Frequencies and percentage of the total for of each variable were calculated to identify the most prevalent botanicals in each media format. These were then cross-tabulated against the applications of botanical products to examine and identify the most frequently mentioned applications for each type of botanical.

Having identified the most common health applications associated with each of the most frequently mentioned botanicals, a PubMed search was conducted seeking published reviews supporting or refuting these claims. The search terms were the names of each of the botanical products or product groups individually and paired with their applications. Where no systematic reviews were available, single research studies were sought under the same search terms.

After consolidating the categories as mentioned previously, the most frequently mentioned application overall was skin care, with several individual products predominating in the mentions. Consistent with its long use, the reviews by Sadoyu et al [32] and Chelu et al [33] supported the role of aloe vera in skin care and wound healing.

Many herbs were noted to have verifiable applications for skin care. Chamomile was also supported as having a role in skin care by reviews from El Mihyaoui et al [34] and Dai et al [35].

A review by Mandlik Ingawale and Namdeo [36] described the pharmacological properties of ashwagandha, including antibacterial and antifungal activity, which have applications in skin care.

Batiha et al [37] reviewed studies of the bioactive components and pharmacological activity of lavender. Although the exact mechanisms are still not well understood, they concluded that topical lavender can be effective against bacteria, fungi, yeasts, and mold and has antioxidant properties, all of which make it a desirable ingredient in skin care products.

A review by de Macedo et al [38] found that there were many topical applications of rosemary in skin care and described the biochemical bases for its efficacy. Another review by Li Pomi et al [39] described the potential for dermatological uses of rosemary and pointed out the evidence for its efficacy as protection from UV sun damage and as an antibacterial agent. While rosemary is considered safe for topical uses and when ingested in small amounts, it may not be safe if taken orally in large amounts [40].

Although peppermint was frequently mentioned as a component of skin care products, evidence for an independent function in this capacity is limited. A review by Zhao et al [41] examined the role of peppermint essential oil in treating skin conditions but not for use with healthy skin in any capacity. The frequent mention of peppermint in products for skin care may be more esthetic than functional.

Tea as applied for skin care was examined in a review by Koch et al [42], reporting that it is beneficial for skin care, including antiaging, as well as hair care. Seaweed similarly had strong evidence supporting its traditional role in skin care, along with other health applications such as antiaging, anticancer, and anti-inflammatory preparations [43-46].

Plant oils were also reported as a significant component of skin care products. A review by Kairey et al [47] found evidence for multiple applications of tea tree oil in skin health, including acne, dermatitis, skin inflammation, and photodamage. They noted that side effects of topical tea tree oil were minimal in the trials reviewed.

The evidence for jojoba as a skin care product was very strong, as described in the reviews by Lin et al [48], Gad et al [49], and Blaak and Staib [50]. No significant side effects were noted by these authors.

Mechqoq et al [51] reviewed the literature on the chemical composition and uses of argan oil and reported on its extensive use as a skin moisturizer, as well as a treatment for skin irritation of various types. Their review noted antibacterial and antifungal actions without notable side effects. A study by Alsatari et al [52] found that topical application of argan oil was an effective treatment for diaper dermatitis in infants. A mouse study by Makbal et al [53] found anti-inflammatory properties in argan oil, with no toxic effects noted even at high doses.

Mushrooms were also included as an ingredient in many topical products. Paterska et al [54] conducted an extensive review of the literature on a range of mushroom varieties for potential antiaging properties. They noted that many in vitro studies have found mushrooms to contain bioactive compounds such as polysaccharides, terpenoids, polyphenols, and peptides that may be beneficial to skin health. However, these conclusions were limited by a lack of human trials.

A review by Mineroff and Jagdeo [55] looking specifically at Tremella fuciformis, or snow mushrooms, found in vitro and animal studies suggesting a role in protection from UV damage and wound healing. However, these were inconclusive due to a lack of human studies. While there seem to be some potential benefits and minimal identified side effects, skin care applications for mushrooms are not strongly supported by published literature.

Oats and oatmeal are common ingredients in skin care products, incorporated for a variety of purposes. Becker et al [56] conducted a review of the safety and efficacy information available from both research and industry sources. They concluded that, when used as per industry guidelines, oatmeal is safe for use in skin care products, with demonstrated efficacy for many, if not all, of its applications. Kim et al [57] studied the means by which oats are able to ameliorate skin irritation from contact dermatitis in mice. They found that a topical application reduced skin lesions through an immune-modulatory mechanism. Similar studies with human participants were not found.

Although not mentioned as frequently as some of the other functions, several botanical products were indicated for applications in cognitive well-being and stress management. A systematic review and meta-analysis by Akhgarjand et al [58] found overall efficacy of ashwagandha for both stress and anxiety. A recent clinical study by Leonard et al [59] found that ashwagandha supplementation improved measures of cognitive function and stress in healthy young people.

