are trying to understand how domestic violence damages the brain. Julio Serratos/Maria E. Garay-Serratos hide caption

Domestic violence may leave telltale damage in the brain. Scientists want to find it

March 8, 2024 • Traumatic brain injuries from intimate partner violence are common, and potentially more severe than those seen in sports.

Elephantnose Fish, Gnathonemus petersii, Congo ullstein bild hide caption

The "shocking" tactic electric fish use to collectively sense the world

March 8, 2024 • Neuroscientist Nathan Sawtell has spent a lot of time studying the electric elephantnose fish. These fish send and decipher weak electric signals, which Sawtell hopes will eventually help neuroscientists better understand how the brain filters sensory information about the outside world. As Sawtell has studied these electric critters, he's had a lingering question: why do they always seem to organize themselves in a particular orientation. At first, he couldn't figure out why, but a new study released this week in Nature may have an answer: the fish are creating an electrical network larger than any field a single fish can muster alone, and providing collective knowledge about potential dangers in the surrounding water.

The "shocking" tactic electric fish use to collectively sense the world

A digital illustration of a circle of hands extending from the edge of the image, each holding a sheet of paper. The papers overlap in the center and, like a puzzle, come together to reveal a drawing of a handgun. Oona Tempest/KFF Health News hide caption

Meet the public health researchers trying to rein in America's gun violence crisis

Kff health news.

March 6, 2024 • After the 1996 Dickey Amendment halted federal spending on gun violence research, a small group of academics pressed on, with little money or support. Now a new generation is taking up the charge.

This artist's concept shows the Voyager 1 spacecraft entering the space between stars. Interstellar space is dominated by plasma, ionized gas (illustrated here as brownish haze). NASA/JPL-Caltech hide caption

The Voyager 1 spacecraft has a big glitch. Now, NASA must figure out how to fix it

March 6, 2024 • The Voyager 1 space probe is the farthest human-made object in space. It launched in 1977 with a golden record on board that carried assorted sounds of our home planet: greetings in many different languages, dogs barking, and the sound of two people kissing, to name but a few examples. The idea with this record was that someday, Voyager 1 might be our emissary to alien life – an audible time capsule of Earth's beings. Since its launch, it also managed to complete missions to Jupiter and Saturn. In 2012, it crossed into interstellar space.

A case of bronchitis in 2014 left Sanna Stella, a therapist who lives in the Chicago area, with debilitating fatigue. Stacey Wescott/Tribune News Service via Getty Images hide caption

Clues to a better understanding of chronic fatigue syndrome emerge from a major study

February 23, 2024 • After seven years of research, the findings shed light on the long-neglected illness. Scientists say the results could lead to future trials for potential treatments.

A 3D model of a short section of the stone wall. The scale at the bottom of the image measures 50 cm. Photos by Philipp Hoy, University of Rostock; model created using Agisoft Metashape by J. Auer, LAKD M-V hide caption

Scientists scanning the seafloor discover a long-lost Stone Age 'megastructure'

February 22, 2024 • The more than half mile long wall, called the Blinkerwall, was likely used by Stone Age hunter-gatherers to herd reindeer toward a shooting blind.

The sun emits a mid-level solar flare releasing a burst of solar material. NASA hide caption

In light of the solar maximum, a look at the biggest solar storm in recorded history

February 21, 2024 • We are at the height of the Sun's activity in its eleven year cycle, known to astronomers as the solar maximum. This means that over the next several months there's going to be a lot of solar activity. It's got us thinking back to 1859. That's when astronomer Richard Carrington was studying the Sun when he witnessed the most intense geomagnetic storm recorded in history. The storm, triggered by a giant solar flare, sent brilliant auroral displays across the globe causing electrical sparking and fires in telegraph stations. This encore episode, Regina talks to solar physicist Dr. Samaiyah Farid about what's now known as the Carrington event and about what may happen the next time a massive solar storm hits Earth.

One woolly mammoth's journey at the end of the Ice Age

February 19, 2024 • Lately, paleoecologist Audrey Rowe has been a bit preoccupied with a girl named Elma. That's because Elma is ... a woolly mammoth. And 14,000 years ago, when Elma was alive, her habitat in interior Alaska was rapidly changing. The Ice Age was coming to a close and human hunters were starting early settlements. Which leads to an intriguing question: Who, or what , killed her? In the search for answers, Audrey traces Elma's life and journey through — get this — a single tusk. Today, she shares her insights on what the mammoth extinction from thousands of years ago can teach us about megafauna extinctions today with guest host Nate Rott .

Tai chi has many health benefits. It improves flexibility, reduces stress and can help lower blood pressure. Ruth Jenkinson/Getty Images/Science Photo Library hide caption

Tai chi reduces blood pressure better than aerobic exercise, study finds

February 14, 2024 • The slow-moving Chinese martial art tai chi is known to increase flexibility and balance. Now, research suggests it's more effective at reducing blood pressure than more vigorous forms of exercise.

Manny and Cayenne wrestle and kiss. LA Johnson/NPR hide caption

Manny loves Cayenne. Plus, 5 facts about queer animals for Valentine's Day

February 14, 2024 • In a Valentine's Day exclusive report, NPR has learned there is currently a gay anteater couple at Smithsonian's National Zoo and Conservation Biology Institute in Washington D.C.But this couple is just the tip of the proverbial iceberg when it comes to queerness in the animal world – it's been documented in hundreds of species. We spoke with wildlife ecologist Christine Wilkinson of the "Queer is Natural" TikTok series to uncover the wildest, queerest animals of the bunch.

Ninety-seven percent of migratory fish species are facing extinction. Whale sharks, the world's largest living fish, are among the endangered. Ullstein Bild/Ullstein Bild hide caption

Across the world, migrating animal populations are dwindling. Here's why

February 12, 2024 • In a landmark U.N. study, researchers found nearly half of the world's threatened migratory species have declining populations. More than a fifth of the assessed animals face extinction.

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New study finds triple-negative breast cancer tumors with an increase in immune cells have lower risk of recurrence after surgery

Kelley Luckstein

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ROCHESTER, Minn. — A new multicenter, international study suggests that people who have early-stage triple-negative breast cancer (TNBC) and high levels of immune cells within their tumors may have a lower risk of recurrence and better survival rates even when not treated with chemotherapy. The study was published today in the Journal of American Medical Association (JAMA).

TNBC is a breast cancer subtype that does not respond to drugs that target the estrogen receptor or the HER2 protein. It grows rapidly, is more likely to spread beyond the breast before diagnosis and is more likely to recur than other breast cancers. TNBC represents about 15% of all breast cancers and is more common in younger people and in women of African American, Hispanic and Indian descent. Immune cells, also known as tumor-infiltrating lymphocytes, or TILs, are naturally existing immune system cells that can move from the bloodstream into a tumor and can recognize and destroy cancer cells.

"This is an important finding because it highlights that the abundance of TILs in breast tissue is a prognostic biomarker in people with early-stage triple-negative breast cancer, even when chemotherapy is not administered," says Roberto Leon-Ferre, M.D. , a breast medical oncologist at Mayo Clinic Comprehensive Cancer Center and first author of the study. "The study's findings may inspire future clinical trials to explore whether patients with a favorable prognosis (high TILs) can avoid intensive chemotherapy regimens."

"This meta-analysis confirms robustly the prognostic value of TILs that we have previously reported in TNBC patients treated with chemotherapy and expands it to patients treated without chemotherapy," says Sarah Flora Jonas, Ph.D., a statistician at Gustave Roussy and co-first author of the study. "Future studies may allow the use of this biomarker along with standard clinicopathological factors to inform treatment decisions in TNBC patients."

"Of interest, the first report suggesting that an increased number of immune cells being associated with better prognosis in breast cancer patients was described by doctors at Mayo Clinic more than 100 years ago," says Roberto Salgado, M.D., co-chair of the International Immuno-Oncology Biomarker Working Group; co-lead of the study; and pathologist from the Peter MacCallum Cancer Centre, Melbourne, Australia, and ZAS Hospitals, Antwerp, Belgium. "It took a global effort and a century later to reexamine this biomarker and bring it closer to application in patient care."

"TILs are not currently measured or reported in the routine examination of tissue samples of breast cancer," says co-senior author, Matthew Goetz, M.D. , a medical oncologist at Mayo Clinic Comprehensive Cancer Center and the Erivan K. Haub Family Professor of Cancer Research Honoring Richard F. Emslander, M.D. "While prior studies have focused on measuring TILs in people treated with chemotherapy, this is the largest study to comprehensively demonstrate that the presence of TILs influences the natural behavior of breast cancer in people who have surgery and/or radiation with no additional medical treatment."

For this study, Mayo Clinic and Gustave Roussy researchers, in collaboration with the International Immuno-Oncology Biomarker Working Group, led 11 additional groups to collect data on 1,966 participants with early-stage TNBC who only underwent surgery with or without radiation therapy but did not receive chemotherapy. The participants had been followed for a median of 18 years. The results showed that higher levels of TILs in breast cancer tissue were associated with lower recurrence rates among participants with early-stage TNBC.

"Five years after surgery, 95% of participants with small tumors, stage 1 TNBC, and whose tumors had high TILs were alive, compared to 82% of patients whose tumors had low TILs. Importantly, the breast cancer recurrence rate was significantly lower among patients whose tumors had high TILs," says co-senior author, Stefan Michiels, Ph.D. , head of Oncostat team, Gustave Roussy, Inserm U1018, University Paris-Saclay. "With nearly 2,000 participants involved in the study, we have now assembled the largest international cohort across three continents of people with TNBC in which the primary treatment was surgery without chemotherapy."

"The results of this study could lead to a recommendation to include TILs in the pathology reports of early-stage TNBC worldwide, as it has the potential to inform clinicians and patients when they discuss treatment options," says Dr. Salgado.

Furthermore, this biomarker would only require a visual evaluation by a pathologist looking through a microscope, meaning there are no additional costs associated with identifying the presence of immune cells. This could be particularly beneficial to regions with limited resources, adds Dr. Leon-Ferre.

Most people with early-stage TNBC undergo chemotherapy either before or after surgery, including people with stage 1 breast cancer. Most people receive multiple chemotherapy drugs in combination, which can cause significant side effects. Currently, the main factors taken into consideration to determine the course of chemotherapy treatment for each person are the tumor size and the presence of lymph node metastases. However, the authors identified that the number of TILs further influences the risk of future recurrence.

The researchers plan to evaluate TILs as biomarkers in prospective clinical trials evaluating chemotherapy selection based on TIL levels. Ongoing efforts to conduct additional research with other potential biomarkers are underway.

For a complete list of authors, disclosures and funding, see the full paper here .  

About Mayo Clinic Comprehensive Cancer Center Designated as a comprehensive cancer center by the  National Cancer Institute ,  Mayo Clinic Comprehensive Cancer Center  is defining new boundaries in possibility, focusing on patient-centered care, developing novel treatments, training future generations of cancer experts and bringing cancer research to communities. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs that are changing approaches to cancer prevention, screening and treatment, and improving the lives of cancer survivors.

About Mayo Clinic Mayo Clinic  is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the  Mayo Clinic News Network  for additional Mayo Clinic news.

About Gustave Roussy Ranked as the leading French and European Cancer Centre and fourth in the world, Gustave Roussy is a centre with comprehensive expertise and is devoted entirely to patients suffering with cancer. The Institute is a founding member of the Paris Saclay Cancer Cluster. It is a source of diagnostic and therapeutic advances. It caters for almost 50,000 patients per year and its approach is one that integrates research, patient care and teaching. It is specialized in the treatment of rare cancers and complex tumors and it treats all cancers in patients of any age. Its care is personalized and combines the most advanced medical methods with an appreciation of the patient’s human requirements. In addition to the quality of treatment offered, the physical, psychological and social aspects of the patient’s life are respected. 4,100 professionals work on its two campuses: Villejuif and Chevilly-Larue. Gustave Roussy brings together the skills, which are essential for the highest quality research in oncology: 40% of patients treated are included in clinical studies. For further information: www.gustaveroussy.fr/en , Twitter , Facebook , LinkedIn , Instagram

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, [email protected]
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Social Media Use Is Linked to Brain Changes in Teens, Research Finds

Teens who frequently checked social media showed an increasing sensitivity to peer feedback, although the cause of the changes was not clear.

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By Ellen Barry

The effect of social media use on children is a fraught area of research, as parents and policymakers try to ascertain the results of a vast experiment already in full swing. Successive studies have added pieces to the puzzle, fleshing out the implications of a nearly constant stream of virtual interactions beginning in childhood.

A new study by neuroscientists at the University of North Carolina tries something new, conducting successive brain scans of middle schoolers between the ages of 12 and 15, a period of especially rapid brain development.

The researchers found that children who habitually checked their social media feeds at around age 12 showed a distinct trajectory, with their sensitivity to social rewards from peers heightening over time. Teenagers with less engagement in social media followed the opposite path, with a declining interest in social rewards.

The study , published on Tuesday in JAMA Pediatrics, is among the first attempts to capture changes to brain function correlated with social media use over a period of years.

The study has important limitations, the authors acknowledge. Because adolescence is a period of expanding social relationships, the brain differences could reflect a natural pivot toward peers, which could be driving more frequent social media use.

“We can’t make causal claims that social media is changing the brain,” said Eva H. Telzer, an associate professor of psychology and neuroscience at the University of North Carolina, Chapel Hill, and one of the authors of the study.

But, she added, “teens who are habitually checking their social media are showing these pretty dramatic changes in the way their brains are responding, which could potentially have long-term consequences well into adulthood, sort of setting the stage for brain development over time.”

A team of researchers studied an ethnically diverse group of 169 students in the sixth and seventh grades from a middle school in rural North Carolina, splitting them into groups according to how often they reported checking Facebook, Instagram and Snapchat feeds.

At around age 12, the students already showed distinct patterns of behavior. Habitual users reported checking their feeds 15 or more times a day; moderate users checked between one and 14 times; nonhabitual users checked less than once a day.

The subjects received full brain scans three times, at approximately one-year intervals, as they played a computerized game that delivered rewards and punishment in the form of smiling or scowling peers.

While carrying out the task, the frequent checkers showed increasing activation of three brain areas: reward-processing circuits, which also respond to experiences like winning money or risk-taking behavior; brain regions that determine salience, picking out what stands out in the environment; and the prefrontal cortex, which helps with regulation and control.

The results showed that “teens who grow up checking social media more often are becoming hypersensitive to feedback from their peers,” Dr. Telzer said.

The findings do not capture the magnitude of the brain changes, only their trajectory. And it is unclear, authors said, whether the changes are beneficial or harmful. Social sensitivity could be adaptive, showing that the teenagers are learning to connect with others; or it could lead to social anxiety and depression if social needs are not met.

Researchers in the field of social media warned against drawing sweeping conclusions based on the findings.

“They are showing that the way you use it at one point in your life does influence the way your brain develops, but we don’t know by how much, or whether it’s good or bad,” said Jeff Hancock, the founding director of the Stanford Social Media Lab, who was not involved in the study. He said that many other variables could have contributed to these changes.

“What if these people joined a new team — a hockey team or a volleyball team — so started getting a lot more social interaction?” he said. It could be, he added, that the researchers are “picking up on the development of extroversion, and extroverts are more likely to check their social media.”

He described the paper as “a very sophisticated piece of work,” contributing to research that has emerged recently showing that sensitivity to social media varies from person to person.

“There are people who have a neurological state that means they are more likely to be attracted to checking frequently,” he said. “We’re not all the same, and we should stop thinking that social media is the same for everyone.”

Over the last decade, social media has remapped the central experiences of adolescence, a period of rapid brain development.

Nearly all American teenagers engage through social media, with 97 percent going online every day and 46 percent reporting that they are online “almost constantly,” according to the Pew Research Center. Black and Latino adolescents spend more hours on social media than their white counterparts, research has shown.

Researchers have documented a range of effects on children’s mental health. Some studies have linked use of social media with depression and anxiety, while others found little connection. A 2018 study of lesbian, gay and bisexual teenagers found that social media provided them validation and support, but also exposed them to hate speech.

Experts who reviewed the study said that because the researchers measured students’ social media use only once, around age 12, it was impossible to know how it changed over time, or to rule out other factors that might also affect brain development.

Without more information about other aspects of the students’ lives, “it is challenging to discern how specific differences in brain development are to social media checking,” said Adriana Galvan, a specialist in adolescent brain development at the University of California Los Angeles, who was not involved in the study.

Jennifer Pfeifer, a professor of psychology at the University of Oregon and co-director of the National Scientific Council on Adolescence , said, “All experience accumulates and is reflected in the brain.”

“I think you want to put it into this context,” she said. “So many other experiences that adolescents have will also be changing the brain. So we don’t want to get into some kind of moral panic about the idea that social media is use is changing adolescents’ brains.”

Dr. Telzer, one of the study’s authors, described the rising sensitivity to social feedback as “neither good nor bad.”

“It’s helping them connect to others and obtain rewards from the things that are common in their social world, which is engaging in social interactions online,” she said.

“This is the new norm,” she added. “Understanding how this new digital world is influencing teens is important. It may be associated with changes in the brain, but that may be for good or for bad. We don’t necessarily know the long-term implications yet.”

Ellen Barry covers mental health. She has served as The Times’s Boston bureau chief, London-based chief international correspondent and bureau chief in Moscow and New Delhi. She was part of a team that won the 2011 Pulitzer Prize for International Reporting. More about Ellen Barry

A Parent’s Guide to Kids and Social Media

Does your child have an unhealthy relationship with social media? This is what problematic use could look like .

We asked experts for one practical strategy that parents can use with their kids to help mitigate the harms of social media. Here’s what they told us .

There are many tools that allow parents to monitor and set limits on their children’s screen time. Here’s what to know about them .

If you’ve already given your teen full access to social media, these three strategies can help them cut back .

Is social media addictive? Here is what the science says .

A new book argues that banning social media isn’t the answer to online safety. Instead, the author says parents should emphasize the importance of digital literacy and privacy .

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The new science of death: ‘There’s something happening in the brain that makes no sense’

New research into the dying brain suggests the line between life and death may be less distinct than previously thought

P atient One was 24 years old and pregnant with her third child when she was taken off life support. It was 2014. A couple of years earlier, she had been diagnosed with a disorder that caused an irregular heartbeat, and during her two previous pregnancies she had suffered seizures and faintings. Four weeks into her third pregnancy, she collapsed on the floor of her home. Her mother, who was with her, called 911. By the time an ambulance arrived, Patient One had been unconscious for more than 10 minutes. Paramedics found that her heart had stopped.

After being driven to a hospital where she couldn’t be treated, Patient One was taken to the emergency department at the University of Michigan. There, medical staff had to shock her chest three times with a defibrillator before they could restart her heart. She was placed on an external ventilator and pacemaker, and transferred to the neurointensive care unit, where doctors monitored her brain activity. She was unresponsive to external stimuli, and had a massive swelling in her brain. After she lay in a deep coma for three days, her family decided it was best to take her off life support. It was at that point – after her oxygen was turned off and nurses pulled the breathing tube from her throat – that Patient One became one of the most intriguing scientific subjects in recent history.

For several years, Jimo Borjigin, a professor of neurology at the University of Michigan, had been troubled by the question of what happens to us when we die. She had read about the near-death experiences of certain cardiac-arrest survivors who had undergone extraordinary psychic journeys before being resuscitated. Sometimes, these people reported travelling outside of their bodies towards overwhelming sources of light where they were greeted by dead relatives. Others spoke of coming to a new understanding of their lives, or encountering beings of profound goodness. Borjigin didn’t believe the content of those stories was true – she didn’t think the souls of dying people actually travelled to an afterworld – but she suspected something very real was happening in those patients’ brains. In her own laboratory, she had discovered that rats undergo a dramatic storm of many neurotransmitters, including serotonin and dopamine, after their hearts stop and their brains lose oxygen. She wondered if humans’ near-death experiences might spring from a similar phenomenon, and if it was occurring even in people who couldn’t be revived.

Dying seemed like such an important area of research – we all do it, after all – that Borjigin assumed other scientists had already developed a thorough understanding of what happens to the brain in the process of death. But when she looked at the scientific literature, she found little enlightenment. “To die is such an essential part of life,” she told me recently. “But we knew almost nothing about the dying brain.” So she decided to go back and figure out what had happened inside the brains of people who died at the University of Michigan neurointensive care unit. Among them was Patient One.

At the time Borjigin began her research into Patient One, the scientific understanding of death had reached an impasse. Since the 1960s, advances in resuscitation had helped to revive thousands of people who might otherwise have died. About 10% or 20% of those people brought with them stories of near-death experiences in which they felt their souls or selves departing from their bodies. A handful of those patients even claimed to witness, from above, doctors’ attempts to resuscitate them. According to several international surveys and studies, one in 10 people claims to have had a near-death experience involving cardiac arrest, or a similar experience in circumstances where they may have come close to death. That’s roughly 800 million souls worldwide who may have dipped a toe in the afterlife.

As remarkable as these near-death experiences sounded, they were consistent enough that some scientists began to believe there was truth to them: maybe people really did have minds or souls that existed separately from their living bodies. In the 1970s, a small network of cardiologists, psychiatrists, medical sociologists and social psychologists in North America and Europe began investigating whether near-death experiences proved that dying is not the end of being, and that consciousness can exist independently of the brain. The field of near-death studies was born.

