Misinformation in Medicine: Scope, Impact, Consequences

The World Health Organization and United Nations characterized the unprecedented spread of news, public health guidance, fact sheets, infographics, research, opinions, rumors, myths, falsehoods, and more during the pandemic as an “infodemic.”¹

This infodemic has set the stage to be exposed to not only accurate, helpful health information but also health misinformation, which is false, inaccurate, or misleading based on the best available evidence at the time, according to the recently released “Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment 2021.”²

On a practice level, misinformation has consequences for quality of care and the doctor-patient relationship, according to Brian T. Kelly, MD, of Midwest Allergy and Asthma Clinic in Omaha, Nebraska.

Brian T. Kelly, MD, of Midwest Allergy and Asthma Clinic in Omaha, Nebraska.

“Misinformation can result in detrimental decisions throughout the field of medicine. Unfortunately, misinformation is readily available and can appear as fact on many different platforms. I suspect that virtually every physician in the USA has conversations with patients each day surrounding some form of misinformation a patient has heard,” said Kelly, who moderated the panel “Combatting Misinformation in Medicine” at the American College of Asthma, Allergy & Immunology (ACAAI) 2021 annual scientific meeting held November 4 through 8 in New Orleans, Louisiana.³ “Combatting this trend through facts and empathy are extremely important to maintain our patients’, communities, and global health.”

Impacting Dermatology and Other Practices

The rise of misinformation has resulted in many problems, according to Kelly. 

“The COVID-19 pandemic and social media have resulted in extreme levels of misinformation,” Kelly said. “Two of these issues include reduced levels of care, [such as] patients not getting necessary care or procedures like a skin biopsy for possible skin cancer, and an unfortunate distrust in medical providers. It is imperative for physicians to engage and provide factual and rational rebuttals to misinformation as doing so will only benefit patients.”

The pandemic has highlighted the pervasive nature of health-related misinformation and how it can negatively impact medical decision making, according to David Stukus, MD, a pediatric allergist at Nationwide Children’s Hospital and participant on the Combatting Medical Misinformation panel at ACAAI.

David Stukus, MD, a pediatric allergist at Nationwide Children’s Hospital.

“Patients often seek medical information online and unfortunately the social media algorithms emphasize emotion generating headlines, which frequently dilutes out evidence-based facts in favor of inaccurate anecdotes or testimonials,” Stukus said. “All health care professionals need to be aware of the influence misinformation has on their patients. Unfortunately, misinformation was a rampant problem prior to COVID-19 and will persist even after the pandemic is over.”

Dermatology is not immune to social media generated misinformation.

Researchers evaluating 49 YouTube videos with a total of 28.2 million views on vitiligo health education found more than half, or 27, were from health care sources, and 22 were from nonhealthcare sources.⁴

Videos from health care sources had significantly higher accuracy scores and significantly fewer views, according to the study.

“Misinformation can lead to potentially harmful interventions and delay in seeking evidence-based care,” the authors concluded.

In another study, researchers assessed 39 YouTube videos about rosacea for accuracy and, again, found that videos by non-health care sources were less accurate and of lower quality but received greater viewer engagement than those produced by health care sources.⁵

“The inaccuracies found were centered around the ability of interventions to ‘cure’ rosacea…,” the authors wrote. “For example, one popular suggestion among the videos included using apple cider vinegar to cure rosacea in addition to treating other conditions such as diarrhea and hypertension.”

What to Do

There are some practical steps every physician and health care professional can take to help combat misinformation, according to Stukus, who offers these 5 tips derived from sources such as the US Surgeon General's report, as well as the growing peer-reviewed publications surrounding this topic. 

1. Each health care professional should spend time online using common search engines to learn about the types of information and sites that appear as they input common questions they receive from patients. 
2. After learning about the various sources of misinformation, health care professionals should learn what the evidence-based resources demonstrate regarding that topic, particularly regarding the discrepancies that appear.
3. Every encounter with a patient is an opportunity to actively address common sources of misinformation in a non-threatening manner. Health care professionals should always remain non-judgmental and spend time actively listening to their patients. It is important to recognize the influences each patient has in their life.
4. It is important to have talking points and resources ready to share with patients. These should be concise, clear, and delivered in a manner that is non-judgmental.
5. It would be great for more health care professionals to engage with social media to provide evidence-based information and fill the void where expertise is often lost online. 

Anne K. Ellis, MD, MSc, professor and chair of the Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario.

Health care providers also can fall victim to misinformation, according to ACAAI panelist Anne K. Ellis, MD, MSc, professor and chair of the Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario.

“It is really important to do you own research. Taking at face value what gets reported in the lay press or on social media can be tempting to make you do or recommend something that may actually be inaccurate,” Ellis said. “Throughout the pandemic I have trusted the Chair of the Division of Infectious Diseases to give the best knowledge ‘as of today’ that I can pass on to my patients and guide my practice. [Remember, it is] important to stay strong and don’t let patients bully you into practicing differently than what you know yourself to be best practice.”

References:

1. Murthy VH. Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment 2021. U.S. Surgeon General Advisory. June 15, 2021. Accessed October 29, 2021. Confronting Health Misinformation (hhs.gov) 
2. Confronting Health Misinformation. U.S. Surgeon General. Accessed November 4, 2021. https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf 
3. Kelly B, Stukus D, Ellis A. Combating misinformation in medicine. Presented at: ACAAI 2021 Annual Scientific Meeting; November 4-8, 2021; in New Orleans, LA, and virtual. 
4. Read C, Wu KK, Young PM, Armstrong AW. Vitiligo Health Education: A Study of Accuracy and Engagement of Online Educational Materials. J Drugs Dermatol. 2021;20(6):623-629. doi:10.36849/JDD.2021.5835
5. Chen AY, Azizi B, Borba AJ, Armstrong AW. Rosacea videos on social media: A comparison of accuracy, quality, and viewer engagement. Dermatol Online J. 2021;27(2):13030/qt55c0g9wz. Published 2021 Feb 15.