By Dr. Eeks
This is my hypothesis, not anyone’s I work for. It’s also my dog’s hypothesis, and so you know, he’s quite bright.
A recent poll conducted among healthcare workers showed that 72% of them state misinformation negatively impacts patients’ decisions about the vaccine, and 71% of them said it negatively impacts their decisions about care related to COVID-19. One-third of respondents stated that misinformation is an urgent problem and that most of it comes from social media and family/friends.
I found the poll particularly interesting given that we are over 2 years into the pandemic and enormous resources and millions of dollars have been allocated to fight misinformation. Despite all those resources and funds, 72% of healthcare workers still consider it an urgent problem? Wow. Perhaps it’s time to review the playing field, the enemy and the strategy.
From the first essay I wrote about the war on misinformation and the different players, I never viewed online censorship or deletions as the smart way to go, especially in the long-term. The main reason is because I view the concept of trying to “take the internet” like trying to definitively win a war against an abstract concept (like a war on terror or a war on drugs), or a war in which your enemy doesn’t care about holding terrain (like the war in Afghanistan or the war in Vietnam.). The heart of the internet IS the democratic sharing of information. This means that anyone with a signal can publish. If one site says no, he/she can go to another site. If that site says no, he/she can go to another site. If that site says no, he/she can set up his/her own site. At the end of the day, you can’t tell someone what he/she can write or say. There can be consequences for what someone writes or says, but you can’t control that initial action, especially online. It’s not surprising to me that we’ve seen the rise of alternative publishing sites amidst the war on misinformation. Sites like Telegram, Rumble, Gettr and Substack. Personal newsletters are also growing. Trying to control who publishes where on the internet is like injecting steroids into the problem of trying to herd cats. As someone who works in Scicomms, I can tell you that the list of media platforms to monitor for “misinformation” has only gotten longer. It’s not only frustrating, but it is beyond time-consuming.
The other thing is not everyone agrees on what misinformation is. There are clear examples, of course, but then there are grey areas (such as the benefit of naturally-acquired immunity to COVID-19 or where the virus actually came from), where someone might erroneously label something as misinformation for ease of executing a policy or to make the digestion of a narrative more comfortable. There are cases where experts disagree with all or portions of a consensus or public health policy, yet we haven’t figured out a good way for weeding out dissent from misinformation. Not everyone agrees with me, but I think it’s important to allow for and hear dissent, particularly in the case of a brand-new viral epidemic, the essence of which is unknowns and uncertainties. And of course, there are historical examples of misinformation that were presented to us by authoritative bodies as fact. One example of government misinformation is Iraq having weapons of mass destruction that led us into a long, costly war and another example is misinformation from drug companies, the FDA, and pharmaceutical distribution companies that significantly downplayed the addictive nature of prescribed opioids. The latter obviously helped fuel the opioid epidemic we are currently fighting.
The biggest issue I have with the War on Misinformation is this: What if it’s more of a trust issue than a misinformation issue? I don’t think misinformation is the root of the problem. I think lack of trust is.
Let’s use the Joe Rogan controversy as an example of why this is more of a trust crisis than a misinformation crisis. Recently a bunch of doctors and scientists wrote a letter telling Spotify that they needed to do something about the “misinformation” on his enormously popular podcast. One of the lead authors gave a TV interview in which she said that Spotify should at least publish a warning about the misinformation on his show with a link to trusted sources like the CDC. That made me laugh, because she didn’t pause to consider that people DO NOT trust the CDC. She didn’t pause to consider that many people don’t trust any government-related organization, the drug companies, conventional doctors, media companies that get ad money from drug companies et al. Ma’am…, if people don’t trust the “trusted sources” not all the misinformation warnings in the world are gonna change that.