Over the next 30 years, researchers collected thousands of case reports of people who had had near-death experiences. Meanwhile, new technologies and techniques were helping doctors revive more and more people who, in earlier periods of history, would have almost certainly been permanently deceased. “We are now at the point where we have both the tools and the means to scientifically answer the age-old question: What happens when we die?” wrote Sam Parnia, an accomplished resuscitation specialist and one of the world’s leading experts on near-death experiences, in 2006. Parnia himself was devising an international study to test whether patients could have conscious awareness even after they were found clinically dead.

But by 2015, experiments such as Parnia’s had yielded ambiguous results, and the field of near-death studies was not much closer to understanding death than it had been when it was founded four decades earlier. That’s when Borjigin, together with several colleagues, took the first close look at the record of electrical activity in the brain of Patient One after she was taken off life support. What they discovered – in results reported for the first time last year – was almost entirely unexpected, and has the potential to rewrite our understanding of death.

“I believe what we found is only the tip of a vast iceberg,” Borjigin told me. “What’s still beneath the surface is a full account of how dying actually takes place. Because there’s something happening in there, in the brain, that makes no sense.”

F or all that science has learned about the workings of life, death remains among the most intractable of mysteries. “At times I have been tempted to believe that the creator has eternally intended this department of nature to remain baffling, to prompt our curiosities and hopes and suspicions all in equal measure,” the philosopher William James wrote in 1909.

The first time that the question Borjigin began asking in 2015 was posed – about what happens to the brain during death – was a quarter of a millennium earlier. Around 1740, a French military physician reviewed the case of a famous apothecary who, after a “malign fever” and several blood-lettings, fell unconscious and thought he had travelled to the Kingdom of the Blessed . The physician speculated that the apothecary’s experience had been caused by a surge of blood to the brain. But between that early report and the mid-20th century, scientific interest in near-death experiences remained sporadic.

In 1892, the Swiss climber and geologist Albert Heim collected the first systematic accounts of near-death experiences from 30 fellow climbers who had suffered near-fatal falls. In many cases, the climbers underwent a sudden review of their entire past, heard beautiful music, and “fell in a superbly blue heaven containing roseate cloudlets”, Heim wrote. “Then consciousness was painlessly extinguished, usually at the moment of impact.” There were a few more attempts to do research in the early 20th century, but little progress was made in understanding near-death experiences scientifically. Then, in 1975, an American medical student named Raymond Moody published a book called Life After Life.

In his book, Moody distilled the reports of 150 people who had had intense, life-altering experiences in the moments surrounding a cardiac arrest. Although the reports varied, he found that they often shared one or more common features or themes. The narrative arc of the most detailed of those reports – departing the body and travelling through a long tunnel, having an out-of-body experience, encountering spirits and a being of light, one’s whole life flashing before one’s eyes, and returning to the body from some outer limit – became so canonical that the art critic Robert Hughes could refer to it years later as “the familiar kitsch of near-death experience”. Moody’s book became an international bestseller.

In 1976, the New York Times reported on the burgeoning scientific interest in “life after death” and the “emerging field of thanatology”. The following year, Moody and several fellow thanatologists founded an organisation that became the International Association for Near-Death Studies. In 1981, they printed the inaugural issue of Vital Signs , a magazine for the general reader that was largely devoted to stories of near-death experiences. The following year they began producing the field’s first peer-reviewed journal, which became the Journal of Near-Death Studies . The field was growing, and taking on the trappings of scientific respectability. Reviewing its rise in 1988, the British Journal of Psychiatry captured the field’s animating spirit: “A grand hope has been expressed that, through NDE research, new insights can be gained into the ageless mystery of human mortality and its ultimate significance, and that, for the first time, empirical perspectives on the nature of death may be achieved.”

But near-death studies was already splitting into several schools of belief, whose tensions continue to this day. One influential camp was made up of spiritualists, some of them evangelical Christians, who were convinced that near-death experiences were genuine sojourns in the land of the dead and divine. As researchers, the spiritualists’ aim was to collect as many reports of near-death experience as possible, and to proselytise society about the reality of life after death. Moody was their most important spokesman; he eventually claimed to have had multiple past lives and built a “psychomanteum” in rural Alabama where people could attempt to summon the spirits of the dead by gazing into a dimly lit mirror.

The second, and largest, faction of near-death researchers were the parapsychologists, those interested in phenomena that seemed to undermine the scientific orthodoxy that the mind could not exist independently of the brain. These researchers, who were by and large trained scientists following well established research methods, tended to believe that near-death experiences offered evidence that consciousness could persist after the death of the individual. Many of them were physicians and psychiatrists who had been deeply affected after hearing the near-death stories of patients they had treated in the ICU. Their aim was to find ways to test their theories of consciousness empirically, and to turn near-death studies into a legitimate scientific endeavour.

Finally, there emerged the smallest contingent of near-death researchers, who could be labelled the physicalists. These were scientists, many of whom studied the brain, who were committed to a strictly biological account of near-death experiences. Like dreams, the physicalists argued, near-death experiences might reveal psychological truths, but they did so through hallucinatory fictions that emerged from the workings of the body and the brain. (Indeed, many of the states reported by near-death experiencers can apparently be achieved by taking a hero’s dose of ketamine.) Their basic premise was: no functioning brain means no consciousness, and certainly no life after death. Their task, which Borjigin took up in 2015, was to discover what was happening during near-death experiences on a fundamentally physical level.

Slowly, the spiritualists left the field of research for the loftier domains of Christian talk radio, and the parapsychologists and physicalists started bringing near-death studies closer to the scientific mainstream. Between 1975, when Moody published Life After Life, and 1984, only 17 articles in the PubMed database of scientific publications mentioned near-death experiences. In the following decade, there were 62. In the most recent 10-year span, there were 221. Those articles have appeared everywhere from the Canadian Urological Association Journal to the esteemed pages of The Lancet.

Today, there is a widespread sense throughout the community of near-death researchers that we are on the verge of great discoveries. Charlotte Martial, a neuroscientist at the University of Liège in Belgium who has done some of the best physicalist work on near-death experiences, hopes we will soon develop a new understanding of the relationship between the internal experience of consciousness and its outward manifestations, for example in coma patients. “We really are in a crucial moment where we have to disentangle consciousness from responsiveness, and maybe question every state that we consider unconscious,” she told me. Parnia, the resuscitation specialist, who studies the physical processes of dying but is also sympathetic to a parapsychological theory of consciousness, has a radically different take on what we are poised to find out. “I think in 50 or 100 years time we will have discovered the entity that is consciousness,” he told me. “It will be taken for granted that it wasn’t produced by the brain, and it doesn’t die when you die.”

I f the field of near-death studies is at the threshold of new discoveries about consciousness and death, it is in large part because of a revolution in our ability to resuscitate people who have suffered cardiac arrest. Lance Becker has been a leader in resuscitation science for more than 30 years. As a young doctor attempting to revive people through CPR in the mid-1980s, senior physicians would often step in to declare patients dead. “At a certain point, they would just say, ‘OK, that’s enough. Let’s stop. This is unsuccessful. Time of death: 1.37pm,’” he recalled recently. “And that would be the last thing. And one of the things running through my head as a young doctor was, ‘Well, what really happened at 1.37?’”

In a medical setting, “clinical death” is said to occur at the moment the heart stops pumping blood, and the pulse stops. This is widely known as cardiac arrest. (It is different from a heart attack, in which there is a blockage in a heart that’s still pumping.) Loss of oxygen to the brain and other organs generally follows within seconds or minutes, although the complete cessation of activity in the heart and brain – which is often called “flatlining” or, in the case of the latter, “brain death” – may not occur for many minutes or even hours.

For almost all people at all times in history, cardiac arrest was basically the end of the line. That began to change in 1960, when the combination of mouth-to-mouth ventilation, chest compressions and external defibrillation known as cardiopulmonary resuscitation, or CPR, was formalised. Shortly thereafter, a massive campaign was launched to educate clinicians and the public on CPR’s basic techniques , and soon people were being revived in previously unthinkable, if still modest, numbers.

As more and more people were resuscitated, scientists learned that, even in its acute final stages, death is not a point, but a process. After cardiac arrest, blood and oxygen stop circulating through the body, cells begin to break down, and normal electrical activity in the brain gets disrupted. But the organs don’t fail irreversibly right away, and the brain doesn’t necessarily cease functioning altogether. There is often still the possibility of a return to life. In some cases, cell death can be stopped or significantly slowed, the heart can be restarted, and brain function can be restored. In other words, the process of death can be reversed.

It is no longer unheard of for people to be revived even six hours after being declared clinically dead. In 2011, Japanese doctors reported the case of a young woman who was found in a forest one morning after an overdose stopped her heart the previous night; using advanced technology to circulate blood and oxygen through her body, the doctors were able to revive her more than six hours later, and she was able to walk out of the hospital after three weeks of care. In 2019, a British woman named Audrey Schoeman who was caught in a snowstorm spent six hours in cardiac arrest before doctors brought her back to life with no evident brain damage.

“I don’t think there’s ever been a more exciting time for the field,” Becker told me. “We’re discovering new drugs, we’re discovering new devices, and we’re discovering new things about the brain.”

T he brain – that’s the tricky part. In January 2021, as the Covid-19 pandemic was surging toward what would become its deadliest week on record, Netflix released a documentary series called Surviving Death . In the first episode, some of near-death studies’ most prominent parapsychologists presented the core of their arguments for why they believe near-death experiences show that consciousness exists independently of the brain. “When the heart stops, within 20 seconds or so, you get flatlining, which means no brain activity,” Bruce Greyson, an emeritus professor of psychiatry at the University of Virginia and one of the founding members of the International Association for Near-Death Studies, says in the documentary. “And yet,” he goes on to claim, “people have near-death experiences when they’ve been (quote) ‘flatlined’ for longer than that.”

That is a key tenet of the parapsychologists’ arguments: if there is consciousness without brain activity, then consciousness must dwell somewhere beyond the brain. Some of the parapsychologists speculate that it is a “non-local” force that pervades the universe, like electromagnetism. This force is received by the brain, but is not generated by it, the way a television receives a broadcast.

In order for this argument to hold, something else has to be true: near-death experiences have to happen during death, after the brain shuts down. To prove this, parapsychologists point to a number of rare but astounding cases known as “veridical” near-death experiences, in which patients seem to report details from the operating room that they might have known only if they had conscious awareness during the time that they were clinically dead. Dozens of such reports exist. One of the most famous is about a woman who apparently travelled so far outside her body that she was able to spot a shoe on a window ledge in another part of the hospital where she went into cardiac arrest; the shoe was later reportedly found by a nurse.

At the very least, Parnia and his colleagues have written, such phenomena are “inexplicable through current neuroscientific models”. Unfortunately for the parapsychologists, however, none of the reports of post-death awareness holds up to strict scientific scrutiny. “There are many claims of this kind, but in my long decades of research into out-of-body and near-death experiences I never met any convincing evidence that this is true,” Sue Blackmore, a well-known researcher into parapsychology who had her own near-death experience as a young woman in 1970, has written .

The case of the shoe, Blackmore pointed out, relied solely on the report of the nurse who claimed to have found it. That’s far from the standard of proof the scientific community would require to accept a result as radical as that consciousness can travel beyond the body and exist after death. In other cases, there’s not enough evidence to prove that the experiences reported by cardiac arrest survivors happened when their brains were shut down, as opposed to in the period before or after they supposedly “flatlined”. “So far, there is no sufficiently rigorous, convincing empirical evidence that people can observe their surroundings during a near-death experience,” Charlotte Martial, the University of Liège neuroscientist, told me.

The parapsychologists tend to push back by arguing that even if each of the cases of veridical near-death experiences leaves room for scientific doubt, surely the accumulation of dozens of these reports must count for something. But that argument can be turned on its head: if there are so many genuine instances of consciousness surviving death, then why should it have so far proven impossible to catch one empirically?

P erhaps the story to be written about near-death experiences is not that they prove consciousness is radically different from what we thought it was. Instead, it is that the process of dying is far stranger than scientists ever suspected. The spiritualists and parapsychologists are right to insist that something deeply weird is happening to people when they die, but they are wrong to assume it is happening in the next life rather than this one. At least, that is the implication of what Jimo Borjigin found when she investigated the case of Patient One.

In the moments after Patient One was taken off oxygen, there was a surge of activity in her dying brain. Areas that had been nearly silent while she was on life support suddenly thrummed with high-frequency electrical signals called gamma waves. In particular, the parts of the brain that scientists consider a “hot zone” for consciousness became dramatically alive. In one section, the signals remained detectable for more than six minutes. In another, they were 11 to 12 times higher than they had been before Patient One’s ventilator was removed.

“As she died, Patient One’s brain was functioning in a kind of hyperdrive,” Borjigin told me. For about two minutes after her oxygen was cut off, there was an intense synchronisation of her brain waves, a state associated with many cognitive functions, including heightened attention and memory. The synchronisation dampened for about 18 seconds, then intensified again for more than four minutes. It faded for a minute, then came back for a third time.

In those same periods of dying, different parts of Patient One’s brain were suddenly in close communication with each other. The most intense connections started immediately after her oxygen stopped, and lasted for nearly four minutes. There was another burst of connectivity more than five minutes and 20 seconds after she was taken off life support. In particular, areas of her brain associated with processing conscious experience – areas that are active when we move through the waking world, and when we have vivid dreams – were communicating with those involved in memory formation. So were parts of the brain associated with empathy. Even as she slipped irrevocably deeper into death, something that looked astonishingly like life was taking place over several minutes in Patient One’s brain.

Those glimmers and flashes of something like life contradict the expectations of almost everyone working in the field of resuscitation science and near-death studies. The predominant belief – expressed by Greyson, the psychiatrist and co-founder of the International Association of Near Death Studies, in the Netflix series Surviving Death – was that as soon as oxygen stops going to the brain, neurological activity falls precipitously. Although a few earlier instances of brain waves had been reported in dying human brains, nothing as detailed and complex as what occurred in Patient One had ever been detected.

Given the levels of activity and connectivity in particular regions of her dying brain, Borjigin believes it’s likely that Patient One had a profound near-death experience with many of its major features: out-of-body sensations, visions of light, feelings of joy or serenity, and moral re-evaluations of one’s life. Of course, Patient One did not recover, so no one can prove that the extraordinary happenings in her dying brain had experiential counterparts. Greyson and one of the other grandees of near-death studies, a Dutch cardiologist named Pim van Lommel, have asserted that Patient One’s brain activity can shed no light on near-death experiences because her heart hadn’t fully flatlined, but that is a self-defeating argument: there is no rigorous empirical evidence that near-death experiences occur in people whose hearts have completely stopped.

At the very least, Patient One’s brain activity – and the activity in the dying brain of another patient Borjigin studied, a 77-year-old woman known as Patient Three – seems to close the door on the argument that the brain always and nearly immediately ceases to function in a coherent manner in the moments after clinical death. “The brain, contrary to everybody’s belief, is actually super active during cardiac arrest,” Borjigin said. Death may be far more alive than we ever thought possible.

B orjigin believes that understanding the dying brain is one of the “holy grails” of neuroscience. “The brain is so resilient, the heart is so resilient, that it takes years of abuse to kill them,” she pointed out. “Why then, without oxygen, can a perfectly healthy person die within 30 minutes, irreversibly?” Although most people would take that result for granted, Borjigin thinks that, on a physical level, it actually makes little sense.

Borjigin hopes that understanding the neurophysiology of death can help us to reverse it. She already has brain activity data from dozens of deceased patients that she is waiting to analyse. But because of the paranormal stigma associated with near-death studies, she says, few research agencies want to grant her funding. “Consciousness is almost a dirty word amongst funders,” she added. “Hardcore scientists think research into it should belong to maybe theology, philosophy, but not in hardcore science. Other people ask, ‘What’s the use? The patients are gonna die anyway, so why study that process? There’s nothing you can do about it.’”

Evidence is already emerging that even total brain death may someday be reversible. In 2019, scientists at Yale University harvested the brains of pigs that had been decapitated in a commercial slaughterhouse four hours earlier. Then they perfused the brains for six hours with a special cocktail of drugs and synthetic blood. Astoundingly, some of the cells in the brains began to show metabolic activity again, and some of the synapses even began firing. The pigs’ brain scans didn’t show the widespread electrical activity that we typically associate with sentience or consciousness. But the fact that there was any activity at all suggests the frontiers of life may one day extend much, much farther into the realms of death than most scientists currently imagine.

Other serious avenues of research into near-death experience are ongoing. Martial and her colleagues at the University of Liège are working on many issues relating to near-death experiences. One is whether people with a history of trauma, or with more creative minds, tend to have such experiences at higher rates than the general population. Another is on the evolutionary biology of near-death experiences. Why, evolutionarily speaking, should we have such experiences at all? Martial and her colleagues speculate that it may be a form of the phenomenon known as thanatosis, in which creatures throughout the animal kingdom feign death to escape mortal dangers. Other researchers have proposed that the surge of electrical activity in the moments after cardiac arrest is just the final seizure of a dying brain, or have hypothesised that it’s a last-ditch attempt by the brain to restart itself, like jump-starting the engine on a car.

Meanwhile, in parts of the culture where enthusiasm is reserved not for scientific discovery in this world, but for absolution or benediction in the next, the spiritualists, along with sundry other kooks and grifters, are busily peddling their tales of the afterlife. Forget the proverbial tunnel of light: in America in particular, a pipeline of money has been discovered from death’s door, through Christian media, to the New York Times bestseller list and thence to the fawning, gullible armchairs of the nation’s daytime talk shows. First stop, paradise; next stop, Dr Oz.

But there is something that binds many of these people – the physicalists, the parapsychologists, the spiritualists – together. It is the hope that by transcending the current limits of science and of our bodies, we will achieve not a deeper understanding of death, but a longer and more profound experience of life. That, perhaps, is the real attraction of the near-death experience: it shows us what is possible not in the next world, but in this one.

• The long read
• Death and dying
• Consciousness
• Neuroscience

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Mpox Vaccine Protection Quickly Fades; Boosters Necessary: Study

By Dennis Thompson HealthDay Reporter

MONDAY, April 1, 2024 (HealthDay News) -- Vaccine protection against mpox fades quickly in the human immune system, even in people who’ve received the full two-dose regimen, a new real-world study shows.

Antibody levels fell to low or near zero within the first few months of getting the vaccine, unless the person had previously received a smallpox vaccine, scientists reported Saturday at the European Congress of Clinical Microbiology and Infectious Diseases in Barcelona.

In the study, less than half of men without prior smallpox vaccination had any detectible antibodies to mpox (formerly known as monkeypox) 28 days after getting their second jab, the findings showed.

“The results presented here indicate that long-term protective immunity might need a booster dose for its maintenance,” said researcher Dr. Klara Sonden , deputy state epidemiologist for the Public Health Agency of Sweden.

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The researchers noted that no clinical trials are underway to investigate a booster dose for the mpox vaccine, and that such trials are needed to inform public health guidelines.

Mpox cases have surged in the latter half of 2023 in European countries, following a sharp decline in the months after the vaccine was approved there in late 2022, researchers said.

A case study also presented at the meeting illustrates the point of the new study: A 35-year-old man had a breakthrough mpox infection despite having received two doses of Jynneos vaccine.

In January 2024, two years after getting the vaccine, the man attended a Vienna event at which he had multiple sexual partners, researchers said.

Five days later, the patient reported fever, chills, headache, discomfort urinating, bloody diarrhea and itching of his penis and anus, researchers said.

Tests revealed that the man had an active and severe mpox infection. It took 25 days for his scabs to fall off and a swab test to show the infection had ended.

“This was Austria's first monkeypox breakthrough case,” said Dr. Luigi Segagni-Lusignani , of the Public Health Authority in Vienna. “Despite no hospitalization, the clinical course was not less severe than in unvaccinated patients, with longer disease duration and higher scores on the monkeypox severity scale.”

For the antibody study, researchers followed up on 100 gay men who went to a sexual health clinic in Stockholm to receive the European mpox vaccine, Vaccinia Ankara–Bavarian Nordic.

Only men who’d been previously vaccinated against smallpox continued to carry potentially protective levels of mpox antibodies when retested at 28 days, researchers found.

Researchers believe that previous smallpox vaccination helped immune “memory” cells better adapt to the mpox virus, since the men already carried antibodies against smallpox.

“Monkeypox vaccination results in neutralizing antibodies only in a proportion of vaccinees, and a significant decline occurs already during the first month post-vaccination,” Sonden’s research team concluded.

The largest sexual health clinic in Sweden is planning to perform a randomized clinical trial of a booster dose, researchers said. However, there have been few mpox cases in Sweden.

Because the findings from the two studies were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.

More information

The World Health Organization has more about mpox .

SOURCE: European Congress of Clinical Microbiology and Infectious Diseases, news release, March 30, 2024

Copyright © 2024 HealthDay . All rights reserved.

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Striking findings from 2021.

As 2021 draws to a close, here are some of Pew Research Center’s most striking research findings from the past year. These 15 findings cover subjects ranging from extreme weather to the COVID-19 pandemic and ongoing demographic shifts in the United States. And they represent just a small slice of the year’s full list of research publications .

A growing share of childless Americans say it is unlikely they will ever have children, an October survey found. Some 44% of non-parents ages 18 to 49 say it is not too or not at all likely that they will have children someday, an increase from the 37% who said the same in 2018. Meanwhile, 74% of adults younger than 50 who are already parents say they are unlikely to have more kids, virtually unchanged since 2018.

