EOScu | Product Evaluation Pillar Page

Infection preventionists and their colleagues are inundated with sales messages promoting the latest products, innovations, new formulations, and next big thing to buy for their facility. It's fairly easy to read between the lines of advertisements, weigh the scientific claims written in bold letters on a flyer, and disregard the emoji-filled email subject lines. But what about the review written up in a trade magazine? What about the speaker at a professional organization breakfast? What about the listing in a online product database? How does the busy infection preventionist or healthcare leader know when they are reading an unbiased review and when they are reading a sponsored pieced approved and paid for by the manufacturer?

LOOK FOR

These phrases indicate pay-to-play

“Paid post”
“Presented by”
“Sponsored by”
“Partnered with”
“Promoted”
“Affiliated with”
“Powered by"

Because we are way more savvy consumers today, it can be difficult to get our attention through typical means. This is why product marketers have had to take alternative routes to get our attention, even sponsoring content that looks and sounds like an unbiased review. When it comes to selecting products for your healthcare facility, you want the science, not the paid promotion. Here are some ways to spot pay-to-play content as you conduct research.

Unaffiliated Author

If you find an article reviewing a new product in a trade magazine, you could easily assume that it is written by a fellow infection preventionist or other healthcare-affiliated author. Someone who knows about infection prevention and control and is writing an unbiased reviews. In these cases, the publication will list the author's name and professional affiliations, degrees, and employer. If the article is instead written by "Staff" or a name but no affiliations are provided, you could be reading a paid, promotional piece. You may even see the company itself as the author, a detail other readers might miss, or assume the company is writing as an "industry leader." They might be an industry leader, but the article cannot be taken as an unbiased evaluation.

Links Back to a Company

Much like a press release, some sponsored content will have clear URL links to the company's product pages. This practice would not be used by a neutral author, as they would want to avoid any impression of being biased.

Article Conveniently Paired with Large Advertisement | Sometimes, publishers will reach out to marketers and offer advertizing space to accompany an article promoting their product. In these cases, a seemingly unbiased article will have an ad for a specific product on the same page. Be extra vigilant in these cases, as the pairings are seldom random.

White Papers

The term "white paper" comes to us from a 100-year-old practice of government reporting in the UK. When government agencies provided data to Parliament to help them make decisions, they would offer three different types: Very long, comprehensive documents with a blue cover, open-ended reports with a green cover, and short, focused reports on a single topic with white covers. This last type, the concise document with information to solve a problem, came to be the formula for what is now known in many industries as a "white paper." Today, white papers are produced for sales purposes by for-profit companies, making them a marketing tool that can often be confused with a neutral scientific paper. While both publications have their purpose, it is important for the consumer to know how they differ. Today we will compare these two documents in order to help our readers see beyond the surface similarities and become aware of the important differences.

On the surface, commercial white papers and scientific papers published in journals appear similar. They are both presented with an emphasis on narrative rather than design, so neither will have flashy artwork or photographs and statistics are presented in black and white tables or graphs. They are similar in length - from 6 to 12 pages, give or take. Both will have citations, either as footnotes or end notes, using current research from respected journals and thought leaders. Even the formatting will look similar, with section headings including a brief summary, background, analysis, and presentation of data. Looking behind the surface, however, reveal 3 important differences.

Difference #1: The Author

Commercial white papers are written by a company's in-house staff or by a freelance writer under contract. The writer meets with the marketing staff to discuss the information to be presented, to determine an angle, and set parameters on facts and messaging. The author may have a background in the topic or product, but this is not required. The entire process can take anywhere from 25 - 50 hours to complete, from planning to publication. Final editing and approval is granted by the sponsoring company. Ultimately, the white paper reflects directly on the company that sponsors it, not directly to the author.

This anonymity could not be further from the authorship of scientific journal articles. For these documents, the authors are not only responsible for the narrative, they are also the lead investigators in the study, the experts analyzing data for their peers in the scientific world. Their published work is inexorably tied to their names, their careers, and their professional legacy. Important publications will continue to be cited in future work, each citation listing their name and article. Journal authors also take complete responsibility for the content of their articles, presenting their data at conferences, answering questions for interviews, and providing additional materials to those researchers wanting to know more. Final approval for these publications is granted by a panel of peer editors as well as the journal editor, often after several rounds of edits and clarifications that can take up to a year - in addition to the months or years required for the study itself.

Difference #2: The Goal

The goal of the white paper is to direct the reader towards making a specific decision. In one definition of a white paper, this type of document is "a persuasive essay that uses facts and logic to promote a certain product, service, or viewpoint." The author directs the reader to a specific conclusion using carefully-selected facts and logic, all with the desired result of portraying the product, service, or viewpoint in the best possible light.

In contrast, an academic paper will present the results of a study in order to contribute to the body of scientific knowledge, "warts and all." That is to say, the author's goal is to put forward data with analysis that add to the scientific conversation, to help clarify a bigger picture, and hopefully encourage further research. The author will build a logical framework with evidence from previous work, while acknowledging opposing viewpoints or possible contradictions. Every scientific paper will contain clear mention of the study's strengths and weaknesses, and any concluding statements will be carefully phrased in order to remain open-ended and neutral.

