Community Guidelines – Improving Discussion of Controversial Issues in Medicine

Lack of civility and reason on the internet is a serious issue. Implementing community guidelines can help.


The internet is full of polarized and insensitive discussion. In fact, the lack of civility is so severe that some science websites like Popular Science have decided to turn off comments completely.1,2 Health and medicine especially are subjects where this polarity is strong. Take for example the Academy of Nutrition and Dietetics, which felt the need to create an online “Pledge of Professional Civility” in order to curb online harassment, especially between dieticians.3 There is a need to become more aware of what we are writing and how we are writing it so that we can start to discuss health and medicine more sensibly online. This article explicitly serves as the Community Guidelines for our own website (as well as our Facebook page), but it may be useful for internet users in general to reflect upon. If you comment on our articles, we will approve, modify, or delete your comment without notice based on your adherence or lack of adherence to these guidelines.

In short, there are three main things commenters must try to do:

  1. Stay on topic.
  2. Substantiate any claims made.
  3. Phrase comments with kindness and civility.

Registering to Comment on Our Site

We use the DISQUS commenting system on our site. In order to improve quality of comments and to have all comments displayed immediately, we require that you have a verified DISQUS account. This means when you sign up for DISQUS (done so at the bottom of any article, in the comments section), you will be sent an email with a verification link. You must click that link before you can comment. We do not allow posting without an account.

Once you’ve registered for a DISQUS account, we recommend changing your privacy settings. To do this, go to your DISQUS profile. At the bottom, click the box that says “Keep your profile activity private”. Then click “Save”. This will make it so others cannot see a history of your past comments.

List of Discouraged Words

Though not strictly banned, we discourage the use of the following words (or variants of them) on our site:

Shill, troll, anti-vaxxer, pro-vaxxer, woo, snake oil, quack, sheeple, allopath, anti-science, debunked

Using these words may increase the chance of your comment being deleted. Some will argue that some of these words are at times accurate ways to describe a person or situation. Nevertheless, these convenient terms are often used too loosely or libelously and are often unnecessarily insulting. From our standpoint, mitigating the use of certain pronouns shifts discussion away from people and shifts it towards the actual topic. Some of these terms are also sometimes used to insinuate that a person has hidden motives for their actions. Usually that is ill-advised, as most people are generally sincere, regardless of whether or not they are correct.

With regard to vaccines in particular, we recommend using the terms “vaccine promoters” and “vaccine skeptics”.

If you have any words that you think should be added to this list of discouraged words, please leave a comment and we will consider it. In addition, there is a list of standard swear words which are automatically flagged by the DISQUS system, requiring such comments be manually approved before appearing.

Questions to Ask before Writing a Comment 

If you want to know why your comment may have been deleted, or if you just want to improve the quality of your comments in general, please reflect on the following questions:

Have I exercised the principle of charity?

The principle of charity is defined by Wikipedia as follows:

“In philosophy and rhetoric, the principle of charity or charitable interpretation requires interpreting a speaker’s statements in the most rational way possible and, in the case of any argument, considering its best, strongest possible interpretation. In its narrowest sense, the goal of this methodological principle is to avoid attributing irrationality, logical fallacies, or falsehoods to the others’ statements, when a coherent, rational interpretation of the statements is available.”4

Hand in hand with this, one should ask, “Have I looked for the potential truth in an argument before looking for potential faults?” A very helpful step to keep conversation friendly and to prevent devolution into hostile fault-finding is to start by first charitably paraphrasing the argument a person is making back to them. Only then consider suggesting defects in the argument. This enables another to feel acknowledged and not dismissed out of hand. It also forces one to see another person’s point of view.

Have I committed the “fallacy fallacy”?

Because a claim has been poorly argued, or a fallacy has been made, that does not necessarily mean that the claim is wrong. Yet this is often used as a reason to reject an opposing view in debate. In truth, most people are not capable of making a well-grounded medical argument with adequate evidence. Since most people are not scientists, it would be absurd to expect otherwise. People should therefore seek to engage with the best possible defense of a claim, and not with what are often flawed commonplace defenses of that claim.

Am I defending something?

Am I discussing a topic dispassionately, or am I defending a sense of self, a reputation, or a desire to be right? Or could I even be defending a financial interest?

Have I remembered that we all want the same thing?

We tend to get identified only with people who agree with our specific views. Yet we forget that actually, we all have the exact same overarching view – namely, that wellbeing is a good thing. We just disagree about how to get it. Being mindful that in reality we all have this same overarching goal can reduce polarity. 

Am I open to being wrong?

Have I already decided that no matter what evidence someone presents, I am not going to be willing to change my views? Have I phrased my arguments in a way that make it clear that there is possibility for other views? For example, have I cited a study as infallible proof of a view? Few studies in isolation ever serve as proof of a claim. Furthermore, studies often don’t actually say what websites claim they say. Avoid stating things with finality, unless you can really back it up. It is good to ask as many questions as are answered. The use of the words “might” and “may” should be relatively common.

