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Published On June 18, 2018

POLICY

The Rise of Fake Medical News

More and more websites are peddling “alternative facts” to deceive the public and sell bogus cures. Fixes won’t be simple.

LAST WINTER, THE WEBSITE YourNewsWire published a story with this headline: “CDC Doctor: ‘Disastrous’ Flu Shot Is Causing Deadly Flu Outbreak.” Appearing during one of the worst flu seasons in years, the article quoted an anonymous physician at the Centers for Disease Control and Prevention who warned that nearly all the people dying of the flu had one thing in common: They had gotten flu shots. “This scares the crap out of me,” says the physician in the article. The story also cast Big Pharma as a co- conspirator for failing to disclose to the public the toxic chemicals contained in the vaccine.

None of this was true; the entire story, including the quotes, was fabricated. Yet that didn’t stop the piece from going viral on the internet, popping up on a variety of alternative-health and conspiracy-theory websites. The story was widely shared on Facebook, generating about 500,000 engagements in January alone—more than any story that week from the Wall Street Journal, NPR, ABC, CBS, CNN or Fox News. It also generated thousands of online comments, some fanning broader fears about vaccinations, with “anti-vax” campaigners writing to support the story’s claims and even purported incidents in which the flu shot itself caused paralysis or even death. Although several fact-checking websites poked holes in the story’s narrative, that did nothing to slow its momentum.

Welcome to the world of fake medical news. During and after the 2016 U.S. presidential campaign, the phrase “fake news” marked a new phase of distrust in media, serving on the one hand as a way for politicians to denounce any news coverage they didn’t like, and describing on the other a proliferation of stories that were baldly untrue. The medical realm is not immune and has become home to some of the most egregious examples. “There’s no empirical way to measure it, but my sense is that of all the categories of fake news, medical news is the worst, and there’s more of it out there,” says Kelly McBride, vice president of the Poynter Institute, a nonprofit journalism school in St. Petersburg, Fla.

Watchdog groups have identified hundreds of websites purveying fake medical news, and countless more fly under the radar. This misinformation runs the gamut from truly ridiculous to more subtle misreporting and overhyping of stories from mainstream news sources. Motivations of its creators vary, but fake medical news can earn clicks and “likes,” which can translate to ad revenue, or further an agenda that targets evidence-based medicine.

Deliberately false information can also drive the sale of expensive, unproven treatments. “These schemes are bilking consumers out of millions and millions of dollars,” says Richard Cleland, assistant director at the Advertising Practices division in the Bureau of Consumer Protection at the Federal Trade Commission in Washington D.C., which has taken action to shut down offenders.

Moreover, after a fake news story is posted, there’s little that can be done to retract the information. “Once it’s on the internet, it’s there forever,” says Joseph Jankovic, a neurologist who heads the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston. Would-be miracle cures for Parkinson’s are a “major, major problem,” he says. “I have to spend a lot of time in patient visits debunking unreliable information from the internet.”

Beyond the chaos they sow, and beyond instances of fraud and unreliable cures, fake medical news also undermines—sometimes intentionally—trust in the medical establishment, according to Melissa Zimdars, an assistant professor at Merrimack College in North Andover, Mass., who has analyzed more than a thousand fake news websites. Health care practitioners, researchers and government health agencies all are weakened by an atmosphere in which the reliability of the authorities is suddenly suspect. “The way health and medicine are discussed and oversimplified in the news is already problematic,” she says. “But that’s made so much worse by websites that destabilize how much the public can rely on science and research.”

FAKE NEWS IN MEDICINE is nothing new. “Bogus medical information has been circulating in one form or another since at least the Middle Ages,” says Jonathan L. Stolz, a retired physician and medical historian in Williamsburg, Va. In the latter part of the nineteenth century, for example, newspapers were crammed with false advertising for questionable elixirs, such as Mrs. Winslow’s Soothing Syrup, the effects of which relied on high concentrations of alcohol and other questionable ingredients, including morphine.

In the 1950s, another category of fake news—misleading industry-funded research—made its debut when tobacco companies underwrote studies to downplay the health hazards of cigarettes. They also launched a far-reaching public relations campaign that included “A Frank Statement,” which the industry placed in hundreds of U.S. newspapers. During the “more than 300 years tobacco has given solace, relaxation and enjoyment to mankind,” the ad read, “critics have held it responsible for practically every disease of the human body. One by one these charges have been abandoned for lack of evidence.”

Holding scientific and medical claims to account, meanwhile, has traditionally been a weak spot even for mainstream publications, says McBride. “Journalism is very much about trying to simplify and distribute information about what’s new and where advances have been made. That’s incompatible with the scientific process, which can take a long time to build a body of evidence.” Moreover, science stories are often far from provocative. “Good information can be really boring,” she says.

