Opinion: social media presents challenges with regards to fake news and misinformation especially when it comes to health matters 

By Cormac MullinsUniversity Hospital Limerick and JJ CoughlanGerman Heart Centre

It started with a tweet on March 14th. 

"Taking anti-inflammatories could worsen the infection": the source was the French Ministre des Solidarités et de la Santé Olivier Vernan. This advice was attributed to an infectious disease expert in southern France who referenced four cases of young patients who became seriously unwell from Covid-19 while taking non-steroidal anti-inflammatory drugs. The hospital released a comment stating it was inappropriate to discuss individual cases in public.

The WHO responded with a follow-up Tweet on March 18th:

The cases of the four young patients remain unpublished and unverified. A subsequent study, while not providing definitive evidence, appeared to show that anti-inflammatory drugs were not associated with hospitalisation or ventilation in Covid-19, and may in fact reduce mortality. While insufficient evidence exists to fully settle this question, it encapsulated the uneasy relationship that exists between healthcare and social media. 

Many of us use platforms like Twitter to share our thoughts and feelings or to comment on topical items. Users can interact with each other by "liking" tweets, commenting, or "re-tweeting". In the era of Covid-19, where hospital-based services have been abruptly curtailed, online platforms and telemedicine have allowed services to continue to function.

Social media can also be used to provide important public health information and to counter misinformation. It has also been associated with benefits in other healthcare settings. Online communities can allow sufferers of similar medical conditions to interact with each other which can be an important source of support. Social media use has even been associated with improved social, psychological and cognitive outcomes for patients suffering with chronic pain. 

The WHO has provided regular updates on social media throughout the pandemic and its most shared tweet was on March 11th which announced that Covid-19 was a pandemic

But while the WHO’s efforts are aimed at providing objective advice on an evolving situation, the discourse that takes place on social media platforms is often highly emotive with an emphasis on opinion and personal experience, rather than on scientific evidence. Accordingly, the tweet that gained the greatest responses on Twitter throughout the pandemic at 1.6 million likes and 361,900 retweets belongs to Elon Musk

If you’re looking for a medical opinion, social media may not be the place to go to. 

Online discourse can distort scientific evidence and medical opinion. A recent study showed that an online parents’ discussion forum had a negative impact on the uptake of childhood vaccinations. Members of the public may be misled on such platforms. Up to 40% of Americans doubt their doctor’s professional opinion when it conflicts with online information from social media websites.

Disparities can exist between the public perception of the medical opinion and the reality. A vocal minority on social media forums can make some views appear more mainstream than they actually are, which can result in the 'echo chamber’ phenomenon, whereby being exposed to opinions similar to our own reinforces them. In this way, the viewpoints of the ‘silent majority’ can be under-represented. The Cambridge Analytica scandal has demonstrated that this knowledge can be used to twist public discourse and manipulate public opinion.

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From RTÉ Radio 1's The Business, a look at the Cambridge Analytica scandal over the use of the personal data of over 50 million US Facebook users 

Users of health services, particularly those who are on long waiting lists, can be vulnerable to misleading information. A review found that YouTube users have a high likelihood of coming into contact with poor quality information, primarily anecdotal, even where high quality material produced by government and professional organisations exists.

The healthcare profession needs to adapt to novel ways of delivering healthcare which should be "in the right place at the right time" according to Sláintecare. Increasingly, this place is online and on social media platforms. New ways of thinking are required in order to develop a symbiosis between the healthcare profession and social media. This may require the development of guidelines and formal education for doctors on the use of social media in the delivery of healthcare. Doctors and scientists can often feel drowned out by commentators who have little or no experience of providing care to patients. This marginalisation is bad for patients.

Social media exists at the sharp end of the 24/7 news media which can prohibit considered reflection on the limitations of science and the uncertainty of medicine, particularly within 280 characters. The information surplus offered by smartphones can be deceptive and offer the illusion of knowledge. Doctors and scientists are needed to mediate online discussions on matters of health by applying the principles of science and medicine, indicating what information is reliable. This can prevent harm for those who do not access healthcare through traditional formats. While social media presents challenges with regards to fake news and misinformation, open engagement from doctors and scientists can help to use social media as a force for good. 

Dr Cormac Mullins is a fellow in pain medicine and anaesthesiology at the Department of Anaesthesiology, Intensive Care and Pain Medicine at University Hospital LimerickDr JJ Coughlan is a medical doctor, specialising in cardiology who is a Research Fellow at the German Heart Centre

The views expressed here are those of the author and do not represent or reflect the views of RTÉ