The Other Pandemic: As Disinformation and Misinformation Go Viral, Attempts to Reign It in Are Met With Confusion and Frustration: Tech Companies and Medical Organizations Are Facing a Major Problem, With No Easy Answers

Abstract

On March 3, 2022, US surgeon general Vivek Murthy, MD, MBA, issued a massive request for data1Call for stories and research on health misinformationUS Department of Health and Human Services.https://www.hhs.gov/surgeongeneral/health-misinformation-rfi/index.htmlGoogle Scholar from major tech companies—social networks, search engines, crowdsourcing platforms, e-commerce platforms, and instant messaging systems—regarding the scale of the coronavirus disease 2019 (COVID-19)–related misinformation. Murthy’s office sought data on the scale and prevalence of the misinformation about the pandemic, including vaccine-related misinformation and demographic data on populations disproportionately exposed to or targeted with the faulty information. The surgeon general’s request for information1Call for stories and research on health misinformationUS Department of Health and Human Services.https://www.hhs.gov/surgeongeneral/health-misinformation-rfi/index.htmlGoogle Scholar was not limited to tech companies. He also called for health care workers, researchers, or victims of misinformation who have seen their loved ones or communities harmed. Murthy’s office was particularly keen on hearing from emergency physicians. Meanwhile, the day following Murthy’s announcement, Beverly Hills–based formerly board-certified emergency physician Simone Gold, MD, JD, the founder of America’s Frontline Doctors (AFLDS), a right-wing group known for spreading false information and conspiracy theories about COVID-19, the pandemic, vaccines, and pushing and selling sham treatments, pleaded guilty2Criminal case no. 1:21-CR-85-CRC-2US Department of Justice.https://www.justice.gov/usao-dc/case-multi-defendant/file/1479691/downloadGoogle Scholar to a misdemeanor charge regarding her role in the January 6, 2021, insurrection at the US Capitol. If the actions seem unrelated to misinformation, they are not. Gold spoke at an antivaccine rally on January 5, 2021. She had originally faced 5 charges related to her actions at the Capitol. She joined a crowd that pushed past police3Beverly Hills anti-vaccine doctor pleads guilty in Jan6 Capitol riot case. Los Angeles Times.https://www.latimes.com/politics/story/2022-03-03/beverly-hills-anti-vax-doctor-pleads-guilty-in-jan-6-capitol-riot-caseGoogle Scholar and, once inside, used a bullhorn to denounce vaccine mandates and stood by as a Capitol police officer was assaulted4A doctor prominent in fomenting opposition to Covid vaccines pleads guilty to Capitol riot charges. The New York Times.https://www.nytimes.com/2022/03/04/world/simone-gold-capitol-riot.html?smtyp=cur&smid=tw-nytimesGoogle Scholar in front of her, according to the news reports and videos in which she appeared. She pleaded guilty to the entering-and-remaining-in-a-restricted-building charge, a class A misdemeanor, and faces a sentence of up to 1 year in prison and a fine of US$100,000. Her arrest and plea deal underscore how entangled medical and political misinformation has become. During the hearing, Gold, whose stature as an emergency physician has lent credence to the group, asked a US District Court judge for the District of Columbia to refer to her as Dr. Gold,5Rubin R. When physicians spread unscientific information about COVID-19.JAMA. 2022; 327: 904-906Crossref PubMed Scopus (3) Google Scholar rather than Ms. Gold, according to The Los Angeles Times. Raising eyebrows was that as of mid-2021, Gold was no longer an American Board of Emergency Medicine (ABEM) diplomate, as she previously had been. However, her ABEM certification was not revoked as a result of any views she espoused or because of the spread of COVID-19–related disinformation. She cited “a voluntary refusal to re-certify,” on her group's website.6America's Frontline Doctors. AFLDS Mission Statement. Accessed June 6, 2022. https://www.americasfrontlinedoctors.org/about-us/mission-statement/Google Scholar A request sent to Gold for comment through her criminal defense attorney was not returned. As of March 2022, Gold still maintained an active medical license in the state of California. The growing pandemic of misinformation and disinformation shows no sign of winding down and may outlast the one caused by COVID-19 as antivaccine groups broaden their agenda to eliminate all childhood vaccines. As Murthy’s call for data and the recent controversy over Fear Factor host-turned-podcaster and COVID-19 influencer Joe Rogan’s prominence at Spotify demonstrate, the battle shows little sign of abatement. For emergency physicians, the problem has warranted a reminder about the physician’s ethics and the peddling of false information. In an August 2021 statement, the ABEM reminded members to “refrain from conduct that the Board determines, in its sole judgment, to be sufficiently egregious that it is inconsistent with ethical behavior by a physician.” “Making public statements that are directly contrary to prevailing medical evidence can constitute unprofessional conduct and may be subject to review by ABEM,” the statement continued. “Should ABEM determine that a physician is promulgating inaccurate information that is contrary to the interests of patients and that adversely impacts public safety, ABEM may withdraw or deny certification for that physician.” This escalation was not a direct response to the Gold affair, the organization said. However, the organization acknowledged that the statement came in response to having received “a number of concerns expressed by the public and many more by physicians,” ABEM president Marianne Gausche-Hill, MD, wrote in an email. “ABEM wanted certified physicians to know that ABEM certification was not a license to say anything and that there are professionalism expectations attached to ABEM certification.” “Too