Fighting false information

By Stacey Butterfield

Vineet Arora, MD, MAPP, MACP, wants to inspire internists concerned about combating the spread of bad health information. "Don't give up. I've seen a lot of people being like, 'Oh, this is never going to work,'" she said Wednesday afternoon. "You're still trusted sources of information."

Dr. Arora, a hospitalist and professor of medicine at University of Chicago Medicine, described her experiences and expertise handling misinformation during the Internal Medicine Meeting precourse on hospital medicine.

"Misinformation is certainly not new. It is getting worse, and physicians have a role to play," she said.

A first step into that role is understanding the difference between misinformation and disinformation. The latter involves the deliberate sharing of misleading information, whereas the former is as simple as saying something incorrect, regardless of intent. "So many of your patients, and even your own colleagues, might be subjected to misinformation," said Dr. Arora.

She offered an example of misinformation she learned during residency: "that patients who leave against medical advice have to pay for their hospitalization." The extent to which such a myth will spread is a factor of its importance to the individual, multiplied by the ambiguity of the evidence on the subject and the density of the social network in which it's released, Dr. Arora said.

The cost of care is obviously important but also hard to understand, she said. And then residency programs, or "densely packed people all in a work room who never see the sun," are a prime example of a social network that's conducive to spreading misinformation.

Of course, being in the same room isn't required for spread anymore, with people "reaching each other through Facebook or Twitter or TikTok, whatever du jour social media is going," she said. That has had some positive effects, such as in the beginning of the pandemic when physicians shared findings about COVID-19 treatment on social media, Dr. Arora noted.

It's also created problems such as the "disinformation dozen," 12 people who are responsible for two-thirds of the anti-vaccine content circulating on social media platforms, she said. "This is a profitable business, unfortunately."

As evidence of the organized nature of these efforts, Dr. Arora cited a recent decline in medical disinformation on social media. "When the Ukraine war hit, we noticed a bot holiday. Literally the volume of disinformation around vaccines fell, because people were just like, 'Oh, let's turn to Ukraine, we have to mobilize,'" she said.

The forces of good information should mobilize as well, and physicians are well placed to take the lead, Dr. Arora urged. "Trust in doctors actually went up during the pandemic and then stabilized," she said, noting that nurses are still even more trusted.

A January 2021 survey found that a doctor's recommendation was the most influential factor in Americans' decisions about COVID-19 vaccination. "So even though we bemoan a lot, you still have a trusted voice," she said.

The Surgeon General certainly thinks so, she said, citing the recent "Confronting Health Information" report. "He says that clinicians should proactively engage with patients and the public, partner with community groups."

This effort includes a solicitation for stories about health misinformation. "The first deadline for the call for stories is next week, and so if you want to have your voice heard, here's a great way," Dr. Arora noted.

Social media is another way to fight misinformation, but there are downsides to engaging there, she warned. "We've also done this study where one in four physicians reported being attacked on social media. One in six female physicians reported being sexually harassed," she said, citing results published by JAMA Internal Medicine in January 2021.

And that was data gathered before the pandemic. "We haven't repeated this study yet, because we know what it would show, which is that that there will be a huge increase," Dr. Arora said.

Another solution is to team up to combat misinformation. "We in Chicago created this network of social media advocates who do this together," she said. The network has worked together to tackle a single issue, such as vaccine hesitancy, with collaborative efforts.

"Leveraging my own identity as a mom, I was asking a lot of moms' groups about this, and one of the top concerns that came up was fertility," Dr. Arora explained. That information led her network of social media advocates to provide information surrounding the COVID-19 vaccines and fertility. "So one of the things to think about is, could you partner with others in your practice or in your community to do this together?" she said.

Physicians can also battle misinformation one-on-one, Dr. Arora noted. "Every day a patient's in the hospital, we're going to ask them about vaccination," she said. "It's like a smoking conversation. On the very first day, you're not like, 'Oh, you need to quit smoking,' you're like, 'Well, tell me a little bit about how often you smoke.'"

Such a gradual approach to uncovering patients' perspectives on vaccines or other areas of misinformation can change minds over time, she said. "Our job is to move the needle so that they consider it," she said. "If you bring it up, they're going to think about it." ■