Difference #3: The Results

If the goal of the white paper produced by a for-profit company is persuading the reader to reach a specific conclusion, then the desired result of that document is a sale by the company that sponsored it. A white paper may not contain a sales pitch, but its carefully crafted message is intended to guide the reader to a specific decision: Investment in the product being described.

For a scientific journal article, the goal is to add to the body of knowledge in a meaningful way. Evidence of the relevance of this contribution can be the citation of that work in future presentation and/or articles published in the same field. Authors of significant work may also benefit from career advancement, requests for presentations at conferences and symposia, and availability of granting opportunities to continue their research. These results may seem amorphous to the layperson, but contributing to the vast body of academic knowledge is the pursuit of every research scientist. Just as the teacher aims to awaken a love of learning in a student, or a doctor works to heal a patient, the research scientist hopes to add a brick to the growing foundation of scientific knowledge, knowing that the brick may be the keystone to even greater discoveries.

This is not to say that all scientific papers add meaningfully to the body of knowledge, nor that all white papers are devoid of scientific value. Not all scientific papers are devoid of corporate influence, with some companies investing in research that then is published in an academic journal (with full disclosures in the publication). And not all white papers are a part of a corporate sales funnel. There are white papers produced by non-profit organizations, including professional associations, that are also persuasive rather than neutral. (An example would be a white paper about climate change produced by an environmental non-profit agency.) In these cases, the goal is to present and defend a specific viewpoint with no direct sales or commercial interest in mind. Some of these types of white papers will be published by trade magazines, appear in conference proceedings, and even be cited in other literature. While they are not neutral per se, they are not commercial in intent.

Commercial white papers can be helpful. For a potential customer considering a product, it can present a lot of information and statistics in a streamlined form, help the reader convince others about their support of a product, and identify practical ways to decide whether or not the product is a good match for one's needs. It's important for readers to always keep in the back of their minds, however, that it is a marketing tool that may not present a complete picture. In an academic hierarchy, the scientific paper will be considered superior, since they are unbiased and peer-reviewed. Ideally, a consumer will use both white papers and scientific research to make the best decision for their needs.

Product Lists and Endorsements

According to the Federal Trade Commission (FCC), paid endorsements must be "clear and conspicuous" so that the reader knows they may not be getting an unbiased opinion, but there are grey areas that can be difficult to navigate. Organizations and marketing platforms exist just to get companies to pay them to list their products as "approved" or "recommended" when in reality, the listing is simply pay-to-play. Additionally, paying companies are often listed as "Partners" or "Industry Affiliates" on the organization's website, providing a kind of endorsement from the agency that is in fact paid for by the company. Sadly, these money-making promotional opportunities have reached professional and trade organizations, who see this type of engagement as a source of income to supplement membership dues and donations. This puts you in the difficult position of questioning information that comes from trusted groups or associations. It also means that companies that choose not to pay are not included in lists of quality products not because they don't meet the criteria, but because they didn't pay to be on the list. The same goes for trusted individuals in the infection prevention field: They promote certain products because they are paid to do so, not because their professional experiences led them to select certain products because of their efficacy. According to the FCC, they must have actually tried the product and must be honest. These individuals, and even the associations with pay-to-play lists, are not trying to mislead the public, but they are choosing to not give the complete picture. Unless they are paid to do so.

Elsewhere on our site, we have covered the rigorous protocol set by the Environmental Protection Agency (EPA) for a product to make public health claims, that is, for a product to be described as protecting public health. These are products like disinfectants, HVAC filters, water treatments, and copper-infused biocidal surfaces such as EOS^CU and copper alloys. For everyone else, there is the "treated article" category which only allows products to be described as protecting the product itself from mold, mildew and odor-causing bacteria.

However, consumers will often see in marketing materials that a product passed "JIS Z 2801" or "ISO 22196" or "ASTM E2149" tests with a percentage reduction in bacteria. Let's look at what those tests measure and how they do not meet the rigor demanded by the EPA (and why marketing materials may try to imply that these tests are the same!)

The Environmental Protection Agency (EPA)

First, let's look briefly at what the EPA requires for public health claims. In the case of solid surfaces, the only EPA registrations currently approved are for copper and copper-infused products. For the products to be able to make public health claims - that they protect patients from healthcare associated infections - the products must have a 100% pass rate on thousands of tests with 99.9% or greater reductions in under 2 hours, after abrasion and after recontamination. Test organisms are considered "bookends," that is, easier-to-kill up to hardest-to-kill organisms. There are three tests, each building upon (and requiring passing of) the last: Copper as a Sanitizer, Residual Efficacy, and Continuous Reduction. A product passing these three tests can make public health claims, and will have an EPA registration number on all marketing materials. They can say the product keeps patients safe, prevents infections, and works continuously.

The Japanese Industrial Standards (JIS) and International Organizations for Standards (ISO)

The most commonly used test can come under two names, but they are the same test: Japanese Industrial Standards Z 2801 (JIS Z 2801) and International Organizations for Standards 22196 (ISO 22196). This test is called "Measurement of antibacterial activity on plastics and other non-porous surfaces" and tests for bacteriostatic or bactericidal activity after 24 hours of contact involving the liquid medium held onto the surface with a plastic film.

