Abstract
Probiotics are over-the-counter products marketed for enhancing human health. Online information has been key in promoting probiotics worldwide. However, only few rigorous clinical studies have met the stringent criteria required to establish the efficacy and safety of probiotics. The present study was undertaken to assess the information quality of webpages referring to probiotics and to compare the recommendations available online with the information collected from trusted scientific sources. We evaluated 150 webpages returned by Google searching “probiotics” in terms of typology of website, health information quality based on the JAMA score and the HONcode certification, as well as completeness of the information based on the presence of four criteria: (1) links to scientific references supporting health claims, (2) cautionary notes about level of evidence for alleged benefits, (3) safety considerations, and (4) regulatory status. We then enumerated the health claims mentioned online and the corresponding clinical trials and reviews registered in the Cochrane library. Finally, the conclusions of Cochrane reviews were used to assess the level of scientific evidence of the information available through Google search. HON-certified websites were significantly more frequent in the top 10 websites than in the remaining websites. In terms of completeness of information, only 10% of webpages met all four criteria, 40% had a cautionary note on benefits, 35% referred to scientific literature, and only 25% mentioned potential side effects. The results of the content analysis led us to conclude that: (1) the most frequent typologies of webpages returned by Google are commercial and news, (2) commercial websites on average provide the least reliable information, and (3) significant numbers of claimed benefits of probiotics are not supported by scientific evidence. This study highlights important biases in the probiotics information available online, underlining the need to improve the quality and objectivity of information provided to the public.
Highlights
The World Health Organization defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit to the host” [1]
A different pattern was observed for the top 10 webpages returned by Google, where the most frequent typology was “health portal” (44%), followed by “commercial” (22%)
The overall trustworthiness of each webpage was assessed by calculating the Journal of the American Medical Association (JAMA) score as defined in the Methods section
Summary
The World Health Organization defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit to the host” [1]. Together with other over-the-counter medicinal products, probiotics are increasingly popular and widely advertised on the Internet [6]. It is important to assess the trustworthiness of the probiotics information that can be found online. For this purpose, we took advantage of an established methodology previously used to analyze health information quality on antioxidants and vaccines [7,8,9]
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