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Published on 12 de diciembre de 2025 | http://doi.org/10.5867/medwave.2025.11.3156

Biases and mistakes in the Official College of Physicians of Barcelona (COMB) document on digital health

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Summary list of biases and errors in the COMB document.
Location in the COMB document1,2What does the COMB document say?Problems or errors
Irrelevance. The authors of the COMB document cite studies that are difficult to apply to the current problem of digital protection in childhood and adolescence.
P 3, Reference 3More screen time, more delays in language development, and fewer language skills.There is no validated measure of screen time; most studies focus on television (since 1973).
P 3, Reference 4Links between overexposure to screens and decreased attention span.Observational, retrospective, and subjective assessments of exposure; children born in the 1990s; television only.
P 3, Reference 5Links between overexposure of minors to screens and aggressive behavior.Small study, Texas; focuses on television, video games, and attention, with no significant association; aggressive behavior refers to guardians or caregivers, not minors.
P 6, Reference 8Risk of cyberbullying and self-esteem in adolescents.Association between social media and social isolation in adults aged 19 to 32. Cyberbullying is not mentioned.
P 11, Reference 12Use of Instagram and body self-esteem.Only men and adults.
Bias due to misinterpretation. The authors of the COMB exaggerate or misinterpret the evidence from the studies cited.
P 4, Reference 6Reduction in opportunities for face-to-face interaction.The study only correlates screen use with brain images in 69 pairs of parents and children.
P 5, Reference 7Links between social media and an increase in seven health risk behaviors.The authors state that the certainty of the evidence is "very low" for six behaviors, due to bias.
P 7 y 8Two paragraphs on social media and eating disorders.Speculative and not based on evidence.
P 14, Reference 14Sedentary lifestyles, obesity, and sleep problems based on a meta-analysis.It is not a meta-analysis but a cross-sectional study, and it is not on obesity (citation problem).
P 14, Reference 17Statements about "learning."Not based on the reference mentioned.
P 15, Reference 18Relationship between "near vision” and myopia."Screens" are just one of many "near vision” activities.
Selection bias of evidence. The authors ignore existing evidence in studies that contradict their thesis.
P 3, Reference 3More screen time, more delays in language development, and fewer language skills.The review reports beneficial effects of "quality" screen time.
P 6, Reference 8Proportionality between social media, electronic devices, anxiety, and depression.Only correlations, for depression and suicide. Relevant evidence ignored.
P 6, Reference 9Related to anxiety and depression.The article is about depression and suicide. It omits substantial gender differences.
P 9, Reference 10Meta-analysis on eating disorders.In reality, it is a thematic analysis that also reports beneficial aspects.
P 14, Reference 16Reported sleep disorders. Only harm was reported.The study also contains inconclusive effects and considerations about methodological quality.
Errors in bibliographic citations in footnotes
-Reference 3Incorrect authors, year, volume, pages, and DOI.
-Reference 5Incorrect journal and DOI.
-Reference 7Incomplete.
-Reference 8Incorrect authors, journal, and DOI.
-Reference 10Incomplete.
-Reference 14Incorrect title, journal, and DOI.
-Reference 16Inconsistent authors, title, and DOI.
-Reference 18Incorrect journal and DOI.

COMB, Official Medical Association of Barcelona. P, paragraph in the ‘Reasons and Clinical Basis’ section. DOI, Digital Object Identifier.

Notes: 1 The paragraphs and references refer to the COMB document. P 1 to 5 on page 7, first column; P 6 to 11 on page 7, second column; P 12 to 14 on page 8, first column. 2 Reference, numbered in the footnotes of the COMB document.

Source: Prepared by the authors of this study.