COMMENTARY

Do Docs Have an Obligation to Fight COVID Misinformation?

Arthur L. Caplan, PhD

Disclosures

September 28, 2020

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This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University's Grossman School of Medicine.

We live in the age of social media, with lots of information being transferred and transmitted to our patients about COVID-19, about how bad the epidemic is, about how to treat the infection, and about how to prevent getting the infection. It's creating a real mess for physicians in terms of how to manage misinformation.

At one end of the spectrum, there are people who are trying to drink bleach. They're hearing that pool disinfectant might help them. They're trying to get their hands on anything they hear is a disinfectant, and they could harm themselves. People have died trying to take those substances.

In the middle of the spectrum are treatments like hydroxychloroquine (HCQ), Donald Trump's favorite drug of choice, but many others are also being promoted. HCQ has been touted as something that can help people recover if they get sick, or prevent them from getting the virus. The US Food and Drug Administration and many other groups say there is no evidence to support these claims. The clinical trials that have been conducted to assess treatment efficacy showed little benefit and potential harm. A few studies are still ongoing on whether it helps block acquisition of the virus, but early results seem to say no. So patients are getting mixed messages about whether to take this prophylactically or, if you are admitted to a hospital, to ask for it or to ask your doctor to give it to your loved one if they're very sick.

At the other end of the spectrum is lots of social media advice circulating about masks, saying that masks are good and significantly help to cut back on transmission. The better the mask, the better the impact. Social media also says that COVID is taking a terrible toll, with many tens of thousands of deaths and millions of infections. But some Americans believe it's a hoax. Others say that masks don't do anything to help; they're just part of a plot. They say, "I don't need a mask," "The whole thing is made up," or "It's a political ploy to get Donald Trump removed from office," or to advance the interests of mask companies, or whatever underlies their resistance. So this sound advice about masks is being undercut by conspiracy, rumor, and people just doubting what experts say.

Where is your responsibility on this spectrum, from outright dangerous, bad information; to the controversial middle-of-the-road information about treatments like HCQ; to proven, established measures like masks?

I think your first obligation is to be aware of what's floating around on the internet. As painful as it may be, you have to take a visit and see just what's circulating in terms of health claims. Be aware, be alert, because you may be dealing with a patient who believes [in potentially] dangerous and outright harmful information. Or you may have to engage the patient on something like mask wearing, in terms of why it's important, when to wear them, and when you don't need to wear them.

If they ask about HCQ, you can tell them what I just said: "Here's the information: HCQ doesn't seem to speed the recovery in someone who's been infected. That's been knocked out of the box and is potentially dangerous. You shouldn't self-medicate with it. We don't know what dose to use, and even for preventing the disease the evidence is not positive. The evidence we have seen is negative."

It's also important to ask patients what they're thinking about. When someone comes in to your office, ask whether they are wearing a mask. If they're not, ask, "Why don't you believe that helps? Do you social distance. Why? Why not? Do you try to isolate yourself as much as possible?" If the patient is in a risk group, with diabetes, heart disease, asthma, or an immune disorder, you need to remind them that it's especially important for them to think about where they or their kids might go.

Some doctors have said to me, "That's all great, but do I have to get into the social media fight? Should I be posting? Should I be saying something?" I want to encourage you to post on social media, knowing that the blowback can be vicious and out of control. When I try to correct mistakes, misinformation, or outright dangerous information on Twitter, Facebook, or other social media sites, a lot of people bark back at me and say bad things about me, or wonder whether I'm in the pocket of the pharmaceutical industry, what my political beliefs are, and so on. But that's just social media. I take the blowback and I don't let it bother me very much.

You may have a different attitude. Many people find it too emotionally upsetting; they don't want to get into it. But if you can deal with it, I do think it's important for professional voices, medical voices, scientific voices to get out there into the mix. Too often, social media is just a place where conspiracy theories, misinformation, and dangerous information are allowed to thrive without any comment or pushback. If you can speak up in your community, whether it's through social media, talking on a webinar, or speaking up at an online high school class, these are important steps you can take.

People respect doctors. They particularly respect their own doctors. If you convey accurate information and point out that information changes and evolves, and that they have to keep tracking the legitimate science and research, you can make a valuable contribution. It may come at a price, but I believe it's a price worth paying. I hope you will try to set the record straight in an era when information often is not accurate, when you find out what your patients believe based on what they see on social media.

I'm Art Caplan at the Division of Medical Ethics at New York University's Grossman School of Medicine. Thank you very much for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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