In the present-day digital world, it is challenging to function comprehensively, given
our increasing reliance on the internet, which has touched every aspect of our lives,
including healthcare. We are constantly inundated by false information, including
medical information—purposefully deployed—that spreads so quickly and persuades so
effectively.1 Some of this online health information includes interactive websites,
internet-based games, online health press rooms, disease symptoms simulations, opinion
polls, Twitter feeds, and doctor–patient online consultations.2–5 The professional
and personal blogs, podcasts, chat rooms and forums are hallmarks of today’s medical
care and a prominent source of health information among different kind of audiences,
including the present group of general practitioners.
Hence, there is an ever-increasing need to check and evaluate data sources, particularly
news items related to health and disease. It is imperative that online communities
on social media platforms, such as Facebook, YouTube and Twitter, are aware of the
authenticity of posted materials.6 Some of the vivid examples of this widespread dissemination
of ‘fake news’ claim statements such as ‘birth control makes women unattractive and
crazy’3 or ‘curing cancer using carrots’.7
In September 2017, a website called eternally.com, registered in Phoenix, Arizona,
published an article with the headline ‘Dandelion weed can boost your immune system
and cure cancer’. It was the most popular article on Facebook with the word ‘cancer’
in the headline last year, receiving more than 1.4 million shares, likes and comments,
according to two separate web analysis tools. This potent root has no clinical evidence
to support its miraculous characteristics.4 A PEW Foundation survey in 2013 in the
USA revealed that 6 out of 10 Americans go online to find the cause for their medical
condition.1 Of those who found a diagnosis online, 35% of respondents said they did
not follow this up with a visit to a professional medical provider. The online medical
advice can reinforce inaccurate views or biases, particularly when lay people follow
online bloggers with false and inauthentic health-promoting or disease-alleviating
claims.2 The Food and Drug Administration in the past decade issued 90 warning letters
to companies for producing products claiming to cure cancer. People who are suffering
from such life-threatening diseases can fall prey to such claims or scams. Unfortunately,
fake medical news can be written very persuasively, and it is easy to be seduced by
false promises.
Before the age of internet, the news that was broadcast was produced and distributed
by a few organisations or private companies like the British Broadcasting Corporation,
the American Broadcasting Corporation or the National Broadcasting Company. These
companies had a rigorous editorial process that checked for any fake news (minimised
or eliminated unverifiable news). However, now, with the advent of the internet, any
individual who has access to the internet is able to broadcast news online without
being subjected to a rigorous editorial process.
In the last two decades, with the heralding of the World Wide Web and millions of
websites on health issues, we have an explosion of varied information leading to information
overload, according to Seymour, an assistant professor of oral health policy and epidemiology
at Harvard University.8–10 As a result, we as health information consumers are faced
with the conundrum of distinguishing between objective facts and personal opinions.
In this atmosphere of information overload, objective facts are less influential in
shaping public opinion than appeals to emotion and personal belief. For example, a
personal account of battle with cancer using alternative therapies might have worked
for an individual, but a personal narrative is used as an instrument to advocate for
questionable therapies.
Seymour opines that we have reached this situation in the present era because the
balance of influence has shifted from broadcasters to individuals. Traditional broadcasters
who used to provide authentic filtered information have been currently replaced by
individual broadcasters who can put out information on the internet with similar ease
as traditional broadcasters. The problem of fake news gets more exacerbated with connected
networks that quickly reject any dissenter or contradictory piece of evidence.
Fake news consists of deliberate misinformation spread via traditional print and broadcast
news media or on social media. Furthermore, fake news, particularly medical news,
is written and published with the specific intent to mislead in order to damage an
organisation and/or a person, often with sensationalist, exaggerated or patently false
eye-catching headlines.
