A Case Study of a Retracted Systematic Review on Interactive Health Communication Applications : Impact on Media , Scientists , and Patients Background In October 2004 , a flawed systematic review entitled `` Interactive Health Communication Applications for People with Chronic Disease '' was published in the Cochrane Library , accompanied by several press releases in which authors warned the public of the negative health consequences of interactive health communication applications , including the Internet . Within days of the review 's publication , scientists identified major coding errors and other methodological problems that invalidated the principal conclusions of the study and led to a retraction . While the original study results and their negative conclusions were widely publicized in the media , the retraction seemed to go unnoticed . Introduction Publication of the Review On October 18 , 2004 , the Cochrane Collaboration , a organization which produces and disseminates systematic reviews of health care interventions -LSB- 1 -RSB- , published a review entitled `` Interactive Health Communication Applications for People with Chronic Disease '' -LSB- 2 -RSB- , which from this point on will be referred to as the `` IHCA review . '' The IHCA review was edited by the Cochrane Consumers and Communication Review Group -LSB- 3 -RSB- . Those who prepare reviews volunteer to work in one of many Collaborative Review Groups , with editorial teams overseeing the preparation and maintenance of the reviews . Interactive health communication applications -LRB- IHCAs -RRB- were defined in the IHCA review as `` computer-based , usually Web-based , health information packages for patients that combine information with social - , decision - , or ` behavior change ' - support '' -LSB- 2 -RSB- . The results of the IHCA review showed that IHCAs had a positive effect on knowledge and on social support , no effect on behavioral outcomes , and a negative effect on clinical outcomes . The principal conclusion of the review was `` consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA '' -LSB- 2 -RSB- . This conclusion was the focus of a press release which the mass media widely circulated -LRB- as will be documented later -RRB- . However , only days later , the IHCA review was found to be flawed and was retracted . Retractions The National Library of Medicine -LRB- NLM -RRB- is a leader in the bibliographic handling of retractions . The Medical Subject Headings -LRB- MeSH -RRB- contain the concept `` retracted publication , '' which identifies a citation previously published and now retracted through a formal issuance from the author , publisher , or other authorized agent . In January 2005 , the PubMed query `` Retracted Publication -LSB- Publication Type -RSB- AND 1971:2004 -LSB- edat -RSB- '' retrieved 619 retracted citations that entered PubMed between 1971 and 2004 . Since the query `` 1971:2004 -LSB- edat -RSB- '' retrieves approximately 12.5 million citations , less than 1 in 10000 publications have been retracted . Friedman -LSB- 4 -RSB- studied 60 fraudulent articles by one scientist . Journals in which the scientist had published were notified of the fraud . Only 7 articles were subsequently tagged in PubMed with `` Retracted Publication . '' The delay between publication of a paper and its retraction often has deleterious effects -LSB- 5 -RSB- . Furthermore , journals and institutions are hesitant to issue a statement of errors in published work unless the author of the work confesses to the error , which authors may resist doing because such an admission can be career-damaging . While very few publications are officially retracted , the concern about factors related to retractions is substantial . The study of retractions itself might be indexed with MeSH concepts such as `` scientific misconduct , '' although the fraction of retractions that stem from error as opposed to scientific misconduct is not known . The query `` Scientific Misconduct -LSB- majr -RSB- AND 1971:2004 -LSB- edat -RSB- '' in PubMed retrieved 1840 citations . This body of literature recommends that medical researchers constructively criticize the research practices of others in their institution to reduce the likelihood of misconduct -LSB- 6 -RSB- . The objective of this paper is to document the IHCA review as an event in the history of medical publishing , to identify the factors leading to the publicizing of a retracted publication , and to assess the implications . Methods The objectives of this research called for various study methods . The author employed the following three methods : -LRB- 1 -RRB- historical processes of collecting documents about a contemporary event and organizing them thematically ; -LRB- 2 -RRB- ethnographic processes of author participation in the event , personal communication with other participants in the event , interpretation of communications , and construction of models ; -LRB- 3 -RRB- content analyses based on bibliographic database and Internet searches , coding of the retrieved documents , and tallying of the code frequencies . The ethnographic method employs the extended case method , and the extended case method applies reflexive science to ethnography . Buroway describes reflexive science as follows : `` Reflexive science starts out from dialogue , virtual or real , between observer and participants , embeds such dialogue within a second