What’s behind the growing share of non-parents younger than 50 who expect not to have children? A majority (56%) say a major reason is that they just don’t want to. Among those who point to some other reason, about two-in-ten (19%) say it’s due to medical reasons, 17% say it’s for financial reasons and 15% say it’s because they do not have a partner. Roughly one-in-ten point to their age or their partner’s age (10%), or to the state of the world (9%).

Around seven-in-ten U.S. adults (72%) said in an August survey that they personally know someone who has been hospitalized or died from COVID-19. As has been the case throughout the COVID-19 outbreak , larger shares of Black (82%) and Hispanic (78%) adults than White (70%) and English-speaking Asian adults (64%) said they personally know someone who had been hospitalized or died as a result of the coronavirus.

Across other major demographic groups, there were modest or no differences in the shares who say this. Democrats and Democratic-leaning independents, for example, were about as likely as Republicans and GOP leaners to say they know someone who had been hospitalized or died (74% and 71%, respectively).

More than 600,000 Americans had died from the virus at the time of the August survey. Since then, the death toll has risen to more than 800,000 .

Americans voted in record numbers in the 2020 presidential election, as turnout rose in every state, according to a January analysis by the Center. Nearly two-thirds of the estimated number of eligible voters and more than six-in-ten people of voting age cast ballots in the election.

Nationwide, presidential election turnout was about 7 percentage points higher than in 2016, regardless of which of three different turnout metrics we looked at. Turnout rates increased in every state compared with 2016, but of the 10 states where it rose the most, seven conducted the vote entirely or mostly by mail.

Minnesota had the highest turnout of any state, with 79.4% of estimated eligible voters casting ballots for the presidential election. Colorado, Maine and Wisconsin all followed close behind at about 75.5%; Washington state, at 75.2%, rounded out the top five. The lowest-turnout states were Tennessee (59.6% of estimated eligible voters), Hawaii and West Virginia (57% each), Arkansas (55.9%) and Oklahoma (54.8%).

About eight-in-ten Asian Americans say violence against them is increasing in the U.S., an April survey found. The survey was fielded after the  fatal shooting  of six Asian women and two other people in the Atlanta area in March, and following  other assaults on Asian Americans .

Amid widespread reports of discrimination and violence against Asian Americans during the coronavirus outbreak , 45% of Asian adults said they had experienced at least one of five specific types of incidents since the start of the pandemic.

Around a third (32%) said they had feared someone might threaten or physically attack them – a greater share than among people in other racial or ethnic groups who said this. Some 27% of Asian adults said people had acted as if they were uncomfortable around them. Another 27% said they had been subject to slurs or jokes. Lower shares said someone had made a remark that they should go back to their home country (16%) or that they were to blame for the coronavirus outbreak (14%).

At the same time, 32% said someone has expressed support for them since the start of the pandemic.

Across 16 publics surveyed in spring 2021 , a median of just 17% of adults said democracy in the U.S. is a good example for other countries to follow. A median of 57% said American democracy used to be a good example for other countries to follow but has not been in recent years. A median of 23% said American democracy has never been a good example for other countries to follow.

Americans largely shared the view that their country is no longer a good model of democracy: 72% said U.S. democracy used to be a good example for others to follow but has not been recently. Democrats and Democratic leaners were twice as likely as their Republican and GOP leaning counterparts to say the U.S. has never been a good model of democracy.

More broadly, the U.S. political system also received generally lukewarm ratings across the 16 advanced economies surveyed. People were split on how the  system is functioning , with a median of 50% saying it works well and 48% who disagreed.

In just five years, the percentage of Republicans with at least some trust in national news organizations has fallen by half – dropping from 70% in 2016 to 35% this year, a June survey found.  

Democrats remain far more likely than Republicans to say they have a lot or some trust in the information that comes from national news organizations (78% vs. 35%). The 43-point partisan gap is the widest measured since at least 2016. 

Women in the U.S. are now more likely than men to have a four-year college degree, according to a November analysis . Around four-in-ten women ages 25 and older (39%) have a bachelor’s degree, compared with a slightly smaller share of men in the same age group (37%). Among those ages 25 to 34 specifically, women are now 10 percentage points more likely than men to have a bachelor’s degree (46% vs. 36%).

The reasons for not completing a four-year degree differ for men and women, according to an accompanying survey of adults who do not have such a degree and are not currently enrolled in college. Men are more likely than women to point to factors that have more to do with personal choice. Roughly a third of men without a bachelor’s degree (34%), for example, say a major reason they didn’t complete college is that they just didn’t want to. Only one-in-four women say the same.

Most Democrats in the U.S. see voting as a fundamental right, while most Republicans view it as a privilege that comes with responsibilities, according to a July survey .

The vast majority of Democrats (78%) say voting is a “fundamental right for every adult U.S. citizen and should not be restricted in any way.” Two-thirds of Republicans say voting is “a privilege that comes with responsibilities and can be limited if adult U.S. citizens don’t meet some requirements.”

Overall, a majority of Americans (57%) say voting is a fundamental right that should not be restricted while 42% express the view that voting is a privilege that comes with responsibilities.

About three-in-ten Americans are religiously unaffiliated, a 10 percentage point rise from a decade ago, according to a survey conducted between May and August . Currently, 29% of U.S. adults are religious “nones” – those who describe themselves as atheists, agnostics or “nothing in particular.” By comparison, 16% described themselves this way when the Center first asked the question in 2007.

Christians continue to make up a majority of the U.S. population (63%), but their share is 12 points lower in 2021 than it was in 2011. Christians now outnumber religious “nones” by a ratio of a little more than two-to-one. In 2007, when the Center began asking its current question about religious identity, Christians outnumbered “nones” by almost five-to-one (78% vs. 16%).

Democrats and Republicans were deeply divided over former President Donald Trump’s role in the events of Jan. 6, according to a March survey .

The vast majority of Democrats (87%) said Trump’s conduct surrounding the riot at the U.S. Capitol was wrong and that senators should have voted to convict him during his impeachment trial, while just 11% of Republicans said the same. Around two-thirds of Republicans (65%) said Trump’s conduct was not wrong and that he should not have been impeached by the U.S. House of Representatives; just 4% of Democrats said the same.

Overall, about half of Americans (52%) said Trump’s conduct was wrong and that senators should have voted to convict him, while 31% said his conduct was not wrong and that he should not have been impeached by the U.S. House. Some Americans (15%) said Trump’s conduct was wrong but that senators should not have voted to convict him.

For the first time, the number of Americans who identify as non-Hispanic White declined between 2010 and 2020, according to the Center’s analysis of U.S. Census Bureau data. The White population of the United States declined by about 5.1 million people during that timespan.

In a related Pew Research Center survey in July , about six-in-ten U.S. adults (61%) said the decline in the White share of the U.S. population is neither good nor bad for society. About two-in-ten (22%) said it is bad, including 9% who said it is very bad. Slightly fewer (15%) said it is good, including 7% who said it is very good.

Only 34% of U.S. adults under the age of 30 now get TV through cable or satellite, down from 65% in 2015, according to a survey fielded in January and February . There were declines in other age groups, too, with decreases of 27 percentage points among those ages 30 to 49 and 14 points among those 50 to 64.

Adults under 30 who are nonsubscribers are also much more likely than older nonsubscribers to have never received TV at home via cable or satellite – and to say they don’t currently subscribe because they can find the content they want online instead.

Two-thirds of U.S. adults say extreme weather events across the country have been occurring more often than in the past, a September survey found. Far fewer Americans say they’re happening about as often (28%), and only 4% say they are happening less often.

Nearly half of Americans (46%) also say the area where they live has had an extreme weather event over the past 12 months, according to the same survey.

Nearly three-quarters of U.S. adults (73%) in the West South Central  census division , which includes Texas, Louisiana, Arkansas and Oklahoma, say they’ve experienced extreme weather within the past year. A majority of adults (59%) say the same in the Mid-Atlantic region, which includes Pennsylvania, New York and New Jersey. By contrast, far fewer say they’ve experienced extreme weather in other regions over the past year.

In most census regional divisions, Democrats are more likely than Republicans to report experiencing extreme weather within the past year. Overall, 51% of Democrats say the area where they live has experienced this, compared with 39% of Republicans.

A growing share of U.S. adults are neither married nor living with a partner , according to an October study . In 2019, roughly four-in-ten adults ages 25 to 54 (38%) were unpartnered – that is, neither married nor living with a partner, according to a Pew Research Center analysis of Census Bureau data for that year (the most recent available). This share was up sharply from 29% in 1990. Men were more likely to be unpartnered than women.

All of the growth in the unpartnered population since 1990 has come from a rise in the number who have never been married, although the unpartnered population does include some adults who were previously married (those who are separated, divorced or widowed).

Around the world, more people mention their family as a source of meaning in their lives than any other factor, according to an open-ended survey question the Center posed to people in 17 advanced economies in the spring.

In 14 of the 17 nations surveyed, more people mentioned their family as a source of meaning than anything else. Respondents highlighted their relationships with parents, siblings, children and grandchildren; quality time spent with their relatives; and the pride they get from family members’ accomplishments. Many also expressed the desire to live a life that leaves an improved world for their offspring.

Read the other posts in our striking findings series:

20 striking findings from 2020.

• 19 striking findings from 2019
• 18 striking findings from 2018
• 17 striking findings from 2017
• 16 striking findings from 2016
• 15 striking findings from 2015

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

More than one alcoholic drink a day raises heart disease risk for women

Young to middle-aged women who drink more than one alcoholic beverage a day, on average, were more likely to develop coronary heart disease than people who drink less, according to new research by Kaiser Permanente Northern California.

Women in the study who reported drinking eight or more alcoholic beverages per week were 33 to 51 percent more likely to develop coronary heart disease. And women who binge drink — three alcoholic beverages per day — were 68 percent more likely to develop coronary heart disease than those who drink in moderation, the research showed.

“There has been an increasing prevalence of alcohol use among young and middle-aged women as women may feel they’re protected against heart disease until they’re older, but this study shows that even in that age group, women who drink more than the recommended amount of one drink per day or tend to binge drink, are at risk for coronary heart disease,” Jamal Rana , a cardiologist with the Permanente Medical Group and the study’s lead author, wrote in an email.

The study will be presented at the American College of Cardiology’s Annual Scientific Session in early April. It was funded by the National Institutes of Health (NIH) and the National Institute on Alcohol Abuse and Alcoholism.

Risk is highest for binge drinking

The study used data from 432,265 adults, ages 18 to 65, who received care in the Kaiser Permanente Northern California integrated health organization. The group was composed of about 243,000 men and 189,000 women who filled out routine assessments between 2014 and 2015 in which they reported their alcohol intake. Researchers then looked at the coronary heart disease diagnoses among participants over the four years that followed.

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Participants were divided into three groups, according to their alcohol intake: low (one to two drinks per week), moderate (three to 14 drinks per week for men and three to seven drinks per week for women), or high (15 or more drinks per week for men and eight or more drinks per week for women).

Participants were also categorized as either engaging in binge drinking or not, with binge drinking being defined for men as having more than four drinks in a single day and for women as having more than three drinks a day, in the prior three months. Those who reported no alcohol use were not included.

During the four-year follow-up period, 3,108 participants were diagnosed with coronary heart disease. Higher levels of alcohol consumption were associated with a higher incidence of coronary heart disease. Both men and women who reported heavy episodic drinking, or binge drinking, had the highest risk.

The link between alcohol and coronary heart disease proved to be especially strong among women, the data showed.

Coronary heart disease, also known as coronary artery disease, is the most common type of heart disease in the United States, according to the Centers for Disease Control and Prevention . The disease develops when the arteries of the heart are unable to deliver enough oxygen-rich blood to the heart because of plaque buildup.

Heart disease is the No. 1 killer of American women , according to the CDC. Symptoms differ, and often there are none until people suffer from a heart attack or other problem, an NIH report said.

“There has long been this idea that alcohol is good for the heart, but more and more evidence is challenging that notion,” Rana wrote.

Alcohol is a risk factor for many health issues

Alcohol is actually a toxin to the heart, said Nieca Goldberg , a clinical associate professor of medicine at NYU Grossman School of Medicine and medical director of Atria New York City. Alcohol raises blood pressure , increases the risk for heart rhythm problems, especially during times of binge drinking, is associated with an enlarged heart and is a toxin to the heart muscle , she said.

“I think this is an important study to do because for a while, people thought that alcohol was protective against the heart because of earlier studies that were done in the past. But in fact, we don’t prescribe alcohol to fight heart disease,” she said.

Alcohol use is rising among women

The link between alcohol and heart disease for women is cause for concern, given that alcohol use among women is on the rise. While men used to drink more, studies over the past several years show that gap is closing.

Approximately 13 percent of adult women report binge drinking , with 25 percent of those women saying they do so at least weekly, on average, and 25 percent saying they consume at least six drinks during a binge drinking occasion, according to the CDC. A study in July in JAMA Network Open showed the number of alcohol-related deaths among women was rising at a faster rate than those among men, particularly for people 65 and older.

“I think this raises an important issue, because oftentimes, we think of heavy drinkers as men only. But we have to have heightened awareness that women may be heavy alcohol drinkers,” Goldberg said.

Occasional binge drinking can affect heart health

But it wasn’t just heavy drinkers who were affected, said Mary Ann McLaughlin , cardiologist at the Mount Sinai Fuster Heart Hospital. The study is interesting because it showed that even occasional drinking, if it reaches the level of binge drinking, can affect heart health, she said.

There are those who thought just drinking on the weekends was not a big deal, because they weren’t drinking every day, she said. “But the fact is, if they have more than four drinks as a woman or more than five drinks as a man on one day, in the past three months, they were at increased risk,” McLaughlin said.

Women are more adversely affected by alcohol

It is not a surprise that alcohol poses a higher risk for women than men when it comes to heart health, said C. Noel Bairey Merz , director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai.

Women are more adversely affected than men by a lot of things such as cigarettes and pharmaceuticals and a bottle of beer or a glass of wine, where the dosage for men and women is the same and yet women are smaller, she said, referring to women being physically smaller, on average. Women also metabolize differently, their blood pressure is different, their liver function is different, they even deposit fat differently, Merz said.

“Women and men are built differently,” she said, noting she wasn’t even referring to the obvious reproductive differences. “It could be that in addition to body surface area … there are just pure biological differences in how the alcohol is metabolized.”

It’s possible to mitigate some of the ill effects of alcohol, the experts said. For instance, when people reduce or stop drinking, their blood pressure can improve and some lose weight as alcohol is a sugar that is no longer being consumed.

But issues such as enlargement of the heart happen with long-term heavy drinking, and even if the person stops, that may not improve, they said.

“If one stops drinking, some of the risk could reverse,” McLaughlin said. “The degree of improvement would depend on the age of the person and number of years of drinking.”

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College of Biological Sciences

New research suggests cerebellum may play important role in autism.

NIMH grant will fund studies on how autism risk gene impacts a crucial, but long-overlooked brain area

• by Douglas Fox
• April 02, 2024

Researchers in the College of Biological Sciences have received a grant to study the role of the cerebellum in autism. “We need a more holistic understanding of the brain circuits that drive this disorder,” says Alex Nord, an associate professor of neurobiology, physiology and behavior (NPB), and a researcher at the Center for Neuroscience (CNS). “The cerebellum is a key component that has been largely overlooked until recently.”

Nord partnered with Diasynou Fioravante, also an associate professor of NPB and CNS researcher, and received an R21 grant from the National Institute of Mental Health (NIMH). Announced in November, it will provide $435,000 of funding over the next two years.

With this grant, they will study how a potent autism risk gene, called chromodomain helicase DNA binding protein 8 ( Chd8 ), alters function in the cerebellum, which plays a crucial role in physical movement, and how this drives autism-like behaviors. Their research ties together two emerging trends in autism research.

Surprising discoveries in autism

Researchers long believed that autism involved genes that regulate communications between neurons — especially the synapses, where neurotransmitters carry signals from one neuron to another. But starting in the early 2010s, genetic studies revealed that many autism risk genes actually play a very different role: they encode proteins that reside far from the synapses — in the cell’s nucleus, where the DNA is located, and regulate the activity of hundreds of other genes.

“This was a huge surprise,” says Nord. Chd8 , a typical member of this group, regulates how tightly DNA is packaged and coiled with proteins. As such, it may regulate many genes that govern the formation and function of synapses.

At the same time, another major area of study is advancing the field of autism research. Scientists had assumed that autism was driven by changes in the cerebral cortex, which performs all sorts of tasks, such as recognizing words and faces, and “executive function” — controlling working memory, guiding our spotlight of attention, and making choices — such as whether to act on the impulse to withdraw one's hand when an unfamiliar dog approaches.

But in 2012, researchers reported that mice with mild abnormalities in the cerebellum developed behaviors that resembled autism in humans, such as reduced social interaction with other mice. “The autism field was really rocked by this discovery,” says Fioravante.

People had previously believed that the cerebellum mainly coordinates body movements such as walking, speaking, and typing. “When you damage the cerebellum, it causes profound movement problems, and this probably made it difficult to see more subtle changes in behavior,” says Fioravante.

But she points out that the cerebellum has significant connections with brain structures like the prefrontal cortex, which guides executive function, and limbic system, which regulates sociability, mood and emotions . People with cerebellar injuries often show autism-like changes in their emotions and social interactions.

Then in 2017, Nord and his colleagues reported a discovery that tied together these two intriguing threads : they found that the autism risk gene Chd8 helped guide the development of the cerebellum. Mice with one non-functioning copy of the gene had smaller cerebella.

That discovery “planted the idea of our project,” says Fioravante. She and Nord sat in offices next door to one another. And while Nord studied Chd8 , she worked on the cerebellum. In 2021 they applied for, and received, an earlier NIMH grant, to study how Chd8 influences the development of the cerebellum in mice, before and shortly after birth. Fioravante also received a pilot grant from the Behavioral Health Center of Excellence at UC Davis that launched Chd8 cerebellar studies in adult mice.

Working on these earlier grants from 2021 to 2023, they found that Chd8 mutations in mice triggered changes in the cerebellum and in behavior that resemble what is seen in humans with autism. For example, mice with a mutant copy of the gene had impaired social cognition. While regular mice prefer to explore and interact with mice they have not met before, mice with mutant Chd8 had more restricted interests — preferring mice or objects that they already knew.

New targets for treatment

With the new grant, Fioravante and Nord will pick up where they left off. In adult mice with normally developed cerebella, they will use genetic tools to disrupt Chd8 . They will examine how loss of Chd8 alters gene expression and function in neurons of the cerebellum, and how the connections between it and other brain areas change. They will also study whether disruption of Chd8 causes autism-like behavioral changes, such as reduced social interaction with other mice, or reduced interest in novelty. Cesar Canales, an assistant professional researcher in NPB, who has expertise in cerebellar anatomy, will take part in these studies.

These experiments “will help shed light on the totality of what the cerebellum does,” says Fioravante — getting beyond the traditional narrow view that it mainly coordinates movement. The team also hopes to uncover new strategies for treating autism.

Although autism involves early brain development, the condition usually isn’t diagnosed until children are years older — when the abnormal brain connections are already established, potentially making treatment difficult.

In these upcoming studies, Nord and Fioravante hope to explore whether the treatment window for autism can be extended. “If we see changes in behavior or neural circuits when Chd8 is disrupted in the developed cerebellum, then we know there is a treatment target,” says Nord.

These studies could also shed light on schizophrenia and obsessive-compulsive disorder, which occur more frequently in people with mutations in this gene, says Nord: “It’s a molecular handle, an entry point into the pathophysiology of these other complex diseases.”

Media Resources

• Douglas Fox is a freelance science writer based in the Bay Area.
• Fioravante Lab
• Germline Chd8 haploinsufficiency alters brain development in mouse ( Nature Neuroscience 2017)
• Cognitive-affective functions of the cerebellum ( The Journal of Neuroscience 2023)

Primary Category

Secondary categories.

Most reported substance use among adolescents held steady in 2022

The percentage of adolescents reporting substance use in 2022 largely held steady after significantly declining in 2021, according to the latest results from the Monitoring the Future survey of substance use behaviors and related attitudes among eighth, 10 th , and 12 th graders in the United States. Reported use for almost all substances decreased dramatically from 2020 to 2021 after the onset of the COVID-19 pandemic and related changes like school closures and social distancing. In 2022, reported use of any illicit drug within the past year remained at or significantly below pre-pandemic levels for all grades, with 11% of eighth graders, 21.5% of 10 th graders, and 32.6% of 12 th graders reporting any illicit drug use in the past year. 

The Monitoring the Future survey is conducted each year by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. 

“The Monitoring the Future Survey is one of the best and most timely tools we have to monitor and understand changes in substance use among young people over time, including through historic events such as the COVID-19 pandemic,” said Nora Volkow, M.D., NIDA director. “It is encouraging that we did not observe a significant increase in substance use in 2022, even as young people largely returned to in-person school, extracurricular activities, and other social engagements.”

The Monitoring the Future survey is given annually to students in eighth, 10 th , and 12 th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perception of harm, disapproval of use, and perceived availability of drugs. Notably, the survey results are released the same year the data are collected. 

