Health misinformation now has powerful allies

Misinformation and conspiracy theories about health had long been a growing problem before the pandemic, but it took COVID-19 to get the government and researchers to take it seriously. Now, a new report in The Washington Post adds to previous reporting from multiple sources describing how allies of misinformation—and not just health misinformation—are striking back under the guise of defending “free speech.”

David Gorski on September 25, 2023

It turns out that health misinformation and disinformation and the “freedom” to promote them now have very powerful allies, as a report in the Washington Post published on Saturday demonstrates:

Academics, universities and government agencies are overhauling or ending research programs designed to counter the spread of online misinformation amid a legal campaign from conservative politicians and activists who accuse them of colluding with tech companies to censor right-wing views.

The escalating campaign — led by Rep. Jim Jordan (R-Ohio) and other Republicans in Congress and state government — has cast a pall over programs that study not just political falsehoods but also the quality of medical information online.

Obviously, the sort of misinformation that this blog has been most involved in combatting is health misinformation. Indeed, over the last three years, the tsunami of misinformation and disinformation about COVID-19 and COVID-19 vaccines has become a primary focus of our work. While it is true that, as the pandemic has subsided somewhat, we have increasingly returned to our pre-COVID-19 subjects, COVID-19 is never far from our concerns. However, the problem described in the Post report goes beyond health misinformation:

Facing litigation, Stanford University officials are discussing how they can continue tracking election-related misinformation through the Election Integrity Partnership (EIP), a prominent consortium that flagged social media conspiracies about voting in 2020 and 2022, several participants told The Washington Post. The coalition of disinformation researchers may shrink and also may stop communicating with X and Facebook about their findings.

This is, of course, exactly the desired result of such campaigns, which intentionally target those who research misinformation, how it is created, how it spreads, and how to combat it, portraying such research as inherently biased against them and an attack on “freedom,” in particular “free speech.” When such campaigns come from powerful legislators (virtually all of whom are right wing Republicans), the end result is this sort of reaction:

The National Institutes of Health froze a $150 million program intended to advance the communication of medical information, citing regulatory and legal threats. Physicians told The Post that they had planned to use the grants to fund projects on noncontroversial topics such as nutritional guidelines and not just politically charged issues such as vaccinations that have been the focus of the conservative allegations.

NIH officials sent a memo in July to some employees, warning them not to flag misleading social media posts to tech companies and to limit their communication with the public to answering medical questions.

“If the question relates in any way to misinformation or disinformation, please do not respond,” read the guidance email, sent in July after a Louisiana judge blocked many federal agencies from communicating with social media companies. NIH declined to comment on whether the guidance was lifted in light of a September appeals court ruling, which significantly narrowed the initial court order.

This is, of course, another consequence of the simple fact that the government funds a lot of science research. Two of the greatest triumphs of science in the US have been the National Institutes of Health and the National Science Foundation. Neither are perfect or completely free from potential biases, but I have in the past argued that the methods by which they review, rank, and fund grant applications come as close to a meritocracy as one is likely to find, with grants being reviewed by panels of scientists with expertise in the subject matter of the applications picking the applications over with a fine tooth comb before giving them a priority score from 1-9 (at the NIH, with which I’m most familiar), lower scores being better. Even more surprising, for the most part, the grants with the lowest priority scores are the ones that are funded, regardless of the conspiracy theories of antivaxxers and COVID-19 cranks that have sought to portray funding decisions as a quid pro quo of: “You support Anthony Fauci and the government’s ‘censorship,’ or your research won’t be funded.”

Purists frequently argue that science and medicine should be apolitical, a position that I have never taken. In years past, I used to argue that supporting science-based medicine is inherently political because government regulates medicine and quacks have long tried to use the the political process to weaken the scientific basis of medicine not just in academia but in the government regulatory sphere. Examples of the interface between politics and medicine include what retired SBM contributor Jann Bellamy used to refer to “legislative alchemy” in which the lead of pseudoscience and quackery (e.g., naturopathy, reflexology, chiropractic, and unregulated supplements) are through the legislative process turned into gold through laws turning pseudomedical specialties into specialties recognized and regulated by the government in much the same way that medical practice by those who actually graduated from real, accredited medical schools and residencies is. Other include laws like one in North Carolina that bars the state medical board from disciplining physicians for using alternative medicine unless it can prove that the treatments utilized are ineffective or more harmful that prevailing treatments. (Note the reversal of the standard of evidence. The quack doesn’t have to prove the treatment is effective or less harmful than prevailing treatments; rather the state medical board has to prove that it is ineffective and/or more harmful than prevailing treatments.) This is a law that was passed in 2010, a full decade before the pandemic, and Jann had a good term for these “health freedom” bills and laws too: Quack protection acts.