The decline of print media, bringing a loss of editors and fact-checkers to verify accuracy, has meant fewer gatekeepers in vetting the quality of information, says Leticia Bode, an assistant professor and media technology researcher at Georgetown University in Washington, D.C. The ascendance of the internet and social media has also raised the dissemination of unreliable medical news to new heights. Online search technology relies on algorithms that automatically—and opaquely—determine what people see, often without concern for substance or accuracy. That reliance on automation encourages the unscrupulous to game the system. “You can figure out how to get your links to rise to the top of search results,” Bode says.

Even those who run reputable websites feel compelled to churn out click-worthy stories, because those clicks are how success (and revenue) is now defined. There are fewer incentives for articles that probe deeply into complex subjects, says Rick Weiss, director of SciLine, a service for journalists based at the American Association for the Advancement of Science (AAAS) in Washington, D.C. “Journalism just isn’t adequately performing a key function it was meant to perform, which is to screen information and provide the public with material that it can reasonably believe,” Weiss says.

The way news is consumed has also shifted the role of editor to users, who have more freedom than ever before to choose the stories they find compelling, with no imperative to screen for truth. On platforms such as Facebook, now the nation’s single-largest social media news source, people share what they like, including posts from blogging platforms that anyone can use. This has created an online world of echo chambers, populated by the opinions of celebrities and other nonexperts who cast themselves as credible sources on medical issues, says Zimdars. “On the internet, you can always find someone to agree with you and reinforce your beliefs,” she adds.

ACADEMIC RESEARCH IS ONLY beginning to explore the causes and effects of fake news. In one massive study—“The Spread of True and False News Online,” published in Science in March—researchers at the Massachusetts Institute of Technology reported the results of a decadelong project probing the habits of millions of Twitter users. They found that false news of all kinds reached more people more quickly than true stories did. The top 1% of false information diffused to as many as 100,000 people, according to the study, while accurate stories rarely reached more than 1,000.

In a separate research project that looks specifically at fake medical news, Zimdars has analyzed about a dozen questionable websites. Most, like YourNewsWire, include junk medical news as part of their overall content, while a smaller number are exclusively devoted to it. The “fraudulence” of mainstream medicine was also a common theme, says Zimdars. “The typical refrain is that Big Pharma is rigged and researchers are controlled by business interests,” she says. “The intent is to make readers fear well-researched, traditional medical treatments.”

That approach can be especially effective when a legitimate debate about research and therapies exists, Zimdars says. Steven Nissen, a cardiologist at Cleveland Clinic, points to statins as a prime example. Statins reduce cholesterol levels and cut the risk of cardiovascular disease, and are among the most widely prescribed treatments. Yet there is a growing debate about whether the drugs should be prescribed to patients who have no history of heart disease. Meanwhile, statins have spurred a torrent of fake or dubious medical stories.

Only about half of the people prescribed a statin continue taking the medicine after six months, a rate that is “shockingly low,” says Nissen. He believes that an “internet cult” of misinformation is partly to blame. In an editorial in the Annals of Internal Medicine last August, he recounted that when he typed “statin risks” into a search engine, he got more than 3.5 million hits. Many of the links were to websites created by people with little or no scientific expertise and which relied heavily on misleading claims. In contrast, when he searched “statin benefits,” he got 655,000 results. “I have scores of patients who have stopped taking statins based on fears that mainly come from the internet,” he says, noting that the consequences can be deadly. Multiple studies have found that patients who discontinue statins are up to five times more likely than those who continue on the therapy to develop cardiovascular disease, and those who abandon statins may have twice the risk of dying prematurely.

Fake medical news also often exploits the hopes of patients desperate for a cure. Last January the website Natural News, which averages more than six million monthly visitors, ran this story: “Top 8 ways to HEAL America from cancer—when every US hospital goes 100% ALL NATURAL with therapy.” It listed therapies—turmeric, vitamins, oxygen and cannabis among others—that would be better treatments than radiation, chemotherapy or other conventional approaches.

That kind of questionable medical advice has real consequences, says Skyler Johnson, a physician specializing in radiation oncology at Yale New Haven Hospital. “I have seen patients with curable cancer who come in with printouts of internet stories like this one, which they’ve usually gotten from well-meaning family members or friends. This helps them decide to choose alternative medicine over recommended cancer treatment,” he says. Yet that choice could be deadly, according to a 2017 study by Johnson and a team of Yale scientists, who compared the two approaches in hundreds of patients with breast, prostate, lung and colorectal cancers. They found that using alternative treatments instead of receiving medically advised cancer care could double a patient’s risk of death from cancer.

