Disinformation, Misinformation and the Multiplying Impact of the Pandemic and Beyond

Commentary

From our perspective and professions of bioethics and public health it has appeared for some time this commentary is overdue. Misinformation is incorrect or misleading information. Disinformation, according to Merriam-Webster, is “false information deliberately and often covertly spread (as by the planting of rumors) in order to influence public opinion or obscure the truth”. Disinformation is often the tool of choice in the lead-up to political takeovers and a business tactic to undermine competition. Both refer to false information, however disinformation one need only seek those who benefit from the change to see the likely source of disinformation. Both of these purposes are unethical and potentially illegal. When the purpose is clouded through politics and complicated by social as well as traditional media, the damage can be even more serious as the resulting “beliefs” are strongly held and the doubts created undermine our collective progress – and in this case, health.

The nature of a free society is grounded in concepts like Freedom of Speech. I remember well in elementary school learning about the Constitution and Freedom of Speech. I also recall there was ever present the example of where that freedom ends. The classic example was always “you can’t yell ‘fire’ in a crowded theater”. Obviously that untruth could cause harm, both in the moment and by undermining confidence in emergency alarms when they are truly needed. This lesson applies today as well. The pundits planting questions, starting rumors, making pronouncements, casting doubt on public health specifically and science in general are generating damage that may not be fully calculated for many years. In some cases, it may be more likely that the intent is to sow enough mistrust that these institutions ultimately fail.

Commentary

Let’s look at where some of that damage can be seen.

First and foremost, in behaviors today such as avoidance of vaccines. Those choosing to avoid vaccines for Covid19 put themselves and those around them at greater risk of contracting the virus, hospitalization, and death. The data collected here in the US and around the world have consistently confirmed these facts [1]. So, the evidence is clear that those choosing to forego (free) vaccines are increasing their risk and that of those they are in contact with in their lives. A second group of individuals have identified the use of strategies proven to avoid contagion (mask use, social distance, and increased ventilation) in some way violates their rights [2]. US law on this topic has for years relied on the decision of the Supreme Court at the time of the 1918 Influenza Pandemic. The Jacobsen decision clearly supports the responsibility of public health (Government) to act to require action to protect the public (in that case to accept vaccine). This has been widely studied since then and deemed to be ethical under a principled approach I’ll address shortly.

The third area we see damage due to disinformation is in the existing and growing health debt, especially among those with higher risk due to the presence of chronic conditions or the risk for other conditions. In one report 41% of American adults had delayed or avoided medical care (12% emergency care and 32% routine care) [3]. Other studies have shown decreases in cancer screenings, biopsies and other treatments [4]. This evidence of growing anxiety and doubt regarding the safety and efficacy of healthcare has the potential to have long ranging impacts for those already impacted and the people they interact with to share their doubts [5].

The last area I want to address is the impact on relationships. These range from the relationships we have in our personal lives from family, friends and others to co-workers, healthcare providers, and people we need to be healthy and productive members of society. The disinformation already in circulation has been the source of tension and division in all these relationships as intended. The disinformation seeds damage that grows as the pandemic evolves, as science evolves, as our reaction evolves all of which add to the volume of the disinformation. At the root of this is the disease that erodes trust. This body of untruths designed to cause the damage that we see every day. Damage that ignores the value of science and points to the growing body of knowledge about the pandemic not as a value we can learn from, adjust our reactions and behavior accordingly, and make collective progress but rather points to the new data and information and sees it as confirmation of former lack of knowledge. This flies in the face of what science is and does. One must only look back a short time to see how far we’ve come because of science [6]. It is unthinkable today that healthcare providers recommended use of tobacco, but it is only since the Surgeon General’s Report in 1964 that we’ve learned so much about the risks associated with tobacco use. Another harm that can’t be well quantified is the decreasing trust in key public health organizations we need to address dangers to our individual and collective health. According to a recent Robert Wood Johnson/ Harvard TH Chan School of Public Health Poll ‘Overall, the poll found that only 52% of Americans have a great deal of trust in CDC. Other health agencies were even lower only 37% of Americans said they had a lot of trust in the National Institutes of Health or the Food and Drug Administration.

The poll found that trust isn’t just a problem for federal health agencies. State health departments have the trust of 41% of Americans, and local health departments only did slightly better at 44% [7]. From the perspective of bioethics we often focus on principles and some of these have been twisted in the purveying of disinformation. Autonomy for example, this principle calls on us to respect the decisions of individuals about their own health. The critical factor here is we’re asked to respect the “fully informed” decisions, those where the individual has a complete understanding of the actual risks and benefits of the proposed action or treatment. Too often the presence of disinformation makes this impossible. The second and third principles, those of beneficence or the intent to do good; and non-maleficence (do no harm) are a balance of our desire to do good and the necessary avoidance of harm. Clearly disinformation is a clear and serious violation of both these principles. Lastly the principle of justice, here we are called on to act fairly with consideration for those around us and others. Once again, the purveyors of disinformation ignore this principle by definition causing harm directly and indirectly to many today and tomorrow through the doubt seeded today.

The point of this Commentary is to recognize the unethical nature of disinformation, predictable damage of misinformation and the ethical responsibility on each of us to correct the record and call out those who would intentionally provide falsehoods with the intention to sow divisiveness and cause harm. We live in a time when silence is dangerous, and we are all called on to talk openly about the importance of recognizing the science we know today. This includes the issues regarding the pandemic, but importantly also includes the need to trust science and the public health and healthcare systems to support our health, help us prevent disease, find issues early and treat them effectively. All the examples above, especially related to health debt including accessing primary and preventive care; following cancer screening guidelines; seeking support to address existing chronic conditions like diabetes and hypertension and risk factors for others; and other recommendations available at citation #5 from the National Association of Chronic Disease Directors Thought Leaders Roundtable on Covid-Related Health Debt and Chronic Disease. All we understand of the principles of bioethics and our professions tells us the time is now to act, any delay in debunking disinformation causes health risk to individuals and populations today and tomorrow.

Conclusion

This Commentary is not about advocacy, or a take on laws or constitutional rights. This is recognition of the damage done by disinformation and misinformation, sometimes through ignorance, sometimes motivated by a desire for control or power, sometimes in the mistaken approach that we as individuals have control over whether we are subject to some of the contagions present in the world where we live. Many have died, others will suffer lifelong physical and emotional pain through these twin scourges. This Commentary is also a call to act to professionals in bioethics, public health, clinical medicine, media, public service and any others with the knowledge and ability to share the science and best-known approaches. We aren’t calling for confrontation, rather recognition that facts matter, and professionals should share the facts consistently in the interest of our collective health and the betterment of society.