There are several types of fake news. The first consists of inadvertent reporting
of mistakes. These happen because of errors and gaps in the editorial process. Second,
sometimes rumours lead to fake news. The third consists of conspiracy theories; these
are, by definition, difficult to verify as true or false, and they are typically originated
by people who believe them to be true. Fourth, satire that is likely to be misconstrued
as factual also lead to fake news. Fifth, false statements by medical professionals
or pharma companies in order to make profits add to fake news. Lastly, the most problematic
fake news consists of reports that are slanted or misleading but not outright false.11
The conception of present-day information sharing is based on the historical marketplace
of ideas metaphor.12 According to this metaphor, the internet is akin to a vast market
where any individual can sell and buy his or her produce. In the context of medical
news, this idea applies as any individual can post medical information on the internet;
however, in this open marketplace of medical information, the consumer has to use
his or use personal discretion to choose the best information that he or she wants.
The underlying philosophy behind this is that robust engagement of ideas in a marketplace
deals with an opportunity of offering diverse valid ideas.13 Additionally, the assumption
is that multiple ideas on medical information should be the corrective to bad ideas
and falsehoods. In this vision, regulation of medical information is not advocated,
given the logic that any editorial intervention would harm the marketplace’s natural
and dynamic progression.
Inherently, Syed14 plays a devil’s advocate and argues that this vision has two fundamental
flaws, depending on how much information is available in a society: she questions
that, what happens when individuals do not interact with contrary medical information
because they are easy to avoid? Moreover, what happens when medical information is
not heard at all because there is too much of it? Furthermore, the marketplace of
ideas12 philosophy is based on the premise that the best and most accurate medical
information wins. However, it fails to acknowledge, let alone address, questions of
power irrevocably relevant in the present-day internet era, particularly with social
media.
As mentioned earlier, the original marketplace metaphor sprang forth a couple centuries
ago when the capacity to reach the general population through ‘more speech’ was restricted
to a powerful few. In that era, few individuals truly had monopoly over information
(like a pulpit or a pamphlet), but communicating to the masses was unattainable to
most. For example, a person such as a preacher was listened to and believed by the
majority of people. Thus, the marketplace never needed to address these power differentials
when only the powerful had the technology to speak at scale.
In the present-day era, the internet, particularly social media platforms, have radically
improved the capabilities of many individuals to put out medical information, but
the marketplace theory lags behind.12 For example, the marketplace theory is not able
to address powerful individuals who post medical information and drown out other voices.
These include pharmaceutical companies who flood Twitter posts critical of their drug
with unrelated content and hashtags to obscure the offending post.
Added to this dilemma is the present situation in which there is intense competition
for legitimate medical information, given the easy access to online advertising revenue,
increased political polarisation and the popularity of social media, primarily the
Facebook News Feed. These play a major role in the spread of fake medical news. Anonymously
hosted fake medical news websites lacking known publishers have also been guilty because
they make it difficult to prosecute sources of fake news for libel. With the expansion
of easy hosting technology, the need for views and ratings has been increasingly higher.
For medical news outlets, the ability to attract viewers to their websites has become
a bigger necessity in order to please advertisers that pay for advertising on their
websites. Publishing medical information with false content has become an easy way
to produce a big caption and attract viewers in order to benefit advertisers and ratings.
There are several questions that are faced by individuals who want to obtain authentic
medical information. According to Syed,14 when we consume medical information on the
internet, we should ask: how do digital technologies change the social conditions
in which individuals put out medical information? Further, in the context of theorising
for better trustworthy medical information, we modify and apply Syed’s suggestions,
arriving at five conspicuous ways to sort and help us filter fake medical news.14–16
Apply multiple checks with online information
While searching for medical information, it is advisable to use multiple checks. Since
there is far too much information to consume in an online environment, there is a
need to weed out authentic factual information from fiction. Thus, there is a necessity
to provide information filters. It is important to use actual typed filters that explicitly
consists of search terms or hashtags on Twitter. These can filter out misinformation:
for example, if one searches ‘cancer cures’, one will receive very different results
than if one searches ‘fake cancer’. Typed medical dedicated filters can also include
trained individuals who curate what is accessible on social media, like the concept
of medical information editors or moderators.15 16
Additionally, medical authorities hosting information should employ less visible implicit
filters. These obvious filters consist of mathematical equations that either watch
your movements automatically or change based on how you filter by typing specific
words. These filters explain how websites decide a particular content helps an individual
user, with the goal of increasing that user’s attention to the medical website. Let
us see how this applies to an individual using the internet. If an internet user glances
at a ‘miracle cure’ or a ‘weight loss programme’, the internet predicts his/her search
as a specific cue to look for cure and weight loss. Multiple such searches cue these
frantic attempts and accordingly supply false medical information. Similarly, viewing
a fake medical article that provides information about a miracle health cure continues
to supply similar content to the internet user applying the mathematical formula,
even though a filter is used. In essence, apply as many filters as possible to narrow
down your search when seeking health information.
