HOMEWORK: MEDIA MISINFORMATION

Counteracting Health Misinformation A Role for Medical Journals?

The growing toll of popular fallacies about health and illness is evident given outbreaks of measles and other preventable communicable diseases in many nations. This “medical misinformation” phenomenon has been described as “a health-related claim of fact that is cur- rently false due to a lack of scientific evidence,”1 but that may be a generous interpretation. Complemen- tary and alternative medical approaches, without firm evidentiary bases, have coexisted uncomfortably with mainstream scientific medicine for decades, and they persist.2 By contrast, contemporary misinformation of greatest concern is supplanting well-proven interven- tions and ideas with unproven ones that are clearly false and, in some cases, harmful.

Crowd-Sourced Lies, Fake Experts, and Misleading Leaders Medical misinformation is nothing new but has become pervasive. Multiple digital sources represent a “new frontier” without editorial oversight or curation. Nearly anyone can say almost anything and be taken seriously at least by some consumers. With billions of individuals online every day, health misinformation can spread at a rapid pace.3 Worse, exciting falsehoods apparently spread faster than boring truths on social media.3,4

This new online world facilitates direct-to- consumer marketing by phony experts, celebrities with armies of Twitter followers, and legions of inde- pendent digital scammers, including some physicians. The result has been torrents of misinformation on

topics as varied as the safety and effectiveness of vac- cinations, the Zika virus outbreak, water fluoridation, genetically modified foods, and treatments for com- mon diseases.

Moreover, in countries such as India, Italy, and the United States, negative attitudes about science appear to have risen in lockstep with ultranationalist senti- ments and the emergence of populist leaders and movements.5,6 For those disadvantaged, despairing, and understandably distrustful of government, these “alternative truths” align with shared skepticism about scientific medicine and belief in traditional remedies.

Do Medical Journals Have a Role in Addressing Medical Information? Chou et al1 highlighted the need for research to address medical misinformation and determine how interven- tion might constrain or refute messages with adverse health implications. Apart from publishing such re- search, should medical journals be more active?

At first blush, the role of medical journals otherwise seems limited because their content is relatively inacces- sibletolaypeople.However,manyjournalshaveembraced the need to more broadly translate medical knowledge. Some produce open-access “patient pages” to assist phy- sicians in educating patients and allow patients to educate themselves, and some produce simpler and briefer sum- maries of research findings. Others have developed digi- tal and social media tools to promote relevant content, supplementing conventional print media. Most journals have the capacity to solicit submissions on particular top- ics and publish entire issues focused on themes of broad scientific, public, or professional interest. Some have natu- ral alliances with the medical profession through sponsors suchasmedicalsocietiesandassociations.Theseandother capabilitiespositionjournalsaspotentiallypowerfulagents in counteracting medical misinformation.

Specific Actions Medical Journals Might Take The Table outlines 4 broad strategies sometimes rec- ommended to help address medical misinformation. The first—containment of dissemination—provides oppor- tunities for journals to shine light on prominent misin-

formation sources and prompt others to act. While censorship targeting sites on the worldwide web is challenging in most jurisdictions, social media companies own their platforms and can take ac- tion. For example, Facebook took sev- eral recent steps to contain the spread of antivaccination claims even though it has so far declined an outright ban on anti- vaccination groups. Containment is more straightforward with curated or edited

media of all types, exemplified by Canada’s Globe and Mail, which has publicly rejected any “false balance” wherein “proven science” is set against “unproven be- liefs and conspiracy theories” about vaccinations.7

General enhancements of science literacy are the province of educators and policy makers at all societal lev- els, and represent both a form of immunization against broader misinformation and a long-term investment in a better-informed citizenry. On the other hand, physicians and medical journals could have involvement with health- specific inoculation by fostering science literacy and edu- cation about human health and illness.

This new online world facilitates direct-to-consumer marketing by phony experts, celebrities with armies of Twitter followers, and legions of independent digital scammers, including some physicians.

VIEWPOINT

Paul W. Armstrong, MD Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.

C. David Naylor, MD, DPhil Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Corresponding Author: Paul W. Armstrong, MD, 2-132 Ki Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1, Canada (paul.armstrong@ ualberta.ca).

