Health misinformation here to stay: CMA poll

Canadians are seeing an increasing growth in misinformation about health and healthcare online and on social media at exactly the same time as many are losing access to their most trusted source of information on these topics – family physicians.

Attitudes towards misinformation about health was the focus of newly initiated annual survey commissioned the Canadian Medical Association (CMA) on the Health and Media, results of which were just released. These results and virtual webinar discussing the results came just days after the World Medical Association held a virtual panel on the topic of disinformation in health care.

The CMA survey of 2500 adult Canadians conducted by Abacus Data in September, 2023 found that the majority of English respondents (57%) reported having often come across health and health system information that they later found to be false or misleading.

The CMA survey found generational differences in responses, with younger respondents being more likely to use social media platforms to access health news and information. However, only about 20% of those polled said they trust these social media sources to provide accurate information.

In addition, the survey also found that 72% of Canadians believe health-related misinformation is here to stay and is in fact getting worse. And 40% of those polled said such misinformation has led to anxiety or mental distress.

At a time when millions of Canadians no longer have access to a family physician it is concerning that the CMA survey confirmed that physicians are their most trusted source of health information – followed closely by nurses and pharmacists.

Misinformation and social media have been a focus of the CMA since the presidency of Dr. Katharine Smart in 2021-2022. She made the explicit link between the current shortage in family physicians and the impact this had on Canadians being able to access to a trusted source of medical information.

In a podcast in 2021 she stated: “We have assumed that Canadians have access to a trusted source of medical information to make their health decisions. But more and more, that’s not the case. Over 5 million Canadians don’t have access to a family care physician, which has always been that foundational relationship that people have had and that source of trusted health information.” She went on to say this declining access to experts had been coupled with an increasing access to information which, on social media, is often poor.

In this and other presentations, Dr. Smart talked about the need to reimagine the role of physicians and “stepping up” to share accurate health information online and counterbalance misinformation.

At a virtual session to discuss the current CMA poll, current CMA President Dr. Kathleen Ross reiterated the need for physicians to take a more prominent role in promoting accurate health information in online discussions and on social media. She and journalist Wency Leung, who was also part of the session, also said those promoting accurate health information online or on social media should have their voices amplified by the media and other sources.

Misinformation was also the focus of a session held at the CMA Summit last year and featuring Tim Caulfield, Canada Research Chair in Health Law and Policy and arguably one of the country’s most pro-science advocates. Caulfield talked about the politicization of health misinformation, the fact this false information was resulting in people dying, and the need for physicians to take a prominent role in promoting accurate information.

The CMA is taking an explicit role in promoting accurate health information with the launch of CMA Media in 2022. In addition to funding health reporting positions at Canadian Press to promote more accurate health reporting, CMA Media also plans to develop new and innovative ways to connect online with the younger audience singled out in the recent polling results.

Messaging from the CMA and WMA was mirrored in an opinion piece published by a pair of physicians from the Netherlands in the BMJ last August. Drs. Leonard Hofstra and Diederik Gommers argued that “orchestrated social media action organised by doctors, in collaboration with media specialists, can be highly effective at countering misinformation” – a point also made by Dr. Ross.

Despite the growing toxic nature of some social media platforms such as X, Drs. Hofstra and Gommers noted “staying focused on medical aspects, instead of commenting on political issues, increased our impact and helped keep us out of trouble (such as direct threats) while using social media.” 

The CMA survey findings are in keeping with a more general survey done by Statistics Canada and reported at the end of last year which showed that 59% of Canadians said they were very or extremely concerned about any type of misinformation online, and 43% felt it was getting harder to determine what was true online compared with three years earlier.

An earlier Statistics Canada survey conducted during the early phase of the COVID-19 pandemic in July 2020, found that 90% of Canadians used online sources for information about COVID-19 and 96% of these saw information online that they thought was misleading, false or inaccurate. Just over half (53%) said they shared this online COVID-19 information without knowing whether it was accurate or not.