From February through June 2022, the Monitoring the Future investigators collected 31,438 surveys from students enrolled across 308 public and private schools in the United States. The completed survey from 2022 is nationally representative and represents about 75% of the sample size of a typical year’s data collection. The Monitoring the Future investigators noted that schools opt-in to participate in the survey, and some schools that normally participate opted-out this year as they continued to operationally recover from the pandemic. All participating students took the survey via the web – either on tablets or on a computer – with between 95-99% of respondents taking the survey in-person in school. 

The survey found that adolescents most commonly reported use of alcohol, nicotine vaping, and cannabis in the past year, and levels generally held steady with those reported in 2021. For substances where reported past-year use did increase between 2021 and 2022, the vast majority of reported use remained at or below the pre-pandemic levels observed in 2020. Compared to levels observed in 2021, data reported in 2022 show: 

• Nicotine vaping remained stable for all three grades surveyed, with 12% of eighth graders, 20.5% of 10 th graders, and 27.3% of 12 th graders reporting vaping nicotine in the past year.
• Cannabis use also remained stable for all three grades surveyed, with 8.3% of eighth graders, 19.5% of 10 th graders, and 30.7% of 12 th graders reporting cannabis use in the past year. Of note, 6.0% of eighth graders, 15.0% of 10 th graders, and 20.6% of 12 th graders reported vaping cannabis within the past year, reflecting a stable trend at the pre-pandemic level among eighth and 12 th graders, and a small increase in reported use among 10 th graders, though reported use among 10 th graders in 2022 is still significantly below pre-pandemic levels.
• Alcohol use remained stable for eighth and 10 th graders (with 15.2% and 31.3% reporting use in the past year, respectively) but returned to pre-pandemic levels for 12 th graders in 2022 (with 51.9% of 12 th graders reporting alcohol use in the past year).
• Any illicit drug use other than marijuana also remained stable for all three grades surveyed, with 4.9% of eighth graders, 5.7% of 10 th graders, and 8.0% of 12 th graders reporting any illicit drug use other than marijuana in the past year. These data build on long-term trends documenting low and fairly steady use of illicit substances reported among teenagers – including past-year use of cocaine, heroin, amphetamines, and nonmedical use of prescription drugs, generally.
• Use of narcotics other than heroin ( including Vicodin, OxyContin, Percocet, etc. ) increased slightly among 12 th graders between 2021 and 2022 (with 1.7% of 12 th graders reporting use within the past year), consistent with the pre-pandemic levels observed in 2019 and 2020 (2.7% and 2.1%, respectively).

When asked a range of questions about the perceived harmfulness of occasionally taking specific prescription medications (such as OxyContin and Vicodin), or the risk of “narcotics other than heroin” overall, the percentage of students who reported perceiving a “great risk” ranged from 22.9% among eighth graders to 52.9% among 12 th graders. The percentage of respondents who reported perceiving a “great risk” associated with taking Adderall occasionally ranged from 28.1% among eighth graders to 39.6% among 12 th graders. 

Though the data have indicated stable or declining use of illicit drugs among young people over many years, other research has reported a recent dramatic rise in overdose deaths among young people ages 14-18. This increase is largely attributed to illicit fentanyl, a potent synthetic drug, contaminating the supply of counterfeit pills made to resemble prescription medications like benzodiazepines, ADHD medications, and opioids. 

“The proliferation of fentanyl in the drug supply is of enormous concern. Though the data indicate that drug use is not becoming more common among young people than it has been in the past, the tragic increase in overdose deaths among this population suggest that drug use is becoming more dangerous than ever before,” said Dr. Volkow. “It is absolutely crucial to educate young people that pills purchased via social media, given to someone by a friend, or obtained from an unknown source may contain deadly fentanyl.” 

The results were gathered from a nationally representative sample, and the data were statistically weighted to provide national numbers. This year, 11% of the 12 th grade students who took the survey identified as African American, 22% as Hispanic, 5% as Asian, 1% as American Indian or Alaska Native, 47% as white, 1% as Middle Eastern, and 14% as more than one of the preceding categories. The survey also asks respondents to identify as male, female, other, or prefer not to answer. For the 2022 survey, 48% of 12th grade students identified as male, 47% identified as female, 1% identified as other, and 4% selected the “prefer not to answer” option. 

“We were curious to see whether the significant decreases in substance use we observed last year would continue into the future, and we now see that there may indeed be a longer lasting impact for some substances,” said Richard A. Miech, Ph.D., team lead of the Monitoring the Future study at the University of Michigan. “The fact that cannabis use and nicotine vaping did not appear to return to pre-pandemic levels in 2022 is a fascinating data point. Moving forward, it will be important to continue to monitor these trends to understand the impact on future drug use behavior and outcomes.” 

The 2022 Monitoring the Future data tables highlighting the survey results are available online from the University of Michigan. 

For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline 1-800-662-HELP (4357) or visit www.FindTreatment.gov . 

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide .

NIH…Turning Discovery Into Health®

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Law enforcement seizures of pills containing fentanyl increased dramatically between 2018-2021

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Study: half of the studies you read about in the news are wrong

And yes, this could be one of them.

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There’s an oft-repeated mantra among scientists: A single study is rarely the final answer. And yet for science reporters, new studies are irresistible — a bold new finding makes a great headline.

Which explains how we get into confusing situations like this:

Why don't people pay attention to health advice? It's a mystery. pic.twitter.com/UQ0J8e580Y — Christopher Snowdon (@cjsnowdon) February 23, 2017

The problem isn’t necessarily that these studies are poorly designed (although some of them may be). The problem is that each headline gives an incomplete glimpse of how science works. One lab produces a result. Another lab — ideally — tries to replicate that result. Rinse and repeat. Eventually someone needs to do a meta-review of the totality of the evidence on the question to reach a conclusion. That meta-review, rather than any one study in isolation, is likely to get closer to the true answer.

Yet as researchers in PLOS O ne recently found , journalists typically only cover those initial papers — and skip over writing about the clarifying meta-reviews that come later on.

What’s more, the study finds, journalists “rarely inform the public when [initial studies] are disconfirmed” — despite the fact around half of the studies journalists write about are later rebutted by follow-up studies.

Journalists cover initial studies far more often than follow-ups or meta-reviews

The authors of the PLOS One paper assembled a huge database of studies in biomedical science, follow-ups to those studies, and meta-studies on those follow-ups. And then they searched the Dow Jones Factiva newspaper database to see how often each type of study was covered.

They found that initial studies were around five times more likely to be reported on than follow-up studies. And meta-reviews were barely covered at all.

What’s more, journalists really, really like to report on studies that deliver positive results — even though studies that deliver negative results are equally valuable. Of the 1,475 newspaper articles in the data set, only 75 articles reported on null findings.

Lastly, journalists seem to flock to studies that concern lifestyle choices like diet or exercise (and especially those published in the most prestigious journals). Non-lifestyle studies — on topics like brain imaging or genetics — were much less common. This “preferential coverage,” the researchers surmise, is due to the fact that readers can take direct action on lifestyle choices.

Nearly half of the single studies that get reported on turn out to be wrong

Here’s why this is a problem. The PLOS One analysis paper found that only 48.7 percent of 156 studies reported by newspapers were confirmed by a subsequent meta-review.* The percentage dropped to 34 when the researchers focused on initial studies only.

(*To be sure, meta-reviews aren’t perfect. Publication bias — the tendency for only papers with positive results to get into journals — can skew even the most careful meta-review. But, in general, they provide a more comprehensive answer than a single study.)

And although journalists gravitate toward covering single studies concerning lifestyle choices such as diet or exercise, these were actually the least likely to be confirmed by a meta-review (as opposed to non-lifestyle papers on topics like genetics).

Overall, the authors conclude:

Our study shows that many biomedical findings reported by newspapers are disconfirmed by subsequent studies. This is partly due to the fact that newspapers preferentially cover "positive" initial studies rather than subsequent observations, in particular those reporting null findings. Our study also suggests that most journalists from the general press do not know or prefer not to deal with the high degree of uncertainty inherent in early biomedical studies.

Why do reporters give undue weight to single studies?

A few possible reasons:

1) Journalists have a need for digestible headlines that convey simple, accessible, and preferably novel lessons. This is fundamentally in tension with how science works, which stresses a slow accumulation of knowledge, nuance, and doubt.

2) It’s not all the journalists’ fault. University press shops are less likely to put out press releases on meta-reviews than they are on a striking and dramatic single study. What’s more the meta studies themselves can be dense and difficult to parse.

3) It’s often the scientific papers or press releases themselves that spread hype about initial findings.

The PLOS One authors have some advice for reporters writing about new studies. Namely: Pick up the phone, and ask researchers whether it is an initial finding, and, if so, they should inform the public that this discovery is still tentative and must be validated by subsequent studies. Indeed, study co-author our result only refers to a small sample of the scientific research.

Also note that this PLOS One study has a few limitations itself. For one, it only looked at newspaper articles. In reality, the science media ecosystem is much, much bigger. There are web-only general interest news outlets like Vox, specialty science magazines such as New Scientist and Scientific American, news operations run by journals like Science and Nature, and television news programs — all of which report on science. “Our result only refers to a small sample of the scientific research,” Estelle Dumas Mallet, the study’s lead author, writes in an email. “Also, we cannot extrapolate these results to other domains such as physics and chemistry.”

The study also only included news articles published within a month of the publication of the scientific papers they cite. It’s possible newspapers do a better job when they cite research when it’s not breaking news.

That said, my guess is that the findings still stand for the broader media environment. As reporters, we’re biased toward what’s new and exciting. But in science, truth takes time.

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• PMC8756300.1 ; 2021 Jun 1
• ➤ PMC8756300.2; 2022 Jan 31

Quality of information in news media reports about the effects of health interventions: Systematic review and meta-analyses

1 Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway

2 Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway

Lillebeth Larun

3 Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway

Giordano Pérez Gaxiola

4 Cochrane Associated Centre and Evidence‐based Medicine Department, Sinaloa's Pediatric Hospital, Culiacan, Mexico

Dima Alsaid

5 Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany

Anila Qasim

6 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada

Christopher James Rose

Karin bischoff, andrew david oxman, associated data, underlying data.

All data underlying the results are available as part of the article and its supporting information files and tables.

Extended data

Zenodo: Quality of news reports about the effects of health interventions - Supporting Information. http://doi.org/10.5281/zenodo.4781182 . 105

This project contains the following extended data:

• - S1 File. Protocol. “Quality of news media reports about the effects and costs of health interventions: Systematic review protocol”.
• - S2 File. Protocol Appendix 1. “Appendix 1: Reference list of potentially eligible studies”.
• - S3 File. Protocol Appendix 2. “Appendix 2: Description of search for an existing review”.
• - S4 File. Dissertation. “Criteria used to measure the quality of news media reports about the effects of health interventions: Systematic review”.
• - S5 File. Detailed search strategy.
• - S6 File. Informed Health Choices Key Concepts. 2019 version.
• - S7 File. Detailed information about deviations from the protocol.
• - S8 File. Forest plots for individual criteria groups.
• - S9 File. Individual risk of bias assessments.
• - S10 File. Individual criteria included in meta-analyses. Sample characteristics, verbatim and reworded criteria, related IHC Key Concepts, overall risk of bias, estimates and confidence intervals, and sample sizes.
• - S1 Table. Included studies . References for all studies included in qualitative summary and reason for exclusion from meta-analyses or number of criteria included in meta-analyses.
• - S2 Table. Sample characteristics and tools by study. Sample size, medium/media, country/countries, time period(s), intervention category/categories, and tool(s).
• - S3 Table. Objectives of included studies.
• - S4 Table. Sampling frames and methods.
• - S5 Table. Reported subgroup analyses.
• - S6 Table. Number of quality criteria included in the meta-analysis per relevant IHC Key Concept.

Reporting guidelines

Zenodo: PRISMA checklist for ‘Quality of information in news media reports about the effects of health interventions: systematic review and meta-analyses’. http://doi.org/10.5281/zenodo.4781182 . 105

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Version Changes

Revised. amendments from version 1.

There are no major differences between this and the previous version of the article. Most of the changes are based on the reviews. The only other substantive changes are adding two references to the discussion, under "Underlying problems": Glasziou and Chalmers 2018, and O'Keefe et al. 2021. Based on the reviews, we replaced "inappropriate [criteria]" with "ineligible". In the abstract, we removed "qualitative summary", and we now explain the term at first mention in the main text. At the end of the introduction, we added a paragraph about the Informed Health Choices (IHC) project, including the authors' involvement. In the methods section, we added numbers to the example of a reframed criterion, and we explain our focus on detection bias. In the results, we revised the formatting of Table 2, so the columns alternate colour, rather than the rows, and we removed reference to the checklist for communicating evidence-based information about health care. We moved up the bullet-point list with overall estimates from the end of "Key findings", in the discussion, to the start of "Synthesis of results", in the results. Under "Key findings", we specified that the samples were diverse in terms of English-speaking and high-income countries (not countries in general), and we adjusted the end of the section where the aforementioned bullet-point list had been. Further, in the discussion, we removed the second clause in the sentence about Heaner's findings; we clarified that IHC is a separate initiative from the Informed Health site; we specified that it is possible for news outlets to improve their reporting "with enough resources"; and we deleted the last paragraphs of the discussion, about IHC. The remaining changes are corrections of typos.

Peer Review Summary

Many studies have assessed the quality of news reports about the effects of health interventions, but there has been no systematic review of such studies or meta-analysis of their results. We aimed to fill this gap (PROSPERO ID: CRD42018095032).

We included studies that used at least one explicit, prespecified and generic criterion to assess the quality of news reports in print, broadcast, or online news media, and specified the sampling frame, and the selection criteria and technique. We assessed criteria individually for inclusion in the meta-analyses, excluding ineligible criteria and criteria with inadequately reported results. We mapped and grouped criteria to facilitate evidence synthesis. Where possible, we extracted the proportion of news reports meeting the included criterion. We performed meta-analyses using a random effects model to estimate such proportions for individual criteria and some criteria groups, and to characterise heterogeneity across studies. 

We included 44 primary studies in the review, and 18 studies and 108 quality criteria in the meta-analyses. Many news reports gave an unbalanced and oversimplified picture of the potential consequences of interventions. A limited number mention or adequately address conflicts of interest (22%; 95% CI 7%-49%) (low certainty), alternative interventions (36%; 95% CI 26%-47%) (moderate certainty), potential harms (40%; 95% CI 23%-61%) (low certainty), or costs (18%; 95% CI 12%-28%) (moderate certainty), or quantify effects (53%; 95% CI 36%-69%) (low certainty) or report absolute effects (17%; 95% CI 4%-49%) (low certainty). 

There is room for improving health news, but it is logically more important to improve the public’s ability to critically appraise health information and make judgements for themselves.

Introduction

For decades, researchers have studied and criticised the quality of health information in the mass media. In 1972, The New England Journal of Medicine—the “most prestigious” general medical journal in the world 1 —published an “examination” of health information on American television (TV). 2 The paper ended in reproach: “The potential of television to inform, instruct and educate should not continue to be wasted and abused, but rather should be used as an integral part of a plan designed to deliver better health care.”

Misleading health information in the mass media continues to be a hot topic. In 2020, the World Health Organization reported that the Coronavirus disease (COVID-19) had been accompanied by an “infodemic”: “an over-abundance of information—some accurate and some not—that makes it hard for people to find trustworthy sources and reliable guidance when they need it.”. 3

Many studies of health news have focused on “traditional” news media, including print, broadcast, and news websites. With the advent of social media, traditional news media have increased competition as a source of lay health information. However, people still get health information from the latter, directly or via social media. Chew and Eysenbach found that about 60% of more than 5000 tweets about the H1N1 outbreak in 2009 included links and about a quarter of those links were to news websites, the most common destination. 4 In comparison, less than 5% of links were to government and public health agencies or to other social media, combined.

Many of the studies focusing on news media have further focused on news reports about the effects of health interventions. This includes “modern” medicine (aka. “academic”, “conventional” or “Western” medicine); “alternative” medicine (aka. “complementary”, “traditional” or “natural” medicine); screening; surgery; devices; diet; exercise; lifestyle interventions; and health systems and policies. We were unable to find a systematic review of such studies (see extended data - S1, S2 and S3 Files 105 ). 5 We then aimed to fill this gap, providing meta-analytical estimates of the quality of news reports about the effects of health interventions, and potentially informing further and related research.

The first part of this study was submitted by the first author, MO, to the University of Oxford as his dissertation, in partial fulfilment of the requirement for the award of Master of Science (MSc) in Evidence-Based Health Care, under the title “Criteria used to measure the quality of news media report about the effects of health interventions: Systematic review” (see extended data - S4 File 105 ).

The study is related to the Informed Health Choices (IHC) project, in which MO, GG, CR and AO have been involved. The project goal is to help people think critically about information about the effects of health interventions, as well as choices about health interventions, so they avoid waste and unnecessary suffering. A premiss for the project is that there is a large amount of unreliable information about the effects of health intervention. This review helped test this premiss, and takes advantage of the IHC Key Concepts framework, which MO and AO have helped develop.

• • To assess the quality of information in news media reports about the effects of health interventions.
• • To assess, map and group criteria used to measure the quality of information in news media reports about the effects of health interventions.

This review was registered in the International Prospective Register of Systematic Reviews ( PROSPERO ) (ID: CRD42018095032 ). The protocol was published on the IHC project website as “Quality of news media reports about the effects and costs of health interventions: Systematic review protocol” (see extended data - S1, S2 and S3 Files 105 ). 5 Appendixes to the protocol were published in a separate compressed folder, on the same website. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist 6 has been included in the Reporting guidelines for this review.

Eligibility criteria

Primary studies had to satisfy four eligibility criteria to be included in the review ( Table 1 ): two related to the sample of news reports included in the study; one related to the outcome measure; and one related to reporting of the study. We included studies in any language in the qualitative summary, but we only included studies in English or Norwegian in the meta-analyses (the two languages spoken fluently by the primary investigator, MO). Note that the qualitative summary is not a synthesis of qualitative studies, but a structured synthesis of results excluded from the meta-analyses. We did not place any explicit limitation on study design, but—in effect—case studies of a single news report and purely qualitative studies were ineligible.

The first eligibility criterion was that the sample include content labelled by the researchers as “news”, taken from newspapers or magazines (print); television, radio or podcasts (broadcast); or dedicated news websites (online). We placed no limits on where in the world or when the news reports were published.

Second, the sample had to include news reports about the effects of health interventions. Other types of health news include non-reports (e.g. features or opinion pieces) and other categories of news reports about health (e.g. reports about the health effects of exposures or about health-related ethical or legal issues). We defined “health intervention” as any action intended to improve the health of individuals or communities, as per the Glossary of Evaluation Terms for Informed Treatment choices ( GET-IT ). 7 We defined “effect” as a negative or positive change or difference in a health outcome, again as per GET-IT.

Third, the researchers had to have used at least one explicit, prespecified and generic criterion to measure quality, herein called a quality criterion. “Quality” was defined as how conducive the report is to informed decisions or, conversely, how misleading it is. Information about the effects of health interventions can be directly misleading—such as claims that an intervention causes an outcome when it is only associated with it—or it can be misleading by omission, such as omitting absolute effect estimates, particularly when the baseline risk is small.

“Criterion” was defined as a standard of quality that could be satisfied or not. “Generic” meant that the quality criterion was not specific to an intervention (e.g. a drug), category of interventions (e.g. “modern” medicine), or condition (e.g. cancer), or specific to any evidence (e.g. findings from a trial). We excluded studies if they only measured the quality of the evidence cited in the news reports; only measured the factual accuracy of the reports; or only described the reports, as opposed to explicitly assessing their quality. We included quality criteria related to cost of the intervention.

The fourth and final eligibility criterion was that the study specified the sampling frame (where the news reports were sampled from), the selection criteria for the news reports, and the selection technique (how the reports were sampled).

To clarify the eligibility criteria, three reviewers piloted them on a sample of five studies from a list of potentially eligible studies of which we were aware before finalising the protocol (Appendix 1 of the protocol; extended data - S2 File 105 ). 5

Search strategy

We searched for eligible primary studies indexed in PubMed on May 24, 2018, and Google Scholar on June 21 and 22, 2018. We searched directly in Open Grey and Grey Literature Report on June 22, 2018, and in ProQuest Dissertations & Theses (Global Full text plus UK and Ireland abstracts) on June 25, 2018. We updated the PubMed search on Aug. 30, 2019.

We conducted citation searches for papers describing the development of tools for assessing the quality of news reports about health: the Index of Scientific Quality; 8 the Quality Index for health-related Media Reports; 9 and a checklist for improving drug information in the general press. 10 We also checked the reference lists of those three papers. Finally, we conducted citation searches and reference lists checks for an arbitrary selection of eligible studies. S5 File in the extended data 105 is a detailed description of the search strategy, including search strings.

Study selection

Screening search results for inclusion in the qualitative summary consisted of two rounds. First, two reviewers screened titles and abstracts. Second, two reviewers screened full texts of studies included after the first round. The two discussed and resolved disagreements after each round. Where two reviewers could not reach a consensus, a third was brought in to arbitrate. Screening reference lists and the results of citation searches included a third, initial round, wherein only one reviewer screened titles. We also screened all of the potentially eligible studies of which we were aware before finalising the protocol (Appendix 1 of the protocol; extended data – S2 file 105 ). We screened search results using Rayyan . 11

If a study included a mix of news reports about the effects of health interventions and other types of health news, we excluded the study from the meta-analyses unless results for the news report about the effects of health interventions were reported separately for at least one eligible quality criterion. Further, we excluded studies from the meta-analyses if they did not include any eligible quality criteria or any such criteria for which results were adequality reported (see the section “Assessing criteria”). Judgements about excluding studies from the meta-analyses were made independently by two reviewers, who then discussed and resolved disagreements.