Have I removed unhelpful emotional content?

Research has shown that collective emotional states can be created and modulated via internet communication and that emotional expressiveness is the fuel that sustains some e-communities.5 We would rather that a dispassionate search for truth sustain internet discussion than emotion. While sometimes it is helpful to describe how something makes one feel, be mindful of how comments are phrased. For example, saying, “It makes me so angry that…”, is better than, “those idiots make me so angry…”. Furthermore, do not use excessive capitalization or excessive exclamation points, which convey emotionalism.

Have I conflated a person with an issue?

It is often a good idea to avoid the use of personal pronouns, when possible. We should try to discuss views more than the people who hold those views. Ad hominems do not address an actual topic at hand. Rather, they stir up defensiveness, making rational discussion more difficult.

Have I appealed to authority?

Have I accepted or rejected someone’s argument on the grounds that he or she is or is not “qualified”? The merit of an argument should be addressed directly, and the qualifications of a person who makes the argument should not be focused upon.

Have I used a straw man argument?

Have I misrepresented someone’s argument in an attempt to discredit it? For example: “Your view is false because “study X” has been refuted.” If the person never cited study X as evidence in support of his/her argument, this is called a straw man argument.

Have I participated in escalation?

If someone writes a comment that is frustrating to us, we should not return in kind. Choose instead to reply kindly, or else do not reply at all. Two wrongs don’t make a right. If you wish, the DISQUS commenting system allows you to vote comments down or else you can also flag a comment as inappropriate, which will bring it to a moderator’s attention. Do not flag a comment merely because you disagree with a viewpoint.

Would I say this same thing to someone’s face?

We need to remember we are talking with real human beings. Many things written online would never be said face to face.

Have I hidden behind anonymity?

Anonymity can sometimes make it too easy to be offensive, lazy, imprecise, and shallow in our thinking and analysis. Though of course, sometimes we still do wish to be anonymous for good reason. But we need to ask ourselves, ‘Would I say the same thing if my real name were attached to it?”

Have I written unnecessarily?

Have I written something when it would have been better to maintain silence? Many comments do nothing to further discussion. Often times we have not had adequate cause to reach a conclusion about an issue and hence should not write anything. Or else an adequate reply to a topic is not possible in a short span of time.  Sometimes giving a partial reply opens a position up to criticism that would not be deserved had it been possible to give a more exhaustive reply. When in doubt, remain silent.

Have I cited open-ended evidence?

Sometimes people say things like, “Read this book”. This is an open-ended statement that usually means the commenter has not actually read the book himself or is not capable of summarizing the evidence presented within it in a concise and logical way. It does little to further discussion. Though some books are very good, some books contain virtually no evidence in support of their claims, yet these claims gain prominence simply by virtue of the fact that they are in a book. If we haven’t read a book and can’t summarize the evidence, should we expect someone else to do it? The same thing goes for saying, “Watch this documentary”. This is again an open-ended statement. Furthermore, many documentaries are emotionally charged and contain so little information that they could be summarized in one page. It would better to link to a balanced discussion of the documentary than the documentary itself. Remember that emotions do not constitute evidence. Another example of open-ended evidence would be pasting a list of 20 studies off of PubMed and not including any commentary about what those studies say.

Have I generalized?

We can always find examples of bad seeds in any field of medicine. Someone doing something bad or dangerous does not mean everyone of a particular group is just as bad. We can also always find examples of bad or dangerous treatments or materials. This does not mean that all treatments or materials like it are dangerous. We can also dismiss links that people cite on the grounds that a particular website produces a lot of poor quality articles. But this does not mean that all articles on that website are completely devoid of useful information or discussion.

Have I sensationalized?

Such and such a person died of cancer after foolishly undergoing chemotherapy, radiation, and surgery. Or such and such a person foolishly died of the flu after having never received the flu vaccine. News stories like this do nothing to help dispassionately review the research pertaining to competing viewpoints on a subject. You can always find specific incidents of anything you want. This is sensationalization.

Have I focused excessively on anecdote?

Some particularly detailed anecdotes can be important, but we must understand that most anecdotes do not contain adequate information to assess what actually caused the change in health that a subject experienced, or whether the change in health truly occurred at all. If anecdotes are described, be willing to concede that others may not be able to alter their opinion simply on their bases. When writing an anecdote, try to give as many details as possible that would substantiate the claim that the alleged treatment(s) are what actually produced the result. This will help to clarify your experience for others. But we must be willing to accept that many of our personal experiences are simply not communicable to others in a way that can sway opinion.

Is my comment totally unsupported?