Lavender was mentioned frequently but not as commonly for stress management. This was despite evidence that it is beneficial for this function. A systematic review and meta-analysis by Donelli et al [60] also looked at lavender as a treatment for anxiety. They found 65 randomized controlled trials and 25 nonrandomized studies of lavender for treatment of anxiety. Their overall conclusions were that oral administration of lavender essential oil is a safe and effective treatment for anxiety. They were more equivocal about inhaled lavender because of the confounding factors in the included studies. A review by Yoo and Park [61] examined studies of the effects of lavender inhalation on anxiety across a variety of human studies in stressful settings. They identified 11 clinical trials, with 10 showing reduction of anxiety using lavender. Sayed et al [62], in another systematic review and meta-analysis, concluded that inhaled lavender is best for short-term interventions for acute anxiety but orally dosed lavender is better for longer-term treatment. None of these authors reported any significant side effects from either route of administration [62].

Cannabidiol, a cannabis derivative, was frequently mentioned in the legacy media in relation to stress management, although less frequently than for other purposes. It was examined for this purpose in a number of review articles [63-66]. While all of these authors found cannabidiol to be a promising therapy for stress and anxiety, they all also called for further research as to its efficacy in specific situations, as well as further understanding of its biochemical mechanisms.

Finally, while often touted for their nutritional value, berries, with their high content of polyphenols, are anti-inflammatory and have also been associated with decreased stress and improved quality of sleep, although the mechanisms of these potential benefits have not yet been determined [67-70].

Multiple reviews have investigated the immune modulation properties of various botanical products. Included in those studies were many of the botanicals identified from mentions in our sample of legacy media. These included aloe vera, anise, ashwagandha, astragalus, bay leaf, bilberry, black pepper, cardamon, chamomile, cinnamon, clove, cumin, echinacea, frankincense, garlic, ginger, ginseng, green tea, lemon, licorice, mint, myrrh, oregano, sage, shiitake mushroom, tulsi, and turmeric [71-73].

There were also reviews about botanicals in the form of essential oils for uses benefiting immune function. Human studies of beneficial effects of essential oils on immune function were described in a review by Peterfalvi et al [74] These included bergamot, cypress, fennel, ginger, lavender, patchouli, pepper, rose, sandalwood, and sweet marjoram. In another review, antimicrobial effects of fennel, peppermint, pine, and thyme essential oils were reported [75]. However, Sindle and Martin [76] advised caution with direct applications of essential oils to the skin in view of incidence of atopic dermatitis in sensitive individuals.

In addition to these multiproduct reviews, there were also many discussions of specific botanicals for immunity support. aloe vera was found to have a positive effect on stress-induced immunosuppression in mice, but no comparable studies in humans were found in PubMed [77]. Guo and Mei [78] cautioned about internal use because of potential toxicity of some compounds contained in aloe. A review by Hęś et al [79] supported the use of aloe as an antioxidant, but these authors cautioned against ingestion of high doses of aloe due to its laxative effects.

A review looking at rosemary by Ahmed and Babakir-Mina [80] found that, while animal studies have shown potential immunological benefits, human studies on this are lacking. Regarding ashwagandha, a review by Mandlik Ingawale and Namdeo [36] described its pharmacological properties, which included immunological activity. They also noted that the studies they reviewed showed little or no toxicity when taken in typical doses. A randomized controlled study by Verma et al [81] found no evidence of toxicity in healthy young adults. However, some caution is warranted as a review by Philips et al [82] found harmful effects in patients with liver disease consistent with a toxic effect.

Ginger was also frequently mentioned in relation to products supporting immunity. The evidence for this is less equivocal than that for aloe, with multiple review articles supporting this application [83,84] and a biochemical theoretical model by Kadhim et al [85] showing potential interference of components of ginger with the spike protein of the COVID-19 virus.

Tea, both green and black, has been studied extensively in terms of its effects on immune function, as reported in multiple review articles, demonstrating efficacy against the common cold and influenza [86], autoimmune disorders [87], and potentially as prevention or adjunctive treatment of COVID-19 [88-90].

Mushrooms are a group of heterogeneous products, but collectively, they have a long history of multiple health applications. These properties were discussed in a review by Yadav and Negi [91] and included “anti-tumor, antioxidant, immunomodulating, radical scavenging, cholesterol-lowering, cardiovascular, antimicrobial, anti-inflammatory, hepatoprotective, detoxicating, anti-obesity, anti-diabetic, analgesic, and various other properties.” The mixed nature of various types of mushrooms makes it difficult to draw definitive overall conclusions, as seen with the mixed results of the studies reported in the reviews by Motta et al [92] and Uffelman et al [93]. Hong et al [94] reviewed literature looking specifically at mushrooms and cardiometabolic diseases. They found some improvements reported for cardiometabolic factors such as glucose control and lipid profiles but not for overall mortality from cardiovascular disease.

Finally, a review by Govers et al [95] found that berries as a class can play a positive role in supporting immunity.

