The purpose of this letter is to respond to the critique of the article by Basch et al. ^{Reference Basch, Mohlman and Hillyer1} raised by Hosseini and Akbarzadeh in their Letter to the Editor, entitled, Persisting on Readability Could Provoke the Risk of Misinformation: A COVID-19 Pandemic Concern. ^{Reference Hosseini and Akbarzadeh2} The premise of the letter, as suggested by the title, is that adjusting for readability in online articles related to coronavirus disease 2019 (COVID-19) can result in misinformation. The authors state, “trying to deliver all information to the general audience may lead to misinterpretation, misjudgment, and misunderstanding.” ^{Reference Hosseini and Akbarzadeh2} In backing up this claim, the authors cite studies that pertain to misinformation on social media, a website search identifying misinformation using the keywords “Wuhan Coronavirus” and a noncomprehensive, nonsystematic summary of the types of misinformation prevalent. ^{Reference Hosseini and Akbarzadeh2} These citations do not support the idea that simplifying language in online information will lead to misinformation. In fact, there is no supporting evidence whatsoever in the letter that validates their position that lowering readability levels to make information understandable changes the meaning of the information or results in misinformation.

The authors state that the “less-educated portion of the society…may not use the Internet and online tools to gather their desired information.” ^{Reference Hosseini and Akbarzadeh2} They continue to suggest that this population may be “chiefly dependent on television and public broadcasting.” ^{Reference Hosseini and Akbarzadeh2} The authors raise the issue that alternative focal points should be on identifying reliable sources rather than “dealing with possible comprehension flaws of the general population.” ^{Reference Hosseini and Akbarzadeh2} Intentionally avoiding the simplification of text rather than creating the most understandable materials possible is discriminatory, as highlighted by the PLAIN language movement. ^3,4 Furthermore, to claim that “comprehension flaws of the general population” are not worthy of attention in preparation of scientific materials without supporting documentation negates widespread advice from public health agencies and lacks merit.

The authors noted in a cursory way that they “repeated the study design” and garnered different results. Here, one must consider that the study by Basch et al. was submitted March 28, 2020, revised, re-reviewed, and first published online May 11, 2020, ^{Reference Basch, Mohlman and Hillyer1} after rigorous peer review. The aforementioned letter appeared nearly a year after the initial submission on February 14, 2021. ^{Reference Hosseini and Akbarzadeh2} Any cross-sectional study repeating a web search for articles roughly 1 y later will yield different results. In fact, Basch et al. state this explicitly in their limitations section. ^{Reference Basch, Mohlman and Hillyer1} Furthermore, although the study by Basch and colleagues appears to be the first on this topic in the published literature, several studies have been published subsequently, which report similar findings using varied keywords. ^{Reference Worrall, Connolly and O’Neill5-Reference Treanor and Radonjic7} We stand by the main inferences drawn, namely that too much public health information is written at a level that is not accessible to a large and often high-risk segment of the population. This undermines the individual’s ability to access up-to-date scientifically accurate information and use it to make informed decisions about health.