As a result of the rather obvious interface between politics, medicine, and public health, traditionally I’ve always said that science-based medicine (the movement and this blog) is not apolitical (nor should it be) but rather should strive to be nonpartisan. Unfortunately, even before the pandemic this stance had become more and more difficult to maintain given how much the center of gravity of health misinformation in general, and the antivaccine movement in particular, had shifted to the right. Indeed, by 2015 I was noting with alarm how much the antivaccine movement had shifted to the right, to the point that Republican candidates for President were using antivaccine talking points cloaked in the rhetoric of “freedom,” opposition to mandates, and vaccine safety, while by 2019 certain state legislators had become rife with antivax legislator that antivaxxers were bragging about it. As early as 2018 I was declaring that Republican Party had become the antivaccine party. (It still is, Robert F. Kennedy Jr.‘s campaign for the Democratic nomination for President in 2024 notwithstanding.) I took no pleasure in saying this, because I’d long feared the consequences that could follow if the one area of public health and medicine about which there had been broad bipartisan consensus, school vaccine mandates, were to become hopelessly politicized, something I was warning about in 2017. I had no idea what was to come.

There are two incidents that the Post story primarily focuses on. Both are intended to shut down government effort (or even government funding of efforts) to study and combat misinformation and disinformation, but one is more of a slam-dunk than the other as far as egregiousness of intent goes. The worst example is Rep. Jordan’s effort to shut down the NIH’s program to fund research into misinformation and how to combat it; the second is Missouri v. Biden, a case now before the Supreme Court seeking to block a ruling from the U.S. Court of Appeals for the 5th Circuit that found that the White House, FBI and top federal health officials had likely violated the First Amendment by improperly influencing tech companies’ decisions to remove or suppress posts on the coronavirus and elections. It’s a case that is not without some reasonable, albeit still fairly weak, arguments that the Biden Administration might have gone too far with respect to government compelling speech. Unfortunately, it’s also a case that likely had significant influence on the NIH’s decision to scuttle—for now—its misinformation research program,

Politicians vs. the NIH and NSF

What Rep. Jordan is doing in terms of trying (and, unfortunately, apparently succeeding) in influencing the NIH to eliminate—or at least make much less robust—its program to study misinformation and how to combat is truly alarming. It goes beyond the NIH, too. According to the Post:

In September 2022, an NIH council greenlit a $150 million program to fund research on how to best communicate health issues to the public. Administrators had planned the initiative for months, convening a strategy workshop with top tech and advertising executives, academics, faith leaders and physicians.

“We know there’s a lot of inaccurate health information out there,” said Bill Klein, the associate director of the National Cancer Institute’s Behavioral Research Program at a meeting approving the program. He showed a slide of headlines about how online misinformation hampered the response to the covid-19 pandemic, as well as other public health issues, including gun violence and HIV treatment.

The program was intended to address topics vulnerable to online rumors, including nutrition, tobacco, mental health and cancer screenings such as mammograms, according to three people who attended a planning workshop.

Yet in early summer 2023, NIH officials contacted some researchers with the news that the grant program had been canceled. NIH appended a cryptic notice to its website in June, saying the program was on “pause” so that the agency could “reconsider its scope and aims” amid a heated regulatory environment.

Remember that memo to NIH employees about contacts with social media companies and warning them not to flag misinformation on social media platforms? That’s almost certainly as a result of Missouri v. Biden. I’m not going to comment on the suit itself much—I am, after all, not a lawyer—other than to note that on September 8, the Fifth Circuit ruled against the federal government, stating that it had “coerced or significantly encouraged social media platforms to moderate content”, which violated the First Amendment. The Court, however, also ruled that the preliminary injunction had been too broad because it blocked legally allowed content between the government and social media services. The Fifth Circuit Court narrowed the ruling to cover only the government “threatening, pressuring, or coercing social-media companies in any manner to remove, delete, suppress, or reduce posted content of postings containing protected free speech.”

Whether you agree or not that there is a First Amendment issue here, there was one thing that stood out to me as I perused some of the filings for the case. Take a gander at this one from the State of Missouri dated July 4, 2023:

The Court heard oral arguments on this Motion on May 26, 2023 [Doc. No. 288]. Amicus Curiae briefs have been filed in this proceeding on behalf of Alliance Defending Freedom,3 the Buckeye Institute,4 and Children’s Health Defense.5

Children’s Health Defense? That’s RFK Jr.’s antivax organization!

But, again, even if you think that Missouri v. Biden is based in legitimate First Amendment concerns about the Biden Administration using the power of government to coerce speech, either by removing or inhibiting it or by encouraging it, I would argue that what Rep. Jordan is about has far less to do with protecting freedom of speech than it does with protecting freedom of speech by those espousing viewpoints with which he agrees and with suppressing freedom of speech by those who espouse viewpoints that he detests. For example, take a look at what he’s doing to Stanford researchers, which is ironic given how much health information comes from Stanford faculty like Dr. Jay Bhattacharya when in June he did this:

Republican House Judiciary Chairman Jim Jordan and his allies in Congress are demanding documents from and meetings with leading academics who study disinformation, increasing pressure on a group they accuse of colluding with government officials to suppress conservative speech.