many physicians have worked too hard to become certified. We don’t want others to devalue those efforts,” Gausche-Hill said, saying that consequences ranged from “a letter of concern or warning up to decertification.” The certification board has followed up on “a number of complaints”; however, Gausche-Hill declined to comment on whether any punitive actions had been taken, saying that “we will not make any public statements while complaints are under review.” Gausche-Hill declined to comment directly on Gold’s status but appeared to distance the board from the right-wing group, saying that “ABEM is not aware that any of ABEM’s certified physicians are currently part of America’s Frontline Doctors. ABEM supports responsible, evidence-based, and scientific discourse in our profession.” Similarly, as of early March 2022, no physician in California had their license revoked in connection with the spread of COVID-19–related misinformation, according to Carlos Villatoro, the public information officer for the state’s medical board. “License revocation is but one form of discipline that the Board may choose when deciding cases—the others include probation, with or without practice restrictions, and public reprimands. Nevertheless, the Board’s disciplinary decisions must meet its mission of consumer protection,” Villatoro wrote in an email. However, the expanding minefield of bad information and the uphill battle to contain it raises questions about another component the surgeon general’s office has asked about—what are the policies that the tech companies use to regulate the COVID-19–related misinformation? And are they enough? In December, Aaron Berman, the misinformation policy manager at Meta, the parent company of Facebook, Instagram, and WhatsApp, informed Annals that the company actively removes misinformation related to COVID-19 that is “imminently harmful.” “We do this when public health experts and authorities have told us that certain claims are both likely to lead to imminent physical harm, and that are also false,” he said, including “fake preventative measures like claims that vitamin C cures COVID, and garlic cures COVID or claims that the virus doesn't exist.” Repeat offenders “that violate the policies and for people or for entities on Facebook, for Pages, for Groups, Instagram accounts that repeatedly violate these policies over time, we remove the whole accounts or page or group,” he said. Yet the AFLDS page, which was created on July 25, 2020, and boasts more than 129,000 followers as of early April 2022, remains active on the platform. “I can't speak to this particular case, that they are not violating our policies anymore, for whatever reason—maybe they were, and we took down some content, they're not anymore,” when asked specifically about AFLDS, Berman said. Yet, he went on to say, “we need to have clear standards for what is allowed and what is not allowed for those who violate those policies. We take aggressive action, we remove the content, and we remove the pages and groups.” However, several posts remain on the group’s page despite promulgating false information. An AFLDS video7Saving lives—the halcomb family. Facebook.https://www.facebook.com/watch/?v=2708154532823305Google Scholar from October 21, 2021, called “Saving Lives,” touts ivermectin as a treatment for COVID-19, with a character saying that “After I started taking doses of ivermectin, my, my body just came alive within three days I was back, ready to go to work.” The video had been viewed more than 22,000 times as of April 2022. During the Omicron surge, the White House COVID-19 Response Team issued a statement8Press briefing by White House COVID-⁠19 Response Team and Public Health Officials. The White House.https://www.whitehouse.gov/briefing-room/press-briefings/2021/12/17/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-74/Google Scholar that said in part, “For the unvaccinated, you’re looking at a winter of severe illness and death for yourselves, your families, and the hospitals you may soon overwhelm.” On December 24, 2021, an AFLDS post attacked the Biden administration, calling this statement regarding the unvaccinated “a new low” and “fear-mongering as an official statement.” It added that “This is not science; it's a tool of tyranny.” The post does not include the word “vaccine” itself; however, its meaning is clear. The post remained up in early April, 2022, with a popup banner that said simply, “Visit the COVID-19 Information Center for vaccine resources.” A February 9, 2022, post stated that “Almost two years ago Dr. Simone Gold wrote a letter to the President signed by 600+ doctors, calling the lockdowns dangerous. They were viciously attacked, silenced, and slandered by the media. Now everyone agrees they were right. But where are the apologies?” That post was labeled as “Missing context: Independent fact-checkers say this information could mislead people.” Nevertheless, it remained up as of early April 2022. Indeed, problems with the group’s content date back to the beginning of the pandemic. In July 2020, what may have been the group’s most widely viewed video was removed by Facebook, Twitter, and YouTube after being published by Breitbart News. Several different versions were shared by then-president Trump (who is banned from Twitter and currently banned from Facebook) with his 84 million Twitter followers. The video was recorded at a press conference in front of the US Supreme Court, where the doctors, dressed in white laboratory coats, claimed that "you don't need masks" to combat the virus’s spread and that “hydroxychloroquine, zinc, and Zithromax” could cure COVID-19. Before it was pulled, it was a top performer on Facebook, garnering more than 14 million views and shared nearly 600,000 times, according to Crowdtangle, a data-analytics firm owned by Facebook. The Crowdtangle team has since been broken up by Facebook, in a move that critics and researchers have called an attempt to block