A recent survey captured declining trust in Biden and the CDC from last year to now, but the decline of trust in conventional “trusted sources” is a trend that has been happening for a while. Why? Why is there such a hunger for alternative sources of information and independent platforms? Why would some people get health advice from Joe Rogan and others feel a sense of urgency to silence him? After all, he’s a comic and a mixed martial arts fanatic. We shouldn’t have to tell people to not take medical or public health advice from Joe Rogan. It should be common sense. Now, I don’t listen to all of his episodes, but I can listen to him tell a story about how he treated an ailment or what supplements he takes and find it interesting or intriguing, but I am not going to run with it as gospel. If he says everyone should take a particular potion, I’m not going to sprint to the health store and buy it. I also know what an anecdote is. I remember when my 6th grade Religion teacher told me she “wished her warts” away. I had a wart on my foot. I tried to wish it away, but that didn’t work, so my mom took me to a podiatrist who froze it off. That said, I had two warts during boot camp that completely went away on their own. A woman who is a registered nurse told me at a restaurant recently that she eats only “alkaline foods” and the diet keeps her healthy and helps fight off cancer more than any other diet. What she says doesn’t make sense to me or my understanding of how the body regulates pH, so I just nodded and will continue to eat what I eat. I use martial arts breathing to strengthen my lungs and control my asthma. I might tell you about that, but that doesn’t mean you should sign up for karate and throw your inhaler in the garbage. I played on a highly competitive soccer team from when I was 8 till I went to college and played on a Division 1 team, I’ve always been super interested in wellness, and I’ve always followed a personally crafted wellness routine that includes things not recommended by the mainstream. Does that mean you should do what I do? No. I can talk about it if you ask me, but it doesn’t mean it’s good evidence for anything. My point? Let’s not downplay the fact that humans are storytellers. We’ve been storytellers for a long time, and we like to share our experiences with each other. It’s how we interact and bond. Sometimes when I listen to Joe and hear him or someone on his show tell a story, it’s similar to sitting next to people at a bar and listening to their stories. Although…thanks to the birth of the internet, Joe is able to tell his story to millions of people at once. Some might argue that is a reason he needs to be “responsible” and always accurate, but he really doesn’t have to be responsible. There is no rule or law that he has to be responsible about anything. And in a democratic nation if people don’t like that, sure, the public can pressure media companies and tech platforms to boot him off, but something tells me that his millions of followers will go wherever he goes. I don’t think he needs Spotify. He probably brings Spotify listeners not the other way around. Which brings me back to the trust issue.
Here’s what I think:
It’s a trust problem more than a misinformation problem. If people are honest and acknowledge that there is a crony-capitalistic influence over our government, media and conventional heatlh systems and they want to rebuild trust in convention, then they need to attack that influence with the same aggression put forth towards podcasts, blogs and indie sites. Why? Because that crony-capitalistic influence has been sowing the seeds of distrust for years. The next couple of paragraphs will highlight some examples:
Purdue Pharma, Johnson and Johnson and pharmaceutical distributors et al’s spread misinformation for years that helped fuel the opioid epidemic that killed thousands of Americans. In the last few weeks, there’s been a lot of news coverage about million-dollar legal settlements between states and these companies. (The other day I joked that my news alert emails are full of stories about pharmaceutical companies paying states millions of dollars for misinformation that led to the opioid epidemic and stories about the dangers of COVID-19 misinformation and frustration over the lack of trust in conventional sources. They read like a game of Connect-the-Dots for Idiots.)
