Fighting Online for SBM

Posting online, as we do here, can be an effective way to engage in meaningful conversation, for public education, outreach, and marketing. But it is also risky because the online world can be brutal, and the rules of engagement seem to favor fanatics, cranks, and frauds. An article in The LA Times, for example, discusses cases in which physicians simply posted pro-vaccine articles on Facebook, and were faced with a massive online backlash.

This backlash was not confined to trolling. If you can’t handle a few nasty comments, you probably should stay away from social media. Not to minimize the impact of trolling – it can overwhelm constructive conversation and poison an online ecosystem. These physicians, however, experienced much more. Some were physically threatened. Their site was swarmed by anti-vaxxers who not only verbally attacked them, but also fraudulently gave their private practice one-star reviews.

The point of the article was to draw attention to the fact that physicians simply wanting to promote uncontroversial (scientifically) good health practices online were silenced through various methods of online harassment. This went beyond name-calling – they were physically and financially threatened. They often achieve their goal of making it not worth it for physicians to engage online.

All of us here at SBM have faced the same thing. We are all long past the point where trolling or name-calling is going to faze us. We actually share the best hate-mail with each other and laugh. To us it is simply evidence of the small-mindedness of the opposition. They are not intellectually honest and they do not have facts and logic on their side, so they largely resort to regurgitating terrible arguments, mindless propaganda, and ad hominem attacks. Being accused of being a pharma-shill is just part of the daily background noise. We take that as evidence, if anything, that we are winning the actual argument.

We can also manage our online properties. That requires careful moderation – allowing dissent and discussion, but knowing where to draw the line when it comes to pathological trolling. It also requires actively cultivating a certain online environment.

These are skills and resources that many physicians, experts, or even academic institutions may lack. The problem is exacerbated when the big online providers don’t have their backs. This is where we could use some real innovation. Online providers can no longer naïvely just create a platform and let it be a free-for-all. It is simply too easy for a fanatical minority to exploit such platforms to spread misinformation, hate, or personal attacks. These platforms, like Twitter, Facebook, YouTube, Reddit, Instagram, and others, are no longer just fun places to play online. They are a critical part of our society’s infrastructure. They can directly affect a business, for example, like the private practice of a physician.

This, of course, gets tricky because it puts a lot of power in the hands of these companies. But it is not true that the only alternative is for them to do nothing, and allow the loudest, angriest, and most ignorant voices to not only dominate online discourse, but actively drown out and harass anyone who gets on their radar.

Online reviews is a great example of where thoughtful rules are necessary. In the examples given by The LA Times the doctors who spoke up online were hurt mainly by bad reviews of their practice, most of which came from outside their state, even other countries. These are obviously fraudulent reviews. Google did eventually delete some of these reviews, but it could have prevented them in the first place – for example by blocking reviews from addresses that come from outside the practice area of the business.

The big social media platforms are starting to experiment with methods to limit use of their platforms to spread misinformation or harassment. Amazon is even removing books from their store that promote fake autism cures or antivaccine misinformation. Facebook also recently announced that its algorithms will reduce the rankings of anti-vaccine misinformation. That’s a good start.

These moves, by the way, are not first-amendment issues, because the government is not involved. Private companies are free to put into place quality control measures. A pharmacy does not have to sell homeopathic potions. A book-seller does not have to sell books that it considers trash.

Online platforms are also already not neutral with regard to information. They have algorithms that decide what to promote to whom. They are simply increasingly realizing the unintended consequences of those rules – the viral spread of misinformation and the creation of sinkholes of self-reinforcing fanaticism. Tweaking their algorithms so they favor quality over “loudness” is not a bad thing, as long as they are careful and transparent.

But also physicians and other experts should not shy away from engaging online simply because it can be difficult. To do so is to abandon our patients (taking the view that society as a whole is the responsibility of the profession as a whole). Otherwise social media may have the unintended consequence of exacerbating the ivory tower effect – experts are increasingly isolated in their academic bubbles, while the broader society is engaged in a conversation that is leaving them out. They are being left out partly because many academics don’t recognize the need to engage with the public (online or otherwise), and because the charlatans, cranks, con-artists, and anti-science ideologues are trying to keep them out through harassment and other techniques.

Unfortunately, one of those other techniques is to sue physicians for libel simply because they expressed a negative opinion online. Everyone at SBM has also been sued, often multiple times. We have been engaged in one lawsuit or another continuously for years now. So far, we have prevailed, but these suits are draining. It takes dedication and resources to fight for the simple right to express our professional opinions online. This is another reason many experts and institutions shy away from criticizing pseudoscience and fraud – it often comes at a personal cost. The charlatans don’t play nice.

This problem has a clear and simple fix – libel law reform. Every state or possibly at the federal level needs an anti-SLAPP law. SLAPP refers to a Strategic Lawsuit Against Public Participation, filing a lawsuit against someone, or threatening to do so, in order to silence their public speech. We get threatened in this way all the time. It is a bullying tactic to shut us up. Anti-SLAPP laws basically recognize that these lawsuits are harassing, they are anti-free speech, and they are unfair. Without a good anti-SLAPP law, even a totally frivolous suit can cost hundreds of thousands of dollars. This means you don’t really have free speech, because anyone can take it from you if they don’t like it – unless you have lots of cash on hand to defend yourself.

What anti-SLAPP laws do is provide a means to quickly end a frivolous libel suit, to limit the upfront cost, and to provide a means for the person sued to recover their expenses if the suit was truly frivolous. This establishes the proper balance, so that the libel laws don’t simply become a mechanism for harassment and silencing, while still allowing for redress when genuine libel occurs.

In the end, this is what we need – a proper balance so that we have free speech and the free and vigorous exchange of ideas (even controversial ideas), but with rules that do not simply favor fanaticism, extreme views, and a willingness to be mean and hateful. We also need to prevent abuse for the purpose of directed attack.

As a first step, we cannot surrender the field. We need to engage online and fight for the reforms we need. The charlatans want us to leave, so that they will be free to exploit the public and spread their propaganda and misinformation unimpeded. But at least here, it’s not going to happen.