Evaluating Health Misinformation

Anchoring Bias: the tendency to rely too heavily on the first piece of information received on a given topic.
 

Authority Bias: the tendency to believe in the opinions of authority figures, regardless of whether the authority is an expert in a relevant field.
 

Backfire Effect: the tendency to believe more deeply in a piece of misinformation after receiving a correction.

• Familiarity Backfire Effect: when misinformation becomes more believable when repeated in a correction.
   
• Overkill Backfire Effect: when misinformation offers a simpler, more believable explanation than an overly complicated correction.
   
• Worldview Backfire Effect: the tendency to reject a correction that clashes with one's worldview, thus reinforcing one's belief in misinformation.
   

Bandwagon Effect: the tendency to believe in something because others believe the same.
 

Confirmation Bias: the tendency to seek out information consistent with their existing beliefs, or to interpret information in a way that confirms these beliefs.
 

Continued Influence Effect: the tendency to default to believing in misinformation even after it has been corrected or disproven.
 

Implied Truth Effect: when misinformation appears to be true because it has not been corrected or disproven.
 

Repetition: when misinformation appears to be true because an individual has been exposed to it multiple times.
 

Tainted Truth Effect: when one is exposed to too many corrections of misinformation, thus making them distrustful of all information on a subject, including that from credible sources.

 

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Sources:

Cooper, N., & Frain, J. (2016). ABC of Clinical Reasoning. John Wiley & Sons, Incorporated.

Howard, J. (2018). Cognitive Errors and Diagnostic Mistakes: A Case-based Guide to Critical Thinking in Medicine. Springer. 

Misinformation can be challenging to address due to various components that interact with this false knowledge, such as an individual’s political, social, cultural and economic perspectives. It can be especially difficult to attend to if a piece of misinformation is deeply rooted as part of someone’s identity as attempts to correct false information may be interpreted as an attack of their character. For healthcare providers, it is essential that they approach this issue with care as criticism, judgement and blame in this sensitive patient communication can lead to deterioration of therapeutic relationships and rapport. 

Below are some guidelines for the “Do’s” and “Don’ts” for addressing misinformation in a clinical setting. 

 

   

 

Do’s
 

Show empathy and find common ground.

Instead of asking "why do you think this way?" (can be perceived as hostile), ask "what have you heard in your community?" (American Medical Society, 2021)   Understand that some members of marginalised communities may have an underlying distrust of the government and healthcare system due to past and present discrimination (American Medical Society, 2021)   Establishing shared understanding supports a healthy clinician-patient relationship and fosters trust (Street, 2021)

Correct misinformation actively as early as possible.

This can prevent misconceptions from becoming entrenched (Vraga & Bode, 2020) Combats the implied truth effect, where someone think something is true because it has not been proven false (Vraga & Bode, 2020)

Ask questions about misinformation claims.

This encourages propagators to reflect on the information. (Shaw, 2020) Appeals to coherence have been found to be more effective than appeals to credibility (Walter & Murphy, 2018)

Explain why something is false, in addition to stating that it is.

Offer an explanation for the origin of the misinformation can boost the power of corrections (Vraga & Bode, 2020)

Introduce the correct alternative to a misinformation claim.

Give patients an alternative explanation to fill their gap in knowledge; otherwise, individuals may continue defaulting to misinformation (Cappella et al. 2015; Chan et al, 2017; Vraga & Bode, 2020)   Introduce an alternative explanation makes it easier to doubt the original misinformation claim (Cappella et al. 2015)

Cite credible information, and provide access to expert sources.

Patients are more likely to trust authorities like government agencies and news media sources (van der Meer & Jin, 2019; Walter et al., 2021)   In addition to giving patients a helpful resource, this can direct negative repercussions away from you (Vraga & Bode, 2020)

Repeat the message even if others have already made the same correction.

Repetition reinforces a message (Vraga & Bode, 2020)

Tailor messages for specific audiences.