Jordan’s colleagues and staffers met Tuesday on Capitol Hill with a frequent target of right-wing activists, University of Washington professor Kate Starbird, two weeks after they interviewed Clemson University professors who also track online propaganda, according to people familiar with the events.

Last week, Jordan (Ohio) threatened legal action against Stanford University, home to the Stanford Internet Observatory, for not complying fully with his records requests. The university turned over its scholars’ communications with government officials and big social media platforms but is holding back records of some disinformation complaints. Stanford told The Washington Post that it omitted internal records, some filed by students. The university is negotiating for limited interviews.

As much as Jordan and his allies cloak this in the rhetoric of the First Amendment and preventing government “censorship” of right wing voices, there is one purpose behind actions like this. It’s the same purpose that abusive Freedom of Information Act (FOIA) requests have when weaponized at scholars working for the government or for state universities where faculty emails are subject to FOIA: to dig for dirt to “expose” and weaponize against academics doing research that they don’t like and thereby to intimidate them either to silence or to tone down their work.

It’s not just the NIH, either. According to this weekend’s report in the Post, Jordan’s committee is going after researchers who have received NSF funding to study misinformation and how to counter it, with the intended results:

Some NSF grant recipients who have not received requests from Jordan’s committee say they are facing a barrage of online threats over their work, which has prompted some to buy services that make it harder to find their addresses, such as DeleteMe.

I’ve been subject to harassment, a libel suit, and abusive FOIA requests just for editing this blog and running my own personal pseudonymous blog, and that was bad enough. I can only imagine what these academics are going through. Let me disabuse you, though, of one idea. This is not just about the NIH and NSF. It’s about using the power of government to silence academics.

Politicians vs. academics

In fact, this is not just about the NIH or the NSF, but about academics in general, as can be seen by further reporting:

Connie Moon Sehat, a researcher-at-large for the group, said she and other researchers have faced online attacks including threats to reveal personal information and veiled death threats. She says members of her team are at times under high levels of stress and having ongoing conversations about how to elevate accurate information on social media, as some platforms become increasingly toxic.

“We are double- and triple-checking what we write, above what we used to, to try to communicate our good intentions — in the face of efforts that willfully misconstrue our work and desire to serve the public,” Sehat said. “And I worry more broadly that we researchers may self-censor our inquiry, or that some will drop out altogether, to stay safe.”

Again, that is precisely the intended result of these “inquiries” into what people like Rep. Jordan are now calling the “censorship-industrial complex.” (Cute.) Those undertaking them want to punish academics whose research threatens them or, failing that, at least make them so afraid that they constantly second-guess themselves, tone down their findings, or even just leave the field altogether.

It isn’t about funding by the NIH or NSF, either. Private groups have been targeted:

Jordan’s committee has sent records requests to a number of universities and independent research groups that worked on the Virality Project, which monitored anti-vaccine narratives across social media platforms after coronavirus vaccines became available, according to a person familiar with the matter who spoke on the condition of anonymity because of not being authorized to speak publicly.

Groups that received demands for information include the Stanford Internet Observatory, the University of Washington, the National Conference on Citizenship, and New York University’s Center for Social Media and Politics as well as its Tandon School of Engineering, the person said.

In one letter obtained by The Post, Jordan alleges strong ties between the Virality Project and federal government agencies, most notable being the Office of the Surgeon General and the Centers for Disease Control and Prevention. The letter seeks years worth of communications between employees at those organizations and representatives of the executive branch and social media companies.

In case you’re wondering what the Virality Project is, it’s a “global study aimed at understanding disinformation dynamics specific to the COVID-19 crisis.” Also, rather interestingly to me, it’s about more than disinformation spreaders:

We have a unique opportunity to address several outstanding research questions:

  1. Tactics: How do governments leverage the full scope of media and social media capabilities – overt and covert – to spread particular narratives? What can we learn about state information capabilities from this crisis?

  2. Priorities: What do government information operations tell us about their geopolitical priorities?

  3. Actors: What role do groups that are partially aligned or not aligned with governments, such as groups opposed to vaccination, play in these information operations? To what extent do these groups coordinate?

  4. Interaction between government narratives and local communities: What is the relationship between government narratives, user-generated content, participatory dissemination, and mass media?

Also, most importantly, the work is being funded by private sources:

This work is being funded by pre-existing grants by Craig Newmark Philanthropies and the Hewlett Foundation. Funding bodies interested in supporting this work are encouraged to reach out to [email protected].

