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DMEJ

Duke Medical Ethics Journal

Digital Actions, Real World Implications: The Effects of Medical Misinfo Online on Health

By Ahilan Eraniyan
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Dr. Vivek Murthy, the US Surgeon General, is one of the country's top medical and public health experts, known as the “Nation’s Doctor." His office is responsible for guiding Americans to healthier choices and lives. In service to this duty, the Surgeon General published a list of the office’s five priorities, which could be considered pressing, urgent threats to our health. [10]

Four of the five are tied to fostering human connection and mental wellness to improve physical health, addressing health worker burnout, youth mental health issues, and more. However, one issue stands out: "Health Misinformation,” defined by the list as false, misleading information on health. The other issues display abstract diagrams and photos as representations. The image for this issue is more concrete: a text conversation. [10] 

A clear paradox emerges from this. Why is digital communication, where identities, faces, and places are concealed, more physically represented than in-person communication? That’s partially because health misinformation is far more widespread; by now, every person in the country has encountered it. We need to look no further than the tragedy of the COVID-19 pandemic to understand this. 

COVID-19, A Case Study in Misinformation

Digital health misinformation, from news features on ivermectin and COVID-19 to articles falsely tying the vaccine to mysterious deaths or illnesses, has jumped out of our screens into the real world. [6] Arguments and protests were fueled by the combination of this misinformation with other conspiracies, especially the “QAnon” movement and related political theories, and exploded into real-world violence. [8] From lockdown protests across states ruled by both parties to January 6th and beyond, COVID and health misinformation became even more tangible than they already were. [1] 

The media and our government most visibly covered the political in-person effects. Still, behind the scenes, medical misinformation had disastrous effects on the overall health and well-being of Americans and has continued to do so since then. [3] For example, lowered vaccination rates as a result of vaccine misinformation online led to 1.5 times more deaths due to COVID-19 as of 2022. [7] The World Health Organization identified uncertainty online as a major global health issue during the pandemic in 2021, which, in their words, led to “fear, anxiety, finger-pointing, stigma, violent aggression and dismissal of proven public health measures” and eventual increases in mortality. [13] 

“Misinformation should be treated like a disease plaguing the online sphere, and the cure is, as with any other disease, to not only get rid of the disease (removing or debunking misinformation interpersonally, through education, or media) but to practice a healthier lifestyle.”

Health Misinformation Before and After COVID

“Uncertainties and fears lead to public health crisis” is unfortunately not an occurrence that started with COVID-19. Vaccine hesitancy, in particular, has persisted since the late 1990s, when a poorly written study linking the Measles-Mumps-Rubella (MMR) vaccine to the development of autism was published in the Lancet. The study was small and poorly designed, yet still received massive public attention. [9] Vaccination rates began to drop despite several refutations of the study, and small communities began to coalesce around opposition to vaccinations on various grounds - health, libertarianism, or religion. [12]

 

Years later, these communities have transformed into massive forces despite this original study being withdrawn. Measles outbreaks continued to rise through the late 2010s, with 2019 having the highest number of measles deaths in nearly thirty years. [5] Anti-vaccination organizations, such as Robert F. Kennedy Jr.’s Children’s Health Defense, have garnered millions of dollars in funding since the pandemic. Healthcare workers and the government struggle to combat the viral spread of vaccination and health misinformation enabled by these groups. [4]

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With all these issues, it’s no wonder that the Surgeon General identified health misinformation as a particularly pressing issue to the point that it’s a top public health priority, earning it a special advisory that helps us clearly define modern medical misinformation’s nature. 

 

Health misinformation has spread due to its often shocking, surprising nature, which is then spread in person and online. The public often needs to improve their scientific understanding of medical diseases, worsened for dynamic issues like COVID-19. [9] It is vulnerable to spreading and amplifying “scientific-sounding” misinformation. The result for the people who believe this misinformation is, as demonstrated by investigations by the WHO, poorer health behaviors and greater exposure to illness and disease. [14]

In addition, healthcare workers also face part of the brunt of medical misinformation. Healthcare burnout was another issue identified as a top priority by the Surgeon General, and that is partially due to increased violence and anger directed at healthcare workers since the pandemic. [9] This outrage is often fueled by medical misinformation, which places the blame for spreading “lies” about health at the feet of the workers. This burnout and anger can lead to workers leaving the field. Healthcare workers and physicians also have increased rates of suicide compared to the rest of the workforce. [2]

 

Social media is often blamed for spreading medical misinformation. Its accessibility and global nature are incredible technological advancements, but they also represent how social media provides a platform for those shunned or rejected by society. Previously, this often included anti-vaccine groups, which experienced far from their modern popularity. They had an online presence, but their attention was somewhat diminished. [12]