Convey messages in a way that is personally relevant to patients, e.g. discuss how public health crises affect vulnerable family members rather than focus on the science behind it (American Medical Society, 2021; Cappella et al. 2015)

Use analogies, pictures, and narratives. (Cappella et al. 2015; Street, 2021)

Create familiarity by relating new information with knowledge/experiences a patient may already have (American Medical Society, 2021)

Increase your own knowledge as a trustworthy authority. (American Medical Society, 2021)

Help educate others in your healthcare team to ensure that the message being sent is consistent. (American Medical Society, 2021)

 

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Don't’s
 

Avoid repeating the misinformation claims in the process of correcting them. (Shaw, 2020)

Familiarity backfire effect: seeing the false claim again can make the misinformation feel more familiar, and therefore deepen one’s belief in it (Vraga & Bode, 2020) Directly quoting or linking to misinformation online can increase its reach and help it attract more attention

Avoid using harsh and confrontational language when correcting misinformation.

Patients may not be open to conversation when they feel judged, as it suggests that their perspectives will not be understood (American Medical Society, 2021)

Don't challenge the propagator's worldview or identity.

Understand that beliefs may be informed by religion, political views, and culture, and do not give opinions beyond correcting the misinformed claims (American Medical Society, 2021; Shaw, 2020)

Avoid jargon that your audience may not understand.  (American Medical Society, 2021)

Common myths and misinformation that are prevalent online can be found debunked below with their respective sources for information:

WHO: Coronavirus Disease (COVID-19) -related myths debunked

• Vitamin and mineral supplements cannot cure COVID-19 → micronutrients such as vitamins D and C as well as Zinc are essential for a properly functioning immune system but there is no guidance on the use of these supplements as treatment.
   
• Prolonged use of medical masks does not cause CO₂ intoxication nor O₂ deficiency → although prolonged medical mask use can be uncomfortable it does not lead to adverse events relating to oxygen insufficiency or carbon dioxide poisoning.
   
• Spraying and introducing disinfectant products into your body will not protect you against COVID-19 → do not under any circumstance spray or introduce disinfectants products such as bleach into your body as these substances are poisonous if ingested.
   

CDC: Autism and vaccine-related myths debunked

• Vaccines do not cause autism → numerous studies have shown that there is no link between receiving vaccines and developing Autism Spectrum Disorder (ASD) 
   
• Vaccine ingredients do not cause autism → numerous studies have found that Thimerosal, a mercury-based preservative used to prevent germs from contaminating vaccine vials, does not cause autism. In fact, all childhood vaccines have been reduced to have  trace amounts of this substance and it is only used in flu vaccines, for which thimerosal-free alternatives exist. 
  

National Cancer Institute: Cancer-related myths debunked

• Cell phones and power lines do not cause cancer → low-frequency energy emitted from cell phones do not damage genes and neither do electrical and magnetic energy emitted from power lines.
   
• Herbal products do not cure cancer → some studies suggest alternative or complementary therapies to help patients cope with side effects of cancer therapies, but there are none that are found to be curative for cancer. 
   
• Antiperspirants or deodorants do not cause breast cancer → studies have found no evidence linking chemicals found in antiperspirants and deodorants with changes in breast tissue.

Canadian Mental Health Association: Mental Health-related myths debunked

• Mental illnesses are not just an excuse for poor behaviour → no one chooses to experience a mental illness and may feel embarrassed or ashamed around others due to changes in their behaviour. However, people with a history of mental illness are like anyone else and are prone to making poor choices or unexpected changes for reasons unrelated to their illness.
   
• People with mental illnesses are not violent and dangerous → research shows that mental illness is not a good predictor of violence and that people who experience mental illness are no more violent than people without mental illness. People who experience mental illness are much more likely to be victims of violence than to be violent.
   
• Kids can have a mental illness like depression → even children can experience mental illness and often many mental illnesses first appear when a person is young. Although mental illness may appear different in children compared to adults, it can significantly impact the way they learn and build skills for the future. 

BC Interior Health: Vaping-related myths debunked

• Vapour products are not harmless → vapour products are marketed as a harmless alternative to smoking, but there is emerging research cautioning of long term risks related to vaping and lung health
   
• E-juice does contain nicotine → vapes can contain psychoactive substances with the most common ones being nicotine and THC. Nicotine is addictive and can change a developing teen’s brain activity in attention, memory, learning, impulsivity and mood. 
   
• The “cloud” from a vape is not just water → the aerosol of fine particles produced from a vape may contain heavy metals such as nickel, chromium and lead as well as formaldehyde during heating. These substances can be inhaled into the lungs and have been linked to cancer and respiratory and heart disease.