Medical Misinformation: The Other Pandemic - Medical Misinformation SourcesMedical Misinformation Blog Series, Part 2 of 3
In part one of this blog series on Medical Misinformation, we describe the harms associated with medical misinformation. In this post, part two, we will describe common medical misinformation sources and why we are so inclined to believe them.
Medical Misinformation Sources - Frauds and Fame
Whether for profit or five minutes of fame there seems to be no end to the cast of characters that disseminate medical misinformation.
- Pseudoscientists and charlatans attempt to make careers out of false, contrarian viewpoints.
- Peddlers of alternative therapies are clearly out to make money.
- Russian robots have even been implicated in disseminating misinformation about vaccines.
Another increasingly common source of medical misinformation is the celebrity.
Consider the curious case of hydroxychloroquine.
Recently prominent persons in American life enthusiastically recommended the use of an antimalarial hydroxychloroquine in the treatment and prevention of COVID-19.
The initial claim was not completely without merit. Some had speculated that the drug’s mechanism of action could be beneficial against the virus and even anecdotal reports of clinical success. However, there were not sufficient trials to warrant a recommendation of widespread use. Anecdotal success (“I tried it and it worked!”) among a few patients may or may not have anything to do with the medication’s therapeutics properties. For example, if patients know they are receiving a drug this knowledge may stimulate the placebo effect. Moreover, COVID- 19 patients who take hydroxychloroquine and show improvement may have been “on schedule” to improve without the drug. That is, improvement may have been incidental rather than causal. “But if there is some chance that the medicine could help” many asked “what is the harm of trying this medication? Let’s give it a try and see if it helps?”
Medical Misinformation Sources - Pharmakos vs. Zeal
The answer to this question lies in the ancient Greek word pharmakos (ɸαρμοκος) from which we get the word pharmaceuticals. For the ancient Greeks, pharmakos was the very same word for both “medicine” and “poison.”
To some patients, with a particular condition, substance “X” — in certain doses — may exhibit therapeutic properties. In other patients, substance “X” may exhibit toxic properties. What the ancient Greeks understood thousands of years ago is that any particular substance is at once both a potential poison and a medicine. The corollary for modern researchers is that all potential medical therapies represent an intricate mix of risks and benefits.
Initially, this intricate mix is hidden from us and it is only through a properly designed research process that this mix of risks and benefits can be made manifest. Only then, when we know a medicine’s capacity to help and to harm, can we offer recommendations that allow our patients to make informed decisions: “This medication has been shown, in some patients, to improve the symptoms of gout but in some patients it causes diarrhea”; “This medication has been shown to reduce the long-term risk of heart attack but in a small percentage of patients, it has been shown to cause muscle aches.”
It is not clear at this point how many people bypassed the research process and took hydroxychloroquine without knowing the potential risks and benefits. We do know that after politicians and media commentators touted the benefits and safety of hydroxychloroquine, sales of the medication skyrocketed.
People fearing infection of COVID-19 not only ingested the antimalarial, but also sang its praises as the number of mentions on social media also skyrocketed. Interestingly, discourse about the medicine on social media reads less like rational consumer interest and more like ideological advocacy — for an antimalarial?
Medical Misinformation Sources - Social Media Spinouts
Social media users posted testimonials about how hydroxychloroquine had prevented them from contracting malaria or had cured their rheumatoid arthritis symptoms; all of the testimonials mentioned benefits and none of the posts, that I read, mentioned anything about potential harms or side effects. One Facebook user posted a patriotic encomium on hydroxychloroquine commending the medication as one of our allies in the struggle against the Nazis (referring to its use as an antimalarial by American GIs in World War II).
The message was clear — hydroxychloroquine was safe, effective, and as American as apple pie.
The borderline religious zeal with which the people advocated an antimalarial seems to be on a continuum of atypical behavior akin to pledging allegiance to amoxicillin or vowing to take a bullet for doxycycline. Patients don’t normally speak in such ways.
Recall the case of statins in the prevention of heart disease.
Despite substantial evidence of therapeutic benefit and minimal occurrence of harm, primary care clinicians frequently run into barriers when trying to prescribe statins to patients. They have been told or read that the statins were dangerous. In stark contrast, hydroxychloroquine was recommended by celebrities with no medical training and against the advice of many medical professionals, but patients flock to the medicine without knowing the potential risks and benefits.
This would all read as comical were it not so dangerous. In a story reported by the Washington Post, a couple in their 60s, fearing they would contract covid-19, found some form of chloroquine in the chemicals used to maintain their aquarium. Believing the chemical to be similar to hydroxychloroquine, the couple ingested the substance mixed into a beverage. Within minutes the couple developed symptoms, and the husband died shortly after arriving at the emergency department. His surviving wife reported their reason for taking the chemical: “We were afraid of getting sick.” Three months after the story ran, the NIH halted clinical trials of hydroxychloroquine in COVID-19 patients — they found no benefit to patients.
The curious case of hydroxychloroquine that reveals how strange and complex our situation has become.
Our ability to make rational decisions has become entangled with our fears, tribal cultures, identity politics, ideological bias, and consumer preferences.
Medical Misinformation - Effective Strategies
As healthcare providers we need effective strategies for communicating with our patients that acknowledges the importance of misinformation and the complexity of our historical situation.
In the next post, part 3, we will discuss some possible strategies for helping our patients to deal with medical misinformation.
 The biggest pandemic risk? Viral misinformation. Heidi J Larson, Nature volume 562 October 18, 2018 page 309
 Thanks to Shannon Ijams for bringing this to my attention, A man thought aquarium cleaner with the same name as the anti-viral drug chloroquine would prevent coronavirus. It killed him. Washington Post. Accessed June 21, 2020. https://www.washingtonpost.com/nation/2020/03/24/coronavirus-chloroquine-poisoning-death/
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