When is it News? The Danger of Reporting Misinformation is that it Spreads, So Does the Damage. We Need to Prioritize a Principled Approach

Commentary

I’m writing to renew and amplify my concerns about misinformation and disinformation initially highlighted in this journal in 2022 [1]. We pointed out at the time that from the perspective of public health and bioethics, there are very real dangers in promoting misinformation and disinformation. We provided examples of key aspects of public health where populations suffer including public health messages on prevention [2], vaccine use, and wellness. The resulting behaviors of populations contribute to incidence of disease, premature death, and growth in the impact of social determinants of health [3]. In our world today we are bombarded with information through television and other media, especially social media, with all kinds of information. Much of what we see, hear, and read is not true. The venue (i.e., Facebook, X, Threads, Cable “News” and others) often defend their action by stating “but so-and-so said”. But without context and clarification it amounts to promoting the untruth, often repeatedly. When colleagues ask, “How can they believe that?” this is the answer. Exposure to repeated messages without context (including the facts) results in broad acceptance of lies as facts.

I was faced with an example at a recent conference where I spoke. After my presentation I was asked privately by a state public health official “how do I handle the Governor’s staff telling us that we can’t use “woke” language like: discrimination, inequity, or SDOH in public forums and publications”. I was at a loss except to say I think it will take Commentary a lawsuit or an election to change that perspective. This policy ignores the significant impact of social determinants of health on disease prevention, wellness, and premature death [4, 5, 6]. Policies such as restricting discussion of facts regarding health based on a political “belief” amounts to gag orders in the face of overwhelming evidence to the contrary. The obvious danger here is that the issue worsens instead of having opportunities to intervene and improve SDOH. I’m aware that similar issues have previously been reported regarding reproductive health, vaccines, HIV, and especially in areas of prevention and control of chronic diseases where a growing body of evidence of what works requires public awareness, professional education, and continued sharing of facts. Addressing this is critical for both public health and health professional education. The problem, as I see it, is that the venues mentioned, while claiming to focus on our “rights” like freedom of speech, use policies that directly harm their audiences - all because they don’t start with principles. In healthcare this would include principles of bioethics [7]. I have proposed previously that it can be applied to other aspects of our lives and culture [8]. The authority in these instances may be either responding to pressure or seeking support - but in either instance it is based on the fallacy that the idea/ concept/ relating an event in question is factual.

While these examples and issues relate directly to health and public health, my concern, and the issue at hand relate to all the issues currently the focus of social media including reasonable regulation of gun ownership, taxes and government spending, elections, etc. You can readily see that many of these are related in many of these communications - especially in identifying and targeting persons defined by speakers as “others”, those who may pose a risk to institutions or “real Americans”. The deep and insidious damage done by allowing these falsehoods to stand without correction and clarification violates all the principles that those in healthcare and public health hold as essential to our professional integrity.

Today I call on those in the media, especially social media, to consider the impact before simply repeating lies. In every instance the idea should always be run through the filters of established principles of bioethics. These principles include:

• Autonomy: The respect for individuals exercising a right to informed decision making requires that facts inform those decisions. Repeatedly exposing them to someone’s opinion that is based on fantasy or falsehood is a violation of the next principle.
• Beneficence: The principle calls on all who participate in the health system to do so to “do good” and benefit all with their participation and knowledge. This goodness sometimes requires the investment of resources to evidenced-based interventions to achieve the good. Can we expect media to also intend good? What are the benefits of repeating lies? Is the intent to show that the individual is engaged in trying to fool their audience? This can be achieved in many ways without repeating the lie, which we now see can cause damage.
• Non-Maleficence: More commonly known as the principle to “do no harm,” calls on all of us to avoid harm whenever possible. When the policy itself can be a source of harm it is unethical at its core. Is this too high a bar for the media? This may be worthy of discussion as ignoring the predictable damage of repeating the content of lies could violate many principles, this one in particular.
• Justice: What we often call the “Fairness Principle,” calling on us to focus on the “All” in “All are Created Equal”. Is it fair to expose people to information (sometimes repeatedly) that is known to be false? How can we then expect them to make good decisions for themselves and their loved ones related to essential components of life like health behaviors, and accessing healthcare (or voting)?

When considering whether repeating an untruth meets the principles of any venue or organization, these concepts provide a good basis for assessing the value of the media, and the potential for damage if principles are ignored. After I’ve reported untruths (with evidence) to some social media venues - only to be told my concern (for promoting lies without context or explanation) didn’t rise to “Community Standards”, I’m reminded of some advice I received long ago: First and always, Be Truthful. I don’t think it’s asking too much for “Community Standards” of a social media site or media outlet to adhere to that advice.