dialogue between local processes and extralocal forces that in turn can only be comprehended through a third , expanding dialogue of theory with itself '' -LSB- 7 -RSB- . Various database and Internet searches were employed to study the impact of the review and to quantify the difference between mass media coverage of the original publication and its retraction . LexisNexis Academic databases of health news and general news were searched , as was Google . The queries were designed in an iterative process that began with keywords from the question to be addressed but refined the query based on study of the query retrieval results . The retrieved results were coded , and the coding language was also developed in an iterative process . First , the obvious codes `` about the review '' and `` about the retraction '' were introduced . Each retrieved document was classified into a single code by the author . If the retrieved document was not appropriately described by an existing code , then the coding language was augmented . The Web of Science was also queried to identify academic citations , but no citations were identified -LRB- data not shown -RRB- . Most database and Internet searches were conducted in May 2005 . To better understand how special the publicity accorded the IHCA review was , this study was extended to three other publications : 2 of these were retracted publications tagged as `` Retracted Publication '' -LRB- 1 Cochrane review , but not eHealth related , and 1 non-Cochrane review , but eHealth related -RRB- , and 1 was a meta-analysis with a scope similar to that of the IHCA review . These 3 reports were identified through PubMed searches . Results The following qualitative results on the impact of the IHCA review are organized into three main sections : scientist reaction , mass media reaction , and patient reaction . The section on scientist reaction considers Cochrane reviewers ' reactions and how eHealth scientists responded to the IHCA review in the comment section of the Cochrane database . The mass media section provides the Cochrane retraction and then explores , via LexisNexis and Google results , the reaction of the mass media to the IHCA review . The patient reaction section shares dialogue from patient-patient online discussions that reveals the reactions of patients to the IHCA review . Scientist Reaction The Cochrane Collaboration allows anyone to submit comments to the published reviews . Two scientists ' comments on the IHCA review appeared independently on October 28 , 2004 . Kummervold and Eysenbach criticized the IHCA review for both its protocol and its coding . Kummervold explained in detail how the coding of the meta-analysis was incorrect : `` We ca n't get the numbers to add up , it looks like they are reversed in 8 of the 11 studies ... '' -LSB- 8 -RSB- . He delineated the facts and the interpretation for each of the 8 studies at issue ; for example , regarding the HbA1c measurement in the Lehmann 2003 paper , he stated that Lehmann reported a reduction in HbA1c of 0.8 for the intervention group , and 0.1 for the control group , which should be interpreted as a positive result for the intervention group . Kummervold added : `` We also find it strange that you focus so much on the overall estimates when there is so much heterogeneity in the material . The conclusion seems to be overstated '' -LSB- 8 -RSB- . Eysenbach had similar comments , stressing that a formal meta-analysis of these heterogeneous studies was problematic , and that the three studies which contributed most to the `` negative '' result were in fact positive : `` Apart from the fact that I do not think that it is legitimate to do a formal meta-analysis using papers measuring totally heterogeneous outcomes with different types of interventions , I also notice that the overall effect estimate is ` negative ' -LRB- eg , ` favoring control ' -RRB- because of three studies ... . However , when I read these three studies I can not find that their result -LSB- s -RSB- are negative ... . If my suspicion is correct , then this is quite a catastrophic error , and quite an embarrassment for Cochrane to let such an error slip through peer-review '' -LSB- 9 -RSB- . On November 10 , 2004 , the Cochrane Consumers and Communication Review Group reacted to the discovered errors -LSB- 10 -RSB- with a notice that included the following : `` The review will be withdrawn as soon as possible ... . As the corrections to the review have not been completed yet , it would be premature to announce any reversal of the review 's findings at this stage . ... The original press releases regarding this review were made not by the Cochrane Collaboration itself but by University College London ... . '' John Wiley & Sons -LRB- the publisher of the Cochrane Database -RRB- released to EurekAlert a retraction on December 6 , 2004 : `` The review originally determined that ... chronically ill people using interactive programmes had worse clinical outcomes than those who did not . Regrettably , errors in data analysis meant that these outcomes were reported incorrectly ... . It is expected that the revised results will be published in April 2005 '' -LSB- 11 -RSB- . The April 2005 edition of the Cochrane Systematic Reviews did not mention the IHCA review . Royle , the chief executive officer of the Cochrane Collaboration , said that further review of the revised report was ongoing and no date