In the medical world, “fake news” is far from new. False medical claims, from snake oil remedies to bogus cures for baldness, date back centuries. Today, however, medical misinformation has gone viral, fueled by the COVID-19 pandemic and a sharp rise in the use of social media.
As false information appears with increasing frequency across a vast range of sources—from political activists all the way to the President of the United States—two questions arise. Does medical misinformation pose a public health risk? And what can doctors do to counteract false claims and steer the conversation to evidence-based facts and information?
A widespread problem
Researchers have been concerned about the spread of medical falsehoods since long before the COVID-19 pandemic took hold.
A study on the spread of medical “fake news” published in 2018 looked at web links containing information on common diseases that were shared on social media between 2012-2017. The authors found that around 40% of the time, links contained misinformation. These sources were shared more than 450,000 times during that period, and the researchers concluded that “Fake, misleading and over-interpreted health news in social media is the potential threat for public health.”
Some studies have examined whether medical misinformation manifests in behavioral changes that can put the health of individuals, or in some cases the general public, at risk. A briefing on health misinformation in Africa, Latin America, and the UK, published in 2020, discusses some notable examples in recent history, including misinformation surrounding the 2014 Ebola virus outbreak, which the WHO described as West Africa’s “most severe acute public health emergency in modern times.”
That year, a team from the CDC and Liberia’s Ministry of Health conducted a rapid anthropological assessment in the areas around the Liberian capital, Monrovia, to determine why such a large number of people were dying from the virus in their homes, rather than at treatment centers. Ebola had killed more than 11,000 people and infected 15,000, yet, as the team discovered, there was widespread disbelief that the virus was real. The researcher found that the rejection of the legitimacy of the virus was due to a variety of conspiracy theories that circulated via the internet, local newspapers, and word of mouth.
Another case in point is the anti-vaccination movement, also discussed in the briefing. Vaccinations save millions of lives every year, and yet skepticism persists about their safety. A 2018 study, which looked at perceived vaccine safety by region, found that 72% of people in North America, 59% of those in Western Europe, and only 40% in Eastern Europe believe that vaccines are safe.
The briefing points out that vaccine hesitancy can be attributed to erroneous beliefs or myths, such as: the flu vaccine causes the flu, vaccines lead to allergies, vaccines cause more harm than they help. This kind of skepticism has real-world impacts. According to figures compiled by the UK-based independent think tank Nuffield Trust, the rate of measles, mumps, and rubella (MMR) vaccination for British children was around 91% in 1995. In 1998, a publication led by Andrew Wakefield, MBBS, claimed there was a link between the MMR vaccine and autism. The study was found to be fraudulent and was retracted; however, fear about the vaccine remained. By 2003, only 80% of British children had received that vaccination. In turn, the UK experienced a bump in measles cases, from 283 confirmed cases in 2017 to 968 in 2018.
But what does all of this mean to a world that finds itself in the grips of an unrelenting pandemic?
COVID-19 myths and misconceptions
A wide range of conspiratorial beliefs around the novel coronavirus have popped up since the virus reached pandemic levels in the first few months of 2020. A survey of US residents conducted in mid-March by the Pew Research Center found that one-third of respondents believe the virus was created in a lab. Of those, 6% thought that the creation of the virus was accidental, while 23% believed it was intentional.
The survey also indicated the prevalence of “fake news” surrounding COVID-19. Researchers found that nearly half of adult respondents reported having come across at least some news and information about the virus that “seemed completely made up.”
A similar story can be seen across the rest of the world. Research by the Oxford Internet Institute found that the average piece of false or misleading health news online has roughly the same distribution levels as an article published by the BBC.
According to a study published by BMJ Global Health, more than one in four of the top-viewed YouTube videos regarding COVID-19 contains misleading or inaccurate information. Among the inaccuracies, popular videos included false statements, such as: “A stronger strain of the virus is in Iran and Italy.” Researchers also found inappropriate recommendations that were not consistent with official government and health agency guidelines, racist remarks and discriminatory statements, and conspiracy theories.
The study pointed out that COVID-related videos from reputable sources are under-represented on YouTube, suggesting that public health agencies should develop strategies to better use the channel to deliver factual information and to minimize the spread of misinformation to the public.
