Responding to Misinformation
This article is written by John Halamka, M.D., president, Mayo Clinic Platform, and Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform.
The singer/songwriter Paul Simon once penned the lyrics: A man hears what he wants to hear and disregards the rest (The Boxer). If that’s the case, how do we respond to misinformation that contradicts the data/evidence guiding development of treatment and cures? If the only audience willing to read such articles are already critical thinkers, perhaps we are just preaching to the choir. And if by chance, a person who believes in controversial ideas does read articles based on real world evidence, will they consider them a one-sided discussion by the “medical-industrial establishment?” In our soon-to-be published book, The Digital Reconstruction of Healthcare (HIMSS/CRC Press), we discuss this dilemma at length. Here are a few highlights from that analysis.
There is evidence to justify at least some mistrust among the public. For example, when physicians were asked what treatment recommendations they would make for patients and what decisions they would make for themselves if they were in similar circumstances, investigators found the clinicians would have made different choices for themselves: “Among those asked to consider our colon cancer scenario (n=242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient.’’(1) Even more concerningly are reports that suggest many medical procedures continue to be performed despite lack of strong scientific evidence supporting their efficacy. The problem has become significant enough to prompt the formation of the Right Care Alliance, “ a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits.”(2)
That misinformation conversation can be much shorter when health care leaders readily admit their mistakes and any uncertainty about the treatment protocols they are recommending. Chances are, such uncertainties are going to be revealed given the public's access to scientific data from clinical research that was once hidden from view.
Building the kind of trust that opens the minds of science skeptics also requires we accurately report the facts, theories and controversies when dealing with patients and the general public. This may seem an obvious weapon in the battle to debunk unscientific views, but it can be challenging for several reasons. Explanations take time and most clinicians are too busy discussing diagnosis and treatment in the short window of time they have with each patient to adequately counter misinformation.
Another barrier to addressing misinformation is the nature of the scientific process itself. During the COVID-19 pandemic, for example, several critics have attacked statements by infectious disease specialists because their advice has changed over time as more data became available from a larger population of infected patients. The assertion, “The experts are constantly contradicting themselves,” reflects a lack of understanding of how the scientific method works, as well as the laws of probability.
When crafting a message that will reach skeptics, it also helps to understand the motivation that’s sometimes behind such doubts. The motivation to believe falsehoods and half-truths, is complicated. Steven Pinker, a Harvard University professor of psychology, offers a plausible theory. Citing the research of legal scholar Dan Kahan, he points out that: “Certain beliefs become symbols of cultural allegiance. People affirm or deny these beliefs to express not what they know but what they are. We all identify with particular tribes or subcultures, each of which embraces a creed on what makes for a good life and how society should run its affairs.” (3) That observation implies that rejecting a deeply held belief is betraying one’s tribe, risking the loss of peer respect.
There is no magic pill to cure the misinformation epidemic we are currently experiencing. The problem has existed for centuries and is unlikely to disappear any time soon. Many believed in astrology in the 12th century just as they do now. Skeptics have likewise questioned the value of vaccinations for centuries. During the 1918 flu pandemic, some even claimed the disease was being spread as a result of a massive nationwide vaccine program. (4) Despite these myths, it is possible to overcome misconceptions with a combination of respect, patience and a willingness to admit that sometimes, the experts are wrong. Perhaps Paul Simon was too cynical.
*Paul Cerrato is a senior research analyst and communication specialist at Mayo Clinic Platform
1. Ubel PA, Angott AM, Zikmund-Fisher B. Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves. Arch Intern Med. 2011; 17: 639-634.
2. Epstein D, ProPublica. When Evidence Says No, but Doctors Say Yes. The Atlantic. Feb 22, 2017. https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/
3. Pinker S. Enlightenment Now. The Case for Reason, Science, Humanism and
Progress. New York, NY: Viking; 2018:357.
4. Reuters Staff. False claim: the 1918 influenza pandemic was caused by vaccines. Reuters. April 1, 2020.
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