'Gut Health' and the Microbiome in the Popular Press: a Content Analysis
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Open access Original research BMJ Open: first published as 10.1136/bmjopen-2021-052446 on 29 July 2021. Downloaded from ‘Gut health’ and the microbiome in the popular press: a content analysis Alessandro R Marcon ,1 Stuart Turvey,2 Timothy Caulfield3 To cite: Marcon AR, Turvey S, ABSTRACT Strengths and limitations of this study Caulfield T. ‘Gut health’ and the Objective Extensive research and important discoveries microbiome in the popular press: on the microbiome have led to a growth in media ► The study included a large data set of microbiome- a content analysis. BMJ Open coverage. This study explores how the microbiome has 2021;11:e052446. doi:10.1136/ related articles from media sources popular among been portrayed in press sources popular among American bmjopen-2021-052446 Canadian and American audiences. and Canadian audiences. ► Analysis was able to provide a detailed examination ► Prepublication history and Design Content analysis. of how ideas around the microbiome are being por- additional supplemental material Methods Using the FACTIVA Database, we compiled a trayed for audiences. for this paper are available finalised data set of (N=830) articles from press sources ► The data set represented only one kind of media online. To view these files, popular among American and Canadian audiences which please visit the journal online output (articles in the popular press). were published between 1 January 2018 and 11 October (http:// dx. doi. org/ 10. 1136/ ► The data set represented only English- language 2019 and which contained at least one of the following bmjopen- 2021- 052446). media. search terms: ‘microbiome’, ‘microbiota’, ‘gut health’, Received 15 April 2021 ‘healthy gut’, ‘unhealthy gut’, ‘gut bacteria’, ‘probiotic’ or Accepted 14 July 2021 ‘probiotics.’ We performed content analysis on the articles to determine how often ideas of the microbiome were accelerated our understanding of the human presented as beneficial, in which health contexts, and microbiome in health and disease. Fuelled whether actions could be taken to reap stated benefits. We by extensive research, important discov- compared this portrayal of benefits with critical portrayals eries about the microbiome have steadily of the microbiome. increased resulting in a growth in coverage by Results Almost all of the articles (94%) described health 1–6 benefits associated with the microbiome with many (79%) the popular media. Researchers have been describing actions which could be taken to reap stated examining the roles that diverse microorgan- benefits. Articles most often described health benefits in isms play in shaping our environments and http://bmjopen.bmj.com/ more broad, general context (34%) and most commonly impacting our health.7 8 This includes explo- outlined actions related to food/drug (45%) as well as ration of how the microbiome may influence, probiotic (27%) intake. Only some articles (19%) provided for example, risk of obesity,9 cancer10 mental microbiome- related critiques or limitations. Some of health outcomes,11 12 and cardiometabolic the articles (22%) were focused on highlighting specific and chronic disorders.13 Other research has research developments, and in these articles, critiques or been investigating the microbiome’s role in limitations were more common. childhood asthma14–16 as well as the how the © Author(s) (or their Conclusions Articles discussing the microbiome 16–18 use of antibiotics alters gut microbiota. on September 25, 2021 by guest. Protected copyright. employer(s)) 2021. Re- use published for American and Canadian audiences typically permitted under CC BY- NC. No hype the microbiome’s impact and popularise gut Currently, however, there are only a few 19 20 commercial re- use. See rights health trends while only offering a little in the way of microbiome- related interventions in use, and permissions. Published by communicating microbiome science. Lifestyle choices and critiques have been made around the BMJ. including nutrition, taking probiotics, stress management hyping21 of gut microbiome’s potential impact 1 Health Law Institute, University and exercise are often promoted as means of reaping in various contexts.1 4 22–27 In particular, while of Alberta, Edmonton, Alberta, the microbiome- related health benefits. The trend research has indicated benefits for the use Canada of actionable ‘gut health’ is foregrounded over more 2Division of Allergy and of probiotics in the context of paediatric evidence- based descriptions of microbiome science. 