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DMEJ

Duke Medical Ethics Journal

Can TikTok Doctors Cure the Health Infodemic?

By Yurika Sakai
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Almost two years after the Center for Disease Control (CDC) announced the outbreak of COVID-19 overseas, the World Health Organization (WHO) published a “Tackling COVID-19 Misinformation” digital toolkit to “empower doctors and nurses… to actively address COVID-19 misinformation and build vaccine confidence globally” [4]. The 24-page toolkit includes a flowchart on how to manage “online trolls,” a list of best practices for the latest social media platforms (Facebook, Instagram, TikTok, LinkedIn, Snapchat, and YouTube), and guidelines on how to handle questions and misinformation regarding the COVID-19 vaccine [4]. Omitting the messages about vaccine safety, the toolkit could easily be a media training pamphlet for social media influencers. The efforts of the WHO to amplify the presence of physicians and nurses on social media underlines how the healthcare profession is changing through the Digital Age. With health misinformation rampant on the internet, it has become necessary for health professionals to provide their services—knowledge regarding medical treatments and health—in the digital landscape in addition to the traditional clinic. It is no longer enough for physicians to write New York Times Op-Eds or publish their latest research in renowned medical journals; their services are needed specifically in the realm of social media, where about half of Americans say they get their news [10]. Yet, media training and digital communication skills are not traditionally expected of clinicians who dedicate their lives to studying human biology and medicine. In an era where people frequently rely on the internet for health information, are health professionals obligated to provide their services through digital platforms?

The immediate benefit of having physicians share information on social media platforms is that patients are more likely to consume health information from their physician while being diverted from misinformed posts. Currently, social media activity among physicians is extremely low, with 90% of physicians posting 0 times per month [2]. Although many major healthcare organizations, government agencies, pharmaceutical companies, and health insurance companies already have a social media presence, Americans tend to trust individual doctors and nurses over these large establishments [5]. Thus, physicians and nurses represent a missing demographic on social media that could be key figures to help combat medical misinformation. 

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High levels of public trust for doctors and nurses underlines the importance of physician to patient communication in the effort to reduce medical misinformation [5].

Older demographics may particularly benefit from an increase in physician activity on social media. While the proportion of social media users is lowest among those aged 65 years and older, with less than half of the age group being active on social media, older adults are most likely to share medical misinformation among any age group [11, 1]. Meanwhile, older patients report the greatest amount of trust for their physicians compared to young adults [6]. By increasing the proportion of physicians and nurses who provide basic medical information or demonstrate support for important public health causes on social media, older patients who trust their physicians will likely encounter more accurate medical information, and simultaneously decrease their engagement with medical fallacy. Subsequently, the impact of these fake new sites at large would be reduced, since social media algorithms typically only boost posts to a wider population of users when they have high levels of engagement [8]. 

Another commonly recognized benefit of social media is its efficiency in sharing information across wide populations. In 2023, it is estimated that 4.9 billion people use social media around the world [11]. Given that the average person spends 145 minutes on social media a day, this would amount to 5.7 years spent on social media platforms over a typical lifespan of 73 years [11]. Social media platforms are designed to condense as much information as possible into limited amounts of time, with the free version of Twitter barring tweets that exceed the 280-character word limit and TikTok restricting videos to 10 minutes or less. Social media is also designed to hook users; terms like “doom scrolling” and “YouTube deep dives,” which describe prolonged periods of constant information consumption, capture the addictive nature of social media. Further, the development of language translation systems has also propagated the exchange of information across international borders. The growing prominence of social media as a news outlet, combined with its unique design for rapid and widespread information consumption, makes it a valuable platform for physicians and nurses to correct medical misinformation. 

 

As much as social media is praised for its extensive outreach, it is important to recognize certain demographic differences in social media usage which can account for an unequal distribution of information. For one, individuals from lower socioeconomic groups are more likely to accept health misinformation [3], making them an important target to provide accurate medical information. However, being from a lower income group is also correlated with less social media use [9]. Similarly, individuals with lower educational levels are at a greater risk of trusting medical misinformation, yet only about 60% of individuals with a high school education or less are active on at least one social media site [9]. Essentially, while providing clarity on health information to individuals from lower socioeconomic backgrounds or lower educational levels could significantly mitigate the spread of medical misinformation, social media may not be the most effective network through which to connect with these individuals. Instead, encouraging live interactions between physicians and nurses and patients, whether during annual checkups or public speaker events, could make a greater impact on reducing medical misinformation within these demographics. 

