What we have seen is the widespread propagation of misinformation and disinformation. And the reason it has taken root is because there was an information vacuum. I come back to our role as physicians. It is critical that we fill that vacuum because if we don’t, others will.
This quote is absolutely infuriating and saddening in 2023, especially coming from Dr. Ashish Jha. While I am glad that one of the country’s top public health officials finally recognizes the deadly role of medical disinformation, why did it take so long, especially after the former director of NIH Dr. Francis Collins repeatedly expressed his regrets about the delayed recognition of this problem? As a critical care physician who spent over three years fighting COVID-19 in intensive care units nationwide and combating disinformation, I have acquired experience in both fields. I would like to share some thoughts about the latter here.
Dr. Jha is correct that an information vacuum existed at the pandemic’s start. He is also right that this vacuum created opportunities for those who peddle falsehoods. However, it is so disheartening for him to blame physicians for not doing enough to fill up this information vacuum. Especially since so many honest and truthful physicians did speak up despite several institutions and workplaces actively discouraging discussing the pandemic publicly. Institutions were unwilling to support their physicians and often capitulated to demands for retribution driven by contrarian anti-vaccine influencers. It is hard not to ask back: “But what have you done to organize the fight against disinformation and anti-science?” Sadly, I think I know the answer.
On the front lines
Working in many intensive care units across America, I witnessed firsthand the effects of false information on patients and society. I clearly remember the video Plandemic playing in the background as I worked in the New York ICU during the spring of 2020. I can vividly recall a nurse spreading misinformation about Elmhurst Hospital in New York, hydroxychloroquine, remdesivir, ivermectin, zinc, quercetin, confused and angry patients and families refusing some treatments and demanding the others, masks, lockdowns, and, of course, vaccines. Each stage of the disinformation campaign directly affected my daily practice, making it extremely difficult to care for patients.
Despite the urgent need, no government effort or leadership was directly dedicated to combating the disinformation movement. The results of the 2020 election would provide us, frontline healthcare workers, with a false hope that having reasonable leadership in 2021 would give us a much-needed reprieve from COVID and disinformation. Unfortunately, the opposite happened. Disinformation became even more rampant as the new anti-vaxx movement merged with older anti-vaccine activity and other fringe movements like white supremacist groups and the newer QAnon movement. Utilizing existing fringe networks, shadowy funds, and psychological warfare techniques, anti-vaxx individuals acquired a substantial following from the general population. This left individual physicians responsible for starting their own campaigns against disinformation and the much larger forces fronting the anti-science narrative.
Having no financial help, media connections, legal protection, or guidance on how to fight disinformation effectively, we did what we thought could work. We were vocal on social media; we ran Spaces on Twitter or rooms on Clubhouse; we published op-eds, substacks, or other articles; we organized non-profit grassroots organizations; and we constantly reached out to leaders of various medical organizations, politicians, and journalists hoping to build a force aiming to combat disinformation. We received hate messages, online and real-life harassment, and death threats. In doing these activities, we risked our jobs and careers due to various social media and media policies, personal and professional relationships, and personal and family safety.
Tales from the trenches
What follows are just a few stories of individual physicians trying to fill the information vacuum and combat the anti-science movement that seems to have gone unnoticed by Dr. Jha until 2023!
One of the most prominent frontline voices and anti-disinformation advocates, Dr. Cleavon Gilman, an ER physician, was vocal on social media from the beginning of the pandemic, sharing experiences from ERs in NYC and Arizona. He created several pages dedicated to people who died from COVID-19 and gave multiple interviews about the reality of the front lines. He once said:
I saw that misinformation was being spread about this virus and that people were dying as a result. I can sleep at night knowing that I did everything that I could to warn people in America about this. I went home and I wrote about it, and I’m on Twitter. So I’ve done everything I could.
At some point, Dr. Gilman had over 170K followers on Twitter, and the number was rapidly increasing. However, he initially suffered retaliation from his hospital for being vocal about his frontline experience and then received so much harassment that he eventually left social media altogether.
Dr. Nick Sawyer, an ER physician, became one of the critical anti-disinformation voices of the pandemic. Working in ERs in California and NYC, he was shocked to see medical professionals spreading disinformation that contradicted everything he saw with his own eyes and was supported by scientific evidence. His experience compelled him to form the non-profit organization, “No License For Disinformation,” aiming to make disinformation healthcare professionals accountable for the harm they caused. Dr. Sawyer called, not once but many times, for organized efforts to combat misinformation. He personally approached leaders of various state and national medical organizations and associations, encouraging actions against the disinformation spreaders. He told ABC News:
Disinformation is needlessly killing Americans. And the people who have the authority to stop just information, whether it be the social media platforms, legislators, the medical boards, need to step up and protect the public from this dangerous, conspiratorial information that’s being pushed out in a massively coordinated way.
However, due to hate, harassment, and threats, Dr. Sawyer left social media and dismantled the organization.