transparency. The dismantling of Crowdtangle, which had been a valuable tool to track misinformation, “illustrates the way that Facebook’s obsession with managing its reputation often gets in the way of its attempts to clean up its platform,” according to The New York Times. In addition, there are signs that AFLDS has been reported for violating policies and is attempting workarounds. A November 11, 2020, post says that “You must signup [sic] our website. We send a weekly newsletter—that's it. You must be independent of FB. The name of the website is the name of this group plus dot org. FB is not permitting me to write it here. Ironic.” As frustrating to some in the medical community that a group of doctors that promotes bogus cures and demonize vaccines has managed to stay on the platform for 2.5 years, it is possible that it learned how to skirt the letter of the law when it comes to invoking the consequences of Facebook’s elliptical moderation policy. Berman mentioned that the COVID-19–related misinformation fell into the broader category of community guidelines, which have been a much-dissected topic of debate as the Meta-owned platforms are continuously scrutinized for their moderation practices. In a New Yorker article from October 2020, former Dublin-based Facebook community operations analyst Chris Gray said that he and the other content moderators felt that they were coaching promoters of hate speech—like misinformation—as they pushed the boundaries of what would get flagged on the platform. “That’s what I’d do anyway, if I were them,” Gray, who is currently suing the company, alleging that his work caused his posttraumatic stress disorder, told the magazine. “Learn to color within the lines.” However, the whack-a-mole of endless false or misleading content is not the only thing that is frustrating the public health experts. There is also the counter example of false positives: platforms flagging solid, valuable, and even crucial information as misinformation and curtailing the reach of accounts from good actors and reputable sources. For example, there is the curious case of Cochrane, the United Kingdom–based international not-for-profit organization that is one of the most prestigious adjudicators of medical information in the world. As recently as February 4, 2022, a Cochrane Instagram post about a Cochrane review debunking ivermectin’s use for the prevention and treatment of COVID-19 was removed for violating community guidelines. The post quoted the review’s authors, saying that “The lack of good quality evidence on efficacy and safety of ivermectin arises from a study pool that consists mainly of small, insufficiently powered RCTs with overall limited quality regarding study design, conduct, and reporting. Current evidence does not support using ivermectin for treating or preventing COVID-19 unless they are part of well-designed randomized trials.” Almost immediately, Instagram removed the post; Cochrane fired back, posting about the removal the same day.9Cochrane. Instagram.https://www.instagram.com/p/CZkBSAggtTY/Google Scholar On February 8, 2022, the organization wrote about the experience on its website.10Trusted information needs to be protected on social media as much as misinformation needs to be challenged. Cochrane.https://www.cochrane.org/news/trusted-information-needs-be-protected-social-media-much-misinformation-needs-be-challengedGoogle Scholar This was not the first time it has had run into problems on social media platforms. In November 2021, it claimed that it was “shadow-banned”—meaning that others could not tag or mention the account @cochraneorg11Cochrane. Instagram.https://www.instagram.com/cochraneorg/Google Scholar on Instagram (a technique used by the platform to limit the reach of content), which meant that it had likely been flagged for violating community guidelines. Cochrane did receive notification that its account “repeatedly posted content that goes against Community Guidelines on false content about COVID-19 or vaccines”—just days after the organization joined a campaign to tackle misinformation for World Evidence-Based Healthcare Day12World Evidence-Based Healthcare Day 20 October 2021.https://worldebhcday.org/Google Scholar and launched a course with Lifeology about identifying and preventing infodemics.13What is an infodemic and how can we prevent it?: a Lifeology and Cochrane collaboration. Cochrane.https://www.cochrane.org/news/what-infodemic-and-how-can-we-prevent-it-lifeology-and-cochrane-collaborationGoogle Scholar “It’s not clear if there is an issue with Instagram’s algorithm or if the issue lies with people ‘gaming’ policies and reporting posts as misinformation when they are not,” wrote the Cochrane’s Editor in Chief, Karla Soares-Weiser, PhD. “What is clear is that there is an issue with how you hold those deliberately creating and sharing mis/disinformation to account and how you form accreditation and approval for official sources of evidence that have met certain quality control standards. We need to make it easier for people to access trustworthy information—and that includes on social media.” What also puzzles the organization’s executives is that Cochrane’s Instagram account, despite its renown and its 19,400 followers, remains unverified (meaning that there is no “blue icon checkmark” next to its handle, indicating that a vetting process had been completed by Instagram). The organization has received messages from many others who have had “evidence-based posts taken down or been shadow-banned, so it seems widespread and from large and small accounts, which makes it hard to determine [whether the root of the problem is] people misusing the reporting features or the algorithm,” Muriah Umoquit, MA, the communications officer on the Cochrane Central Executive Team, wrote in an email, noting that most people want to know what they should do to correct the issue. “I don’t know the answer to that and there doesn’t seem to be a clear pathway.”