could be given as to when the review might be published -LRB- personal communication , April 25 , 2005 -RRB- . Mass Media Reaction The Cochrane Database of Systematic Reviews is not read by the typical consumer . However , Murray 's employer , the University College London -LRB- UCL -RRB- , worked with Murray to widely publicize the result . UCL posted a news bulletin on its website on October 18 , 2004 that remained there as of May 25 , 2005 . The bulletin was titled `` Knowledge may be hazardous to web consumers ' health '' and stated the following : `` People who use their computers to find information about their chronic disease often wind up in worse condition than if they had listened to their doctor , according to a UCL review of studies on internet health . ... One reason ... might be because knowledge-seekers become so steeped in information from the Internet they make treatment choices on their own , contradicting advice from their doctors '' -LSB- 12 -RSB- . Most significantly , the UCL bulletin was circulated to information intermediaries that are considered the main entrance to the world 's mass media , including AlphaGalileo and EurekAlert . A search on LexisNexis Academic with the query `` Elizabeth Murray AND health '' for the period June 2004 to May 2005 revealed a total of 15 relevant press reports , in the following categories : Medical and Health News : There were 9 publications with titles such as UCL 's press release title of `` Knowledge may be hazardous to web consumers ' health . '' The publications appeared in places like Life Science Weekly , Law and Health Weekly , and Health and Medicine Week . General News -- Major Papers : There were 5 relevant articles , such as one entitled `` Why medical advice from the internet can be bad for your health '' in the British The Daily Telegraph and another entitled `` Medical Web sites may be unhealthy places to learn about ills '' in the Omaha World Herald . Only 1 article was about the retraction , published in the Ottawa Citizen on October 18 , 2004 . Time Incorporated Publications : There was 1 article in the November 1 , 2004 issue of Time entitled `` Click to Get Sick ? '' -LSB- 13 -RSB- . Among the 15 results from the LexisNexis Academic database , only 1 newspaper report , authored by Tom Spears , dealt specifically with the retraction -LSB- 14 -RSB- . Spears , in personal communication with this author -LRB- November 18 , 2005 -RRB- , said , `` I was fairly stunned today to learn that it -LSB- IHCA review -RSB- has been withdrawn ; I found out only because I was looking up the study for my daughter , a science student . Now I 'm covering the sequel for tomorrow 's paper . ... I scan EurekAlert faithfully , as many reporters do , and never saw a hint of anything there . '' To further test whether the media emphasized the false negative result but minimally covered the retraction , a content analysis on Google was performed on May 24 , 2005 . The query was `` health AND Cochrane AND Murray AND -LRB- interactive OR web OR internet -RRB- '' for English pages , within the past year . Of the first 200 retrieved hits , 170 pages were not related to the IHCA review . Of the remaining 30 pages , 23 -LRB- 77 % -RRB- were reports about the original publication that did not mention the retraction , and an additional page was a bibliography -LRB- at a UCL site -RRB- that included a citation to the IHCA review , again without mentioning the retraction . All reports -LRB- except the bibliography -RRB- used a title such as `` Click to Get Sick ? '' and emphasized the negative impact on clinical outcomes of using the Web . The reports came from such reputable sources as the British Broadcasting Corporation and US News and World Report . In contrast , only 6 pages -LRB- 20 % -RRB- addressed the retraction : 2 were the original press releases now marked with `` retraction '' but still emphasizing in their particulars the negative health impact , 3 were Web pages at Cochrane sites , and 1 was an announcement from MedicalNews entitled `` Updated press release to October 2004 Cochrane Review . '' The latter was the only non-Cochrane -- related page primarily addressing the retraction . The grey literature reported on the mass media . For example , The Neuroscience for Kids Newsletter summarized -LSB- 15 -RSB- the `` Click to Get Sick ? '' Time article by Sanjay Gupta , and a Web archive for patient education at the Samaritan Health Center pointed patients to Gupta 's article . This author wrote to Gupta and asked him to write about the retraction , but Gupta did not reply . NLM indexed the IHCA review and entered the citation for it -LRB- including its abstract -RRB- in PubMed on October 21 , 2004 . The `` Retracted Publication '' tag did not , however , appear in PubMed until March 24 , 2005 . Patient Reaction Some patients reported the news about the IHCA review to their patient-patient online discussion groups . In a neurology patient discussion group -LSB- 16 -RSB- , a patient posted the entire BBC news story . Patients responded in two ways . Some rejected the IHCA review result and added strong comments , such as `` I have gotten more help and answers for problems from knowledgeable people on this Internet Forum than I have from any of the multitude of doctors I have seen over the last 12 years . '' Others accepted the conclusion but insisted that patients could filter bad information from good