Homework: media misinformation

Counteracting Health Misinformation
A Role for Medical Journals?

The growing toll of popular fallacies about health and
illness is evident given outbreaks of measles and other
preventable communicable diseases in many nations.
This “medical misinformation” phenomenon has been
described as “a health-related claim of fact that is cur-
rently false due to a lack of scientific evidence,”1 but
that may be a generous interpretation. Complemen-
tary and alternative medical approaches, without firm
evidentiary bases, have coexisted uncomfortably with
mainstream scientific medicine for decades, and they
persist.2 By contrast, contemporary misinformation of
greatest concern is supplanting well-proven interven-
tions and ideas with unproven ones that are clearly
false and, in some cases, harmful.

Crowd-Sourced Lies, Fake Experts,
and Misleading Leaders
Medical misinformation is nothing new but has become
pervasive. Multiple digital sources represent a “new
frontier” without editorial oversight or curation. Nearly
anyone can say almost anything and be taken seriously
at least by some consumers. With billions of individuals
online every day, health misinformation can spread at
a rapid pace.3 Worse, exciting falsehoods apparently
spread faster than boring truths on social media.3,4

This new online world facilitates direct-to-
consumer marketing by phony experts, celebrities
with armies of Twitter followers, and legions of inde-
pendent digital scammers, including some physicians.
The result has been torrents of misinformation on

topics as varied as the safety and effectiveness of vac-
cinations, the Zika virus outbreak, water fluoridation,
genetically modified foods, and treatments for com-
mon diseases.

Moreover, in countries such as India, Italy, and the
United States, negative attitudes about science appear
to have risen in lockstep with ultranationalist senti-
ments and the emergence of populist leaders and
movements.5,6 For those disadvantaged, despairing,
and understandably distrustful of government, these
“alternative truths” align with shared skepticism about
scientific medicine and belief in traditional remedies.

Do Medical Journals Have a Role in Addressing
Medical Information?
Chou et al1 highlighted the need for research to address
medical misinformation and determine how interven-
tion might constrain or refute messages with adverse
health implications. Apart from publishing such re-
search, should medical journals be more active?

At first blush, the role of medical journals otherwise
seems limited because their content is relatively inacces-
sibletolaypeople.However,manyjournalshaveembraced
the need to more broadly translate medical knowledge.
Some produce open-access “patient pages” to assist phy-
sicians in educating patients and allow patients to educate
themselves, and some produce simpler and briefer sum-
maries of research findings. Others have developed digi-
tal and social media tools to promote relevant content,
supplementing conventional print media. Most journals
have the capacity to solicit submissions on particular top-
ics and publish entire issues focused on themes of broad
scientific, public, or professional interest. Some have natu-
ral alliances with the medical profession through sponsors
suchasmedicalsocietiesandassociations.Theseandother
capabilitiespositionjournalsaspotentiallypowerfulagents
in counteracting medical misinformation.

Specific Actions Medical Journals Might Take
The Table outlines 4 broad strategies sometimes rec-
ommended to help address medical misinformation. The
first—containment of dissemination—provides oppor-
tunities for journals to shine light on prominent misin-

formation sources and prompt others to
act. While censorship targeting sites on
the worldwide web is challenging in most
jurisdictions, social media companies
own their platforms and can take ac-
tion. For example, Facebook took sev-
eral recent steps to contain the spread of
antivaccination claims even though it has
so far declined an outright ban on anti-
vaccination groups. Containment is more
straightforward with curated or edited

media of all types, exemplified by Canada’s Globe and
Mail, which has publicly rejected any “false balance”
wherein “proven science” is set against “unproven be-
liefs and conspiracy theories” about vaccinations.7

General enhancements of science literacy are the
province of educators and policy makers at all societal lev-
els, and represent both a form of immunization against
broader misinformation and a long-term investment in a
better-informed citizenry. On the other hand, physicians
and medical journals could have involvement with health-
specific inoculation by fostering science literacy and edu-
cation about human health and illness.

This new online world facilitates
direct-to-consumer marketing
by phony experts, celebrities with
armies of Twitter followers, and legions
of independent digital scammers,
including some physicians.

VIEWPOINT

Paul W. Armstrong,
MD
Canadian VIGOUR
Centre, University of
Alberta, Edmonton,
Alberta, Canada; and
Division of Cardiology,
University of Alberta,
Edmonton, Alberta,
Canada.

C. David Naylor, MD,
DPhil
Department of
Medicine, University of
Toronto, Toronto,
Ontario, Canada.

Corresponding
Author: Paul W.
Armstrong, MD, 2-132
Ki Ka Shing Centre for
Health Research
Innovation, Edmonton,
AB T6G 2E1, Canada
([email protected]
ualberta.ca).