Data extraction

Data were extracted by a single reviewer and entered into spreadsheets (Microsoft Excel, Version 16.49). We only extracted reported data. For example, if a study did not include the country or countries in which the sample of news reports were published, we did not attempt to code the individual news reports by country or contact the study authors for that information. A second reviewer checked a sample of the extracted descriptive data and checked all the extracted quality criteria that were included in the meta-analyses, as well as results for those criteria.

For the qualitative summary, we extracted descriptive data about the samples of news reports and the tools (sets of quality criteria) used to assess the reports. Data about the sample of news reports included: the categories of media in which the reports were published; the countries in which they were published; the time period in which they were published; the categories of health interventions that were the subject of the reports; and the financial models of the news outlets that published the reports. We also extracted study objectives, sampling frame, selection criteria and technique, and reported subgroup analyses.

All categories and the time periods were predetermined in the protocol. The categories of media were newspaper; magazine; radio; podcast; television; and news website. The categories of intervention were: “modern” medicine; “alternative” medicine; screening; surgery; devices; diet; exercise; lifestyle; and systems and policies. The two categories of financial model were non-commercial (public or independent) and commercial.

We extracted quality criteria verbatim. For the meta-analyses, we extracted all response options for each included quality criterion, the number of relevant news reports (reports about the effects of health intervention) to which the quality criterion was applied, and the results for those reports. Some quality criteria were not applied by researchers to the total sample of relevant reports in a given study, meaning the researchers did not consider the quality criterion universally applicable.

Again, if a study included a mix of news reports about the effects of health interventions and other types of health news, we only included results for the former. We excluded studies if those results were not reported separately.

For the meta-analyses, we were interested in the proportion of relevant news reports that satisfied a given quality criterion. If this was not reported explicitly, we imputed the proportion using reported data, if possible. We excluded quality criteria if the proportion was not explicitly reported and it was impossible to calculate the proportion based on the reported data—for example, if only mean scores were reported.

Assessing criteria

After selecting studies to be included in the meta-analyses ( Figure 1 ), two authors assessed criteria used in those studies: both quality criteria and other criteria, such as descriptive criteria or criteria measuring factual accuracy, using spreadsheets. We excluded ineligible criteria, as well as criteria for which it was not possible to extract results for only news reports about the effects of health interventions.

We assessed each criterion in each study, even if the researchers used a tool used in a previous study, in case it had been modified. For example, the Media Doctor Australia tool is used in several studies, including those by Smith et al . 12 and Bonevski et al . 13 However, while Smith et al . asked whether there is “objective evidence to support the treatment”, Bonevski et al . asked whether the study methodology is reported, which is more specific.

Two reviewers independently assessed criteria, then discussed and resolved any differences. We excluded criteria if they were non-generic or if they assessed factual accuracy, if they were descriptive, or if they were not clear or sensible (i.e. if their face validity was inadequate 14 ). We also excluded global scores and composite quality criteria because they can be difficult to interpret, and they are difficult to compare across studies using different scoring systems.

Mapping and grouping quality criteria

We mapped and grouped quality criteria, using spreadsheets, to be able to synthesise results across studies using different tools. For the mapping, we used the IHC Key Concepts framework. The most recent version of the framework was published on IHC website in 2019 and includes nine high-level concepts and 49 low-level concepts organised in three overarching groups (see extended data - S6 File 105 ). 15 The IHC Key Concepts are essential concepts for assessing information about the effects of health interventions and making informed choices. 15 – 17 The framework is based on a mix of evidence and logic. It has a combination of characteristics that make it unique, as well as uniquely useful for this study. First, it has been developed systematically, transparently and iteratively. Second, it only includes concepts that are intended to be relevant to the general public (typically the target audience of health news). And third, it is intended for mapping and assessing measurement tools (amongst other purposes). Moreover, the starting point for the framework included checklists for journalists and input from journalists. 18

Two reviewers independently mapped the included quality criteria against the low-level IHC Key Concepts, then discussed and resolved any disagreements. Finally, one reviewer grouped the criteria, informed by the results of the mapping, and a second reviewer assessed whether the groups were sensible (i.e. face validity 14 ).

Meta-analysis

Where an included quality criterion had more than two response options, one reviewer dichotomised the categories and a second reviewer assessed the dichotomisation. For example, for studies that used the Index of Scientific Quality, where response options range from a score of one to five, we considered a score of four or five as satisfying the quality criterion.

Furthermore, we reframed negative quality criteria as positive, and paraphrased all quality criteria, for the data to be consistently framed and worded, and for the criteria to be succinctly labelled. For example, Bubela et al . report the number of news reports that “did not” specify whether a study was randomized (503 of 553, 91%), which was reframed as the number of news reports that did specify whether a study was randomized (50 of 553, 9%). 19

For each individual quality criterion and group of criteria, we estimated mean proportions with 95% confidence intervals (CIs), using a random effects model, quantifying precision using 95% confidence intervals. Where criteria groups included more than one criterion from the same study, we included results for both criteria. We performed statistical analysis using Stata 16 (StataCorp LLC, College Station, Texas, USA). Each of the included studies provided data on the number of relevant news reports assessed and how many of those reports met a given criterion. For each study and quality criterion for which necessary data were available, we estimated the proportion of relevant news reports meeting the criterion. These point estimates and 95% confidence intervals were transformed to the logit scale for meta-analysis (Stata's default scale for meta-analysis of proportions). We had anticipated substantial between-study heterogeneity and therefore used random effects meta-analyses. We estimated the percentage of variance that can be attributed to between-study heterogeneity rather than chance (I 2 , expressed as a percentage) and calculated P-values to test the null hypotheses of no between-study heterogeneity using Cochran's Q statistic. We back-transformed meta-analytical estimates from the logit scale to present estimates as percentages (in forest plots summarizing meta-analytical results from different criteria groups) or proportions (in forest plots for individual groups).

Two reviewers assessed whether what the different quality criteria in each group measured was similar enough that it was sensible to report an overall estimate. If a group included a single quality criterion, we did not report an overall estimate.

Risk of bias

Two reviewers independently assessed the risk of detection bias for each criterion included in the meta-analyses, then compared judgements and resolved disagreements. Detection bias was assessed using three questions:

• 1. Was the criterion applied by at least two researchers independently?
• 2. Were the researchers blinded in terms of the journalist and news outlet?
• 3. Does the criterion require substantial judgement?

As explained in the protocol (extended data – S2 file), we decided to focus on detection and selection bias based on the critical appraisal tool developed by Munn et al . for systematic reviews of observational epidemiological studies reporting prevalence data, 20 the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, 21 and methods used by the Cochrane Methodology Review Group to systematically review the prevalence of an outcome in a population of information (as opposed to people). 22 As explained in this article, in the section on deviations from the protocol, we later found that the item we had developed to assess selection bias told us more about applicability than bias, and therefore only assessed detection bias.

If the authors did not state how many researchers applied the criterion or whether the researcher(s) did so independently, we recorded the answer to the first question as “unclear” and counted it as a “no”. If from looking at the criterion in and of itself, it was unclear how much judgement was required, we looked at whether the researchers reported or referenced any guidance for applying it. If they did, we looked at how detailed and specific the guidance was. If the researcher(s) applying the criterion received training, but the authors did not report what this entailed—i.e. what guidance was provided—we considered the criterion to require substantial judgement.

We considered the risk of detection bias as low if the criterion did not require substantial judgement. We considered the risk of detection bias as moderate if the criterion required substantial judgement, but at least two researchers applied the criterion independently and they were blinded in terms of the journalist and outlet. We considered the risk of detection bias as high if the criterion required substantial judgement and only one researcher applied it or the researchers were not blinded.

If there was a high risk of bias for criteria providing ≥50% of the weight in a given criterion group, we considered there to a be a high risk of bias for the overall estimate.

Rating the quality of the evidence

We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach as a framework for rating the quality of evidence. 23 GRADE considers five factors that can lower the certainty of evidence for effect estimates: risk of bias, inconsistency of results, indirectness of evidence, imprecision, and publication bias. We did not consider publication bias, as we are not aware of any research documenting publication bias in studies of the quality of news reports or similar studies. We also did not consider directness, which was irrelevant.

Again, if there was a high risk of bias for criteria providing ≥50% of the weight in a given group, we considered there to be a high risk of bias for the overall estimate. If a CI is wider than 0.25 (a quartile), we considered there to be important imprecision, based on guidance from the Cochrane Effective Practice and Organization of Care (EPOC) group. 24 We used an I 2 of >75% as a rule of thumb for there being substantial inconsistency.

GRADE factors for increasing the certainty of the evidence were irrelevant.

Deviations from the protocol

We report the main deviations from the protocol here. In S7 File (see extended data 105 ), we provide detailed information about all deviations. Some of the deviations were in part due to the originality of our research question in terms of a systematic review and meta-analysis, meaning there was lack of methodological guidance or precedence for the study as a whole. In other words, we were in “unchartered waters”. Other deviations were due to limited time and resources. This review had no funding and as noted in the background section, the first part of the review was MO's MSc dissertation, meaning he was required to do as much as possible of that work himself.

In terms of search strategy, we did not search Scopus as planned, aside from citation searches, since the time saved outweighed the likelihood of identifying additional eligible studies, based on the results of searching the other databases. Also, we only conducted reference list checks and citation searches for arbitrary samples of included studies, due to limited time and resources, as well as decreasing yield (extended data – S5 File 105 ).

In terms of eligibility, we made explicit that at least one of the criteria that researchers in a given study used to assess quality had to be prespecified and generic, and used specifically to assess the quality of news reports, not describe their content or assess the quality of underlying evidence. As mentioned, we included studies in any language in the qualitative summary, but only included studies in English and Norwegian (the two languages spoken fluently by the primary investigator, MO) in the meta-analyses.

In terms of data extraction, a second reviewer checked all data extracted for the meta-analyses, but only a sample of data extracted for the qualitative summary due to limited time and resources. There were no errors in the sample. In terms of assessing risk of bias, we were originally going to assess selection bias by looking at how news reports were sampled: randomly, sequentially or other. However, we found this told us more about applicability than bias, since samples typically consisted of all news reports that met the researchers’ eligibility criteria, rather than a sample of those reports. Therefore, we only assessed the risk of detection bias, as described earlier.

In terms of synthesising results and rating the quality of the evidence, we have not reported overall estimates for groups of quality criteria if what those criteria measure is too different for a synthesis to be sensible, despite the criteria being clearly related. Nor have we reported overall estimates for groups that include a single criterion. Further, we did not rate the quality of the evidence in these cases. Where we do report an overall estimate and rate the certainty of the evidence, if we assessed the risk of bias as high for criteria providing ≥50% of the weight in a given group, we assessed the risk of bias as high for the group as a whole. We did not consider assessing risk of bias for whole criteria groups in the protocol.

We screened 2063 unique records and retrieved and assessed 140 full texts for eligibility, as shown in the PRISMA flow diagram ( Figure 2 ). We identified 44 primary studies for inclusion in the qualitative summary (see extended data - S1 Table 105 ): 31 in English, five in German, four in Spanish, three in Norwegian and one in Slovenian. We excluded most (78) full-text articles from the qualitative summary based on one or more of the four eligibility criteria. We excluded another 16 full-text articles that were not research (e.g. commentaries), and two duplicates: one doctoral thesis that is a composite of other studies that we assessed 25 and one working paper 26 superseded by the final publication. 27 The third eligibility criterion—that the researcher had used at least one explicit, prespecified and generic quality criterion—was least often satisfied. We excluded 47 full-text articles solely for failing to satisfy that eligibility criterion.

Of the 44 studies included in the qualitative summary, we included 18 (41%) in the meta-analyses. Of the 26 studies only included in the qualitative summary, we excluded nine (20%) from the meta-analyses for being in a language other than English or Norwegian; 16 for inadequate reporting (36%); and one (2%) where the sample of news reports 28 was included in a larger sample in a later study. 29 Only one of the 18 studies included in the meta-analyses was in Norwegian, 30 meaning the rest were in English.

Study characteristics

Table 2 is an overview of the samples of news reports in the studies included in the qualitative summary. Descriptive data for each study can be found in S2 Table in the extended data.

Sample sizes varied from 17 to 3096 units. We use “units” here since some samples include content besides news reports, such as non-news websites, 31 or include health news that is not news reports about the effects of health interventions, for example news features 32 or news reports about the effects of exposures, such as recreational cannabis (as opposed to medical cannabis). 33

Newspaper was the most common medium, with newspaper content explicitly included in 35 of the 39 studies (90%) in which a medium was specified ( Table 2 ). However, the number of studies that included newspaper content versus content from news websites should be interpreted with caution, since newspaper content may also have been published online. In the study with the second-largest sample, Walsh-Childers et al . write that news reports “must have been published on the news organization's website,” but categorise those reports only as newspaper content. 29

The United States (US) was the most common country in terms of where content assessed in the included studies was published. Of the 40 studies where at least one country was specified, 12 samples (30%) included content published in the US ( Table 2 ). Twenty-five (63%) of those 40 studies included content published in English-speaking countries (see extended data - S2 Table 105 ).

We categorised time periods according to what authors reported. This was in some cases the period in which news reports were published and in others the period in which reports were assessed. Differences between the two are likely minor, since all studies focused on the recent past (relative to the time that the study was conducted). The earliest year of publication was 1996. 34

“Modern” medicine was included in 24 of 32 samples (75%) where a category of interventions is specified. In some cases, it was not possible to use the categories pre-specified in the protocol for this review. For example, Haneef et al . included news reports about “non-pharmacological” interventions, 35 which could include “Alternative” medicine, devices, diet, etc. In these cases, we used the category “Other”.

Financial model was not specified in any of the included studies—i.e. it was not explicitly reported whether the news outlets that published news reports included in the sample were commercial or non-commercial (public or independent).

The tools used to assess the quality of news reports in each study are presented with the descriptive data in S2 Table in the extended data. 105 Most studies used a tool that was, to varying degrees, original or modified. Only one tool was used in >4 of the 44 studies included in the qualitative summary: the Index of Scientific Quality, which was used in seven studies (16%). 31 , 33 , 34 , 36 – 39 However, even more studies used tools that were to some extent, directly or indirectly, based on the criteria developed by Moynihan et al . 40 This includes the four studies that used the Media Doctor Australia tool 12 , 13 , 41 , 42 and the 3 studies that used the Health News Review tool, 28 , 29 , 43 which was based on the Media Doctor Australia tool. 28 Two studies used two separate tools. 41 , 44 We did not identify any studies that used the Quality Index for health-related Media Reports 9 or the checklist for improving drug information in the general press. 10

Objectives, sampling frames, selection criteria and technique, and reported subgroup analyses

The explicit or implicit objectives of studies included in the qualitative summary are presented in S3 Table, the sampling frames and selection criteria and techniques in S4 Table, and the variables used in the reported subgroup analyses in S5 Table (see extended data 105 ). Detail and clarity varied. For example, some studies reported explicit inclusion and exclusion criteria for news reports, while others simply stated that they assessed news reports that included health or medical information.

Thirty-one studies (70%) reported at least one subgroup analysis, exploring differences in quality between subgroups of news reports. The most common overarching variables were ones related to time, medium, and outlet. How subgroups were categorised for the same overarching variable, as well as what categories were included, varied. For example, some studies included subgroup analyses based on specific intervention (e.g., comparing the quality news reports about one medicine with news reports about another medicine). Others included subgroup analyses based on the category of intervention (e.g., comparing news reports about “modern” medicines versus news reports about other categories of interventions). Furthermore, the specific interventions or categories of interventions varied.

Assessment, mapping and grouping of criteria

Two reviewers assessed all 208 criteria applied to news reports in the 18 studies included in the meta-analyses. Not all criteria were measures of quality. Of the 208 criteria, 77 (37%) were excluded: 66 (32%) for being non-generic or descriptive, for measuring factual accuracy, or for not being clear or sensible (having inadequate face validity); and 11 (5%) for being global scores or composites. We provide examples in Table 3 . Quality criteria were judged not to be sensible if they were in conflict with the IHC Key Concept and research evidence, for example a criterion assessing whether research presented in a news report is peer-reviewed. 43 , 45 The same two reviewers mapped the remaining 131 of 208 quality criteria (63%) against the IHC Key Concepts. Based on the results of the mapping, we established 19 groups of quality criteria (criteria groups), as well as eight subgroups.

In S6 Table in the extended data, 105 we present the number of quality criteria included in the meta-analyses per relevant IHC Key Concept. We were unable to identify or include quality criteria related to several IHC Key Concepts that are important for communicating information about the effects of health interventions in the news media or otherwise. For example, there were no criteria related to the concept “ Average differences between treatments can be misleading ” (2.3c).

Synthesis of results

Of the 208 criteria used in the 18 studies included in the meta-analysis, we included 108 (52%) in the meta-analyses. We calculated overall estimates for five of the 19 main criteria groups (26%) and 6 of the 8 subgroups (75%). In those cases, we found:

• • 86% of news reports do not commit “disease mongering” (95% CI 78%-91%) (low certainty),
• • 22% adequately address conflicts of interest (95% CI 7%-49%) (low certainty),
• • 93% do not selectively report “statistically significant” results (95% CI 87%-97%) (high certainty),
• • 53% quantify effects (95% CI 36%-69%) (low certainty),
• • 68% do not use misleading language (95% CI 35%-90%) (low certainty),
• • 17% report absolute effects (95% CI 4%-49%) (low certainty),
• • 36% include adequate information about alternative interventions (95% CI 26%-47%) (moderate certainty),
• • 82% do not focus on surrogate outcomes or extrapolate from surrogate to important outcomes (95% CI 76%-86%) (high certainty),
• • 40% mention, discuss or explain potential harms of the intervention (95% CI 23%-61%) (low certainty),
• • 18% mention or discuss the cost of the intervention (95% CI 12%-28%) (moderate certainty), and
• • 97% mention at least one benefit (95% CI 56%-100%) (moderate certainty).

Of the 131 quality criteria included in the 19 groups, we excluded 22 (17%) from the meta-analyses for inadequate reporting of results, meaning it was impossible to impute the proportion of relevant news reports that satisfied the criterion based on the reported data. The distribution of the remaining 108 criteria amongst the 19 main groups and eight subgroups, is presented in Table 4 , with the order of the groups based on the IHC Key Concept framework. In one case, we included a criterion in two groups: the third criterion in the study by Stassen, 43 which we included in Criteria related to qualitative descriptions of effects and Criteria related to pros and cons. Several criteria from the same study were included in three of the 19 main groups (16%) and four of the eight subgroups (50%). Criteria related to “disease mongering” 12 stem from a paper by Moynihan et al. 46

N = criteria included in the meta-analyses.

The primary meta-analyses are summarised in Figure 3 , excluding subgroups. The samples of news reports in two of the studies included in the meta-analyses overlap. 12 , 13 For groups that included a criterion from both of these studies, we performed primary analyses that included only the largest and most-recent study by Bonevski et al ., 13 and an ad hoc sensitivity analysis that also included results from the study by Smith et al. 12 The sensitivity analyses are summarised in Figure 4 , again excluding subgroups. There were no important differences between the overall estimates and CIs for the primary analyses versus the sensitivity analyses. Forest plots for each criteria group, including individual estimates and CIs for each criterion, are presented in S7 File in the extended data. 105

For most of the main groups (14 of 19) and a minority of the subgroups (two of eight), we did not consider it sensible to report overall estimates because—although the criteria in the group are clearly related—what they each measure was too different for it to be sensible to synthesise results. For example, in the group Criteria related to associations and randomization, the ninth criterion from the study by Bubela et al . measured whether the news report specifies that a trial was randomized or not, whereas the 12 th criterion from the study by Haneef et al . measures whether there is a causal claim based on a non-randomized study. The two are clearly related, but at the same time, synthesising results would clearly not be sensible. Leaving out whether a study was randomized might be misleading by omission, but this can be compensated for by distinguishing causation and association and pointing out potential confounding. On the other hand, making a causal claim based on a non-randomized study is directly misleading. Further, we do not report overall estimates for the groups that include a single criterion.

Due to heterogeneity, as well as inadequate reporting and small sample sizes in some studies, we did not conduct any of the six subgroup analyses considered in the protocol, exploring differences in quality between news reports:

• 1. in different media (broadcast vs. other),
• 2. from different decades,
• 3. by commercial vs. non-commercial outlets,
• 4. by health or science journalists vs. others,
• 5. in low-income countries vs. middle or high-income countries, or
• 6. in broadsheet vs tabloid newspapers. 5

The individual risk of bias assessments for each of the 108 criteria included in the meta-analyses are presented in S9 File in the extended data. 105 We considered there to be a high risk of bias in 13 cases (11%), including in the case of the one criterion included in two criteria groups (the third criterion in the study by Stassen 43 ). The 13 criteria for which we considered there to be a high risk of bias are the 13 that required substantial judgement to be applied, according to our assessment. In 12 of those 13 cases, it was—in addition—unclear whether researchers were blinded to the publication and journalist behind the news report. In the remaining case, it was clear that they were not blinded. In four of the 13 cases, it was also unclear whether the criterion was applied independently by at least two researchers.