28 Immunology, Department of antibiotic- associated diarrhoea, critiques Pediatrics Faculty of Medicine, have also been raised about the exaggerated University of British Columbia, benefits attributed to probiotics.29–31 British Columbia Children's INTRODUCTION Hospital, Vancouver, British Concerns have also been raised around Columbia, Canada The term microbiome (derived from the the popularisation and commercialisation 3Faculty of Law, University of Greek for ‘small life’) encompasses the of microbiome- related research, particularly Alberta, Edmonton, Alberta, microbial community that lives in and on with regard to its portrayal in the popular Canada our bodies, as well as the genes these micro- press and on social media.3 4 6 12 22 32 Searches Correspondence to organisms express and their metabolic on Google, for example, yield an extensive Timothy Caulfield; activity. Over the past decade, technological assortment of microbiome- related discourse caulfield@ ualberta. ca advances in genetic sequencing have greatly detailing products, therapies and research Marcon AR, et al. BMJ Open 2021;11:e052446. doi:10.1136/bmjopen-2021-052446 1 Open access BMJ Open: first published as 10.1136/bmjopen-2021-052446 on 29 July 2021. Downloaded from developments, including gut makeovers, gut health After the removal of duplicates by FACTIVA, our diets, cleanses, microbiome reboots, probiotic prod- initial dataset totalled 1395 articles, which were down- ucts, skin regimens, cures for disease, and treatments loaded into and made accessible for analysis through the such as colonic hydrotherapy or colonic reflorastation. creation of customised platform. We then developed a It was also observed during the COVID-19 pandemic coding frame using the inductive and deductive methods that ideas of gut health circulated often when immune- established by our team from previous studies,38 39 which boosting was discussed.33 In the case of faecal transplants, involved creating an initial coding frame, applying it to for example, while clinical research is progressing and a large sample of the data, and modifying it as neces- showing signs of promise,34 there has already been a case sary to accurately capture the reality of the content. of a Canadian naturopath using the procedure to treat The coding frame had three primary objectives: (1) to children with autism.35 Research has shown that in the determine if claims of health benefits were made in rela- context of microbiota–gut–brain axis, articles in popular tion to the microbiome (including ideas captured with press simplify research and potential health impacts by associated rhetoric, ‘gut health’, ‘gut bacteria’, ‘probi- highlighting ‘dietary change (including probiotics) as a otics’, ‘microbiota’, etc), and if so, which health topics ‘natural’ means of changing the microbiome, and thus these benefits were described in relation to (ie, allergies, host health status.’4 Further media research has indicated cancer, skin health, general health (‘wellness’), etc); (2) that microbiome coverage tends to focus on observa- to determine if the article described actions that could tional studies with less coverage given to clinical trials and be taken to reap the claimed benefits, and if so, what systematic reviews.32 Indeed, as noted by Reid et al 30 ‘on these actions were (ie, eat certain foods, take probiotics, a consistent basis scientists, media and industry misrepre- perform faecal transplants, etc); and (3) to determine sent probiotics or make generalised statements that illus- if any benefits or research related to the microbiome trate a misunderstanding of their utility and limitations.’ might be portrayed as unproven, uncertain, ineffective This project analysed portrayals of the microbiome in or exaggerated. Through the sample analysis, specific popular English- language news sources for American categories to classify health benefits and related actions and Canadian audiences. We mapped out how often, were developed, and three further coding categories and for which health topics and conditions, microbiome were established: (1) whether the article’s principal focus ideas were portrayed as beneficial. We then determined was on scientific research, either pertaining to a partic- how often, and which actions were presented in order ular project or summarising a body of work; (2) whether to obtain stated benefits. Lastly, we examined how often the article discussed babies or children in relation to the ideas of the microbiome were presented critically—that is, microbiome; and (3) whether an article portrayed taking whether microbiome benefits or actions were presented probiotics as beneficial without describing or connecting as unproven, uncertain, ineffective or exaggerated. that probiotic intake to health benefits associated with http://bmjopen.bmj.com/ the microbiome. See online supplemental material 1 for complete coding frame. During coding, articles that were coded as irrelevant METHODS were removed, and the finalised total data