Review for 10.1186/1471-230X-13-5 (2013)

Reviewer's report
Title:An analysis of online messages about probiotics
Version: 2Date:28 November 2012
Reviewer: Levinus L.A. Dieleman
Reviewer's report:
This manuscript examines a sample of 72 websites presenting information about
probiotics. Online searches were completed using two popular search
engines-Google and Yahoo. The analysis was limited to the samples of the first
50 results of each search engine query. Subsequently the analysis was
independently reviewed, a coding sheet was developed regarding quality, as well
as the use of the validated Sandvik scale. Subsequently, descriptive statistics
were examined using independent sample t-tests and Fisher’s exact tests. There
were comparisons made between commercial and noncommercial websites.
Commercial websites contained about 51 % of the websites.
The authors found that there was a clear bias to presentation of therapeutic
benefits over safety in commercial websites regarding probiotics In addition, over
70% of commercial websites had to more information about a specific probiotic
product. They concluded that many internet websites, especially commercial
ones, contain unsubstantiated and misleading claims about the therapeutic
benefits of probiotics and are suffering from a relative lack of information about
the risks of using probiotics.
Strengths: Due to the lack of regulation on the use of probiotics by the Food and
Drug Administration and the readily available internet information, patients with
chronic gastrointestinal diseases typically rely on internet websites regarding the
information usage efficacy and risks of probiotics. The authors should be
applauded to take on this effort to systematically review these websites regarding
their quality, which likely affects the usage of probiotics by patients. I consider
this the major strength of this manuscript and I found the systematic analysis
appealing enough to be read by a larger audience. In fact, it confirms our
suspicions that commercial websites on probiotics are biased and frequently lack
scientific rigidity on the benefits and the safety of probiotics. In addition, they are
also found that these websites suggested the individuals such as patients and
healthy individuals to consult a physician prior to using probiotics. This typically
does not take place in real life. This underlines even more the necessity of
providing adequate information on these websites, which is often lacking, and is
commercially biased, confirmed by this study.
Minor concern:
On page 4, last sentence, the author stated that after two independent analysts
coded websites for quality content, their respective scoring and code sheets were
compared and used to establish a single consensus code sheet. The authors
need to provide Kappa scores to see how much agreement there was between
the two independent analysts. This is important, especially as this parameter
regarding quality scoring of the websites is the most important one in the
manuscript
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare I have no competing interests.