Quality of the evidence

We only assessed the quality of the evidence for the five main groups and six subgroups where we report an overall estimate. Quality varied from low to high. In all but two of 10 cases, we downgraded quality for substantial inconsistency. In half of the cases, we downgraded for important imprecision. Finally, for the group criteria related to “disease mongering”, we downgraded for overall high risk of bias.

Results by criteria group

We summarise the main findings here. Details of these analyses are reported in S10 File in the extended data. 105

Criteria related to associations and randomization

Many news reports included causal claims based on associations, and few said whether trials were randomized. We included three estimates, from three studies, 19 , 35 , 47 related to the IHC Key Concepts that “An outcome may be associated with a treatment but not caused by it” (1.2d) and “Comparison groups should be as similar as possible” (2.1a). Based on estimates for single criteria with a low risk of bias, 51% of news reports make causal claims based on non-randomized studies (95% CI 40%-62%) 32 and 9% specify whether a given trial was randomized (95% CI 7%-12%). 19

Criteria related to the need for comparisons

Some news reports concluded that an intervention has an effect despite a lack of a comparator, and many did not include evidence to support the effectiveness of the intervention. We included three estimates, from three studies, 12 , 35 , 41 related to the IHC key concept that “Identifying effects of treatments depends on making comparisons” (1.2f). Based on an estimate from a single study, three quarters (74%) of news reports avoid concluding there is a beneficial effect when there is a lack of a comparator (95% CI 63%-83%). 35 Two studies found that only a third (34%) 12 to half (55%) 41 of news reports include evidence about the effects of the intervention (95% CIs 25%-43% and 38%-72%). The risk of bias for these two criteria was high.

Criteria related to consistency between studies

Few news reports considered and soundly assessed the consistency of evidence. We included a single criterion, from the study by Krauth and Apollonio, 31 related to the IHC Key Concept that “The results of one study considered in isolation can be misleading” (1.2g) and “Consider how certain you can be about each advantage and disadvantage” (3.3d). The risk of bias was low for this criterion. The study found that 13% (95% CI 7%-26%) of news reports published in American newspapers and magazines about tobacco cessation therapy “consider” and make a “well-founded” assessment of consistency between studies.

Criteria related to “disease mongering”

Some news reports committed disease mongering. We included five estimates, from five studies, 12 , 13 , 29 , 41 , 43 related to disease mongering, which is addressed by the IHC Key Concept that “Earlier detection of ‘disease’ is not necessarily better” (1.2k). All five criteria had a high risk of bias. Overall, 86% of news reports do not commit disease mongering (95% CI 78%-91%) ( Figure 3 ). The certainty of the evidence for that estimate is low due to substantial inconsistency (I 2 = 92%) and the high risk of bias.

Criteria related to conflicts of interest

Many news reports failed to address conflicts of interest. We included seven estimates, from seven studies, 19 , 29 , 30 , 40 , 41 , 43 , 48 related to the IHC Key Concept that “Competing interests may result in misleading claims” (1.3b) All criteria had a low risk of bias. Overall, 22% (95% CI 7%-49%) in some way disclose potential conflicts of interest ( Figure 3 ). The certainty of the evidence for that estimate is low, due to substantial inconsistency (I 2 = 99%) and important imprecision.

Criteria related to opinions

Some news reports failed to adequately distinguish opinion and fact. We included a single estimate, from the study by Krauth and Apollonio, 31 related to the IHC Key Concept that “Opinions alone are not a reliable basis for claims” (1.3d). The study evaluated American newspaper and magazine reports about tobacco cessation therapy. It found that three quarters (73%) of news reports adequately distinguish opinion and fact (95% CI 6%-83%). The criterion had a low risk of bias.

Criteria related to study design and risk of bias in general

Many news reports did not address the “quality of evidence”. We included five estimates, from five studies, 13 , 29 , 31 , 41 , 43 related to the risk of bias (“type”, “credibility” or “quality” of the evidence), which is addressed by multiple low-level IHC Key Concepts under the high-level concepts “Comparisons of treatments should be fair” (2.1) and “Syntheses of studies need to be reliable” (2.2). Three of the criteria had a high risk of bias. The proportion of the news reports that meet the criterion used in each study varied from 8% (95% CI 3%-20%) 31 to 77% (95% CI 73%-81%). 43

Criteria related to blinding

Few news reports said whether trials were “double blinded”. We included a single criterion, from the study by Bubela et al ., 19 related to the IHC Key Concepts that “The people being compared should be cared for similarly apart from the treatments being studied” (2.1c), “If possible, people should not know which of the treatments being compared they are receiving” (2.1d) and “Outcomes should be assessed in the same way in all the groups being compared” (2.1e). The study evaluated reports in newspapers in English-speaking countries about herbal remedy and conventional pharmaceutical trials. It found that 7% (95% CI 6%-9%) of news reports specify if a trial was “double-blinded”. The criterion had a low risk of bias. The term “double blind” is a problematic term since it can have several meanings. 40 The study did not address this.

Criteria related to loss to follow-up

Few news reports said anything about follow-up of participants in trials. We included a single criterion, from the study by Bubela et al ., 19 related to the IHC Key Concept that “It is important to assess outcomes in all (or nearly all) the people in a study” (2.1g). This was the same study that evaluated whether news reports specify whether a trial was “double blind”. 18 The risk of bias was low for this criterion. The study found that 7% (95% CI 5%-9%) of news reports specify withdrawals or dropouts from a trial.

Criteria related to selective reporting

Few news reports selectively reported “statistically significant” results. We included two estimates, from two studies, 35 , 47 related to IHC Key Concepts that “Failure to consider unpublished results of fair comparisons may result in estimates of effects that are misleading” (2.2b) and “Deeming results to be ‘statistically significant’ or ‘nonsignificant’ can be misleading” (2.3g). Overall, 93% (95% CI 87%-97%) of news reports avoid selectively reporting “statistically significant” results ( Figure 3 ). The certainty of the evidence for that estimate is high.

Criteria related to qualitative descriptions of effects

Many news reports used misleading language to describe intervention effects and did not quantify effects. We included seven estimates, from five studies, 29 , 30 , 35 , 40 , 43 related to the IHC Key Concept that “Verbal descriptions of the size of effects alone can be misleading ” (2.3a) Overall, four studies that reported six criteria related to quantification of effects found that 53% (95% CI 36%-69%) of news reports quantify effects, as opposed to only describing them qualitatively. There was a high risk of bias for two of the criteria. The certainty of the evidence for this estimate is also low, due to substantial inconsistency (I 2 = 99%) and important imprecision. Overall, two studies, found that 68% (95% CI 35%-90% of news reports do not use misleading language to describe intervention effects. One of the criteria had a risk of bias. The certainty of the evidence for that estimate is low, due to substantial inconsistency (I 2 = 98%) and important imprecision.

Criteria related to absolute effects

Most news reports did not report absolute effects. We included five estimates, from five studies, 12 , 13 , 40 , 41 , 49 related to the IHC Key Concept that “Relative effects of treatments alone can be misleading” (2.3b). All five criteria had a low risk of bias. Overall, 17% (95% CI 4%-49%) of news reports report absolute effects ( Figure 3 ). The certainty of the evidence for that estimate is low, due to substantial inconsistency (I 2 = 97%) and important imprecision.

Criteria related to the play of chance

Few news reports claimed that an intervention has a benefit despite a small sample size, and more than half specified the sample size of trials, but few clearly and soundly “assessed the precision” 8 of reported estimates of effect. We included four estimates, from four studies, 19 , 31 , 35 , 39 related to the IHC Key Concepts that “Small studies may be misleading” (2.3d) and “The use of p-values may be misleading; confidence intervals are more informative” (2.3f). Based on estimates from single studies 95% (95% CI 88%-98%) of news reports do not claim there was a benefit despite a small sample size, 35 and 63% (95% CI 59%-67%) specify the sample size of trials. 19 Two studies found that 6% (95% CI 1%-38%) 39 and 8% (95% CI 3%-20%) 31 of news reports “clearly and soundly” assess the precision of estimates or risk of random error.

Criteria related to subgroup analyses

Most news reports did not focus on inappropriate subgroups. We included a single estimate, from the study by Yavchitz et al ., 47 related to the IHC Key Concept that “Results for a selected group of people within a study can be misleading” (2.3e). The study found that 94% (95% CI 85%-98%) of news reports avoid focusing on an “inappropriate subgroup”. The criterion had a low risk of bias.

Criteria related to lack of evidence

Most news reports avoided claiming that interventions have equivalent effects based on a difference that was not “statistically significant”. We included a single estimate, from the study by Yavchitz et al ., 47 related to the IHC Key Concept that “Lack of evidence of a difference is not the same as evidence of ‘no difference’” (2.3h). The study found that 93% (95% CI 83%-97%) of news reports do not claim equivalence when there was a “statistically nonsignificant” difference. 47 The criterion had a low risk of bias.

Criteria related to options

Most news reports did not include information about alternative interventions. We included seven estimates, from six studies, 13 , 29 , 41 , 43 , 50 related to the IHC Key Concept “Be clear about what the problem or goal is and what the options are” (3.1a). Overall, 36% (95% CI 26%-47%) of news reports include information about alternative interventions ( Figure 3 ). The certainty of the evidence for that estimate is moderate, due to substantial inconsistency (I 2 = 96%).

Criteria related to extrapolations

Some news reports focused on surrogate outcomes or extrapolated from surrogate to important outcomes. Some news reports did not report indications for interventions and most did not report contraindications. Few news reports did not clearly report to whom the information applied. Some extrapolated from study participants to a larger or different population. Many news reports did not consider the availability of the intervention or the dosage of the intervention. Some interventions extrapolated from the study intervention to a different intervention.

Altogether, we included 21 criteria, from 12 studies, 12 , 13 , 19 , 29 , 31 , 35 , 38 , 41 , 43 , 47 , 50 , 51 related to the IHC Key Concepts that “Attention should focus on all important effects of treatments, and not surrogate outcomes” (3.2a), “Fair comparisons of treatments in animals or highly selected groups of people may not be relevant” (3.2b), “The treatments compared should be similar to those of interest” (3.2c) and “There should not be important differences between the circumstances in which the treatments were compared and those of interest” (3.2d). There was a low risk of bias for all the criteria.

We included two criteria, from two studies 35 , 50 related to the IHC Key Concept that “Attention should focus on all important effects of treatments, and not surrogate outcomes” (3.2a). Overall, 82% (95% CI 76%-86%) of news reports do not solely focus on surrogate outcomes or extrapolate from surrogate to important outcomes. The certainty of the evidence for this estimate is high.

We included eight criteria, from six studies, 31 , 35 , 38 , 41 , 50 , 51 related to IHC Key Concept that “Fair comparisons of treatments in animals or highly selected groups of people may not be relevant” (3.2b). Five of these criteria, from three of the studies, 41 , 50 , 51 addressed reporting of indications and contraindications. Indications are reported in 70% (95% CI 64%-76%) to 97% (95% CI, 95%-98%) of news reports, whereas contraindications are only reported in 4% (95% CI 2%-8%) to 13% (95% CI 11%-16%) of news reports. Two criteria, from two studies, 31 , 38 addressed whether it was clear to whom the information applies. These criteria are met in 94% (95% CI 81%-98%) to 100% (95% CI 98%-100%) of news reports. The other criterion, from the study by Haneef et al ., 35 assessed whether results were extrapolated from study participants to a larger or different population. The study found that 85% (95% CI 72%-92%) of news reports do not extrapolate to a larger or different population.

We included eight criteria, from eight studies, 13 , 19 , 29 , 35 , 41 , 43 , 51 related to the IHC Key Concept that “The treatments compared should be similar to those of interest” (3.2c). Five of these criteria addressed availability of the intervention. The availability of the intervention is reported in 41% (95% CI 37%-45%) to 79% (95% CI 66%-88%) of news reports. Two of the criteria addressed dosage. Those studies found that 14% (95% CI 11%-17%) 19 to 50% (95% CI 46%-54%) 51 of news reports specify or mention dosage. The other criterion addressed extrapolation from the study intervention to a different intervention. That study 35 found that 85% (95% CI 72%-92%) of news reports do not extrapolate to a different intervention.

Criteria related to animal studies

Some news reports extrapolated a beneficial effect from an animal study to humans. We included a single estimate, from the study by Haneef et al ., 35 related to the IHC Key Concept that “Fair comparisons of treatments in animals or highly selected groups of people may not be relevant” (3.2b). The study, which had a sample of 29 news reports, found that 79% (95% CI 61%-90%) of reports do not extrapolate beneficial effects in humans from animal studies. 35 The criterion had a low risk of bias.

Criteria related to pros and cons

Few news reports failed to mention at least one benefit of an intervention. On the other hand, few mentioned or discussed the cost of the intervention, and most did not mention or adequately discuss or explain potential harms.

Altogether, we included 32 estimates, from 17 studies, 12 , 13 , 29 – 31 , 35 , 38 – 41 , 43 , 47 – 52 related to IHC Key Concepts that “Treatments can cause harms as well as benefits” (1.1a) and “Weigh the benefits and savings against the harms and costs of acting or not” (3.3a). One criterion was also included with criteria related to qualitative descriptions of effects, related to the IHC Key Concept that “Verbal descriptions of the size of effects alone can be misleading” (2.3a). That criterion was the only one that had a high risk of bias.

We included 14 criteria, from 13 studies, 12 , 13 , 30 , 35 , 40 , 41 , 43 , 47 – 52 related to harms. Overall, 40% (95% CI 23%-61%) of news reports about the effects of health interventions mention or adequately discuss or explain potential harms of the intervention. The certainty of the evidence for that estimate is low, due to substantial inconsistency (I 2 = 99%) and important imprecision.

We included 10 criteria, from nine studies, 13 , 29 , 30 , 40 , 41 , 43 , 49 – 51 related to cost. Overall, 18% (95% CI 12%-28%) mention or discuss the cost of the intervention. The certainty of the evidence for that estimate is moderate, due to substantial inconsistency (I 2 = 98%).

We included two criteria, from two studies, 41 , 50 related to benefits. Overall, 97% (95% CI 56%-100%) of news reports mention at least one benefit. The certainty of the evidence for that estimate is moderate, due to imprecision.

Key findings

Overall, we found that researchers have conducted many empirical studies of the quality of news reports about the effects of health interventions, assessing diverse samples of reports in terms of medium, country (although primarily English-speaking and high-income), and categories of interventions, using many different tools and criteria. Some criteria did not make sense and some relevant aspects of quality were not covered. We were able to synthesis results for some criteria groups, showing that there were several prevalent and important problems with the quality of news reports about the effects of health interventions. Many of the reports gave an unbalanced and oversimplified picture of the potential consequences of the interventions, leaving out information about conflicts of interest, alternative interventions, potential harms, and costs, and failing to quantify effects in absolute terms or at all.

Specifically, we identified 44 primary studies for inclusion in the qualitative summary (see extended data - S1 Table 105 ). Newspaper was the most common medium. Of the 39 studies that specified a medium, newspaper content was explicitly included in 35 (90%). The United States (US) was the most common country in which content was published. Of the 40 studies where at least one country was specified, 12 (30%) included content published in the US, while 25 (63%) included content published in English-speaking countries. “Modern” medicine was the most common category of health interventions. In the 32 samples where a category of intervention was specified, 24 (75%) included news reports about “modern” medicine. No study specified whether sampled reports were published by commercial or non-commercial outlets. Most studies used a tool that was original or modified.

The Index of Scientific Quality was the most common tool (set of criteria). It was used in seven studies (16%). 31 , 33 , 34 , 36 – 39 However, a larger number of studies used tools directly or indirectly based on the criteria developed by Moynihan et al. , 40 including the four studies that used the Media Doctor Australia tool 12 , 13 , 41 , 42 and the three studies that used the Health News Review tool. 28 , 29 , 43

Of the 44 studies included in the qualitative summary, we included 18 (41%) in the meta-analyses. We mapped all 208 quality criteria used in those studies against the IHC Key Concepts. Some of the criteria were in conflict with IHC Key Concepts, such as those that asked whether research discussed in a news report was peer-reviewed. We were unable to identify or include quality criteria related to several highly relevant IHC Key Concepts, for example “ Average differences between treatments can be misleading ” (2.3c).

In the end, we included 108 of the 208 criteria (52%) in the meta-analyses, organised in 19 groups, as well as eight subgroups. We calculated overall estimates and rated the certainty of the evidence for five of the 19 main criteria groups (26%) and 6 of the 8 subgroups (75%). Those estimates ranged from 17% of news reports satisfying criteria related to reporting absolute effects (95% CI 4%-49%) (low certainty), to 97% satisfying criteria related to reporting on benefits (95% CI 56%-100%) (moderate certainty).

Media doctor Australia and health news review

Some of the studies included in our review report partial results from initiatives aimed at helping journalists and the public assess health information in the news and improving health journalism. This includes studies related to the Media Doctor Australia initiative 12 , 13 , 42 and its American counterpart Health News Review (or HealthNewsReview.org ). 28 , 29 These initiatives involved an editorial team rating news reports about the effects of health interventions on a running basis and posting individual ratings with lay explanations on a dedicated website. Both have been shut down. We were unable to include the most complete published results from either initiative in our meta-analyses, but those results were consistent with the earlier results that we were able to include, as well as our overall findings.

In terms of Media Doctor Australia, we were able to include the studies by Smith et al. 12 and Bonevski et al . 13 in the meta-analyses. The former includes results from the first 104 ratings, published between Feb. 1 and Sept. 1, 2004, while the latter includes results from the first 222 ratings of news reports about “complementary” and “alternative” medicine, published between Jan. 1, 2004, and Sept. 1, 2007. Meanwhile, Wilson et al . include results from 1230 ratings, posted between March 2004 and June 2008, in a paper titled “Media reporting of Health Interventions: Signs of Improvement, but Major Problems Persist”. 42 We included the study by Wilson et al. in our qualitative summary, but not in the meta-analyses, since the authors only reported mean scores and not the sample sizes for each quality criterion. We knew from the two other Media Doctor Australia studies that sample sizes varied between criteria because a criterion was not always considered relevant to a given news report and, in those cases, not applied. In other words, we could not extract the exact proportions of news reports satisfying each criterion from the study by Wilson et al . That said, as the title of paper suggests, there were no notable differences between the new Media Doctor Australia results and the previous results reported by Smith et al . (see Table 2 in the study by Wilson and colleagues 42 ).

In terms of Health News Review, we were able to include the studies by Schwitzer 28 and Walsh-Childers et al. 29 in the qualitative summary. The former included results from 500 Health News Review ratings, published between April 2006 and February 2008, while the latter included results from 1889 ratings published from July 2005 through March 2013. Hence, we only included the study by Walsh-Childers et al. in the meta-analyses. The Health News Review team continued to publish ratings until the end of 2019, finishing at 2610. 53 In a blog post published Dec. 20, 2018, the founder and publisher, Schwitzer, shared a final “report card” with some of the results from all 2610 ratings. 53 Like with the Media Doctor Australia studies, there were no notable differences between the most recent results, published in Schwitzer's blog post, and those previously reported and included in this review, from the study by Walsh-Childers et al .

Underlying problems

Problems with the quality of information in health news reports could be explained by underlying problems occurring at different stages of the information pipeline, from when scientists plan, conduct and report studies, to when academic institutions and journals promote studies, to when news outlets cover studies. Not to mention deliberate misinformation by commercial industries and organisations. 54

Ioannidis has estimated that most published research findings are false due to small studies and small effect sizes, testing many relationships without preselecting those tests, flexibility in study designs, definitions, outcomes and analyses, financial and other conflicts of interest, and competition. 55 Similarly, Chalmers and Glasziou have estimated that 85% of research is wasted due to wrong research questions, unnecessary or poorly designed studies, failure to publish relevant research promptly or at all, and biased or unusable reports of research. 56 , 57 Meanwhile, Chi and colleagues have found problems with the quality of information in biomedical literature that correspond with problems found in health news reporting, for example inappropriate use of causal language. 58 A vast amount of poorly planned, conducted and reported research provides a terrible starting point for health and science journalism. Parenthetically, these studies provide additional evidence that peer review is a poor indicator of quality.

Several studies have identified problems with press releases about health research. Wang et al . found randomised trials were less likely to be the subject of a medical journal press release compared to observational studies. 59 Woloshin et al. assessed press releases from academic medical centres and found many were directly misleading or misleading by omission. 60 Yavchitz et al. found press releases for two-arm, parallel-group randomised trials often included some form of “spin”, for example conflating lack of evidence of a difference with no difference. 47 Sumner et al. have found exaggerations in press releases from both academic institutions 61 and scientific journals, 62 such as causal claims based on observational studies, were associated with exaggerations in related news reports. This finding was supported by a replication study conducted by Bratton et al . 63

Amend and Secko conducted a qualitative synthesis of studies exploring journalists’ experience of covering health and science. 64 They included 21 studies involving 788 journalists in total. Many of the themes cutting across studies were barriers to high-quality health and science journalism, including deadline pressure and limited time for researching and preparing stories; limited time or space for telling stories; limited budgets and staff, including a lack of specialised health and science journalists; competition and commercialization; pressure from advertisers and interest groups; and lack of education or training. More recently, O’Keeffe et al . found some of the same barriers to reliable reporting when they interviewed 22 Australian journalists, most of whom were specialised in health. 65

Other mass media sources of health information

Other studies have focused on other mass media sources of lay information about the effects of health interventions. This includes both other forms of journalism, besides news reports, and other mass media, besides news media. Some of those studies were included in this review. Overall, it appears quality varies depending on the source, but that there are problems across the board, granted we have not systematically reviewed or critically appraised studies focusing on other sources.