Opinion

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One approach would be commissioning evidence-based re-
views of areas in which quack nostrums and dangerous fallacies have
gained popular traction. Journals could then use their in-house com-
munications expertise to compile and widely disseminate acces-
sible summaries in multiple media showing the comparative effec-
tiveness and safety of scientific vs crowd-sourced treatments. These
could be promoted as public interest pages alongside patient pages.
Medical journals could also solicit and publish research on medical
misinformation, including studies of the effectiveness of different
strategies designed to mitigate the influence of misinformation. Such
efforts could be foundational for medical educators as they pre-
pare the next generation of health professionals to navigate a world
of endemic health-related misinformation.8 The resulting combi-
nation of relevant scientific content and lay-accessible summaries
would also equip individual physicians, journalists, and others in 2
respects: (1) for broad public education and advocacy and (2) for ac-
tivism against pseudoscience by directly debunking myths and dis-
crediting purveyors of medical misinformation (Table).3

A Global Collaboration?
Medical journals have a history of forging a global consensus and tak-
ing action on matters of broad scientific and public interest. The
International Committee of Medical Journal Editors, for example, has
addressed issues such as criteria for authorship, requirements for reg-
istration of clinical trials, and more recently, data sharing. Interna-

tional collaborative efforts regarding medical misinformation are still
in their infancy, although many cardiovascular journals published an
identical editorial warning about this phenomenon in January 2019.9

One possibility would be to extend this model by coordinating
efforts related to specific topics affected by medical misinformation.
In this regard, JAMA and other journals have previously coordinated
global theme issues on topics of wide relevance to public health. This
collaborative strategy could be very effective in addressing issues for
which medical misinformation has had adverse effects. For example,
agroupofgeneralandrelevantspecialtyjournalscouldcommittopub-
lishingresearchreportsandopinionarticlesspecificallyaddressingthe
issue of childhood vaccines, and publish them at an opportune time,
for example, during World Immunization Week. These efforts could
promote cross-disciplinary, cross-national and cross-cultural learn-
ing, and would very likely capture global media attention. Such col-
lective action may today seem unthinkable, yet, until recently, so too
was the reemergence of myriad preventable infectious diseases and
the current epidemic of pseudoscience and willful ignorance.

Conclusions
The rising tide of medical misinformation is already having adverse
effects on global health. It requires a robust and coordinated
response from health professionals, organizations, institutions, and
mainstream media. Medical journals now have an opportunity to
galvanize and support this important effort.

ARTICLE INFORMATION

Published Online: April 22, 2019.
doi:10.1001/jama.2019.5168

Conflict of Interest Disclosures: Dr Naylor is a
member of the Journal Oversight Committee for the
JAMA Network. No other disclosures were reported.

REFERENCES

1. Chou WS, Oh A, Klein WMP. Addressing
health-related misinformation on social media. JAMA.
2018;320:2417-2418. doi:10.1001/jama.2018.16865

2. Hellmuth J, Rabinovici GD, Miller BL. The rise of
pseudomedicine for dementia and brain health.
JAMA. 2019;321(6):543-544. doi:10.1001/jama.2018.
21560

3. Merchant RM, Asch DA. Protecting the value of
medical science in the age of social media and “fake
news”. JAMA. 2018;320:2415-2416. doi:10.1001/
jama.2018.18416

4. Vosoughi S, Roy D, Aral S. The spread of true and
false news online. Science. 2018;359(6380):1146-1151.
doi:10.1126/science.aap9559

5. Falling vaccination rates pose a global health risk.
Financial Times. https://www.ft.com/content/
225c3124-06a9-11e9-9fe8-acdb36967cfc.
Published December 28, 2018. Accessed
March 4, 2019.

6. Kumar S. In India, Hindu pride boosts
pseudoscience. Science. 2019;363(6428):679-680.
doi:10.1126/science.363.6428.679

7. Stead S. No need to offer “false balance”
to anti-vaxxers. The Globe and Mail.
https://www.theglobeandmail.com/public-editor/
article-no-need-to-offer-false-balance-to-anti-
vaxxers/. Published March 12, 2019. Accessed
March 22, 2019.

8. Wenzel RP. Medical education in the era of
alternative facts. N Engl J Med. 2017;377(7):607-609.
doi:10.1056/NEJMp1706528

9. Hill JA, Agewall S, Baranchuk A, et al. Medical
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039193

Table. Potential Strategies for Counteracting Medical Misinformation

Category Agents Goals/Tactics
Containment of
dissemination

Physicians and medical journals Identify purveyors of clear-cut misinformation

Regulators, social media executives Limit their capacity for dissemination

Editors in traditional and
new media

Avoid legitimizing falsehoods about health and illness in
the name of “balance”

General immunity
through science
literacy

Primary and secondary
schools/educators

Ensure that high school graduates understand how and
why the scientific method works and possess some
critical-thinking tools

Colleges and universities Ensure that every baccalaureate has meaningful exposure
to common cognitive errors and logical fallacies involving
both qualitative and quantitative information

Health-specific
inoculation and
education

Health professionals, faculties, and
organizations; public health
agencies; communications experts;
medical journals

Promote general understanding of medical science and
communicate about common misconceptions using
websites, digital media, town halls, and conventional
print and broadcast media. Prepare the next generation
of health professionals to navigate a world of
“truthiness” and pseudoscience

Debunking myths and
discrediting purveyors

Journalists and journals/media
outlets; health professionals and
researchers; medical journals

Direct rebuttals of medical misinformation using a variety
of media platforms. Undertaking critical reviews of the
provenance of misinformation, unveiling purveyors’
credentials and conflicts of interest

Opinion Viewpoint

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