I am going to bring this series of blog posts on identifying disinformation to a conclusion. In this part V, I will summarize the key messages from the first four blog posts and add a few other pointers.
During this pandemic, those of us dedicating significant amounts of time to educate the public found that we still couldn’t keep up with all the false information. In this case, I am referring to addressing “disinformation,” the spread of incorrect information with the intent to harm, confuse, mislead, or otherwise affect people’s hearts and minds to accept lies and/or support the position of those who are spreading the false information. This is opposed to “misinformation” that is incorrect information, but the person spreading it did not realize that the information was incorrect or incorrect at the time. Whether it be misinformation or disinformation, the other thing we found is that combating it was like playing the game whack a mole, in that every time we successfully countered incorrect information, new misinformation or disinformation popped up to replace it. Because of this, we cannot successfully win this battle for truth on our own; we must educate the public how to recognize suspicious information. Fortunately, we had so many examples of people spreading disinformation that patterns that can alert us to disinformation emerged.
Disinformation comes from many sources, including foreign countries. The motives of those who spread disinformation can be diverse. For a foreign country, it often is the intent to sow distrust in the U.S. government and discontent among the populace. For home-grown purveyors of disinformation, perhaps they stand to financially benefit, sometimes there are political aspirations or motivations, and sometimes these sowers of disinformation like the public attention and adoration they receive from those who want to believe the lies. There may be other reasons as well. But, a common thread was narcissism and lack of empathy. These persons do not care if they harm others so long as they gain whatever benefit it is they are seeking for themselves.
What are the patterns that can alert the public to be suspicious of the information being conveyed?
We often saw that physicians and other health professionals who were promoting misinformation and disinformation were not in specialties that generally treat patients with COVID-19 or have expertise in treating acute infections, respiratory disorders and hospitalized patients. Examples were pathologists, neuroradiologists, ophthalmologists and chiropractors. Certainly, that does not mean that the physician may not have very specialized knowledge about COVID-19, but this should be a red flag when that advice is contrary to physicians who are specialists in those areas of practice in much the same way that a dermatologist offering advice about prenatal care that is inconsistent with information put out by the American College of Obstetricians and Gynecologists should be suspect.
2. The use of grandiose, overly dramatic or inflammatory language.
Reputable physicians and scientists generally try to maintain objectivity and professionalism. It would be greatly out of character for these experts to use inflammatory or offensive language in explaining science or public health recommendations to the public. On the other hand, one physician who was spreading disinformation repeatedly referred to the COVID-19 vaccines as “needle rape.” To compare vaccination to one of the most psychologically and physically traumatizing events that can happen to a person is beyond the pale and offensive in its trivialization of the dehumanizing trauma that these victims of sexual assault have suffered. The language is obviously intended to inflame the hearts and passions of those they are spreading disinformation to rather than to stimulate the mind. We also heard many of those spreading disinformation about the vaccines using language to conjure up images of Nazi Germany, making reference to the Nuremburg Code, and often using variations of the phrase “crimes against humanity,” all of which were intended to create a false equivalency between vaccinations and various historical atrocities. When you hear or read this kind of language, a red flag should be raised to suggest that an attempt is being made to emotionally manipulate you and that the information is likely unreliable.
3. The use of emphatic and absolute statements.
There are very few things that we can say are absolutes in medicine – always happen or never happen. That is because diseases can manifest themselves and behave differently between children and adults, between young adults and the elderly, between men and women, between the immunocompromised and the healthy, and even in individuals of the same age and gender. So, another warning sign is when sources make statements that are absolutes. Physicians and scientists will often qualify their statements and advice – “based upon what we know today” (understanding that new data may come along in the future that could change our understanding of the disease or its treatment), or “based on a recent study” (leaving open that more studies or larger studies might change our understanding), or “based on the limited data we have available” (acknowledging that we have some data, but it may not apply to people that are different than those who were study participants, or to people with additional medical conditions than those studied). An example of an absolute statement that should raise a red flag that we heard during this pandemic was “masks do nothing.” Now, we can debate the effectiveness of different kinds of masks, their effectiveness under different conditions, or the effectiveness with different variants, but if someone tells you masks provide absolutely no protection or if someone tells you that masks provide complete protection, this should be reason enough to look for another source.
Another very helpful indicator as to whether you can trust a source is that reputable physicians and scientists will often answer questions when there is a new development with some variation of “we don’t know” or “we need more information before we can answer that,” whereas those spreading disinformation rarely answer questions by admitting that the science is evolving or that it is too early to answer the question with any certainty.