Another test of antimicrobial activity that is often seen in marketing materials is American Society for Testing and Materials E2149 (ASTM E2149). This test is called “Determining the Antimicrobial Activity of Immobilized Antimicrobial Agents Under Dynamic Contact Conditions” and involves submerging the (typically irregularly shaped) product into a liquid medium with the bacteria, agitated for 1 -24 hours, and then the liquid is tested for bacteria, with reductions compared to a control.

Why EPA is the Gold Standard

	JIS Z 2801 and ISO 22196	ASTM E2149	EPA Protocols for Public Health Claims
Microorganisms	Staphylococcus aureus and Escherichia coli	Escherichia coli	Staphylococcus aureus, Enterobacter aerogenes, and Pseudomonas aeruginosa
Duration	24 hours	1 - 24 hours	2 hours
Dry conditions	No,	No	Yes, both wet and dry
Abrasion	No	No	Yes
Pass/Fail Rate	No	No	Yes, 99.9% cut off
Laboratories	Any	Any	EPA-approved only
Modifications	Allowed	Allowed	Not allowed
Public health claims	No	No	Yes
Weaknesses	Not representative of actual surface contamination events Wet conditions facilitate interaction between product and bacteria Results vary between testing laboratories Protocol does not require results provide details about inoculum concentration, temperature/humidity, and other conditions	Must account for product leaching in separate test As stated on testing laboratory website, "many products that “pass” the ASTM E2149 test do not produce an appreciable antimicrobial effect in more realistic situations... often there is no difference between the “antimicrobial” sample and a negative control sample"	Expensive Requires thousands of samples Must be performed at EPA-approved laboratories Protocol cannot be modified Pass/Fail only

There are other standards organizations - European, Asian, industry-specific, and more. Those listed above are considered "gold standard" test standards, until you get to the point where public health claims are sought. For those, only the EPA registration process is acceptable, both from an efficacy as well as a legal perspective.

Put simply, products that cannot achieve the requirements for public health claims use ISO 22196/JIS Z 2801 and ASTM E2149 as a way of showing antimicrobial activity, and it is up to the consumer to recognize the limitations of these tests. It would not be surprising if many consumers believed that these tests demonstrate more than they do - and in fact, many marketing materials take advantage of this by placing these test results at center stage. Sadly, these marketing materials will often suggest, or even declare, that these results mean the users will be safer, more protected, and less likely to get an infection (even in direct violation of the EPA's public health claims regulations). It is our job - those of us in the know, which now includes you! - to spread the word. Not all tests are created equal, and therefore their results should not be considered equal. There is a place for ISO 22196/JIS Z 2801 and ASTM E2149, but that place is not the hospital room.

At conferences for infection control professionals, the vendor area is a combination of globally-recognized brands (typically in large, flashy booths) and smaller vendors around the edges representing smaller companies, professional organizations, support services, and more. How do you best approach such a packed, energetic environment?

Research in Advance

Prior to the conference, take some time to familiarize yourself with the vendors who will be exhibiting. Visit their websites, look up peer-reviewed research on their products, and identify those that align with your research interests or professional needs. This will help you prioritize which booths to visit and make the most efficient use of your time. You can even reach out to the vendors in advance! (They would LOVE that.)

Ask Questions

Don't hesitate to engage with the representatives at the vendor booths. Ask questions about their products, services, and any special offers they may have for conference attendees. This may be one of the only chances that you can have face-to-face access to experts on the product where you can ask your toughest questions, even bringing up those peer-reviewed studies you found!

Collect Information

Be sure to collect informational materials such as brochures, flyers, and product catalogs from the vendor booths. Keep in mind that this marketing material is produced by the company and will therefore have sales in mind, including white papers. You will want to follow-up on claims you read in these materials by going to read the sources they cite, for example.

Demo Products

Many vendors offer live demonstrations of their products or services at their booths. Take advantage of these opportunities to see firsthand how their solutions work. Whether it's a software tool, laboratory equipment, or cleaning product, experiencing a demo can help you make informed decisions about whether a particular product is right for you and your facility.

Network with Vendors

Building relationships with vendors can be beneficial beyond the conference. Exchange contact information, connect on professional networking platforms, and stay informed about future updates, promotions, or events from the vendors you interact with. Often, the conference app will enable the vendor to scan your ID and therefore get your contact information - be sure to get that same information from them!

Attend Vendor Presentations or Workshops

Many vendors host presentations, workshops, or product showcases during the conference. These sessions provide in-depth insights into their offerings and may include case studies, best practices, or user testimonials. Again, keep in mind that these presentations all have sales as a goal, so there will be an emphasis on positive results and feedback. Take every claim with a grain of salt and follow up with your own research.

Don't Ignore the Little Guys

Some companies have the financial means to rent enormous booths with all the bells and whistles. Some smaller, newer companies do not, but what they have to offer can be just as good, or better. Take some time to have a look at the smaller booths - you just discover a treasure.

Product Evaluation