Opinion

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One approach would be commissioning evidence-based re- views of areas in which quack nostrums and dangerous fallacies have gained popular traction. Journals could then use their in-house com- munications expertise to compile and widely disseminate acces- sible summaries in multiple media showing the comparative effec- tiveness and safety of scientific vs crowd-sourced treatments. These could be promoted as public interest pages alongside patient pages. Medical journals could also solicit and publish research on medical misinformation, including studies of the effectiveness of different strategies designed to mitigate the influence of misinformation. Such efforts could be foundational for medical educators as they pre- pare the next generation of health professionals to navigate a world of endemic health-related misinformation.8 The resulting combi- nation of relevant scientific content and lay-accessible summaries would also equip individual physicians, journalists, and others in 2 respects: (1) for broad public education and advocacy and (2) for ac- tivism against pseudoscience by directly debunking myths and dis- crediting purveyors of medical misinformation (Table).3

A Global Collaboration? Medical journals have a history of forging a global consensus and tak- ing action on matters of broad scientific and public interest. The International Committee of Medical Journal Editors, for example, has addressed issues such as criteria for authorship, requirements for reg- istration of clinical trials, and more recently, data sharing. Interna-

tional collaborative efforts regarding medical misinformation are still in their infancy, although many cardiovascular journals published an identical editorial warning about this phenomenon in January 2019.9

One possibility would be to extend this model by coordinating efforts related to specific topics affected by medical misinformation. In this regard, JAMA and other journals have previously coordinated global theme issues on topics of wide relevance to public health. This collaborative strategy could be very effective in addressing issues for which medical misinformation has had adverse effects. For example, agroupofgeneralandrelevantspecialtyjournalscouldcommittopub- lishingresearchreportsandopinionarticlesspecificallyaddressingthe issue of childhood vaccines, and publish them at an opportune time, for example, during World Immunization Week. These efforts could promote cross-disciplinary, cross-national and cross-cultural learn- ing, and would very likely capture global media attention. Such col- lective action may today seem unthinkable, yet, until recently, so too was the reemergence of myriad preventable infectious diseases and the current epidemic of pseudoscience and willful ignorance.

Conclusions The rising tide of medical misinformation is already having adverse effects on global health. It requires a robust and coordinated response from health professionals, organizations, institutions, and mainstream media. Medical journals now have an opportunity to galvanize and support this important effort.

ARTICLE INFORMATION

Published Online: April 22, 2019. doi:10.1001/jama.2019.5168

Conflict of Interest Disclosures: Dr Naylor is a member of the Journal Oversight Committee for the JAMA Network. No other disclosures were reported.

REFERENCES

1. Chou WS, Oh A, Klein WMP. Addressing health-related misinformation on social media. JAMA. 2018;320:2417-2418. doi:10.1001/jama.2018.16865

2. Hellmuth J, Rabinovici GD, Miller BL. The rise of pseudomedicine for dementia and brain health. JAMA. 2019;321(6):543-544. doi:10.1001/jama.2018. 21560

3. Merchant RM, Asch DA. Protecting the value of medical science in the age of social media and “fake news”. JAMA. 2018;320:2415-2416. doi:10.1001/ jama.2018.18416

4. Vosoughi S, Roy D, Aral S. The spread of true and false news online. Science. 2018;359(6380):1146-1151. doi:10.1126/science.aap9559

5. Falling vaccination rates pose a global health risk. Financial Times. https://www.ft.com/content/ 225c3124-06a9-11e9-9fe8-acdb36967cfc. Published December 28, 2018. Accessed March 4, 2019.

6. Kumar S. In India, Hindu pride boosts pseudoscience. Science. 2019;363(6428):679-680. doi:10.1126/science.363.6428.679

7. Stead S. No need to offer “false balance” to anti-vaxxers. The Globe and Mail. https://www.theglobeandmail.com/public-editor/ article-no-need-to-offer-false-balance-to-anti- vaxxers/. Published March 12, 2019. Accessed March 22, 2019.

8. Wenzel RP. Medical education in the era of alternative facts. N Engl J Med. 2017;377(7):607-609. doi:10.1056/NEJMp1706528

9. Hill JA, Agewall S, Baranchuk A, et al. Medical misinformation: vet the message! Circulation. 2019; 139:571-572. doi:10.1161/CIRCULATIONAHA.118. 039193

Table. Potential Strategies for Counteracting Medical Misinformation

Category Agents Goals/Tactics Containment of dissemination

Physicians and medical journals Identify purveyors of clear-cut misinformation

Regulators, social media executives Limit their capacity for dissemination

Editors in traditional and new media

Avoid legitimizing falsehoods about health and illness in the name of “balance”

General immunity through science literacy

Primary and secondary schools/educators

Ensure that high school graduates understand how and why the scientific method works and possess some critical-thinking tools

Colleges and universities Ensure that every baccalaureate has meaningful exposure to common cognitive errors and logical fallacies involving both qualitative and quantitative information

Health-specific inoculation and education

Health professionals, faculties, and organizations; public health agencies; communications experts; medical journals

Promote general understanding of medical science and communicate about common misconceptions using websites, digital media, town halls, and conventional print and broadcast media. Prepare the next generation of health professionals to navigate a world of “truthiness” and pseudoscience

Debunking myths and discrediting purveyors

Journalists and journals/media outlets; health professionals and researchers; medical journals

Direct rebuttals of medical misinformation using a variety of media platforms. Undertaking critical reviews of the provenance of misinformation, unveiling purveyors’ credentials and conflicts of interest

Opinion Viewpoint

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