28 February 2019
Preventing fake news: controlling the outbreak of misinformation
Fake news can spread as quickly as any outbreak - how do we prevent and control the infection?
This article is based on the ideas put forward in the paper ‘Fighting the good fight; the fallout of fake news in infection prevention and why contect matters’, published in the JHI. This article can be read in full here: https://www.journalofhospitalinfection.com/article/S0195-6701(18)30411-0/fulltext

Fake news and peer reviewed medical literature

Not everything we see online is true. People are becoming increasingly aware of the perils of ‘fake news’ – false or inaccurate stories created to encourage sharing, thus spreading misinformation. We think we are savvy to misleading headlines and clickbait, but most would assume that the scientific and medical literature is largely free of such false information, and that peer review and publishing means that scientifically accurate information is available to all. Unfortunately, this is not always the case. If we say that fake news is like an infection, how do we prevent and control it?

Fake news can spread as quickly as any outbreak

Fake news can often be characterised by the divisions it causes around controversial issues, including in infection prevention and control (IPC). The medical literature should provide clarity on best practice, however poorly conducted studies that slip through the net can muddy the waters. Several studies have been published disputing the efficacy and safety of alcohol-based hand gel rubs (ABHR) (Hormann et al., 2014, Pidot et al., 2018) in contrast to the established wisdom, which includes recommendation by the World Health Organisation. ABHR are widely used both by healthcare workers and the general public, and as such negative studies are a potential lightning rod for media attention. Fake news can spread as quickly as any outbreak, and in the case of ABHR, which saves millions of lives through preventing infection, fake news can be as deadly.

The dangers of misinformation and the consequences for public health

A continuing example of the dangers of misinformation and the consequences for public health is the ongoing battle against anti-vaccination campaigns. Despite retraction, the infamous Wakefield paper continues to be used as justification not to vaccinate children against measles.  This has likely led to recent outbreaks in the US and the Philippines, as well as measles cases tripling in 2018 across Europe. The significance of this is very real – 70 children have died in the recent Philippines outbreak, and 900 in Madagascar. Despite numerous high-quality studies confirming no link between the MMR vaccine and autism, the hold on the public imagination remains strong. It is crucial that fake news be prevented from entering the public domain, and not enough to simply issue a rebuttal once it has. Alarmist fake news headlines are more likely to be read and shared than scientific studies, and once the genie is out of the bottle, it is difficult to put back.

Unreviewed and unverified scientific work is entering the public domain

Peer review is considered the standard method to ensure quality and accuracy of the medical literature. However, in the Internet age, authors have responded to rising journal costs by creating platforms that can disseminate their work while bypassing the traditional journal model entirely. Preprint servers, such as bioRxiv, allow authors to post their work pre-submission for others to read and comment on. This has a lot of potential for good, for example helping authors to improve their manuscripts, however they create a problem in that unreviewed and unverified scientific work enters the public domain. The lines between preprint servers and traditional publishing models may become blurred, and it is not known if these servers have the same capability to self-correct inaccurate or falsified studies through retractions, etc. They will, however, continue to proliferate for the same reasons as open access, which is particularly important in providing access to medical literature in the developing world as subscription prices rise.

Beware of predatory publishers

It seems inevitable that with the rise of open access models, unscrupulous companies would take advantage of those seeking to publish. Predatory journals may appear attractive on the surface, offering low publication fees, rapid acceptance and a significantly lower threshold of scientific rigour, however the majority offer little to no real publishing services such as peer review, often going as far as to appoint vanity editorial boards or advertise fake conferences. While lists of these publishers are available, there are no definitive criteria to define them, and educating authors has proven difficult, which can pose a real risk to public education and to IPC. At particular risk are authors from developing countries and those without significant experience in scientific publications. Those in need of rapid information are not able to assess each individual journal as genuine, and while those in IPC may be better posed to identify poor-quality evidence than those in the public, the field can still become muddied by these publications which carry an implied but false badge of validity through peer review.

The true impact of a journal should be based on the potential for education it provides to the global IPC community

It is important, in order to combat the wave of misinformation, that all those in the medical profession regardless of funding or career stage have access to legitimate outlets for their work, as well as access to this research to aid in their professional development and improve medical care. Such outlets should still offer rigorous editorial standards and thorough peer review, at a cost that is not prohibitive to publication. It is with this in mind that we have launched Infection Prevention in Practice, a new low-cost fully open-access journal from the Healthcare Infection Society. IPIP has been established to allow researchers from all over the world to share their experiences in IPC, considering all sound research, and without aims to seek an impact factor. We believe that the true impact of a journal such as IPIP is not based on a number of citations but the potential for education it provides to the global IPC community. We hope to be able to widely disseminate the challenges being faced by IPC practitioners daily and provide a valid outlet to combat the predatory publishers and their fake news.


Hormann, A.M., Vom Saal, F.S., Nagel, S.C., Stahlhut, R.W., Moyer, C.L., Ellersieck, M.R. et al. Holding thermal receipt paper and eating food after using hand sanitizer results in high serum bioactive and urine total levels of bisphenol A (BPA).PLoS One20149e110509

Pidot SJ, Gao W, Buultjens AH, Monk IR, Guerillot R, Carter GP, et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcoholsSci Transl Med. 2018;10(452)