In 2012, GlaxoSmithKline pleaded guilty and agreed to pay 3 billion for unlawfully promoting certain prescription drugs, not reporting safety data and for falsely reporting prices. In 2007, Merck agreed to pay 4.85 billion to settle 27,000 lawsuits by individuals who reported that their prescription drug for pain, Vioxx, killed or injured their family members. In 2005, Eli Lilly paid 690 million to settle over 18,000 lawsuits by individuals that stated Zyprexa, their top-selling drug for bipolar disorder and schizophrenia, gave them diabetes. In 2013, Johnson and Johnson was found guilty of illegally marketing off-label use of Risperdal, an antipsychotic drug, and specifically charged with giving illegal payments to healthcare providers who gave it to elderly patients with dementia. They were forced to pay 2.2 billion. More recently, there’s been the FDA’s controversial approval of Biogen’s Aduhelm that even Medicare said it won’t cover unless a patient is part of a clinical trial. There’s also the ongoing issue of everyday Americans not being able to afford the drugs they need while voting for people who promise to lower their drug prices and being consistently disappointed when powerful industry lobbyists work with our government to keep drug prices high. Then there’s the ad money Big Pharma spends, particularly on TV ads. According to this 2020 report, “Pharma TV advertising remained the cornerstone of spending with 4.58 billion, a whopping 75% of the total spend. That’s up just slightly from 2019 when national TV was 73% of pharma’s investment.” With that kind of money being put into mainstream media TV ads, can everyday Americans trust the MSM to honestly assess and hold those companies accountable when those companies are part of the hand that feeds them? Don’t forget that it was an enormously aggressive Big-Pharma funded marketing campaign that propelled the opioid problem to the next level.
There’s also the issue of pharmaceutical companies’ influence over medical journals, like this study that analyzed how much money US drug companies and medical device companies paid to journal editors. The study authors concluded, “Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research.” Last year I featured some of the authors of this study (Whose shoulders is health research standing on? Determining the key actors and contents of the prevailing biomedical research agenda) on my Causes or Cures Podcast. You can listen to that podcast here, but one thing is clear: the drug companies have tremendous influence over the dominant research agenda, and you don’t have to be a genius to understand that they are biased towards research agendas that have the potential to make them lots of money and not necessarily research agendas that prevent the most disease. There’s also the issue of drug company advertisements in top medical journal. This 2018 study concluded that “claims of efficacy made by drug advertisements in leading medical journals are often supported by studies performed by authors with conflicts of interest; Just under half of drug advertisements investigated provided no supporting references from peer reviewed medical literature, and that many journals do not operate the same oversight with respect to advertising as they do to articles published.” There’s also the issue of drug companies paying doctors and influencing prescription practices. This 2021 review concluded that “the association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.”
I could go on with the examples, but I think you guys get the picture: There is a lot of evidence for why we have a trust crisis, and it’s been building for years. And it is a problem, because when people don’t know who or what information to trust, you have systemic breakdown and mass chaos where basically anything goes. And then we live in a world where “all evidence is equal” and anecdotes start counting as much as clinical trials and basically, it’s a disaster for science.
In addition to aggressively going after that crony-capitalistic influence in order to restore trust in the science and healthcare apparatus and given that everyone is online and everyone can find a place to publish online, I also suggest promoting education on how to critically assess information. I think you’ll get more bang for your buck this way, and maybe even help create a more intelligent society, instead of engaging in an endless and expensive campaign to censor the internet. Let me share the imagery I get when I think of trying to ban information from the internet: Imagine being on a forever road trip with someone in the passenger seat who you are mentoring… and various signs pop up along the road. You like what some of the signs say but you really don’t like what a lot of the signs say. You don’t know where or when the signs are going to pop up. Imagine feeling the need to cover the eyes of the person in the passenger seat or stop the car and throw a blanket over the signs so no one else can see the information. Does that sound exhausting to you? What about futile? You also risk your passenger getting curious over what the sign says, and why you don’t want them to see the information. The passenger might get out of the car one day and start removing your blankets, just to see what you want to hide. What if, instead, you and your passenger discussed the contents of the signs? What if you had a conversation about it? What if you discuss who posted it, if there’s evidence for it, what does or doesn’t make it credible, and what action (if any) you should take? You know, the cultivation of critical thinking skills. If you’re sitting there reading this and saying, “That’s not possible, because there are too many dumb people out there or too many crazy people et al…”, well then you have a big, big, BIG problem on your hands, because you can’t ban dumb, crazy or any kind of people from the internet.
This is me on Instagram as well.
I’ll see you here next time. Maybe.