THE FOOD AND DRUG ADIMINISTRATION and the FTC have some power to censor online medical content when it is used to advertise fraudulent products. During the past year, for instance, the FDA issued warning letters to more than a dozen companies that the agency said were illegally selling products on the internet that fraudulently claimed to prevent, treat or cure cancer. The FTC, which coordinates its efforts with the FDA, has filed 120 cases during the past decade challenging medical claims for supplements. It has also tried to crack down on fake online medical content that the agency considers deceptive marketing.

Weight-loss supplements and drugs claiming to reverse age-related mental decline are two of the biggest categories for bogus products, according to the FTC’s Cleland. “Those generate heavy online traffic, with lots of money changing hands,” says Cleland. But he notes that the agency doesn’t have the resources to keep up with that volume, and even the relative handful of regulatory actions from the FTC and FDA don’t always stick. Some companies simply change their names and reintroduce disguised versions of their websites and the disputed products.

Other solutions are needed, Cleland says. Yet much of what exists or has been proposed depends on consumers themselves blowing the whistle on false or exorbitant claims. Both the FTC and FDA websites feature links for reporting fraud and unlawful sales of medical products, and Quackwatch, a website run by retired North Carolina psychiatrist Stephen Barrett, provides guidance on spotting fraudulent sites. Snopes.com is dedicated to weeding out fake news stories in general, and HealthNewsReview.org focuses exclusively on the accuracy of medical news.

Moreover, dozens of major global news sites as well as social media platforms, including Facebook and Twitter, are experimenting with “trust indicators”—flags on an article that show whether it is news, opinion, analysis or advertising; give details about the site’s funders; and, for some articles, provide sources used to back up its claims.

Other institutions are also working on ways to combat fake medical news and to encourage factual reporting. The AAAS, for example, recently launched SciLine, a service that connects journalists with credible science experts when they write or produce stories about science and medicine. The nonprofit also posts background summaries of science-related topics in the news. “There are a lot of people who now do fact-checking after a story is published,” says SciLine’s Weiss. “We want to help journalists have the resources so their work is accurate when it’s first published, rather than worrying about how to correct bad information once it’s out there.”

Facebook often finds itself in the middle of debates about fake news, medical and otherwise. Yet its attempts to address the issue have gained little traction and have sometimes had unintended consequences. In December, for example, the company announced that it would no longer use red flags to identify questionable stories—because sometimes the flags increased traffic to those pieces.

Other Facebook initiatives have included adjusting its newsfeed algorithm to give preference to posts shared by friends and family, rather than those from third-party organizations, and a new process for vetting content that asks users what news sources they find trustworthy. “We decided that having the community determine which sources are broadly trusted would be most objective,” Facebook founder Mark Zuckerberg wrote on his Facebook page.

Although these and other policies may affect how people distribute and consume news, Zimdars questions how useful they’ll be. She notes that sharing posts among friends and family members who likely have similar views will only reinforce the “echo chamber” effect that already plagues so many online interactions. “How will Facebook prevent this process from being gamed by the mobilized readers of consistently inaccurate websites?” she asks.

More thoroughgoing reforms will be needed. An essay from 16 political scientists and legal scholars, published in the issue of Science that contained the MIT fake news study, called for interdisciplinary research to redesign the “information ecosystem in the 21st century.” The experts said changes were needed “to reduce the spread of fake news and to address the underlying pathologies it has revealed.... How can we create a news ecosystem and culture that values and promotes truth?”

Until fixes are identified and put in place, fake medical news will continue to be produced and widely shared. In a disturbing follow-up to the YourNewsWire story about dangerous flu shots, the site identified a CDC scientist who had disappeared and later drowned as the source of its “scoop.” The website even implied that the missing scientist was the victim of a deliberate government conspiracy to silence him. After that story also went viral, generating more than 170,000 Facebook engagements within a week, police investigators and the scientist’s family dismissed the rumors—noting, among other things, that he hadn’t worked in the CDC’s infectious disease unit and wouldn’t have had access to information about the flu vaccine. The site took no notice and both articles are still live, gathering more views and shares by the day.

DOSSIER

The Spread of True and False News Online,” by Soroush Vosoughi et al., Science, March 9, 2018. This study on fake news, the largest to date, examines the habits of 3 million Twitter users and documents how misinformation spreads.

I Do Not Believe You: How Providing a Source Corrects Health Misperceptions Across Social Media Platforms,” by Emily K. Vraga and Leticia Bode, Information, Communication & Society, April 19, 2017. This investigation looks at mechanisms for correcting health misinformation about the Zika virus circulating on Facebook and Twitter.

Science Reporting in the Age of Fake News,” by Carl Zimmer, lecture delivered at American Association for the Advancement of Science event, Oct. 12 2017. Science writer Carl Zimmer talks about the history of fake science news and its implications for public policy. 

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