Years before the COVID-19 pandemic, Dr. David Gorski, Professor of Surgery and Oncology, started debunking medical disinformation and anti-science. As a founding blogger and later managing editor of Science-based Medicine, Dr. Gorski has been publishing scientific essays exposing the anti-vaccine movement and other pseudo-scientific quackery for more than 15 years. During the COVID-19 pandemic, he and other SBM contributors, including Dr. Jonathan Howard, published many articles debunking fraudulent and incorrectly done studies and constantly exposing new COVID-related conspiracies. Being in the field of countering disinformation for the longest time, Dr. Gorski has suffered from harassment and hate attacks also for the longest:
I’ve had orchestrated campaigns against me, just for my blog work. For instance, as early as 2010, when I rarely used Twitter. A bunch of anti-vaccine activists tried to get me fired from my university; emailing and calling the board of governors about a bogus non-existent conflict of interest that they thought they found against me.
Dr. Allison Neitzel, a physician-researcher, became interested in studying the roots of medical disinformation and its connection with political agendas after she suffered from a complicated relationship with her mother, a physician radicalized by disinformation. Personal experience and trauma motivated Dr. Neitzel to create “Misinformation Kills“, a non-profit organization that exposes political and financial forces orchestrating medical disinformation. Dr. Neitzel started her anti-disinformation activity in 2021 with an open letter to NFL quarterback Aaron Rodgers calling him out for sharing misinformation about the COVID vaccine. Almost immediately after publishing the letter, Dr. Neitzel received death threats and other forms of harassment. Since her research on the roots of disinformation is ongoing and she posts frequently, various forms of hate continue to go her way regularly.
Dr. Michael Patmas, an internal medicine physician, medical director of utilization management and referral relationships, and a life-long vaccine advocate, reported Robert Malone to Maryland Medical Board for vaccine disinformation. As a result, Dr. Patmas received various forms of online and personal harassment and threats; his personal information was disclosed at one of Joe Rogan’s shows, which exacerbated the level of harassment and retaliation against him. Dr. Patmas described the consequences of his experience in the following way:
Retaliation for a complaint – if that’s allowed to stand, then other physicians are going to be reluctant to hold one another accountable. If doctors who do that get their heads cut off, well, you’re going to let doctors get away with bad things. It’s unethical, and it’s morally wrong.
Most recently, under FOIA, Dr. Jonathan Laxton, an internal medicine physician, requested and received earlier versions of the Florida anti-vaccine study. Analysis of the received versions showed that the study was altered by Florida’s Surgeon General Joseph Ladapo, a former member of America’s Frontline Doctors group, and this alteration significantly impacted the interpretation of the results. Dr. Laxton is constantly receiving death threats and cyber harassment, which include mentions of Nuremberg 2.0 trials or pictures of the gallows.
The anti-disinformation fight did not spare me. A deep fake tweet was published under my name early this year, which was widely shared by prominent right-wing supporters, including journalists, lawyers, and politicians. The tweet eventually made it to Joe Rogan’s show, where he and Bret Weinstein discussed it for 11 minutes. After this much publicity, I received a massive amount of hate messages, hate reviews, threats, and tags to my licensing, certifying, and employing organizations. It made me seriously rethink whether I should continue the anti-disinformation work.
Having my personal experience and watching the experiences of other doctors, I cannot imagine the amount of hate that goes to Dr. Peter Hotez, an American scientist, pediatrician, and advocate in the fields of global health and vaccinology, since he is one of the most vocal and most publicly known anti-disinformation doctors. And I am infinitely thankful to Dr. Hotez that he continues to speak up and bring the voice of science to TV, social media, and his academic talks in universities and specialty societies.
Continuing the fight
While some physicians left the field of anti-disinformation and anti-science work completely, others, including myself, continue this fight. A fantastic group of scientists and physicians run Twitter Spaces and YouTube streams debunking poorly done research studies and explaining science and medicine to the general public. This year three books debunking disinformation are being published. The book We Want Them Infected by Dr. Jonathan Howard was recently released, and the books The Deadly Rise of Anti-science by Dr. Peter Hotez and Misinformation Kills by Dr. Allison Neitzel will be published later this year. An international group of anti-disinformation research enthusiasts investigates disinformation actors, their networks, funds, and political affiliations. Several grassroots organizations run projects combating COVID-related disinformation. A new organization, American Information Integrity Alliance, is being built with a broader view of the information space in general, medicine, and public health in particular. We hope to unite physicians and scientists to strategize and develop an effective plan to clean up the current polluted information space.
However, these initiatives are totally voluntary and should not be taken for granted. At some point, even the strongest and most resilient of us may say that this is enough — enough to spend personal time for anti-disinformation activities, sufficient to take time away from families, enough to carry the emotional burden of the fight while feeling helpless and hopeless, enough to deal with various threats, to adequately worry about personal and family safety, enough to deal with legal and administrative issues, enough to debunk the same conspiracies over and over again without public health or academic leadership speaking about them even once.
For example, in the last several days, the conspiracy of ventilators killing many patients in ICUs during the early pandemic was again revived on social media. Many physicians, including Drs. Craig Spencer, Jonathan Laxton, Eric Burnett, Jonathan Howard, and others, debunked this ventilator conspiracy in the past and did it again now. All are currently being threatened and harassed. The current situation is even more disturbing because the ventilator conspiracy was revived by a third-year medical student.