Oats and ginger were 2 products mentioned for gastrointestinal health for which supporting literature was found. Oats are known to be a good source of soluble fiber and β-glucans. The soluble fiber increases gastrointestinal transit time and slows absorption. A range of gastrointestinal disorders have been shown to improve with increased intake of β-glucans [96].

A review by Fabiano et al [97] explored the prebiotic effects of oat consumption on the composition of the gut microbiome. They noted that oats are a source of short-chain fatty acids, which have been shown to decrease inflammation. However, these properties must be interpreted with caution due to a lack of large-scale studies in humans.

Ginger has long been used as a folk remedy for gastrointestinal symptoms, with substantial evidence of efficacy [84]. A review and meta-analysis by Li et al [98] concluded that the overall preponderance of published literature indicates that ginger is a safe and effective treatment for managing nausea and vomiting from a variety of causes, including pregnancy and cancer chemotherapy.

Many studies have examined the accuracy of health information available on the internet and social media platforms. Looking specifically at websites for herbal supplements, Owens et al [99] found that <3% of the websites they surveyed included references to scientific literature to support their claims. They also noted the presence of testimonials from product users on these sites without oversight by website administrators. Some of these testimonials make potentially misleading claims about these products as treatments or cures of diseases, again without citing any peer-reviewed evidence.

A series of articles by Ng et al [100-103] used the DISCERN instrument to look at online consumer information on dietary and herbal supplements as recommended for fatigue [100], weight loss [101], hypertension [102], and pain [103]. The overall results of these studies found a high degree of variability in the quality of information available on these websites, with commercial websites generally providing poorer-quality information than the websites professional organizations or health care institutions. In a similar study of dietary and herbal supplements for COVID-19, Ng et al [104] examined information provided on Twitter and found comparable levels of misinformation circulating even more quickly than via web pages. An earlier study from Swetland et al [105] had reported that >25% of tweets about herbs and dietary supplements contained inaccurate information. Those authors also noted that they found no association between the accuracy of the content of these tweets and the number of likes or retweets they received. This indicates that accuracy made no difference in the response to the information presented and shared. Australian Instagram posts about dietary supplements were similarly inaccurate [106]. This is of concern because information found on the internet was found to be the most common reason for starting the use of supplements, usually without consulting a physician or pharmacist [107].

Investigations of social media in languages other than English have also found misinformation. Kharbat and Abu Daabes [108] found that the quality of information about herbs and cancer treatment in Arabic on YouTube was inadequate to properly advise patients. A total of 3 studies looking at health information on TikTok videos in Chinese all found that the science-related content of these videos was of variable quality, with those contributed by for-profit organizations having the lowest information quality [109-111].

Inclusion of misinformation seems to be no bar to the popularity of the health information presented online. In total, 2 studies of health videos posted on YouTube, one about kidney disease [93] and one about diabetes [112], found that, based on the number of views and likes, misleading videos were actually more popular than those containing evidence-based health information.

To address inaccuracies in health communications throughout the media landscape, it is important to have clear definitions of what is meant. El Mikati et al [113] described the distinctions between misinformation, disinformation, and malinformation. Each of these has its own root causes and motivation by creators, and thus, different approaches to management are needed.

It has been noted by many researchers in this area that inaccurate information of every type proliferates in areas where there is a dearth of information provided by health professionals on platforms used by the public. There have been calls for an increase in engaging educational content to be created for this purpose [99,108,110,114-116]. Joseph et al [117] refer to a “tug-of-war” between dissemination of evidence-based health information and the spread of misinformation online.

Infodemiology and infoveillance provide approaches to understanding online misinformation and to organizing and winning this proverbial tug of war. Infodemiology examines both the existing information on the web (the “supply side”) and the information needs of the web-searching public (the “demand side”) [118]. Infoveillance is the monitoring of these sources of information with the goal of obtaining insights about users’ prioritization and responses to health-related issues [15]. Having a clearer understanding of the full scope of information both as provided in the media and as sought by the public can help establish the means to address the issue of inaccurate health information.

Suarez-Lledo and Alvarez-Galvez [16] identified 4 knowledge gaps to be filled that align with public health infoveillance goals. These can be summarized as (1) identifying dominant trends, (2) understanding mechanisms of misinformation spread, (3) determining the impact of misinformation on health behaviors, and (4) developing communication strategies to reduce and mitigate the negative impacts of misinformation.

The World Health Organization also addressed these issues in their first infodemiology conference [119]. They called for the creation of systems for social listening, signal detection, and analysis to identify emerging information trends. To achieve this, they recommended building collaborative partnerships beyond the usual health system networks to include people in journalism, digital media developers, and community organizations to develop a multifaceted toolkit of strategies. They noted that the health information ecosystem includes both online and offline environments and the inclusion of both is necessary to reach all communities.

Strategies have been proposed to add some options to the needed toolkit. Ishizumi et al [120] discussed “upstream” activities such as improving health literacy in populations, prebunking through education, and enhanced presence on social media platforms. They also promote social listening as a means to identify information needs and build trust.