As of August 2023, the COVID-19 pandemic has led to over 100 million confirmed cases and over 1.1 million deaths in the United States, causing meaningful declines in overall life expectancy for Americans. In those that survived an infection, the physical and mental consequences caused by post-COVID Conditions (e.g., “Long COVID”) is difficult to quantify but is estimated in the tens of millions of Americans. While vaccines have been shown to reduce the risk of severe disease, hospitalization and death, uptake of the vaccine has been modest in the United States, with 69.2% completing the primary vaccine series and only 15.5% receiving the bivalent booster to date.
Reasons for individual decisions related to COVID-19 have been discussed here and elsewhere, and include government recommendations (that changed during the pandemic), general mistrust/distrust of health organizations or institutions, and even political beliefs, as Mark Crislip discussed earlier this week.
COVID-19 misinformation is false, inaccurate, or misleading information as evaluated against the best available evidence, while disinformation has a deliberately malicious and harmful purpose. Both misinformation and disinformation about COVID-19 are commonly found on social media, despite promises from the major platforms during the pandemic to better control its dissemination. Physician-propagated misinformation and disinformation during a public health emergency may have an outsized impact, given they are typically considered to be credible sources of health information. While there seems to be support for disciplining physicians who intentionally share misinformation, little action has been taken against physicians to date, as David Gorski has discussed previously.
In a paper published on August 15, 2023, Sahana Sule and colleagues describe the types of COVID-19 misinformation propagated by American physicians after the vaccine became available, the characteristics of these physicians, and the platforms used to spread this information.
The study
This was a mixed-methods study, combining qualitative (context and meaning analysis) and quantitative (statistical) research methods in a single paper. It looked at information communicated online between January 1, 2021 and May 1, 2022. The authors defined COVID-19 misinformation as assertions unsupported by, or contradicting US Centers for Disease Control and Prevention (CDC) guidance on COVID-19 prevention and treatment during the period assessed, or contradicting the existing state of scientific evidence for any topics not covered by the CDC. For example. They classified all inaccurate information as misinformation, based on their stated inability to infer intent.
The researchers searched social media platforms in late spring 2022 to identify media containing misinformation. Included were US-based physicians (posting and self-identifying as either an MD or DO) who were unlicensed or licensed to practice. Search terms included “COVID,” “vaccine,” “doctor” or “physician,” “ineffective,” “pharmaceutical,” “medication,” “ivermectin,” “hydroxychloroquine,” and “purchase” “COVID misinformation,” “doctor” or “physician,” and/or “conspiracy theory.” Platforms searched were Instagram, Twitter, YouTube, Facebook, Parler, TikTok, The New York Times, and National Public Radio. The researchers noted,
Due to the large volume and repetitiveness of Tweets, Twitter searches focused initially on America’s Frontline Doctors’ Twitter profile because of the volume of COVID-19 misinformation in its Tweets,19 its large following, and the potential for physicians propagating misinformation to follow the page. Followers of the America’s Frontline Doctors’ page with an MD or DO in their header were traced on Twitter and other platforms as well.
The information collected included:
- The following information was collected from each source: physician’s name
- medical specialty
- state(s) in which they were currently or had been licensed
- whether their license to practice was active, had lapsed, or been revoked based on state medical board site searches
- when the misinformation was posted (if available)
- the source
- the number of followers the physician had (if the source was a social media platform)
Misinformation was classified as follows:
- medication
- vaccine
- mask/distancing
- other unsubstantiated or false claims
In addition to descriptive statistics on the misinformation, the researchers examined the nature of the misinformation itself, identifying themes, subthemes, and supporting quotes.
Findings: A lot of misinformation propagated by physicians
A total of 52 US physicians were identified as disseminating COVID-19 misinformation. All but 2 were or had been licensed to practice medicine in the US; the others were researchers.Most specialties were represented:
I am not sure what the authors mean by “Allopathic Medicine” as a specialty, as the term is a pejorative used against conventional (science-based) medicine. Most (44/50) physicians (88.0%) held an active license in at least 1 state; three (6.0%) did not have an active license, four (8.0%) had had a license suspended or revoked, and one (2.0%) had active licenses in 2 states and revoked/suspended licenses in 2 other states. Nearly one-third of physicians (16 of 52) were affiliated with groups with a history of propagating medical misinformation, such as America’s Frontline Doctors. I am not sure what other groups the authors may have included other than AFD.
Over one-third of physicians posted misinformation on five or more different social media platforms, and over three-quarters appeared on five or more third-party online platforms. Not surprisingly, Twitter was the most used platform with 37 of 52 using this platform, to audiences with a median size of 67,400 followers:
Misinformation themes
If you’ve been reading this blog since early 2020, the themes identified will not surprise you at all. They included:
- Claiming vaccines were unsafe and/or ineffective: Discouraging vaccination was common by these physicians, who promoted fear and distrust while encouraging reliance on “natural immunity”. They also made unfounded claims about vaccine harms, including myocarditis misinformation.
- Promoting unapproved medications for prevention or treatment, such as ivermectin or hydroxychloroquine.
- Disputing mask-wearing effectiveness, portraying masks in a negative light, and making unsubstantiated claims about effectiveness or harms, e.g., the “harms” to children and the purported problems with mask mandates in schools.
- Other misinformation, including unsubstantiated claims (e.g., virus origin (“Plandemic“), the withholding of information by governments and public health agencies, the behavior of pharmaceutical companies) and other conspiracy theories.
The physicians aren’t named in this paper, but you may be able to identify some strictly from the quotes and specialty.
Action needed by state medical boards and academic institutions
Much has now been written (even a book!) about the medical professionals who spread misinformation about the SARS-CoV-2, virus, COVID-19 infections, and the pandemic. This paper from Sule and colleagues provides a snapshot and analysis of medical doctors sharing misleading and even completely incorrect information during a public health crisis. Regrettably, COVID-19 misinformation, like all misinformation, seems to be subject to Brandolini’s law, which states:
The amount of energy needed to refute bullshit is an order of magnitude bigger than that needed to produce it.
Importantly, this paper doesn’t examine the motivations of the physicians who have spread COVID-19 misinformation. Is it all a grift? Audience capture? Is a consequence of the decades-long effort to encourage magical thinking and the acceptance of “complementary and alternative medicine” into conventional medicine, leading to acceptance of “different ways of thinking” and the rejection of science-based medicine?
Others at this blog have done a better and much more thorough job examining and questioning the motivations behind these actions. And while studies like these are helpful to permanently document the misinformation propagated by health care professionals, what’s needed is action – and consequences. State medical regulatory boards owe a duty to protect the public. However, disciplinary action is rare, and regulators seem unwilling to enforce a standard of care, which may be influenced by legislative pressure. Institutions that may employ these physicians should also be examining the information that has been communicated by these individuals and evaluating the public health consequences (and reputational risk) of this misinformation. Regrettably, without any consequences, it seems reasonable to expect the dissemination of medical misinformation from physicians to continue.