 

The online shift during COVID-19 turned more eyes toward social media than ever before. This naturally shined a greater spotlight on anti-vaccine and medical misinformation groups. [9] Boosted by the new online world and the nature of COVID-19’s being a health emergency, health misinformation groups were suddenly absurdly popular. Their posts were sensational and explained the mysterious gaps in COVID-19’s origins and spread that science and the government had not yet answered. [4] People provided digital engagement to these posts and spread their impact further. In addition, as people interacted with medical misinformation more, social media algorithms exposed them to increasingly more misinformation, leading them down a deeper rabbit hole than simple word of mouth could. [12] Besides social media, historical distrust of medicine among certain minorities (i.e., institutional racism) and a generally greater engagement with health and political spheres have both contributed to misinformation’s spread. [11]

Finding Solutions and a Path Forward

Medical misinformation harms everyone - healthcare workers, patients, and those in between and in the broader community. Per the Surgeon General, the best way to stop misinformation is to elevate science and health research above it and stomp out its spread. [9] Misinformation should be treated like a disease plaguing the online sphere, and the cure is, as with any other disease, to not only get rid of the disease (removing or debunking misinformation interpersonally, through education, or media) but to practice a healthier lifestyle. That lifestyle involves training the public to identify and shun fake news and misinformation, holding social media groups accountable to acknowledge and stop the spread, and encouraging healthcare to educate and work with the public proactively. [9] A major healthcare issue has been a “separation” between patients, the government, and physicians. Practices like these allow more personal connection and trust in healthcare with patients, building a path to a healthier tomorrow.

Review Editor: Kate Lee
Design Editor: Sonali Patel
References

[1] Andone, D. (2020, April 17). Protests are popping up across the US over stay-at-home restrictions. CNN. https://www.cnn.com/2020/04/16/us/protests-coronavirus-stay-home-orders/index.html 

[2] Berger, S. (2023, September 27). U.S. health care workers are at risk for suicide. Columbia University Mailman School of Public Health. https://www.publichealth.columbia.edu/news/u-s-health-care-workers-are-risk-suicide

[3] Burnett, E. (2023, April 20). Medical misinformation is a threat to your health. Columbia University Irving Medical Center. https://www.cuimc.columbia.edu/news/medical-misinformation-threat-your-health

[4] Cancryn, A., Messerly, M., Goldenberg, S., Shepard, S., & Piper, J. (2023, September 24). Anti-vaxxers are now a modern political force. POLITICO. https://www.politico.com/news/2023/09/24/anti-vaxxers-political-power-00116527

[5] Centers for Disease Control and Prevention. (2023, November 3). Measles cases and outbreaks. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/cases-outbreaks.html

[6] Huang, P. (2021, September 19). How ivermectin became the new focus of the anti-vaccine movement. NPR. https://www.npr.org/sections/health-shots/2021/09/19/1038369557/ivermectin-anti-vaccine-movement-culture-wars

[7] Martínez, A., & Aubrey, A. (2022, May 16). How vaccine misinformation made the COVID-19 death toll worse. NPR. https://www.npr.org/2022/05/16/1099070400/how-vaccine-misinformation-made-the-covid-19-death-toll-worse

[8] Morelock, J., & Narita, F. Z. (2022). The Nexus of QAnon and COVID-19: Legitimation Crisis and Epistemic Crisis. Critical Sociology, 48(6), 1005-1024. https://doi.org/10.1177/08969205211069614

[9] Murthy, V. (2021). Confronting health misinformation. Office of the Surgeon General. https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf

[10] Murthy, V. (2023). Current priorities of the U.S. Surgeon general. Office of the Surgeon General. https://www.hhs.gov/surgeongeneral/priorities/index.html

[11] Nava-Schellinger, V. (2021, August 30). How Misinformation Hurts Communities of Color Most. The National Council on Aging. https://www.ncoa.org/article/how-misinformation-hurts-communities-of-color-most

[12] North, A. (2022, March 4). The long, strange history of anti-vaccination movements. Vox. https://www.vox.com/the-goods/22958419/covid-vaccine-mandate-pandemic-history

[13] World Health Organization. (2021, April 27). Fighting misinformation in the time of covid-19, one click at a time. World Health Organization. https://www.who.int/news-room/feature-stories/detail/fighting-misinformation-in-the-time-of-covid-19-one-click-at-a-time

[14] World Health Organization. (2022, September 1). Infodemics and misinformation negatively affect people’s health behaviours, new who review finds. World Health Organization. https://www.who.int/europe/news/item/01-09-2022-infodemics-and-misinformation-negatively-affect-people-s-health-behaviours--new-who-review-finds 

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