We need to talk about Kevin
Two years before completing medical school, the third-year medical student Kevin Bass became vocal on Twitter and began criticizing experts in different areas of medicine while being approved and encouraged by disinformation spreaders. Sadly, the unethical behavior of this medical student remains “invisible” to his medical school leadership, and Kevin continues to promote non-evidence-based treatments, disinform the public about the results of COVID-related studies, undermine the expertise of the public health and medicine leaders, and further damage the public trust in doctors and medicine in America.
The blindness of Kevin’s medical school fits the general pattern of academic institutions when it comes to their response to disinformation. Thus, top academic institutions blatantly ignore when their physicians and researchers are involved in unethical activities as long as they satisfy the publication and other metrics and bring funds and publicity to institutions. This is probably why some of the top disinformation spreaders, Dr. Jay Bhattacharya and Dr. Vinay Prasad, are not only holding faculty positions at Stanford and UCSF but the latter was promoted during the pandemic.
Academic institutions are not the only ones that failed to join the fight against anti-science. Unfortunately, state and national specialty organizations and medical associations demonstrated inadequate responses to medical disinformation. Rare educational print-outs, press releases, and articles published on organizations’ websites do not reach the general public and therefore fail to become practical tools for fighting medical conspiracies. Adopted anti-disinformation policies are a significant starting point but are toothless if no follow-up action exists. Recently, fifty national organizations announced the formation of the Coalition for Trust in Health & Science, aiming to combat medical disinformation. However, the fruits of this initiative, if any, are yet to be seen.
Celebrity doctors who took every opportunity to be on media platforms during the early pandemic, with little-to-no idea about the realities of the COVID front lines, suddenly became silent about medical disinformation. Journalists have not been consistent in the fight against medical disinformation. They occasionally partner with anti-disinformation doctors and publish some pro-science content; however, the outreach of these rare articles is not comparable to social media and media outreach used by conspiracy spreaders. Politicians either don’t see medical disinformation as worth their time or become prominent promoters of anti-science like Robert Kennedy Jr., who is now running for the highest political office in the country.
Whatever happened to Dr. Jha?
Dr. Jha was somewhat vocal about the danger of medical disinformation before becoming the White House Covid-19 response coordinator. Thus, in 2021 he said:
We have to find ways of reaching out to people who live outside our information ecosystem and engaging them. I think combatting misinformation is the biggest challenge of our time.
He also seemed to understand the necessity of special training for the next generation of doctors and public-health figures in the peculiarities of modern information space and new ways to foster effective communication:
So I have come to believe that the next generation of public-health figures all absolutely have to be trained in these things, have to engage in these things. Otherwise, we leave this new medium completely wide open to one group of people who are very, very good at exploiting it and using it for nefarious purposes. You just can’t walk out of the battlefield. This is the battlefield of information now. And you know, hearts and minds of the public are won by it.
However, as the White House COVID-19 response coordinator, he became much less vocal about disinformation and eventually ceased almost all activity in this area. He addressed “journalists and people who own platforms” and asked them to be responsible for the content they produce:
For journalists and for people who own platforms, what I would say is you should be thinking about what your personal responsibility is, and do you want to be a source of misinformation and disinformation? That’s up to those individuals.
The next time Dr. Jha’s speech about disinformation got widely shared in news media was in April 2023, when he called out physicians for not doing enough to fill the information vacuum.
Dr. Jha’s title in the White House COVID-19 response team is Coordinator. I believe that coordination of response to COVID-related disinformation falls into the direct responsibilities of the WH COVID-19 Response Coordinator. Calling individual physicians to step up and fill the vacuum is not what coordinated effort should look like. It is shifting responsibility from self to others.
It would be great to have the WH COVID-19 response Coordinator:
- Create physician’s training in infodemiology and effective communications, considering the power of social media in influencing the beliefs of the general public.
- Organize state and national media campaigns promoting science and medical knowledge.
- Publish regular articles accessible to the general public addressing medical conspiracies.
- Organize town halls for the general public where people can ask questions and be heard.
- Organize advocacy efforts reaching out politicians.
- Build a risk management strategy in case doctors involved start experiencing legal or administrative problems as a result of anti-disinformation work.
And so much more.
However, instead of doing any of these activities, Dr. Jha called physicians to do what he failed or got too scared to do. While mentioning threats to himself and Dr. Walensky — two top national public health officials with resources incomparable to any individual doctor in terms of safety and security — he didn’t offer any action plan or guidance to physicians in case they end up with legal or administrative problems with licensing or certifying bodies or hospital credentialing, or in case they start receiving hate messages, other forms of online harassment including negative reviews on the doctor rating sites, and threats including death threats.
As a person who experienced hatred himself, Dr. Jha should be concerned about physicians’ safety because we know that the anti-science crowd may come with actions because they have done this before by stalking people and sending drones. He also should be concerned about the emotional ability of physicians to handle such an amount of hatred because we also know that already burned out and morally injured people need only one last straw to cause irreparable consequences, and harassment by the anti-science crowd can be that last straw. Dr. Jha should be concerned about all this, but unfortunately, he isn’t.