Lower income and educational level are correlated with less social media use [9].

Social media can also create a false sense of intimacy that may alter the professional expectations of a physician-patient relationship. The appeal of social media is that it makes communication casual, quick, and unfiltered. Meanwhile, our trust for our physicians is built on their professionalism, reinforced through appointment-based treatment and plaques hung on the walls of their medical clinics. In attempting to merge medicine with social media, there lies the difficulty of maintaining a physician’s professional role while filtering it into a casual context. How would such a shift affect our trust for our physicians? Social media companies also pay accounts that accumulate high levels of engagement, which often leads to the production of low effort posts that value quantity over quality. How might the financial incentives of social media affect the quality of posts that a physician is willing to craft, and how would these digital health services compare to their work at in-person clinics.

“In an era where people frequently rely on the internet for health information, are health professionals obligated to provide their services through digital platforms?”

Normalizing social media as a source to communicate with professionals for health information also increases the risks of amplifying individuals with outdated credibility. In 2020, scientist Judy Mikovits became famous for endorsing the message that “wealthy people intentionally spread the virus to increase vaccination rates” and that “wearing face masks is harmful” in an anti-vaccination film, “Plandemic”. While Mikovits had the title of “scientist” and an extensive career of over 20 years working for the National Cancer Institute, she also had criminal and civil charges filed against her for fraud within the research institute that she later worked for (and was fired from in 2011) [7]. Amidst the digital information overload, viewers must make quick decisions to try and distinguish real professionals from fakes. Navigating the digital landscape for credible information can be challenging, particularly in health, where fear for life is on the line and medical fallacy can be more comforting than truth. While “Plandemic” was eventually removed from social media platforms including Facebook, YouTube, and Vimeo, it still became a national sensation that was all the evidence that anti-vaxxers needed to reaffirm their suspicions [7]. If social media is to be used as a source of medical information, companies must improve their algorithms to filter fact from fallacy, and individuals must be better educated on how to safely navigate online news. 

Ultimately, social media is a platform intended for self-expression that has transformed into a place where professionals, organizations, businesses, and citizens can exchange information on critical issues. For health professionals who value their individual contributions to the common good, social media is a novel avenue through which they may feel incentivized to promote public health. Throughout the COVID-19 pandemic, the infodemic has highlighted the values and risks associated with this unique information source: the rapid distribution of essential health information as well as the amplification of health conspiracies. With the amount of health misinformation available on the internet today, individual health practitioners could be key figures in delivering accurate health information to the public. They are well trusted by patients and can redirect older age groups, who tend to reshare medical misinformation on social media at the highest rates, away from fake news.

However, social media is still designed for casual communication and would alter the professional relationship between physicians and patients. The ability to be paid for creating posts with high engagement also begs the question of whether physicians should be paid for these online health posts, and how digital content would differ from any diagnosis or treatment that they would provide in an office. Regardless, the risk of untrustworthy scientists and health workers spreading misinformation online is always present. With social media becoming an integral part of the way we communicate information at a national and transnational level, encouraging health professionals to become active on social media is simply another precaution in the collective effort needed to combat future health infodemics.

Review Editor: Jerry Liu
Design Editor: Jessica Pham
References
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  3. [3] Pan, W., Liu, D., & Fang, J. (2021). An Examination of Factors Contributing to the Acceptance of Online Health Misinformation. Frontiers in psychology, 12, 630268. https://doi.org/10.3389/fpsyg.2021.630268

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  5. [5] Pearson, C. (2021, May 21). Surveys of Trust in the U.S. Health Care System [slideshow]. Retrieved from https://www.norc.org/content/dam/norc-org/pdfs/20210520_NORC_ABIM_Foundation_Trust%20in%20Healthcare_Part%201.pdf

  6. [6] Prochaska, M. T., Zhang, H., Meltzer, D. O., & Arora, V. M. (2022). Patient Characteristics Associated with and Changes Over Time in Trust in Inpatient Physicians. Journal of general internal medicine, 37(1), 266–268. https://doi.org/10.1007/s11606-021-06649-0

  7. [7] Shepherd, K. (2020, May 8). Who is Judy Mikovits in ‘Plandemic,’ the coronavirus conspiracy video just banned from social media?. The Washington Post

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