and benefit in the end from the web . These patients were not aware of the retraction of the IHCA review . This author reported the Time `` Click to Get Sick ? '' article to two head-and-neck cancer patient discussion groups to which he belongs . A day later he reported the retraction from the Cochrane Database . One member of the discussion group replied : `` Thanks for the update -- the negative findings seemed odd to me when I read it , so I 'm glad it 's being revised . '' This author , in his role as a cancer patient , also formally commented on the IHCA review at the Cochrane Database site -LSB- 17 -RSB- . The typical patient with a chronic disease has no formal medical training and is ill prepared to critique a meta-analysis of clinical trials . However , the typical patient is vulnerable to cultural pressures , as they are partially shaped by and reflected in the mass media . Comparison With Another Cochrane Retraction For comparison , a search for further retracted Cochrane reviews using the PubMed query `` Cochrane Database Syst Rev -LSB- TA -RSB- AND Retracted Publication -LSB- PT -RSB- AND 1971:2005 / 5/25 -LSB- edat -RSB- '' was conducted . One reference , in addition to the IHCA review already discussed , was identified , which was a retracted review by Brewster et al -LSB- 18 -RSB- about antihypertensives . The retraction for the Brewster et al review is explained on the Cochrane website as follows : `` This systematic review has been withdrawn temporarily because its contents are potentially misleading . '' A search on LexisNexis with the query `` Brewster AND antihypertensive '' for the period November 2004 to May 2005 retrieved no articles in either the `` General News -- Major Papers '' category or the `` Medical and Health News '' category . A search on Google for `` Brewster antihypertensive '' followed by an examination of the first 100 retrieved pages identified 23 relevant pages , which had a very different content pattern than the hits for the IHCA review . They all contained citations of papers from Brewster et al , who have published elsewhere on the same subject as in their review . The Brewster et al publication attracting the most attention was an article -LSB- 19 -RSB- in the Annals of Internal Medicine that was not retracted but has the same title as the Cochrane review . Thus , the only other retracted Cochrane review had a very different mass media , scientific , and web impact than the IHCA review . Comparison With Other Retracted Articles Related to eHealth To determine whether other articles on a similar topic to the IHCA review have been retracted , a search was first made for articles on a similar subject that had been MeSH indexed in PubMed . The article by Demiris -LSB- 20 -RSB- seemed relevant , and its two MeSH index terms were `` Disease Management '' and `` Internet . '' A search on PubMed for `` Retracted Publication -LSB- PT -RSB- AND Disease Management -LSB- majr -RSB- AND Internet -LSB- majr -RSB- AND 1995:2005 / 5/25 -LSB- edat -RSB- '' returned no citations . When the search was broadened by removing the term `` Disease Management , '' 1 retracted reference was retrieved , entitled `` The quality of surgical information on the Internet '' -LSB- 21 -RSB- . As previously described in the Journal of Medical Internet Research , this article was retracted due to a case of cyberplagiarism , with large sections of the paper having been lifted from different websites -LSB- 22 -RSB- . A search on LexisNexis Academic with the query `` McKinley and surgical and Internet '' for the period 1995 to May 2005 revealed no relevant press reports , neither in the `` General News -- Major Papers '' category -LRB- three hits were all not relevant to the McKinley article -RRB- or in the `` Medical and Health News '' category . A search on Google for English pages with the query `` McKinley surgical Internet '' revealed 96 irrelevant pointers in the first 100 results . Of the remaining 4 relevant hits , 1 was the article about the plagiarism -LSB- 22 -RSB- , which precipitated the retraction of the McKinley et al manuscript , and 3 were academic references to the McKinley et al article , which did not note it being retracted . Thus , the only other retraction of a published article appearing in PubMed similar in topic -LRB- the Internet -RRB- to the IHCA review had a very different pattern of reactions than the IHCA review . A Similar Meta-Analysis on eHealth The IHCA review addressed a topic that the mass media found interesting . Have any other recent publications also been a meta-analysis on the impact of interactive applications on health , and , if yes , what was the mass media reaction ? Using the query `` Meta-analysis AND Web AND Chronic Illness '' in PubMed , we found only 1 citation : Wantland et al -LSB- 23 -RSB- did a meta-analysis on Web-based health interventions that was published -LRB- in the Journal of Medical Internet Research -RRB- about the same time as the IHCA review . The paper concluded that `` the effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables . '' What has been the impact of the Wantland et al paper and how does that compare to the impact of the IHCA review ? The Wantland et al paper was not announced with a press release in EurekAlert . A search on LexisNexis Academic for newspaper articles about the Wantland et al paper retrieves no articles . The queries performed were similar to