4. The use of anecdotes as evidence.
We often heard those promoting misinformation making comments such as “I treated [fill in the number] patients with ivermectin and they all did great.” That is an anecdote; that is not science. Were all of those patients young, healthy and low risk and would be expected to have good outcomes even without treatment? Did all of them have confirmed infection? How do you know none of them deteriorated and didn’t go straight to the hospital without notifying you, especially since a number of physicians making this claim did not treat patients in hospitals?
5. Internal inconsistencies in their arguments.
Think about a person in an interrogation room at a police station. A skilled detective can tell when the person is being truthful, because truth has internal consistency to it. The various pieces fit together and make sense that they would occur in the manner and the order the witness describes. On the other hand, when you can get a person to talk for an extended period of time and that person starts out with a lie, it is incredibly difficult to maintain the lie because things eventually don’t make sense and cannot be connected in a logical way. So, too, if you give someone spreading disinformation enough time to talk, you will generally see them get tripped up. Let’s look at an example. A very common internal inconsistency arose when some doctors made the argument that people should not take the COVID-19 vaccine because it was only authorized for emergency use, but not yet fully approved by the FDA. That could certainly be a reasonable concern for some people and worthy of discussion. However, what they suggested as the alternative, and what patients seemed more than willing to do, was to take various medications that were neither authorized or approved by the FDA for prevention or treatment of COVID-19. In fact, the FDA even warned the public not to take one of the recommended medications. The inconsistency was using FDA approval as the criteria for prevention of COVID-19 and using it to arguing against one measure, but then disregarding it in recommending another.
6. Misuse of data.
One common tactic used to create fear of getting vaccinated was for purveyors of disinformation to point to the thousands of deaths reported to VAERS (the Vaccine Adverse Event Reporting System) as being due to the vaccines. This would make sense to the majority of Americans who are not familiar with VAERS, but can tell from the name that this is a system that reports vaccine adverse events. But, this was intentional deception by the physicians who were suggesting causality, when in fact, the site is for reporting by the public so that the CDC and FDA can be alerted if the frequency of an adverse reaction exceeds the background rate of those symptoms or conditions. Prior to the pandemic, more than 8,000 persons in the U.S. die each day on average. To keep the math simple, if you consider that about half of the U.S. was vaccinated this year, you would expect roughly 4,000 deaths each day unrelated to COVID-19 among the vaccinated, in fact, even higher than 4,000 because those being targeted for vaccination were the elderly and those with underlying medical conditions. Those perpetuating fears of vaccination attributed all of the deaths in VAERS that would be expected under pre-COVID conditions and unrelated to COVID-19 and the vaccines to the COVID-19 vaccines. Even just resorting to common sense, if the FDA temporarily stopped vaccinations with the J&J COVID-19 vaccine when only three cases of Thrombosis with Thrombocytopenia Syndrome were identified through the VAERS reporting, it should cause everyone to question that the CDC and FDA could then believe that there were thousands of deaths caused by the vaccine, yet take no action or even issue a warning.
7. Failure to cite studies and identify any limitations to those studies.
It is not uncommon for purveyors of disinformation to indicate that studies show support for their position, but then not produce those studies when asked. Further, we have never heard these disseminators of falsehoods ever describe any limitations to the studies they are referring to. Reputable physicians and scientists are always willing to provide the evidence for their statements or opinions. They also are quick to point out limitations of these studies, such as patient selection or study design, and usually will provide caveats that we cannot be certain that the findings will apply to patients that are different than those who made up the study participants or who are treated under different conditions than those used in the study.
Health professionals can certainly have differing opinions about the best treatment for a particular patient. These differences can arise because clinical trials have not yet provided us with evidence of the best treatment or because the particular circumstances of the patient are different than those who have been enrolled in clinical trials. These professional differences of opinion are appropriate.
My objection is to health professionals who offer the public and their patients advice that is clearly and demonstrably erroneous, contrary to the guidance of the CDC, FDA, professional associations and their own peers, and has great potential to harm patients. At the heart of this, physicians always have a duty to act in the best interests of our patients and we have an obligation to inform our patients and tell them the truth, as best we understand it. Lying to and deceiving patients should be abhorrent to physicians.
We are starting to see physicians held accountable for purposeful and repeated dissemination of disinformation. I believe appropriate actions can include discipline by state medical boards, loss of hospital privileges and revocation of board certification.
However, the disciplinary process is a lengthy one because of the need for investigations and hearings. In the meantime, it is essential for the public to be aware of the red flags of disinformation that we have listed above in order to protect themselves until the system can, because in an internet and social media age, disinformation spreads faster than the virus.