Newspaper features and advice columns – Heaner assessed news features and news reports about nutrition and physical activity. 32 She found features were generally of higher quality. Molnar et al. assessed medical advice columns for elderly readers and found that recommendations were often inappropriate or potentially dangerous. 66

Entertainment – Wilson et al . assessed the quality of advice popular magazine articles and found especially those with “health” in the title of the publication presented poor-quality, unreliable advice. 67 Korownyk et al . and Mishori et al. assessed recommendations made on medical talk shows. 68 , 69 Both studies found the recommendations were often unreliable or misleading.

Social media – Moorhead et al. conducted a systematic review of the uses, benefits and limitations of social media for health communication and found that concern about the quality of information was common across studies. Li et al. found that over a quarter (19) of the 69 most-viewed YouTube videos about Covid-19 contained misleading information, including “inappropriate recommendations”, consistent with previous studies of YouTube videos about other pandemic diseases. 70 Haber et al. found many of the health science articles most often shared on Twitter and Facebook in 2015, as well as media coverage of those articles, often used causal language that was too strong for the strength of the evidence. 27

Advertising – There is a long tradition of misleading advertisements for health interventions. Dushman has provided 10 examples from the early 20 th century, including an ad for Dr. William O. Coffee's “world-famous”, “marvelous” and “remarkable” treatment for deafness. 71 Frosch et al . and Faerber and Kreling have found problems with modern advertisements for both prescription and over-the-counter medicines. 72 , 73 In sales materials for herbal dietary supplements, the United States Government Accountability Office has found “improper” and illegal claims that the supplements can cure cancer, among other conditions. 74

Other consumer and patient sources – In a systematic review of studies assessing the quality of online health information for consumers, Eysenbach et al. found 55 of 79 studies (70%) had concluded that quality was a problem. 75 In more recently published studies, others have found problems with the information on anti-vaccination websites, 76 cancer and oncological industry websites, 77 websites for clinics offering weight loss surgery, 78 and websites for fertility centres. 79 In their study of media coverage of practice-changing clinical trials in oncology, Andrew et al . found the cancer and industry websites provided higher-quality information than newspaper and cable news reports. 77

Studies focusing on patient sources of information have found problems with patient health portals, 80 patient materials, 81 and brochures from a health fair. 34 Glenton and Oxman (AO) surveyed and interviewed leaders of organisations representing health care users. 82 They concluded that the organisations did not appear to promote evidence-based health care and that when they did promote scientific information, they appeared to do so uncritically, relying on limited sources and traditional authorities.

Last but not least, in a review published in 2019, Oxman and Paulsen assessed free, online sources of “trustworthy” information about the effects of health interventions. 83 They found that patients and the public could access trustworthy information using two websites: Cochrane Evidence ( www.cochrane.org/evidence ) 84 and Informed Health ( www.informedhealth.org ). 85 However, they concluded that both websites could be improved by consistently reporting information about the size of both benefits and harms, and the certainty of the evidence. They noted that many websites excluded from their review claim to provide evidence-based or reliable information about the effects of health interventions, but that it was difficult to assess the reliability of the information on those websites since the information was not explicitly based on systematic reviews.The Informed Health website is a separate initiative from the Informed Health Choices project.

Other problems with health news

Other studies have found other problems with health news, besides the quality of information. Wang et al . found that observational studies and small randomised trials reporting surrogate outcomes generated as much news coverage as large, randomised trials reporting important outcomes. 59 Dumas-Mallet et al. found that newspaper reports about biomedical research were typically about findings from initial studies. 86 Such findings were often contradicted by a meta-analysis, but this was rarely reported by news outlets.

As far as we are aware, this is the first systematic review of the quality of any type of health news. It provides a larger, more detailed picture of the quality of health news than any primary study that we identified. It also provides a starting point for similar reviews and alternative analyses, and it highlights important issues for interpreting and planning new studies. We conducted an expansive search and identified several studies outside the peer-reviewed literature (see extended data - S1 Table 105 ). We assessed records and full texts in any language for inclusion in the review, and included studies in five different languages in the qualitative summary (English, German, Norwegian, Slovenian and Spanish) (see extended data - S1 Table 105 ). We synthesised results from up to 13 different studies, using different tools and criteria, and pooled results for up to 4116 unique news reports (see extended data - S8 and S10 Files 105 ). The review provides an accessible summary of what is known about the quality of news reports about the effects of health interventions, in print, broadcast and online news media, for those aspects of quality that have been measured and reported. It also identifies gaps in what is known and directions for future research.

Limitations

The findings of this review are limited to information about the effects of health interventions and “traditional” news media. In the section “Other mass media source of health information”, we reference and discuss findings from research focusing on other news media and other non-news media, but we have not systematically reviewed or critically appraised such studies. Furthermore, we did not explore applicability of the synthesised results to different types of traditional news media due to limited sample sizes, as well as inadequate reporting in the included studies.

Examples of other types of health information include the accuracy of diagnostic tests and information about the health effects of exposures. News reports about the health effects of exposures (e.g. fatty foods) can be difficult to distinguish from news reports about the effects of health interventions (e.g. a low-fat diet). Some primary studies included in this review conflated the two, such as the study by Hackman and Moe, which assessed news about nutrition-related research. 87 We included this study in the qualitative summary, but not the meta-analyses. We did this because key concepts for assessing or communicating information about the effects of interventions may not apply to the same degree, or at all, to information about associations between exposures and outcomes. For example, Woodruff and Sutton point out that randomised trials are “virtually precluded” from evidence about hazardous environmental exposures because of ethical considerations”. 88 It is possible, if not likely, that there are important differences in quality between news reports about the effects of exposures versus interventions.

We excluded studies or criteria that were only descriptive, even though criteria that were descriptive sometimes provided the same data as criteria explicitly intended to assess quality. For example, Mercurio and Eliott describe Australian news about “alternative” medicine for cancer, but do not explicitly assess the quality of those news reports, 89 so we excluded the study. However, one of their coding variables was “Mention of risks, benefits and costs”. The data for this variable would have fit with data in our meta-analyses, in the group Criteria related to pros and cons. We consider it unlikely that inclusion of studies or criteria that were only descriptive would have substantially altered the findings of this review. Similarly, we only included studies in the meta-analyses if they were in English or Norwegian (one of the languages spoken fluently by the primary investigator, MO), but consider it unlikely that the studies reported in other languages would have substantially altered the findings of this review either, given that the underlying problems discussed earlier on are unrelated to language.

We did not code raw data ourselves or contact authors for help where data were inadequately reported for our purposes. Finally, we did not consider which criteria were more informative, only whether they were eligible and sensible, nor did we consider statistical measurement properties. 90

Implications

Implications for different stakeholders are summarised in Table 5 and explained in more detail in the subsequent sections.

Implications for journalists, editors, and news outlets

There is clearly room for improving the quality of health and science journalism. Based on our meta-analyses, journalists and editors should pay special attention to the following IHC Key Concepts (see extended data - S6 File 105 ) when communicating information about the effects of health interventions:

• • “Treatments can cause harms as well as benefits” (1.1a),
• • “Competing interests may result in misleading claims” (1.3b),
• • “Verbal descriptions of the size of effects alone can be misleading” (2.3a),
• • “Relative effects of treatments alone can be misleading” (2.3b),
• • “Be clear about what the problem or goal is and what the options are” (3.1a), and
• • “Weigh the benefits and savings against the harms and costs of acting or not” (3.3a).

Based on individual estimates from primary studies included in this review (see extended data - S8 and S10 Files 105 ), there is likely also room for improvement related to other highly relevant IHC Key Concepts, such as “ The treatments compared should be similar to those of interest ” (3.2c). Moreover, there is likely room for improvement related to highly relevant IHC Key Concepts that were not captured by any quality criteria, such as “ Average differences between treatments can be misleading ” (2.3c) (see extended data - S10 File 105 ).

Journalists and editors should take a critical approach to reports of research, especially single studies and observational studies, and to press releases (see “Underlying problems”). When reporting on the effects of interventions, they can search the Cochrane Evidence ( www.cochrane.org/evidence ) 84 and Informed Health ( www.informedhealth.org ) 85 websites for summaries of relevant systematic reviews. If possible, news outlets should provide or support special training for health and science reporters, as well as provide adequate time for researching and preparing stories, and adequate time or space to tell stories.

Journalists and editors who are interested in learning more about IHC Key Concepts can do so for free on the “That's a claim!” website ( www.thatsaclaim.org ), 91 where all of the concepts are explained in plain language, and there are references to relevant learning resources for each individual concept. They can also find free learning resources for respective concepts via the Teachers of Evidence-Based Health Care portal ( www.teachingebhc.org ). 92

Implications for researchers, scientific journals, academic institutions, and research funders

Researchers, journals, and academic institutions should pay special attention to the same IHC Key Concepts as journalists and editors, as well as other highly relevant concepts (see previous section), when reporting the results of studies assessing the effects of interventions in research papers and press releases, as well other contexts, such as conferences. More fundamentally, they should work to reduce false findings and research waste. This also goes for organisations that fund research.

The results of this review have a series of implications for investigators planning new studies of the quality of information about the effects of health interventions in mass media (as well as peer reviewers assessing new studies), from objectives, to methods, to reporting. First, they should think carefully about their goal. New studies can be designed to have practical value, for example informing interventions to improve a particular population's ability to think critically about health information by identifying the IHC Key Concepts that are most relevant for that population—e.g. a study of health claims in advertisements targeted at young people. In addition, they should consider research gaps that we have revealed. Again, there does not appear to be studies assessing the quality of health news reports in terms of several highly relevant IHC Key Concepts (see extended data - S6 Table 105 ). Neither does there appear to be studies that compare the quality of reports published by commercial outlets versus public or independent outlets. Others have pointed out that research is needed about how best to communicate information about the effects of health interventions, 93 including how to communicate uncertainty. 94

Second, they should think carefully about what tools and quality criteria to use, whether using a previously developed tool, adapting one, developing a new tool, or some combination. They should avoid criteria that are overly general (e.g. global scores and composites) or unclear (e.g. criteria assessing whether “double blinding” is mentioned), and criteria that do not make sense (e.g. criteria assessing whether research was peer-reviewed). They should be deliberate about the trade-offs between how straightforward it is to apply a criterion and report the results versus how informative it is. For example, it is relatively easy to see whether a news report mentions the design of a study. It is more difficult, but also more informative, to assess whether the report adequately discusses strengths and limitations of said design.

Third, regarding samples of news reports, they should consider applicability and potential explanatory factors, for example those we highlighted in the protocol for this review (see extended data - S1 File 105 ) as possible variables for subgroup analyses: medium; time period; financial model (commercial vs. non-commercial); specialisation (specialised health or science journalist vs. other); country income level; and newspaper type (broadsheet vs. tabloid). Fourth, they should consider risk of bias. If possible, two researchers should assess each news report or other unit of mass media content, and the researchers should be blinded to factors that could introduce bias, such as the name of the journalist or publication. This is especially important for criteria that require substantial judgement.

Fifth, when reporting new studies, researchers should be explicit, clear and comprehensive. They should include the study objective, the sampling frame, and the selection criteria and technique, with concern for applicability and comparing results across studies, including results for subgroups. They should include the time period in which the content was published, as well as when it was assessed; the country in which it was published or, if online content, the country that the outlet primarily targets or where it is based; the categories of interventions that the content focuses on; and the financial models of the outlets. If using a previously developed tool, they should provide reference to where the development is described, note whether they made any adjustments and, if so, explain them. If using a new tool, they should clearly describe how it was developed and what informed it, possibly in a separate paper. If the researchers received any training in applying the criteria, they should describe what this entailed. Finally, they should report results for each quality criterion separately, not just mean scores, and report absolute numbers (the total number of news reports or other units to which the criterion was applied and the number of units that satisfied the criterion), including for subgroups.

Implications for consumers and patients

The implications for consumers and patients are similar to those for journalists and editors. They should pay special attention to the same IHC Key Concepts, as well as other highly relevant concepts (see “Implications for journalists”); they should approach health information in the mass media critically; they can refer to the Informed Health and Cochrane Evidence websites for summaries of relevant systematic reviews; and they can take advantage of the “That's a claim!” website and Teachers of Evidence-Based Health Care portal to learn more about IHC Key Concepts.

Implications for citizens and policymakers

The results of this review, as well as the results of related studies referenced in the section “Other mass media sources of health information”, show that the global “infodemic” was compounded by Covid-19, but started long before the World Health Organization coined the term in their situation report on the virus published Feb. 13, 2020. 3 The infodemic is so dangerous because we know so many people are unable to critically assess claims or evidence about the effects of health interventions. 95 , 96 When people act on those claims or beliefs that are unreliable or fail to act on reliable advice, they may suffer unnecessarily or waste resources. It follows that infodemic is probably an important factor in the enormous, worldwide overuse of ineffective or harmful interventions 97 and underuse of effective interventions. 98 Even one misleading news report might contribute to wasteful, harmful, and even deadly choices. A dramatic example of misleading health news is coverage of the baseless suggestion that the measles, mumps and rubella vaccine causes autism. 99 Incidentally, news reports often focus on the benefits of interventions while ignoring or downplaying the harms, but this example illustrates that unbalanced reporting can also go in the opposite direction.

If the only goal of news about the effects of health interventions was to facilitate well-informed health choices, the content and format might look more like Cochrane plain language summaries, which have been systematically developed towards exactly said end. 100 , 101 The reality is that news outlets existentially depend on getting people's attention, not informing them. Commercial media rely on advertising, not least advertisements for health interventions, which provides incentive to sensationalise. In turn, this can create pressure on competing public and independent outlets to do the same. Along the same lines, the raison d'être of press releases is inciting media coverage, while scientists are forced to “publish or perish”. Setting aside systemic barriers to reliable health news (see the section “Underlying problems”), it may be difficult if not impossible for journalists to produce news reports that satisfy all sensible, applicable criteria identified in this review in a report that people would understand and want to read, not to mention other potential criteria related to other highly relevant IHC Key Concepts. Even if a report includes and appropriately presents all relevant information about an intervention, it is possible that many people will not read more than the headline, missing important details, such as potential side effects.

With enough resources, it is possible for news outlets, including commercial ones, to improve their health and science coverage without shrinking their audiences and perhaps even increasing their numbers of readers, listeners, or viewers in some cases. But putting an end to unreliable health news is a Sisyphean task, not to mention health misinformation from other sources. In 2009, during a debate titled “Does the media support or sabotage health?”, Goldacre suggested: “The future of people getting information about health does not lie in journalism but people having direct access to information or the world of blogs where people can link direct to primary sources. There is no role for the health journalists of the future other than as entertainers". 102 However, it seems unlikely that giving people more health information—even if it is reliable—will solve the problem, when they are already overwhelmed and lack the skills needed to “separate the wheat from the chaff”.

As the saying goes, give someone a fish and you will feed them for a day; teach them to fish and you feed them for a lifetime. In other words, you can provide people with reliable health information or advice, and maybe they will believe you. If you help them understand why it is reliable, or why a claim is unreliable, you are preparing them to assess information and make informed choices for themselves in the future, inoculating them against unreliable claims and uninformed choices. Hence, we should be helping people gain basic critical appraisal and decision-making skills, in addition to providing access to reliable information. Moreover, by improving people's ability to assess evidence or recognise a lack of reliable evidence, the public may start to demand reliable studies, reducing false findings and research waste.

Focusing on the education system allows for reaching large groups of people, gathered specifically to learn. It is important to start young, when people have time to reinforce and build upon what they have learned, and they have less to unlearn. The IHC network, which includes authors of this review, has developed respective interventions to help primary school children 103 and university students 104 master select IHC Key Concepts.

Data availability

Author contributions.

MO drafted the protocol and this paper. AO provided feedback on the draft protocol. All co-authors provided feedback on drafts of this paper. MO, LL and AQ piloted the eligibility criteria for primary studies. MO conducted all database searches, including citation searches. MO, LL, GG, DA, AQ and KB checked reference lists. All authors apart from CR contributed to study selection. All authors apart from AO and CR contributed to data extraction. MO and AO assessed, mapped and grouped the quality criteria. CR conducted the meta-analyses. MO and LL assessed risk of bias. MO and AO rated the certainty of the evidence.

Acknowledgements

Mike Clarke provided early guidance in a course on systematic reviews. Carl Heneghan and Kamal Mahtani were MO's MSc supervisors and provided feedback on the protocol and the first part of the review (MO's dissertation). Marit Johansen provided feedback on the search strategy. Anette Blüme, Tina Poklepović Peričić, Rob J.P.M. Scholten and Michel Wensing helped assess full texts in German, Slovenian and Dutch for inclusion in the qualitative summary. We are grateful to Mark Oette for providing a copy of his study, included in the qualitative summary. This review is dedicated to Lisa Schwartz who was a pioneer in the field 106 and a dear colleague and friend.

[version 2; peer review: 4 approved]

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

Reviewer response for version 2

David henry.

1 Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia

My only remaining concern is the way the conclusion is framed: "it is logically more important to improve the public’s ability to critically appraise health information and make judgements for themselves". While education is preferable to regulation I don't think that improving media coverage of health is an alternative to educating the public to be more critical of health claims. We should be trying to encourage both.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Is the statistical analysis and its interpretation appropriate?

Are sufficient details of the methods and analysis provided to allow replication by others?

Are the conclusions drawn adequately supported by the results presented in the review?

Reviewer Expertise:

clinical epidemiology, pharmacoepidemiology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Reviewer response for version 1

The other reviewers of this article have highlighted its considerable strengths and I won’t repeat their comments. This is a solid attempt to summarise studies that have made structured attempts to quantify and report key characteristics of medical news stories that report therapeutic claims. It is very useful to have this summary.

Many of these studies were carried out to highlight the weaknesses in the reporting of medical advances in the mainstream media in the hope that this would raise standards. But there is no strong evidence that this has resulted from these efforts.

The studies included in this review preceded the news coverage of COVID-19, its preventive and therapeutic interventions. It would be very instructive to measure how the media performed during the epidemic and whether reporting evolved. My informal impression is that respect for science, and possibly the reports themselves, have improved. However, this has been countered by ignorant and some willfully and politically motivated inaccurate reporting in a few mainstream outlets and social media. My point is that the media landscape may have changed because of Covid-19.

I only have a few specific comments:

• I don’t think that conventional meta-analysis produces meaningful data in this situation. Meta-analysis is at its best when we can assume that there is an underlying single effect of interest that is measured imprecisely by individual studies. For instance, the relative effects of many important medications (e.g, statins, anticoagulants), which seem constant across different settings and background risks. Meta-estimates of prevalence are less helpful as there is usually an assumed variation. That is the case here where the study methods, story topics, settings, and reporters vary. There is no reason to assume a common effect to be meta-analysed. Some of the I 2 values are huge. In my view it would be preferable to present more as a scoping review, displaying and discussing the range of values reported by the studies.
• The investigators, appropriately, have mapped the varying scales and items to a common framework. They have used their own Informed Health Choices (IHC) Key Concepts framework. That’s fine, but the paper seems to assume a familiarity with the framework that many readers will not possess. I think a simplified version of the framework needs to be presented in the main text. At present, it seems to be buried in Supplementary data.
• In the Abstract, the authors conclude: ‘There is room for improving health news, but it is logically more important to improve the public’s ability to critically appraise health information and make judgements for themselves.’ The paper does not provide data to support this conclusion. The authors have done important ground-breaking work with IHC but the extensive coverage they provide themselves in the Discussion of an already long paper seems excessive. A separate editorial/opinion piece making these points would be welcome.
• I think there may be a mistake in the dot point summary in the Discussion which states ‘• 86% of news reports commit “disease mongering” (95% CI 78%-91%) (low certainty).’ In the paper they state ‘Overall, 86% of news reports do not commit disease mongering (95% CI 78%-91%)’. I think the latter is correct.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Norwegian Institute of Public Health, Norway

We are grateful to you and the other reviewers for your time, effort, and constructive criticism. Thank you! We have pasted your comments below, in italics, with responses in turn.

1. I don’t think that conventional meta-analysis produces meaningful data in this situation. Meta-analysis is at its best when we can assume that there is an underlying single effect of interest that is measured imprecisely by individual studies. For instance, the relative effects of many important medications (e.g, statins, anticoagulants), which seem constant across different settings and background risks. Meta-estimates of prevalence are less helpful as there is usually an assumed variation. That is the case here where the study methods, story topics, settings, and reporters vary. There is no reason to assume a common effect to be meta-analysed. Some of the I2 values are huge. In my view it would be preferable to present more as a scoping review, displaying and discussing the range of values reported by the studies.

