Tweet your story, doctor

Physicians sharing personal stories on Twitter are seen as being more effective in communicating COVID-19 recommendations than impersonal messages from federal officials. That’s the conclusion of a study just published online by Dr. Rachel Solnick and colleagues based on a randomized experiment conducted with more than 2000 US adults.

This timely study underscores one of the most important points made at the recent Canadian Immunization Conference, namely that physicians and other health care providers are the most effective communicators when it comes to communicating the importance of COVID-19 vaccines.

“You’re abandoning your patients and leaving them open to an incredible amount of disinformation if you don’t get involved on social media,” said Dr. Todd Wolynn, a Pittsburgh pediatrician speaking at the meeting, during a session on countering the anti-vaccination movement. At the session, Dr. Wolynn was accompanied by Dr. Philipp Schmid, a behavioral scientist at the University of Erfurt in Germany who in 2016 literally helped write the book (along with Canadian pediatrician and former dean Dr. Noni MacDonald and others) on publicly responding to vocal vaccine deniers.

This and other sessions at the immunization conference came as public health experts and others plan on how to effectively disseminate vaccines against COVID-19 at a time when COVID-19 deniers and anti-science advocates are running rampant on social media.

The anti-vaccination movement is one of the older and most dangerous of the anti-science movements for its attempts to sway a number of well-meaning parents against life-saving vaccinations for their children. In recent months in Canada I have seen two other examples of physicians coming under virulent personal attacks as a result of their defense of public health initiatives.

The first was at the Canadian Cardiovascular Congress in late-October when I tweeted remarks from Drs. Stanton Glantz and Andrew Pipe on the negative impact of vaping which drew the ire of pro-vapers throughout North America on Twitter that did not subside for more than 24 hours. The second came just days ago when the Canadian Medical Association promoted the award it had given Dr. Najma Ahmed, a trauma surgeon in Toronto, co-founder of Canadian Doctors for Protection from Guns. The tweet from @CMA_Docs prompted days of attacks on Dr. Ahmed, other physician gun-control advocates and the CMA with many attempting once again to apply misdirection by referencing opioid overdoses, medical errors and physician privilege as reasons to discredit physician views.

These two recent incidents demonstrate just what can be involved for physicians who choose to take public health stances on social media that draw the ire of a segment of the social media population that is not afraid to stoop to any tactic to defend their views and discredit the opposition. It also underscores that the fact despite the acknowledged need for physicians to speak up on Twitter, this may come at a price that many are not willing to pay.

Physicians who choose to advocate for evidence-based public health initiatives to improve population health have to remember, as Drs Schmid and Wolynn pointed out, that their audience, is the general public and not the zealots posting against them. Social media and especially Twitter have never been the place for a full and frank debate about an issue so don’t expect to win any one-on-one arguments there.

Even knowledge or science itself is not a talisman against attackers. Your enemies will use science against you even if it is the science of the pre-print, press release, retracted paper or cherry-picking of evidence. More importantly, as Dr. Frédéric Bouchard, dean of arts and science at the University of Montreal, pointed out at another session during the immunization conference, “we must accept that scientific expertise is not just about facts and methods but also about building trust and working with integrity.”

Unfortunately it is when physicians are pitted against other physicians on social media that discussions often become most heated and upsetting.  Many Canadian physicians currently face lawsuits for challenging a colleague who they felt had published inaccurate and potentially dangerous views about COVID-19 treatments. Whether these suits are valid or not they raise the specter of libel chill which can dissuade even the most well-meaning physician advocate from venturing onto social media. But trite though it may sound, truth is an absolute defence against libel in virtually every jurisdiction in Canada.

The reality is that social media is where information is being most widely shared and disseminated these days. And to quote the brilliant English fantasy writer Terry Pratchett “a lie can run around the world before the truth has its boots on.”

Physicians such as Dr. Jennifer Gunter and academics such as Tim Caulfield are proof that people can survive or even thrive in the face of the anti-science movement. “Hide, ban or delete” is an effective method of dealing with comments from those who would mount ongoing personal attacks against you, your family and your motives on social media, as Dr. Wolynn pointed out.

And as the publications of Dr. Schmid and others demonstrate there are effective tactics to counter not just the anti-vaccination movement but any anti-science campaign.

tellAs we move into the critical phase of rolling out vaccines to control the COVID-19 pandemic, physician voices on social media are not just nice to have – they are essential for making certain science-based approaches are applied.

An earlier version of this blog was posted on kevinmd.com

Illustration shows the cover of The Debunking Handbook 2020 written by Dr. Schmid, Dr. Gordon Pennycook from the Hill-Levine School of Business, University of Regina, and others which summarizes the current state of the science of misinformation and its debunking.

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