those performed for the IHCA review and included `` Wantland AND health '' for 2004 through 2005 in General News/Major Papers . A search was done on Google for `` Wantland health Web '' on May 24 , 2005 . Of the first 200 returns , 182 were not relevant . Of the remaining 18 hits , 15 pages contained academic citations to Wantland et al , 2 announced the appearance of the article , and 1 was a personal blog that commented on the article . Thus , most of the Google returns that gave Wantland et al citations are academic in character and very different from the mass media coverage afforded the IHCA review . Discussion As shown , the IHCA review provides a perhaps unprecedented case from which lessons should be drawn . Only one other Cochrane review -LRB- about antihypertensives -RRB- has been retracted , and that one received negligible mass media attention . The only retracted publication in PubMed that is indexed under the MeSH concept of `` Internet '' -LRB- the IHCA review did not have time to get indexed before it was withdrawn -RRB- received no newspaper coverage . The paper most similar to the IHCA review in topic and method -LRB- the Wantland et al report -LSB- 23 -RSB- -RRB- received considerable academic attention but no newspaper coverage . In other words , special circumstances must have come together for the IHCA review situation . This section next presents a framework based on tiers of response . The first tier is medical scientists . The second tier is the mass media spreading medical press releases . The third tier is the patient community reacting to the mass media and the scientists . First-Order Problem In an effort to critique the problem that occurred , one might build on the analysis of misconduct in toxicology by Purchase . Purchase -LSB- 24 -RSB- identified four roots of misconduct : Intention of the work Conduct of the studies Design and interpretation of studies Bias from conflict of interest In the case of the IHCA review , the intention was scientifically appropriate , namely to gain further insight about IHCAs through a systematic review . In the other three categories , fault can be found : The errors in the coding of data should not have been made . The coauthors Nazareth and Tai , who are credited with doing the coding , have good enough credentials to not lay the blame on lack of experience : Nazareth is a Professor at UCL and is Scientific Director of the British Medical Research Council 's General Practice and Research Framework , and Tai has coauthored several articles over the past two decades that appeared in refereed medical journals . An explanation for the miscoding in terms of experience of the coders is not apparent . The design of the study has been criticized as lumping together studies which are too heterogeneous in their design , interventions , and outcomes -LSB- 8,9 -RSB- . The protocol might have been more rigorously vetted by the Cochrane Review Group , and the authors should have been more cautious in their interpretation of results and emphasized the weakness of the design in their publicity . The reporting of the work suggests possible bias . The authors and their employers have sensationalized a result that catches the media 's attention . For some observers , the review appeared biased in that the authors , who are affiliated with medical institutions , concluded that patients should listen to their doctor , instead of seeking help on the Internet . Purchase -LSB- 24 -RSB- claims that a partial solution to this first-order problem is the institutionalization of quality controls . In the 1970s , good laboratory practice regulations were introduced , but comparable regulations do not exist for meta-analyses . For quality control of a meta-analysis the scientific community relies on the research team , the researchers ' institution , and the referees . A medical research institution , such as the UCL Medical School , presumably embraces results from its researchers that can earn mass media coverage and is not the appropriate institution to prevent sensationalizing . Referees can not be expected to detect when laboratory data are intentionally modified -LSB- 25 -RSB- ; however , in this case they could have been expected to detect when data available to them are miscoded . Problems with refereeing have been frequently noted and in particular for the Cochrane Database -LSB- 26 -RSB- . Open commentary , as exists for the Cochrane Database after a publication , is one way to identify flaws . Extending the open commentary to the refereeing phase might reduce the likelihood of something going to press with errors . A submitted article might be available to the public and a community of hundreds of registered scientists could be invited to make anonymous comment . Submissions online would require extensive online commenting that reached a consensus before a submission could be considered `` published . '' Other approaches to increase the commentary on the research process include refereeing the protocol phase -LSB- 27 -RSB- , which is done by the Cochrane Collaboration but apparently not with the necessary rigor or topic expertise . Second-Order Problem The second-order problem is a press release and subsequent mass media coverage of the release . Winsten 's classic study of science and the media shows how the truth is repeatedly misrepresented by journalists and researchers : `` The most striking finding which