What’s the harm in… social media?

From unfounded fears about Coronavirus to ill-educated advice from our peers, what’s the risk of getting health advice online? Tannice Hemming investigates.

As a mum to two children under 5, I spend quite a bit of time in mum groups. I find them useful for picking up tips and learned most of what I know about weaning online. There’s no doubt that social media groups now form at least part of ‘the village’ that our parents’ generation had in person. Ask a question at 4am about your toddler’s high temperature and you’ll be inundated with advice. It’s the same with breastfeeding support – crucial since breastfeeding support funding has been slashed across the country. Yet not all advice is of equal value and many social media groups are becoming more and more aware of the trend to seek medical advice online. Several explicitly ban posts of that nature. Others thrive on recommending herbs and homeopathy over ‘allopathic’ medicine. 

Pregnancy groups are also full of it – does anyone have any experience with high blood pressure? Should I decline the glucose tolerance test? Should I decline vaccines when I’m pregnant? It’s clear that people now see doctors and other healthcare professionals in a different way to the generations before who grew up without access to instant information and ‘Dr Google’. We’re less subservient to medical professionals and definitely don’t suffer with ‘white coat’ syndrome anything like as much as our elders did. 

Being informed can usually only be a good thing, but what’s the danger of too much information? What’s the worry behind seeking advice online and what could lie behind the advice those internet strangers give out?

Public Health and Social Media

It appears health authorities are keenly aware of the dangers posed by asking health questions online. Lately there have been health drives to discourage the use of home dopplers in pregnancy  as well are an attempt to raise awareness of the importance of tracking baby movements in pregnancy. Many women have been told that babies will move less towards the end of their pregnancy as they get larger. It seems plausible yet this is old-fashioned and downright dangerous advice. Belief in myths like this can mean women wait far too long to seek medical assistance.

Death by crappy advice

Newspapers and social media groups have been full of the news of the death of a young boy from flu after his mother was discouraged from giving him the prescribed Tamiflu. Just 4 years old, the Colorado boy’s mother spent time within social media groups dedicated to anti-vaccination agendas. The group, according to the Guardian, is named “Stop Mandatory Vaccination”, with almost 140,000 members. Soliciting ‘natural cures’, the boy’s mother received ideas ranging from use of peppermint oil to lavender. The family also received care for their 10-month-old whose heart stopped because of the flu.

The American Academy of Family Physicians, where the boy lives, released the results of a survey in January 2020, revealing that a shocking 59% of parents have refused flu shots for their children due to misinformation. Results that are likely similar in the UK where parent groups are full of people decrying the efficacy and worthiness of these life-saving vaccinations. I see it on a weekly basis.

Whose responsibility is it? What can Facebook do?

In July 2019 it was reported that Facebook were going to ‘crack down’ on groups that perpetuate anti-vaccination agendas. However, they fell short of removing posts entirely, preferring to ‘diminish the reach’ of the posts by degrading their prominence in search results and removing ads or recommendations for the groups. Yet, in November 2019, a major new study by researchers at the University of Maryland, George Washington University, and Johns Hopkins actually found Facebook doing the polar opposite. They were blocking adverts that were pro-vaccine for being “overly political” and allowing anti-vaccination campaigners to specifically target women in their mid-twenties (the most likely to be new mums) specifically in areas that were struggling with measles outbreaks. Critics of the social media platform will lay a lot of the blame for the boy’s death at Zuckerberg’s empire.

The study stated: A small set of anti-vaccine advertisement buyers have leveraged Facebook advertisements to reach targeted audiences. By deeming all vaccine-related content an issue of “national importance,” Facebook has further politicized the vaccines.” 

Labelling vaccination health posts as political is itself ludicrous, given that the medical consensus that vaccines are safe and there’s no link with autism.

What’s a Public Health communicator to do?

Straight refutation of anti-vaccine propaganda can often backfire spectacularly. So Public Health communicators have a huge problem on their hands. Studies show that directly confronting myths actually only serve to reinforce the belief in the original falsehood. These techniques backfire so spectacularly, it’s now known as the backfire effect. Also known as confirmation bias, it means that we are more likely to double down on our pre-existing beliefs and the repetition of the falsehood just serves to further strengthen our conviction.

As psychologist Thomas Gilovich states in his seminal tome, How We Know What Isn’t So, “when examining evidence relevant to a given belief, people are inclined to see what they expect to see, and conclude what they expect to conclude…for desired conclusions, we ask ourselves, ‘Can I believe this?,’ but for unpalatable conclusions we ask, ‘Must I believe this?’”

Breaking through cognitive dissonance is difficult and something researchers have been battling since the birth of the internet and the rapid spread of misinformation the technology affords.

behaviouralpolicy.org have had a go at tackling this thorny issue with their guide to tackling erroneous beliefs. This five step approach asks consumers to look at the social consensus, supporting evidence, consistency with their own beliefs, the coherence of the ‘story’ and the credibility of the source of evidence. 

Crucially, they reference the backfire effect when they argue “The popular myth-versus-fact format unwittingly reinforces the myths by repeating them, which makes them more influential once memory for the less familiar (and often more complex) facts fades”

Steffens et al, 2019 have specifically tackled the issue of how public health organisations should tackle misinformation online. They concluded: “organisations promoting vaccination face multiple challenges on social media, including misinformation, anti-science sentiment, a complex vaccination narrative and anti-vaccine activists. [The organisations] developed a range of sophisticated strategies in response, including communicating with openness in an evidence-informed way; creating safe spaces to encourage audience dialogue; fostering community partnerships; and countering misinformation with care.”

The key recommendation from the study was that “refutations should be straightforward, succinct and avoid emphasizing misinformation. Communicators should consider pairing scientific evidence with stories that speak to audience beliefs and values.” 

As we rapidly see ourselves as consumers of a health service, rather than subservient patients, it is always right to question healthcare providers, assess risk and ask questions. Those questions should be posed to healthcare professionals, however. Not people who have a degree in Google and agenda-driven sites dripping with conspiracy theory and bunkum.

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