Information ecosystem disrupts health, Ex #2: health care professionals undermining evidence-based health advice

I’m continuing examples of how the information environment uniquely affects public health problems. It can impact people’s attitudes and behaviors that challenge a health organization’s efforts to promote health guidance, health services, and products or disseminate health information.

Health systems aren’t yet equipped to mitigate the challenges the information environment poses to its mission to provide evidence-based health care and promote public health. In my recent talk I spoke about this, #trust building and #demand promotion in health, which will also be available as a recording on the CAPHIA Vimeo channel.

A common misperception of the problem is that it is the volume of “bad information” that needs to be dealt with. But when people who are trusted in our lives to provide health information turn around and promote products or services that are unsupported by evidence, this can have a disproportionately large impact in the communities where they provide health care, and also more broadly. A small number of people who are perceived as trusted sources of health information can have a big impact.

So, if we are talking about trusted messengers who spread health misinformation, we cannot avoid discussing healthcare professionals who undermine evidence-based advice.

The issue isn’t only that they mislead and misinform their patients and the public. These are licensed healthcare professionals who forego their health training, including evidence-based health advice and medicine, to promote misinformation.

Health care professionals are the most trusted source of health information across countries, contexts and cultures.

But some health workers use this trusted role to spread misinformation about health products and services.

When some healthcare workers counter the training they were licensed for, they endanger upholding the Hippocratic oath of doing no harm through their work.

They undermine their professions and the licensing and governing standards of their professional associations and boards.

They also politicize health, which makes provision of health care and public health more vulnerable to being hijacked by disinformation, deceptive marketing, foreign influence and political campaigns.

Such actions can obstruct the ability of the health authorities to deliver health services, improve public health and well-being, and protect the health of the most vulnerable.

These are not isolated individuals working on their own. Here’s some examples from Canada, Europe, the US, and Australia, they are health workers that align with or belong to organized health worker organizations or even hold public health office.

• We saw more of this dynamic play out during the COVID-19 pandemic. Here’s some examples of doctors promoting non-evidence-based treatments in Australia, Canada, the US, and New Zealand. There’s research from the US that showed that few doctors spread misinformation during the pandemic, but those that did have a wide reach and added to the distrust of vaccines and treatments and to the confusion in the conversations people had about COVID-19 mitigation online. For example, one of the most vocal vaccine deniers in the US is an osteopathic physician. It’s even more harmful when government officials do not use evidence and public health standards in their work, such was the case of the Surgeon General in Florida in the recent measles outbreak.
• What’s also worth noting is that doctors who deviate from evidence-based recommendations form political organizations, such as America’s Frontline Doctors, or Doctors for the Truth in Germany, Spain, Italy and other European countries. The issue with such organizations is that they pull together people because of their anti-government and political beliefs. Health is a topic that is relevant to all people and, therefore, can be misused to connect to politically-sympathetic people for power or profit (see also this article on profiteering from COVID-19 misinformation).
• Such behavior challenges the enforcement of professional conduct standards, and adds more work to medical licensing boards in investigating alleged misconduct than they had to before. Globally, the medical boards are keeping doctors to account for professional conduct and hippocratic oath. In the US, however, weaknesses in medical board operation result in fewer doctors being held to account for spreading health misinformation.

Bottom line:

• Health authorities must support, empower and protect health care workers to have quality conversations with their patients as well as respond to health concerns and questions online. Some have taken their digital skills online to answer questions and concerns (here are just two examples from the UK and the US, but there are plenty of similar ones globally). Some have faced online trolls and backlash and they should be supported and protected while they do their work.
• The medical profession and licensing boards need to face the new reality of the information ecosystem and politicization of health, which is pushing against their profession’s standards of work and conduct. Keeping medical professionals accountable for how they use their trusted role with patients and in their communities is ever important.

PS: for discussion of lawyers and doctors spreading misinformation, see this in depth analysis and examples in The Professional Price of Falsehoods: What role should professional organizations play in responding to lies and misinformation spread by those within their ranks?