In light of all this, counteracting medical falsehoods is more important than ever. So, what can physicians do to help combat the problem?
How doctors can help stem the tide of medical fake news
It may seem like the rampant rise of medical misinformation is unstoppable. But a number of organizations and medical professionals have started offering advice on what doctors can do to counter the problem and provide people with the guidance and information they need.
A recent “Ethics Talk” videocast, published by the American Medical Association’s Journal of Ethics, featured an interview with Vish Viswanath, PhD, professor of health communication in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, Boston, MA, in which he explored the ways physicians can steer conversations away from conspiracies and toward evidence-based facts.
First, it’s important to be realistic about what individual physicians can accomplish in addressing fake news during one-on-one time with patients in the exam room. Time is limited, he pointed out, and it’s unreasonable to expect a doctor to be able to refute all the false or misleading information to which a patient is exposed.
“We have to shift the burden from individual physicians to a more collective mobilization of physicians,” Dr. Viswanath said, although he added that individual intervention is a key part of this, both in the exam room and out.
“Given that there is tremendous credibility attached to physicians and the trust people have in physicians, it’s very critical that they do not sit on the sidelines, but actively and aggressively intervene whenever warranted.”
Many physicians are already using social media to help educate the public. They can use those channels to refute false claims and provide factual information. While not many doctors have either the time nor inclination to chase down false medical information on social media, they can still provide influence by collaborating with respected journalists and media outlets.
“Physicians as a group have tremendous credibility, and journalists, when they cover news, do rely on physicians,” he explained. By providing information or statements to reporters, doctors can offer sound medical information to a broader public audience beyond patients they see in the exam room.
Doctors can look to respected physician groups such as the AMA to provide critical support on COVID-19, Dr. Viswanath noted, “as gatekeepers and as arbiters of sound and fact-based, evidence-based information.”
When countering misleading medical statements, physicians should avoid repeating the falsehood itself and aim to use different language to provide sound, accurate information. By repeating a misstatement, Dr. Viswanath says that the physician “plant[s] a seed in people's minds.”
Of course, this effort shouldn't fall exclusively on doctors. Writing for JAMA Network, Canadian physicians Paul W. Armstrong, MD, and David Naylor, MD, PhD, argued that the editors of medical journals and social media executives should be working to limit the dissemination of misinformation. Likewise, journalists can help by not providing a platform for false or misleading theories purely in the name of “balanced reporting.”
Naylor and Armstrong’s essay, however, reasserts Dr. Viswanath’s notion that doctors can work with journalists to provide sound medical knowledge to the general public. They note that physicians can do so by promoting a general understanding of medical science and using media outlets to dispel common misconceptions. In this vein, the pair advise providing direct rebuttals, exposing the origins of conspiracy theories, revealing a source’s lack of credentials, or demonstrating conflicts of interest that explain why a source may be intentionally spreading falsehoods.
These sentiments were echoed by Peter Hotez, MD, PhD, dean, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, who was interviewed during an AMA COVID-19 video update in June. While Dr. Hotez said that social media can be a useful tool in combating misinformation, he warned against going down “very unproductive rabbit holes” or arguing with trolls online. Instead, Dr. Hotez said that writing commentary pieces for biomedical journals or op-eds for local newspapers can have “a very powerful impact” and may be the best way to make a difference.
Finally, it helps to reiterate that, because this is a novel coronavirus, researchers are constantly gleaning new information, so it can often feel like what was true yesterday isn’t true today. However, as Sonny S. Patel, MPH, MPhil, a public health executive and Fellow at Harvard University, wrote in a blog post, a lack of updates from reputable sources shouldn’t drive people to blindly accept information from disreputable sources.
On the contrary, some of the CDC’s best COVID safety advice to the public has remained the same, including: you can stop the spread of COVID-19 by knowing the symptoms; protective measures include wearing a mask, practicing social distancing, and washing your hands regularly; and diseases can make anyone sick regardless of their race or ethnicity.
The bottom line
The research suggests that medical misinformation is a major public health concern, with potentially disastrous real-world effects that put society in unnecessarily precarious positions. As such, it is every physician’s duty to step up and work individually and collectively to fight medical falsehoods, wherever and whenever the opportunity arises.