The global battle against health misinformation

Misinformation and disinformation about health and healthcare is never “old news” and must be challenged repeatedly using a variety of strategies and tools.

That was one of the key messages to emerge from a World Medical Association virtual panel discussion featuring a panel of international experts who made it very clear that the spread of false information about health and healthcare whether done maliciously or not is a major global threat.

Speakers at the virtual session were:

• Dr. Natalia Solenkova, a critical care physician and moderator of the panel. Dr. Solenkova is a prominent advocate for vaccination with a strong social media presence.
• Katie Owens, an information and communications officer for the European Commission.
• Siddhartha Shankar Datta, a regional adviser on vaccine-preventable diseases to the World Health Organization regional office in Europe.
• Dr. Natalia Pasternak (PhD), a Brazilian microbiologist and prominent pro-science advocate in Brazil. She currently teaches science for policy-making at the School of International Relations and Public Affairs at Columbia University.
• Dr. Osahon Enabubele, a family physician and past president of the World Medical Association and the Nigerian Medical Association

While panelists focused on the spread of mis- and disinformation during the COVID-19 pandemic they stressed how the phenomenon has existed long before COVID-19 and has infiltrated all areas of healthcare from cancer to mental health. Each speaker was careful to differentiate between misinformation intended to deliberately spread false information and disinformation in which relaying incorrect information is not intentional.

In her introductory remarks, Dr. Solenkova noted the global spread of misinformation and how some physicians and other health care provides have contributed significantly to this spread. She also noted how the growth in the number of published research articles contributing to misinformation has documented by the growing number of retractions of articles.

In her presentation, Owen noted how a small, but vocal and coordinated group of individuals spread misinformation and sow “fear and uncertainty” across a variety of topics from vaccines to climate change, migration and health and the Russian invasion of Ukraine.

Owens documented the impressive number of steps the European Union has taken against mis- and disinformation in healthcare noting the need to find a balance between countering incorrect information and allowing free speech.

She noted that when challenging misinformation “prebunking” through education and information is often more effective than “debunking” false information that is already circulating. She talked about the importance of communicating at the right time, using appropriate language, on the most used channels, using trusted messengers. Owens and other panelists also talked about the value of networks and collaborative approaches.

Datta discussed the complexity of the journey to vaccination and how dealing with the issues involved is not linear. He said the demand for vaccines and acceptance of vaccination is multifactorial and context specific – depending on time, location, and the vaccine involved.

In common with other speakers, he stressed the importance of physicians and other healthcare providers as being trusted sources for information on health issues and how their interaction with patients or caregivers is critical in getting vaccines accepted.

“Parents desire consistent and accurate information about vaccination benefits and safety presented clearly and in simple language, conveyed in a respectful and positive manner,” Datta said.

Marginalized and underserved communities are often reached last when it comes to providing official information on vaccines and other health interventions and this means those promoting misinformation will often reach them first. Complex and locally designed interventions and community leaders and micro-influencers are effective, he said.

Dr. Natalia Pasternak discussed her work with the Instituto Questão de Ciência, a non-profit organization in Brazil dedicated to the promotion of scientific and critical thinking and the use of scientific evidence in public policies.

“We are trying to bring science into policymaking by engaging by government members and medical associations,” she said, in addition to providing courses for physicians and healthcare workers and journalists.

She discussed her 9-hour deposition against then Brazilian president Jair Bolsonaro (who warned the COVID vaccine can turn people into crocodiles) and learning how difficult it is to speak to different publics in a polarized, political environment.

“Scientists need to be more capable of speaking to politicians. We have to be there. We have to provide them (politicians) with tools to make better decisions,” Dr. Pasternak said.

She also talked about working with the Brazilian Society of Pediatricians and how many pediatricians were concerned they did not have the proper information or training to communicate about vaccine safety. “Physicians want this training and someone should be providing this training,” she said. During pandemic people started questioning all vaccinations – got pediatricians “really, really worried” that they don’t know what to say to these parents and that they required training