All of this does, of course, risk angering those whose power and careers depend on spreading misinformation, and the techniques of harassment should sound familiar to longtime readers of this blog:

As the field of disinformation research has grown more politically contentious, researchers say that records requests, subpoenas and lawsuits have become tools of harassment. The fear of being targeted is profound enough that several researchers spoke on the condition that they not be named, and one prominent professor asked to be removed from the story entirely, citing concerns about his family’s safety.

“The set of techniques used to harass people online has gotten more sophisticated,” said Alice Marwick, an associate professor of communications at the University of North Carolina at Chapel Hill. “Right now, there’s a lot of bad actors who are using freedom of information requests to harass academics working at public universities. And that wasn’t something we saw until a few years ago.”

Neo, not really. Those of us who have been combatting the antivaccine movement and various forms of quackery for a long time recall that abusive FOIA requests were “pioneered” many years ago and had become pretty common by the time the pandemic hit. I myself have been subject to at least three. I will say that the most recent of these abusive FOIA requests did have an amusing aspect to it. An antivaxxer wanted any correspondence between the NIH and me. While I have had NIH collaborators and a PubMed search will find several papers on which I’m co-author that involve NIH researchers, in reality the amount of correspondence that I have with NIH researchers is rather limited. I am, however, on several NIH listservs, which means that I have hundreds, if not thousands, of emails from those listservs. Since the crank who had subjected me to the abusive FOIA did not specify to exclude listserv results, I suggested that the university counsel send him everything. While this made only a little more work for the lawyer, because those making FOIA requests have to pay, it increased the expense of the request. I am hoping that I got a little bit of revenge that way.

Academics respond

Unfortunately, my bit of fun with one harasser is just one minor time when I feel as though I might have returned the favor in terms of causing inconvenience to a tormentor. The vast majority of the time, the academic targeted has no recourse other than to hunker down and hope the harassment blows over, combined possibly with either abandoning the targeted line of research or making their research somehow less threatening. In fact, it’s getting so bad that academics are considering this:

Many academics, independent scholars and philanthropic funders are discussing how to collectively defend the disinformation research field. One proposal would create a group to gather donations into a central fund to pay for crisis communications and — most critically — legal support if one of them gets sued or subpoenaed in a private case or by Congress. The money could also fund cybersecurity counseling to ward off hackers and stalkers and perhaps physical security as well.

This is a good start. Certainly, back in the day, when Dr. Paul Offit was receiving death threats, complete with harassing phone calls indicating that the caller knew the names of his children, where they went to school, and where his family lived in response to his defense of vaccines and pushback against antiavax misinformation, things were a lot less organized. Fortunately for Dr. Offit, he was on the CDC’s Advisory Committee on Immunization Practices, which meant that he had a physical guard whenever he attended, and his university was supportive and willing to expend the resources to screen his mail. Still, two decades ago, cases like his were anomalies. They aren’t anymore. They’re much more common, victims of an intentional tactic to silence.

Another idea that sounds as though it might work but won’t is:

University academics are also mulling ways to rebrand their work to attract less controversy. One leader in a university disinformation research center said scholars have discussed using more generic terms to describe their work such as “information integrity” or “civic participation online.” Those terms “have less of a bite to them,” said a person, who spoke on the condition of anonymity to speak on the private discussions. Similar conversations are occurring within public health agencies, another person said.

Superficially, this sort of approach seems reasonable. However, you can bet that right wing defenders of misinformation like Rep. Jordan will not be mollified by a rebranding or renaming of the research. They won’t be mollified by anything less than cessation of such research or changing the research so that it exonerates their allies who are promoting conspiracy theories and misinformation about health and so many other areas. It’s why the far right, assisted by Rep. Jordan and his committee, has targeted the Center for Countering Digital Hate (CCDH). It is all part of a coordinated strategy.

I realize that misinformation is not just being spread by the right and the Republican Party. Indeed, back in the day, it was much easier to be political in my advocacy for SBM while remaining, for the most part, nonpartisan. 15 years ago, there was some truth to the common stereotype of the antivaccine movement as being primarily made up of crunchy granola munching lefties. (The stereotype was always an exaggeration, but let’s just say that the leftwing component of the antivax movement was much more prominent in those days.) Here and now, in 2023, it can no longer be denied that, however much misinformation might emanate from left wing sources, the sheer volume of misinformation and disinformation that emanates from right wing sources far exceeds it. The recent volley coming from Congress is nothing more than the latest chapter in the long-running saga of the war on science-based regulation of medicine and public health in which the pandemic has served as a convenient event to push quacks and right wing activists and politicians who view all government regulation as the enemy into bed together. It is a conflict that goes back 200 years.

I am far less optimistic about the outcome than I used to be.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.