Enhancing digital communities
Just like information filters assist in weeding out false medical content, we, as
informed consumers of health information, need ‘digital community-based interpersonal
filters’. An essential skill is to ask for suggestions from your immediate social
network for places to look before seeking medical information. In this case, trusted
information that has been found useful by your ‘closed in person group’ is tested.
Likewise, if you find any information online that looks interesting, share it first
with your immediate colleagues and get their opinions. The personal digital community
that you belong to can easily overcome any problems of distances. Build your own trustworthy
group of individuals; for example, one can have a closed Facebook online community
network with a moderator who controls and appraises the information communicated via
this network. In this way, there is a good filter, especially for fake information.
Through developing these social networks, these groups can produce their own methods
to create, put out and avoid fake medical information. Your personal online group—consisting
of friends you trust—can provide you with different choices that are authentic based
on their personal experiences. This mechanism will provide a grounds-up approach that
is full of personal trust as opposed to conventional confusing flow of information
from the wide-open World Wide Web.14–16
Detecting and avoiding information growth
Information on the internet spreads like wildfire, in part due to the ‘amplification’
process. During amplification (information growth or multiplication), fake medical
information rotates through filters and reaches groups because of the immense capacity
of the internet. There are a couple ways by which this happens: (1) to start with,
untrustworthy medical news is generated in isolated areas of the internet, and (2)
second, this medical information floods into traditional journalism outlets where
it is accessible to everyone. It is here that this untrustworthy medical information
overcomes the typed filters that we put in. After this process, individuals attach
a hashtag that leads to more quick spread on Twitter, thus increasing the viewpoint
that a specific medical story is good. It is here that the acceleration helps in perpetuating
the viewpoint that a particular medical news story is authentic or not. The literature
in personal psychology explains that we as consumers of information evaluate information
logically and, more importantly, by a process of outside cues that point out if the
information can be believed. The pointers of trust are related to if the information
provider is trustworthy and also the information consumer’s earlier thoughts and a
person’s familiarity with the information. The familiarity is most important here
as we are more prone to believe the information that is told to us again and again.
Avoiding the traps of amplification could help falling in the trap of consuming fake
medical information.14–16
Recognise and counter profit-related motives
During each search for medical information, it is important to recognise that profit
motive drives the social media platforms, and this makes fake medical news all the
more prone to manipulation. Each online visit to a medical article results in adding
to the popularity of the article thus helping raise the ad revenue generated. This
is the incentive which fuels the desire to produce medical information which does
not involve much editorial cross checking. Any popular medical information that is
made up to further the profits is preferred by social media platforms. It can again
happen in two ways: The advertising dynamics leads to adding to false content as unlike
the traditional printing process, the online distribution does not involve the production
and distribution efforts. The online production further fuels this process. Second,
it is difficult to distinguish between advertising platforms disguised as medical
websites. It leads to conflict between the authenticity of information and external
monetary incentives. Computer-based algorithms can now filter ‘false advertisements
‘on the internet.14–17
Practical tips and proposed solutions for managing fake medical information
In conclusion, we have three suggestions for medical and healthcare practitioners:
Each one of us has to empower ourselves with informed tools to navigate health information.
Healthcare practitioners need to use the following criteria for evaluating internet
resources (particularly websites): applying multiple checks with online information,
enhancing digital communities, detecting and avoiding information growth, and recognising
profit-related motives.16 17
The previously mentioned filters should greatly assist general practitioners as well
as lay people in weeding out false information and news.