February 3, 2023 by
Jan Carney, M.D., M.P.H.
Jan Carney, M.D., M.P.H. (Photo: Brent Harrewyn)
Jan Carney, M.D., M.P.H., associate dean for public health and health policy and professor of medicine at the Larner College of Medicine, is board-certified in both internal medicine and preventive medicine and served as Vermont’s Commissioner of Health under three gubernatorial administrations championing improvements in children’s health insurance, preventing teen smoking, and improving cancer screening. She was recently awarded the UVM President’s Distinguished University Citizenship and Service Award for her innovative teaching, creative leadership, and service to the UVM community. Below is her commentary on confronting medical misinformation.
California’s New Law
In late August, California legislators passed a law allowing their medical regulatory board to discipline physicians, defining “false or misleading” medical information about COVID-19 vaccines and treatments as “unprofessional conduct.” Earlier, in 2021, the Federation of State Medical Boards (FSMB) publicly reminded physicians that because of their ethical and professional responsibilities, high level of public trust, and risks to patients, spreading COVID-19 vaccine misinformation could potentially result in disciplinary measures to their medical license. In April 2022, the FSMB Ethics and Professionalism Committee published a statement of professional expectations. Fifteen state medical boards had published similar statements, and large medical groups, such as the AMA, echoed ethical concerns about physicians spreading disinformation. As of February 2022, at least fourteen states proposed laws limiting such actions by state medical regulatory boards. The AMA Journal of Ethics previously pointed out that physicians may have government limitations under categories of false speech and professional speech. By the end of November 2022, California’s law – before it took effect – already had two legal challenges, and on January 26, 2023, a federal judge halted the law’s enforcement. It is unclear yet what the outcome of the new California law will be.
Efforts to legislate physician conversations pre-date the COVID-19 pandemic. In 2015, physician conversations with patients about firearms, abortions, and fracking were the subject of restrictions. A 2011 Florida law restricting physician conversations with patients about guns was described as a physician “gag law” by the AMA Journal of Ethics. In May 2017, the NEJM described the legal ruling affirming such conversations between physicians and patients, writing “the full court’s ruling highlights the opportunity that physicians have to reduce firearm violence.”
Misinformation and Disinformation: Approaches to Improve Public Health
Firearms and pandemics are serious public health issues with lethal consequences and controversial remedies. Legal arguments aside, one might ask: are these debates a symptom of a much larger problem? The spread of misinformation was so extreme during the pandemic – from unproven remedies to vaccine myths – that the U.S. Surgeon General launched a campaign against health misinformation for the public. From a public health perspective, shouldn’t we leverage opportunities to promote high-quality health information available to people through internet sources and social media? On a population level, making it easy for people to find reliable health information online would go a long way toward improving health.
In addition to focusing on physicians and health professionals, we need to identify where people get health and scientific information and whom they trust, and address challenges of improving health literacy on a patient and population level.
According to National Institutes of Health’s (NIH) National Library of Medicine, health literacy “involves the information and services that people need to make well-informed health decisions.” This includes personal, organizational, digital, and quantitative literacy (also called numeracy). Health literacy goes beyond reading; it requires skills – the ability to comprehend and apply health information – and taking action to get a flu shot or seek care for a chronic condition. Nearly 90 percent of U.S. adults find this process challenging. And because health literacy is integrally related to social and structural determinants of health, it is key to achieving health equity. It makes sense that improving health literacy can help people improve their own personal health and create healthier communities.
An explosion of new scientific and medical information is increasingly availability to the public. A 2017 study from the National Trends Survey showed that people used commercial websites (71.8%), search engines (11.6%), academically affiliated sites (11.1%), and government-sponsored websites (5.5%). Also, people are much more likely to use social media as part of their search for health information. The Pew Research Center found in 2021 that most Americans use YouTube (80%) and Facebook (nearly 70%), with younger adults also using Instagram, Snapchat, TikTok, and Twitter; online platform choices vary by gender, race and ethnicity, education, income, and whether you live in a rural or urban setting. In 2018, popular Facebook science-related pages had from 3 million to 44 million estimated followers. A 2021 paper from the National Academy of Medicine emphasizes opportunities to share high-quality health information with broader audiences, despite the challenges of navigating scientific debates and widespread misinformation.
Sources of High-Quality Health Information Online
There are many publicly available high-quality sources of health and science information.
MedlinePlus from the NIH’s U.S. National Library of Medicine is an online health resource with evidence-based information about health topics, medical tests, prescription drugs, and supplements, serving as a “medical encyclopedia” for the public. This extensive site has a tutorial and checklist for evaluating internet health information that includes asking questions about the “who,” “where,” “how,” and sources of funding. For example, when visiting a website, here are some questions to ask:
- Who runs the site?
- Why have they created the site?
- Who is paying for the site?
- Is the information reviewed by experts?
- Where did the information come from?
- Does the site make unbelievable claims?
- Is it up to date?
- Do they want your personal information?
Other sources of high-quality health information include government web sites, such as the Centers for Disease Control and Prevention, NIH, and World Health Organziation. Large health professional groups, such as the American Academy of Pediatrics, American College of Physicians – and many others – provide medical and scientific information to help people counter misinformation and disinformation. Learning the differences between website addresses (.gov, .edu, .org, and .com) is an essential first step.
Whom Do People Trust for Medical and Scientific Information?
It depends. Earlier in the pandemic, community leaders outpaced scientific and medical experts in gaining trust for key health messages. Recent studies from the Ad Council Research Institute’s 2022 Trusted Messengers Study reinforce that people trust those closest to them, medical professionals, and scientists, but they also trust news media messengers. Younger people in the United States are more likely to trust social media influencers and celebrities. Trust in science and medicine differs according to political affiliation and geography. Religious leaders are trusted sources in both rural and urban areas, whereas people in rural areas generally have less trust in expert messengers. A 2022 Pew Research Report of nearly 15,000 U.S. adults notes declining trust in scientists and medical scientists since the pandemic began, with large differences by political affiliation, although overall trust in experts remains high, with “a fair amount” or “a great deal” of trust in more than 75 percent of people responding.
When we look globally, we get a more optimistic view. The Wellcome Trust, a London-based health research foundation, publishes reports on public perceptions of science. Their 2020 Global Monitor report showed a dramatic increase in trust in science and scientists in 2020 as compared to 2018, as well as confidence in doctors and nurses basing their decisions on science. However, levels of trust in science varied regionally and was also related to other factors: overall science knowledge and confidence in government leadership.
What can we do, given the loud volume of controversy and vast scope of misinformation? Health literacy involves learning about sources of high-quality information and understanding health risks. We can remember that health literacy is a skill that takes practice, and as scientists, health care, and public health professionals, we can present – at every opportunity – clear, accurate, and easily understandable health information. We can share information from high-quality sources and promote them on social media. We can also remember that – despite claims to the contrary – working side-by-side with community leaders and many others, health professionals and scientists are trusted sources for health information.
A Few Recommended Sources
- Online Health Information: Is It Reliable? | National Institute on Aging (nih.gov)
- National Institutes of Health (NIH) | Turning Discovery Into Health
- MedlinePlus – Health Information from the National Library of Medicine
- Health Misinformation – Current Priorities of the U.S. Surgeon General (hhs.gov)