We assume that this comment is suggesting the studies were too heterogeneous for estimating average proportions across studies to be meaningful. We were conservative about synthesising results this way, and cautious in our interpretation. We used a random effects analysis, which explicitly assumes there is not a common effect, but rather that the studies estimate distinct effect sizes. The large I2 values are a property of the literature included. The range and results for individual studies are available in the supplementary material, with the forest plots. We elected to exclude this information from the text because it would make the text harder to read, and it would not substantially alter the results—i.e., despite substantial heterogeneity, the overall estimates and confidence intervals provide an appropriate indication of what was found across the studies in each meta-analysis, and a better indication than the median and range, or range alone.

2. The investigators, appropriately, have mapped the varying scales and items to a common framework. They have used their own Informed Health Choices (IHC) Key Concepts framework. That’s fine, but the paper seems to assume a familiarity with the framework that many readers will not possess. I think a simplified version of the framework needs to be presented in the main text. At present, it seems to be buried in Supplementary data.

The article is already long, as pointed out in Reviews 1 and 3. We have included the framework as S6 File and reference the file at first mention of the framework in the methods section, where we also summarise its content, and explain why and how we used it.

3. In the Abstract, the authors conclude: ‘There is room for improving health news, but it is logically more important to improve the public’s ability to critically appraise health information and make judgements for themselves.’ The paper does not provide data to support this conclusion. The authors have done important ground-breaking work with IHC but the extensive coverage they provide themselves in the Discussion of an already long paper seems excessive. A separate editorial/opinion piece making these points would be welcome.

We have removed the last three paragraphs of the discussion, which were about IHC.

4. I think there may be a mistake in the dot point summary in the Discussion which states ‘• 86% of news reports commit “disease mongering” (95% CI 78%-91%) (low certainty).’ In the paper they state ‘Overall, 86% of news reports do not commit disease mongering (95% CI 78%-91%)’. I think the latter is correct.

Correct. We have fixed this typo.

Thank you again for the valuable feedback!

Amanda Wilson

1 School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia

This is a systematic review of studies assessing the quality of health news articles which provides a meta-analysis of the results. This is an interesting paper which provides a quantitative approach to what is likely to be considered a difficult area to quantify – that is quality of reporting. The influence of news reporting on health behaviours is well known and the current climate of pandemic and vaccination information makes this a highly pertinent area to explore.

The methodology is sound and rigorous with the authors following the gold standard approach of registering the review and publishing the protocol. All steps of the literature review are described in detail and the analyses and interpretation are sound.

The paper is extremely well written and I have little critical feedback on the structure of the research or presentation of the paper. My only criticism is that it is extremely long and possibly overly detailed. The length and detail are worthy of a Cochrane review but without the saving grace of a plain language summary. I wonder if some ruthless editing might enhance the number of readers who make it the whole way through. It feels like a PhD chapter rather than a journal article. Having said that, in the Discussion on page 18, I was interested to know which criteria did not make sense and which aspects of quality were not covered.

Public health, health literacy, health reporting in the media, health education

My only criticism is that it is extremely long and possibly overly detailed. The length and detail are worthy of a Cochrane review but without the saving grace of a plain language summary. I wonder if some ruthless editing might enhance the number of readers who make it the whole way through. It feels like a PhD chapter rather than a journal article. 

Please see our response to Review 1. 

Having said that, in the Discussion on page 18, I was interested to know which criteria did not make sense and which aspects of quality were not covered.

Regarding criteria that did not make sense, some conflict with IHC Key Concepts, such as the example in Table 3, or criteria that conflate a “statistically significant” effect with an important effect, including respective criteria used by Haneef et al. and Yavchitz et al. Others are imprecise measures of quality, for example criteria focusing on the novelty of the health intervention, or how much of a news report was based on a press release, since a report can be low or high-quality regardless of these characteristics. 

Regarding the aspects of quality not covered, S6 Table shows which IHC Key Concepts were not related to any criteria included in the meta-analyses.

Joel R. Lexchin

1 School of Health Policy & Management, Faculty of Health, York University, Toronto, Canada

2 Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada

3 Department of Emergency Medicine, University Health Network, Toronto, Canada

This is an extremely comprehensive and well-done systematic review on an important topic. The authors have obviously put an enormous amount of effort into the project and the results show that. The study is well written and easy to follow. However, there are some areas where I believe that improvements can be made.

• There is a potentially relevant article that the authors appear to have overlooked: Cassels et al . Open Medicine 2008;2(1):e20–23. Another study (Cassels et al.,  2003) is a longer version of one that the authors use – reference 48.
• Page 3: The authors use a 2009 paper to claim that most people get health information either directly or indirectly from traditional news media as opposed to material that appears only on social media. However, studies that evaluate information sourced from the two different types of media may no longer be relevant to the present-day environment.
• Page 18: The authors say that their findings come from a diverse range of countries but don’t they mean primarily western countries?
• Page 20: The length of a newspaper story is not necessarily a measure of quality. Cassels et al.  have shown that there are few significant differences in the overall quality between short news briefs and longer stories. (Cassels et al ., 2003)
• Page 22: The recommendations for improving the reporting of journalists, editors and news outlets at least partially assume the existence of resources and time to educate journalists and editors about science journalism. However, the authors do not assess whether the necessary resources are actually present and available especially in smaller media outlets.
• Page 22: Informed Health is only available in English and German. Therefore, it is limited in terms of usefulness to those speaking other languages. Cochrane Evidence is superior in that regard.
• Page 23 (last line): Is it Informed Choices or Informed Health? Are these the same or different?
• Page 24: Earlier the authors refer to Informed Health and Informed Choices. Now there is a third name Informed Health Choices. Are all three the same?
• Page 24: Have any of the educational interventions that the authors mention (references 99-104) looked at the long-term (e.g., more than 1 year) effects?

Pharmaceutical policy, intellectual property rights

1. There is a potentially relevant article that the authors appear to have overlooked: Cassels et al. Open Medicine 2008;2(1):e20–23. 

We excluded Cassels et al. 2008 based on the fourth eligibility criterion, specifically for inadequate specification of the selection criteria for news reports and missing specification of the selection technique.

Another study (Cassels et al., 2003) is a longer version of one that the authors use – reference 48. 

We assume you are referring to the paper “Drugs in the News: How well do Canadian newspapers report the good, the bad and the ugly of new prescription drugs?” published by the Canadian Centre for Policy Alternatives. We were unaware of this version. However, it does not include data that we were missing from the shorter version. 

2. Page 3: The authors use a 2009 paper to claim that most people get health information either directly or indirectly from traditional news media as opposed to material that appears only on social media. However, studies that evaluate information sourced from the two different types of media may no longer be relevant to the present-day environment.

Our claim is that “people still get health information from the [news media],” not that most people get information directly or indirectly from traditional news media. We agree that distinguishing news and social media is challenging, and not necessarily sensible, which is an important point for new primary studies of the quality of health information in mass media.

3. Page 18: The authors say that their findings come from a diverse range of countries but don’t they mean primarily western countries?

Yes, except we mean English-speaking and high-income countries, not Western. We have specified this. 

4. Page 20: The length of a newspaper story is not necessarily a measure of quality. Cassels et al. have shown that there are few significant differences in the overall quality between short news briefs and longer stories. (Cassels et al., 2003)

We agree and we have removed the second clause of the sentence, which was a possible explanation for the finding that features were generally of higher quality than news reports. 

5. Page 22: The recommendations for improving the reporting of journalists, editors and news outlets at least partially assume the existence of resources and time to educate journalists and editors about science journalism. However, the authors do not assess whether the necessary resources are actually present and available especially in smaller media outlets.

In the section “Implications for citizens and policymakers”, we now specify that news outlets can improve their reporting “with enough resources”. In the section “Implications for journalists, editors, and news outlets”, we had already specified that news outlets should provide or support training, and provide adequate time and resources, “if possible”. And in the section “Underlying problems”, we had already pointed out that in their synthesis, Amend and Secko found limited time or space for telling stories, and limited budgets and staff were barriers to high-quality health and science journalism. 

In fact, we assume most outlets either cannot provide training or resources to improve their health and science journalism, or will not prioritise such spending, which is part of why we argue that it is so important to help all people, not just journalists, learn how to think critically about health information for themselves. That said, we already referred to free learning resources that journalists can use to improve their skills, without necessarily spending a lot of time. 

6. Page 22: Informed Health is only available in English and German. Therefore, it is limited in terms of usefulness to those speaking other languages. Cochrane Evidence is superior in that regard.

We agree, but it is still helpful to be aware of both sites.

7. Page 23 (last line): Is it Informed Choices or Informed Health? Are these the same or different?

It is “Informed Health”. We have corrected the typo.

8. Page 24: Earlier the authors refer to Informed Health and Informed Choices. Now there is a third name Informed Health Choices. Are all three the same?

At first mention of the Informed Health website, we now note that it is a separate initiative from the Informed Health Choices (IHC) project. Again, where we have referred to the site as “Informed Choices”, it should have said “Informed Health”, and we have fixed this. 

9. Page 24: Have any of the educational interventions that the authors mention (references 99-104) looked at the long-term (e.g., more than 1 year) effects?

No, and we believe that a series of interventions is necessary, reinforcing and building on what people have learned. However, this has not been tested. Note that we have removed the last three paragraphs, in response to Review 1.

Raymond Moynihan

1 Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

General Comments.

This review is extremely valuable – the first summarizing evidence about the quality of news reports about health interventions.

I have a few short general comments and some specific comments.

In relation to the use of the word  “qualitative” - I wonder if the authors might consider using a different word – or adding more explanation – perhaps saying “qualitative summary of results”  – as it sounds to the casual reader like when you refer to “qualitative” you may have done a SR of “qualitative” studies of news coverage (i.e. focus groups with journalists etc.) – whereas I think you have a different meaning in mind. (e.g.  P8 “qualitative summary”, which is also mentioned in Abstract).

Re: IHC. Given the importance of IHC concepts for this SR, and the role of the authors in IHC world, and the advocacy of IHC in the Discussion, I think the IHC concepts etc. needs to be mentioned in the Introduction and expanded on in the Methods (as to how and why exactly the IHC concepts interacted with your analysis in the SR) - and the authors link to IHC can be mentioned in Methods somewhere. This is important and will help explain how the Discussion section becomes a little like advocacy for IHC materials.

The paper is long and complex – but with much valuable information. If any more material can be moved into Supp files, that will be helpful.

I have no biostats training so I have not assessed the stats.

Specific comments.

• Search strategy: It seems almost 2 years since it was updated. Authors might consider updating before indexing.
• P5:  “We excluded inappropriate criteria…’   Perhaps “ineligible” might be better?

While this makes sense, I presume that sometimes that re-framing was not straight forward – and I wonder if there is anything more to say on any complexities associated with this approach. Also, if you can give a little more detail in the Bubela example, with numbers, that could help the reader.

• P7: “Risk of Bias”. Can the authors add a few words in text explaining why the "risk of bias" was solely about the risk of detection bias? A reader of an SR might normally expect a few different domains, so it would be good to just explain why this single domain was most relevant.
• P10: Table 2. I think Table 2 needs re-thinking – as it took me some time to work out what was going on. I was treating each row as a discreet coherent entity, but in fact you have multiple parts to each row. I am sure you can make it clearer somehow.
• P11: “In contrast, a checklist for people communicating evidence-based information about the effects of healthcare interventions includes the item “Help your audience to avoid misinterpreting continuous outcome measures,” granted the checklist is not for journalists.” I don’t fully understand meaning of this sentence - perhaps be a little clearer?

Also – a related point - I find the three paragraphs on P12 (and into P13) complex and hard to follow. I wonder whether this level of detail is necessary in the main text – and whether it might be moved to a supplementary – but that is for authors to decide. At the very least – if there is any way to make it all a little clearer around this point – that would be great for the reader. An example of the mention of the “ninth criteria” from Bubela and 12 th from Haneef.  I think this is way too much detail for main text and authors run the risk of losing readers, for what is a very valuable SR.  

Now I have read further I realise you have a long section  - starting on P14 – on the results – as they relate to IHC concepts. After having read that very long section, I still feel the need for some kind of punchy summary of the key findings (e.g. harms, COIs, costs, other options not often mentioned…) somewhere in the results section.  This kind of summary doesn’t appear until start of Discussion – but I think could be included earlier.   

• P18: I wonder if the dot points at bottom of P18 might be better in the Results – and help to drive the kind of summary I am suggesting above.
• Discussion: the paper feels like it morphs in the Discussion into a passionate advocacy for IHC materials – with a sometimes moralistic tone. I think the tone could be addressed. And I also think that in order to justify the IHC material in the Discussion, more needs to be said about IHC in the Introduction – and the authors relations with IHC need to be made more explicit in the Methods – as noted above.  

I cannot comment. A qualified statistician is required.

Medicine and Media; Conflicts of Interest; Overdiagnosis

In relation to the use of the word  “qualitative” - I wonder if the authors might consider using a different word – or adding more explanation – perhaps saying “qualitative summary of results”  – as it sounds to the casual reader like when you refer to “qualitative” you may have done a SR of “qualitative” studies of news coverage (i.e. focus groups with journalists etc.) – whereas I think you have a different meaning in mind. (e.g.  P8 “qualitative summary”, which is also mentioned in Abstract).

We have replaced “qualitative summary” with “review” in the abstract. And at first mention of “qualitative summary” in the main text, we explain that it is, not a synthesis of qualitative studies, but a structured synthesis of results excluded from the meta-analyses.

We have added a paragraph about IHC to the end of the introduction, where we mention the IHC Key Concepts and the relevant authors’ involvement in the project. In the methods section, on pages six to seven in the first version of the article, we already explained why and how we used the IHC Key Concepts framework in the review. We do not think it is necessary to mention the authors’ involvement in IHC in the methods section. We have removed the last three paragraphs of the discussion, which were about IHC.

We agree that the article is long and complex, which follows the study being large and complex. There are already 10 supplementary files and six supplementary tables, and we do not think it would be helpful to have more. We appreciate that the article was a demanding read for the reviewers, however we do not expect many other people will read it start-to-finish. The findings are summarised in the abstract and “Key findings” section, and the implications are summarised in Table 5. Moreover, there will be a short, plain-language post on the F1000Research blog summarising the findings and discussing the implications. Although we include implications for other groups, the target audience for the article itself is primarily researchers. Communicating the findings and implications to other groups is a separate task. 

Search strategy: It seems almost 2 years since it was updated. Authors might consider updating before indexing.

It is possible that there have been new, eligible studies since the last search, and we agree that an updated review could be of value, at some point. Others planning or reporting new studies may, indeed, want to conduct updated searches. However, that is beyond the scope of this review, which summarises relevant research up to August 2019.There are good reasons for ensuring that reviews of interventions, which inform healthcare decisions are up to date when they are published (and are kept up to date). However, this is a review of descriptive studies and we do not believe those reasons are relevant to this review. 

• P5:  “We excluded inappropriate criteria…’   Perhaps “ineligible” might be better?

We have replaced “ineligible [criteria]” with “inappropriate”, in the main text and Figure 1.

We found reframing the criteria straightforward, and there were few criteria that needed to be reframed as positive. As noted in the main text, each criterion included in the meta-analyses is presented in S10 File verbatim, as reported in the primary study, together with the reframed and paraphrased version that we used in the review. We have added numbers to the example with the criterion from the study by Bubela et al.

• P7: “Risk of Bias”. Can the authors add a few words in text explaining why the "risk of bias" was solely about the risk of detection bias? A reader of an SR might normally expect a few different domains, so it would be good to just explain why this single domain was most relevant.

We have added a paragraph about why we only assessed detection bias to the relevant section, with reference to the protocol and the section on deviations from the protocol, where we provide a detailed explanation.

• P10: Table 2. I think Table 2 needs re-thinking – as it took me some time to work out what was going on. I was treating each row as a discreet coherent entity, but in fact you have multiple parts to each row. I am sure you can make it clearer somehow.

We have asked the journal to change the formatting of Table 2 so that the columns are alternate colours, rather than the rows. 

• P11: “In contrast, a checklist for people communicating evidence-based information about the effects of healthcare interventions includes the item “Help your audience to avoid misinterpreting continuous outcome measures,” granted the checklist is not for journalists.” I don’t fully understand meaning of this sentence - perhaps be a little clearer?

Mentioning the item in the checklist was meant to emphasise that the concept is important for laypeople. Upon reconsideration, we have simply removed the sentence since it was unclear and inessential.

• P12: This is a structural suggestion. By the sub-heading “Synthesis of Results” I am really wanting to hear some of the key findings – in terms of content (i.e. a strong compelling prose version of the data in Figure 3)  – but I feel I am still getting a lot of complex fine detail about the characteristics of studies and elements of them. I understand there is a lot to report – but some clear statements of the key findings – even summarised and abstracted a little – would be helpful around here to orient the reader.

We have added a summary to the start of the “Synthesis of results” section, by moving up content from the “Key findings” section, like you suggest further down.

• Also – a related point - I find the three paragraphs on P12 (and into P13) complex and hard to follow. I wonder whether this level of detail is necessary in the main text – and whether it might be moved to a supplementary – but that is for authors to decide. At the very least – if there is any way to make it all a little clearer around this point – that would be great for the reader. An example of the mention of the “ninth criteria” from Bubela and 12th from Haneef.  I think this is way too much detail for main text and authors run the risk of losing readers, for what is a very valuable SR.  

Please see our response to your comment further up, about moving more material into supplementary files.

• Now I have read further I realise you have a long section  - starting on P14 – on the results – as they relate to IHC concepts. After having read that very long section, I still feel the need for some kind of punchy summary of the key findings (e.g. harms, COIs, costs, other options not often mentioned…) somewhere in the results section.  This kind of summary doesn’t appear until start of Discussion – but I think could be included earlier.

We have added a summary to the start of the “Synthesis of results” section, by moving up content from the “Key findings” section, including the dot points.

• Discussion: the paper feels like it morphs in the Discussion into a passionate advocacy for IHC materials – with a sometimes moralistic tone. I think the tone could be addressed. And I also think that in order to justify the IHC material in the Discussion, more needs to be said about IHC in the Introduction – and the authors relations with IHC need to be made more explicit in the Methods – as noted above.

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During a total solar eclipse, the Moon perfectly blocks the bright face of the Sun, casting a small swath of Earth in darkness. With the Sun’s main light masked, the much dimmer solar corona becomes visible to the naked eye. This provides scientists a unique opportunity to study this mysterious region of the Sun. The brief blocking of sunlight also allows scientists to study how the Sun’s light affects Earth’s atmosphere.

In the past, solar eclipses have driven numerous scientific discoveries. For this solar eclipse, NASA is funding several scientific experiments – including the three using the WB-57s – to make measurements during the eclipse. NASA’s WB-57s fly much higher than commercial aircraft. This altitude allows the jets to fly above clouds – meaning no chance of missing the eclipse due to bad weather. Additionally, the height puts the jets above most of Earth’s atmosphere, which allows for the cameras to take crisper images and capture wavelengths, such as infrared light, that don’t make it to the ground. Since the planes can travel at 460 miles per hour, they’re also able to extend the time they spend in the Moon’s shadow. While the eclipse will last no more than four and a half minutes at any point on the ground, the planes will see an eclipse that lasts about 25 percent longer, over 6 minutes and 22 seconds.

“By extending the duration of totality, we’re increasing the duration of how much data we can acquire,” said Shadia Habbal, a researcher at the University of Hawaii who leads of one of the WB-57 eclipse experiments.

Habbal’s experiment will fly spectrometers – which record specific wavelengths of light and cameras. The instruments will measure the temperature and chemical composition of the corona and coronal mass ejections, which are large bursts of solar material. With this data, scientists aim to better understand the structure of the corona and identify the source of the solar wind, the constant stream of particles emitted by the Sun.

Habbal hopes the results of their study will help differentiate between different competing models of how the corona is heated. “This light is our best probe short of sticking a thermometer in the corona,” Habbal said.

For another team, led by Amir Caspi at the Southwest Research Institute in Boulder, Colorado, it’s not their first time chasing eclipses by plane. Caspi led a previous trailblazing experiment with the WB-57s during the 2017 total solar eclipse that crossed America from sea to sea. Images taken from the jet were used to study the structure of the corona.

That time was the first the jets had ever been used to study an eclipse. This time, an improved camera setup will allow measurements in more wavelengths from infrared to visible light that will hopefully reveal new information about structures in the middle and lower corona. The observations, taken with a high-resolution, high-speed camera, could also help study a dust ring that circles the Sun and help search for asteroids that may orbit near the Sun.

“There isn’t a lot of data of the Sun at some of the wavelengths we’ll be studying,” Caspi said.  “We don’t know what we’ll find, so it’s extra exciting to be making these measurements.”

A third experiment will study the effects of the Moon’s shadow on the ionosphere using an instrument called an ionosonde, which was designed at JHU APL. An ionosonde functions like a simple radar. The device sends out high-frequency radio signals and listens for their echoes rebounding off the ionosphere, which allows the researchers to measure how charged the ionosphere is.

“The eclipse basically serves as a controlled experiment,” said Bharat Kunduri, leader of the ionosphere project and a research assistant professor at Virginia Tech in Blacksburg, Virginia. “It gives us an opportunity to understand how changes in solar radiation can impact the ionosphere, which can in turn impact some of these technologies like radar and GPS that we rely on in our daily lives.”

By  Mara Johnson-Groh NASA’s Goddard Space Flight Center , Greenbelt, Md.

Related Terms

• 2024 Solar Eclipse
• Heliophysics
• Heliophysics Division
• Skywatching
• Solar Eclipses
• Space Weather
• The Sun & Solar Physics

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