emerged from the interviews -LSB- of medical journalists -RSB- is the dominant distorting influence of the competitive force in journalism . ... As economic competition among hospitals has intensified , they have begun to compete aggressively for publicity . ... With increasing frequency ... scientists ... are using the media to attach their names to important findings before their competitors do . ... The result has been a spiraling competition , sometimes characterized by exaggerated claims '' -LSB- 28 -RSB- . Online media have stimulated further competition -LSB- 29 -RSB- . The case of the IHCA review reflects these pressures . The UCL press release contained inaccuracies , even if the review would have been scientifically sound , in order to gain mass media attention . For instance , the subtitle of the press release was `` Knowledge may be hazardous to web consumers ' health . '' In truth , the IHCA review was not about Web applications , per se , but about IHCAs , which are defined more broadly than `` Web applications . '' However , writing a news article about IHCAs is less likely to catch attention than an article about the Web . The UCL press release did not introduce and define the term IHCA , and Murray issued statements that implied the Web was the issue . By the time the information from the press release made it into the mass media , the material had been modified enough to lose any mention of IHCAs . For instance , the Time article said , `` People who use the Web to get information about their chronic diseases often wind up in worse shape than before they logged on . '' One way for researchers to prevent the mass media from misrepresenting the truth is for researchers to understand how the media work and to interact with the media accordingly -LSB- 28 -RSB- . Murray should have known that her words might be twisted to emphasize what would sell newspaper space and should not have wildly speculated . The reputations of the Cochrane Collaboration and UCL partially account for the wide dissemination of the original press release . Yet , neither organization has taken adequate steps to undo the impact of the media reporting on the IHCA review . The honesty of the press could be improved with the Internet -LSB- 30 -RSB- . Online health care mass media publications could allow the public to make comments on news articles . Rating techniques , such as employed at eBay and Slashdot , might be used to give prominence to quality feedback -LSB- 31 -RSB- . Third-Order Problem The third-order problem concerns the long-term impact of the mass media . While electronic publications might be erased from a computer or marked as retracted , this does not consistently happen . Furthermore , some of the mass media coverage of the IHCA review is on paper and sits on people 's bedside tables with no practical way to be retracted -LSB- 32 -RSB- . Although this author did not -LRB- yet -RRB- find any citations to the IHCA review in Web of Science , previous studies have confirmed that a retracted scientific publication may continue to have impact without readers recognizing its retracted status . For instance , one study -LSB- 33 -RSB- tracking the citation pattern of 82 retracted articles revealed that , together , they were cited 733 times after their retraction , but only a small fraction of the citations referred to the retraction . In the case of the mass media , retracted publications might be read by people without them seeing the separate retraction notice . If and when the revised IHCA review is published , what could it say that would undo the effect of the original publication ? If the conclusion is that IHCAs result in improved clinical outcomes , then the medical profession will want to closely study the protocol and might have grounds to discredit the conclusion . The media trumpeted the IHCA review conclusion partly because it was counterintuitive but was backed by top-notch institutions . If the conclusion becomes intuitive , then the media are unlikely to be interested in it . The reactions to the IHCA review in patient online discussions highlight the importance of virtual communities in helping patients deal with published information . Simple extensions to Web-based , patient , discussion systems could help patients connect to Web-based publications . For instance , when a patient posts a message to a Web-based discussion board , the Web system could parse the message and provide links from the message to relevant articles on the Web . Patients might follow the links and engage in discourse about the validity and implications of the literature . This might lessen the potential ill effects of publications that are wrong or misleading . Conclusions This special medical publishing event was marked by incorrect coding and a desire for maximum publicity . The IHCA review authors , their employers , and the Cochrane Collaboration were responsible for quality control , and failed . The mass media played their part by widely publicizing a sensational message but not reacting to the notice that that sensational message was false . The false result that patients are clinically harmed by interactive applications was very strongly delivered to patients worldwide . The broad lesson to be re-learned is that potentially sensational results should be carefully scrutinized before being sensationalized .

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