Have I made a claim and offered zero reason or evidence for it? Such unsupported comments – even if they are correct – do not facilitate understanding of a subject and may be removed. It may be better to write a comment that includes wrong reasoning than to make a comment without any reasoning or citations at all. The prior can foster discussion and at least illuminate errors in our thinking. The latter cannot.

Having said this, we are more lenient about allowing statements that concur with the views expressed in the article in question. The reason for this is that the article itself in some cases may serve as the support for the statement. We do not consider this to be a double standard.

Have I claimed literary omniscience?

“There is no evidence that […]” is a popular argument. Oftentimes, what that really means is, “there is evidence, but I am not aware of it’s existence, or otherwise just want to bypass any fair debate”.

Have I replied hastily?

Sometimes it might be good to sit on a reply for 24 hours. This may help prevent us from saying things imprecisely or even unkindly.

Have I looked for opposing viewpoints before I comment?

It is good to look for opposing viewpoints and sincerely try and see if there is any truth in them before writing or commenting on the internet. Failing to do so is a frequent source of ridicule when fallacious news is indiscriminately spread, only to be refuted within a couple days by people who looked a little deeper.

Have I presumed guilt?

We live in an internet age where a single false accusation against a physician, researcher, organization, or other individual can gain traction as being the unquestionable truth within a matter of days. Damage wrongly done to individuals can be irreversible. When such news stories come to bear, we should always wait for complete information to emerge before reaching a conclusion. This includes deliberately seeking to hear the side of any accused person or persons.

Have I respected a person’s choice?

Sometimes we see people undergo medical treatments we think are ill-advised. But once a person has decided to do so, we need to consider carefully whether or not the time to disagree with them has passed.  Sometimes, we need to simply respect the choices of others rather than cause them unnecessary emotional and psychological burden. This is especially the case in illnesses where timely action is crucial.

Have I posted private information?

If private information regarding yourself or another is posted, the moderator may remove the comment.

Have I requested medical advice of our team?

Though we will generally allow people to discuss their own health with other commenters, please know that the EMR team is unable to respond to most such questions.

Have I engaged in self-promotion?

Links posted on our site must be relevant to the discussion. No posting just to get backlinks. No soliciting of products or services is allowed.

Have I written a totally irrelevant comment?

If comments drift too far off the subject of the article in question, we may delete those comments/threads.

Have I remembered that my comments reflect on others?

Remember that your comments may reflect on groups of people larger than just yourself.  Do not say things that will injure your cause or the credibility of others who are discussing the same subject. Do not tempt others to make generalizations about the sensibility of other people who share your viewpoint.

Have I put myself in someone else’s shoes?

We should try to see things from the life experiences of those who disagree with us. One thing to note especially is that when a person is willing to be criticized for having an unpopular view, this in itself is something that is admirable and with which we should sympathize, regardless of whether or not the view is correct.

Is my comment understandable?

Have I used good spelling, grammar, and punctuation? Have I used jargon or acronyms without defining them?

Have I committed any other logical fallacy?

Though we have already made mention of what we consider to be the most relevant fallacies found in online medical discussion, it would be a productive use of time to review the 24 types of logical fallacies described on the website Your Logical Fallacy Is.

Community Guidelines Summary

To summarize the present guidelines, there are three things we consider most in deciding to remove a comment. One is going completely off topic. The second is leaving a totally unsupported statement. The third is a lack of kindness. This means there should not be unnecessary negative emotions, insulting tones, or insinuations. In this case, the content of a comment may actually be valuable, but we may still delete it due to the emotional presentation. In some instances, we will not remove a comment, but just edit parts of it. Sometimes your comment may not appear immediately because it contains something that the system has flagged for manual approval by a moderator. In this case, please do not repeatedly submit the same comment. If users of our website find that we are removing a much higher percentage of comments than moderators of other websites might, please understand that this is not personal. It is just that we hold our commenters to a higher standard than most websites. If we delete your comment, you are welcome to submit it again, minus the objectionable elements. We believe deleting a high percentage of comments is preferable to disabling comments altogether, which an increasing number of high profile websites are choosing to do. We allow “thank you” type comments, but if they become too numerous and clutter up the comments, we may delete them. Please don’t take it personally.

In short, treat everyone like a friend and not an enemy, and your comment will probably be approved.

Doug Gross, CNN B. Online comments are being phased out – CNN. Published November 21, 2014. Accessed November 7, 2016.
WHY WE’RE SHUTTING OFF OUR COMMENTS. Popular Science. Published September 24, 2013. Accessed November 7, 2016.
Dewey C. There’s drama on dietitian Twitter, and it’s exposing deep rifts in nutrition doctrine. The Washington Post. Published November 28, 2017. Accessed December 13, 2017.
Principle of Charity. Wikipedia. Published February 14, 2019. Accessed February 14, 2019.
Chmiel A, Sienkiewicz J, Thelwall M, et al. Collective emotions online and their influence on community life. PLoS One. 2011;6(7):e22207. [PubMed]