Fake News!

Michael Schubert interviews Timothy Caulfield
 

Timothy Caulfield’s career began in general health and science policy research – but the more he investigated how matters of science and medicine are represented in the public sphere, the more aware he became of the growing problems of misinformation and disinformation. We asked him about the scale of the issue, the most common – and most difficult – misinformation he encounters, and what pathologists and laboratory medicine professionals can do to help combat it…

Has the volume of misinformation increased in recent years?
 

I think the intensity and the impact have increased. This is largely because social media has increased the reach of misinformation – and its sway. I think we’ve seen that throughout the pandemic, but it was a problem even before COVID-19. The other factor is the role of pop culture in the spread of misinformation. Celebrities have played a major role in how we perceive health issues, which is something we saw starting to happen in the 1990s, but which accelerated throughout the pandemic.

What are some of the most common pieces of misinformation you see?
 

This is a very important question right now, because we’re starting to get a lot of revisionist history of what happened at the height of the pandemic, what the misinformation was like, and how wrong it really was. Weren’t there a lot of contested issues that went unresolved? Why wasn’t there more open debate?

That is all nonsense. The misinformation was pretty clear – it’s things like:

• “The vaccines don’t work.”
• “The vaccines kill more people than they save.”
• “The vaccines cause infertility.”
• “Ivermectin and hydroxychloroquine are effective against COVID-19.”
• “COVID-19 was caused by 5G technology.”
• “COVID-19 is a hoax.”

Those are just some examples; there was a constellation of entirely false narratives that did real harm. Before the pandemic, a lot of the same narratives existed within the anti-vaccine community – but we brushed them off. We laughed at health misinformation – that you can detox your body, that you need cleanses, that natural products are always better than pharmaceuticals – instead of paying attention. We shouldn’t have, because ignoring or enabling misinformation facilitates its spread. We need to take pseudoscience seriously.

What is the hardest misinformation to counter?
 

I think it gets really challenging when those who are spreading misinformation do certain things.

The first is when they leverage scientific uncertainty – something that has happened a lot during the pandemic. They say things like, “Oh, you know, public health experts didn’t know about masks. Two years ago, they told us they didn’t work.” Of course, science evolves – and, of course, recommendations should evolve with it. But those who push misinformation effectively leverage that uncertainty to push more uncertainty and more misinformation. They create information chaos. And that works well, unfortunately, and can be difficult to counter.

The second is when they marry misinformation with ideology. That has been a trademark of misinformation in the pandemic era; in fact, there’s an almost perfect correlation between ideology, belief in misinformation, and disagreement with public health measures, such as vaccination or judicious mask requirements. At this stage of the pandemic, at least in most developed countries, we’re hearing less about issues such as equity, access, or even pain and needle phobias. Although those are all very real and important issues, we’re largely left with individuals who are ideologically motivated to embrace misinformation.

That said, “anti-vaxxers” are not a homogeneous group. Many are ideologically opposed – but others are simply hesitant or under-informed. It’s always important to listen and to have empathy.

You’ve touched on a common objection – “the science is always changing.” Experts know why that is, but how do you explain it to people who don’t?
 

Hopefully, this is a lesson we will learn from the pandemic. Scientists, science communicators, public health experts – we could have done better. A good example is the discussion surrounding masks early in the pandemic. We were too dogmatic. And that’s partly because the first rule of public health communication during a crisis is clarity. We all erred on the side of too much clarity regarding the recommendations at the time, which meant that we weren’t transparent enough about the scientific uncertainty that accompanied them. We didn’t explain well enough that science is not a list of facts that never change; it’s a fluid process. We should have said, “These recommendations are based on the best available evidence right now – so they may change as we learn more.” We need to invite the public to join us on that uncertainty journey.

The other thing we need to tell people is that science is still the best tool we have. For example, let’s say your neighbor thinks that the weather is caused by a machine in the sky and Big Weather produces rain to force us all to work harder. If a meteorologist (who bases his assumptions on data) tells us it’s going to be sunny tomorrow and the neighbor tells us it’s going to rain – and then it rains – that doesn’t mean we should listen to conspiracy theorists. We should still listen to the science-informed voice. Unfortunately, we’re seeing a lot of revisionist misinformation along the lines of, “Science said this and it was wrong, so that’s proof that we shouldn’t ever listen to the science.” We’ve got to push back against that.

Healthcare professionals are in a unique position to fight misinformation. How can they help?
 

Healthcare providers should join the conversation. Engage with your patients and community. Call out misinformation when you see it. I know that can be difficult and not everyone wants to do it – but those who do need to know that they have the support of their colleagues and institutions, as well as legal support if things go sideways. Research tells us that healthcare providers are among the most trusted voices out there – so you can do real good as a voice for science and truth.

“Misinformation burnout” is prevalent among scientific and medical professionals. Do you have any tips for dealing with it?
 

The good news is that the science communication community has blossomed throughout the pandemic – so you’re joining a wonderful community that can help you with misinformation fatigue. We hold each other up and give each other encouragement. You should also ensure that you have institutional support.

But the other important thing is to take breaks from the noise. You can do that on a “micro” level when you encounter misinformation by simply taking a beat before you engage with it. It may sound ridiculously straightforward and simple, but there’s evidence that it makes you less susceptible to misinformation. You can also do it on a “macro” level. Step away from the noise in the evening or give yourself a weekend off – especially when it comes to things like social media. Too much exposure to negative news and misinformation can generate stress. It’s important to take a break for the sake of not only your critical thinking skills, but also your mental health.

What do you do when the “other side” doesn’t want to listen?
 

It’s important to know when to step away. When you know you’re not going to change someone’s mind, it’s okay to stop trying.

But that doesn’t mean you should lose your optimism. Your goal is to give people a path to credible information and there are a lot of different ways to do that. Narratives matter – so why not share your own experience? If you can find some common ground with the person you’re speaking to, you may be able to break down some defenses and open up that path. People generally don’t change their minds right in front of you, but you may still make a difference – perhaps not today, but in the future.

Do some ways of addressing misinformation work better than others?
 

The silver lining of the misinformation explosion is that there has been more research on what works and what doesn’t to debunk misinformation. This is a complex phenomenon, so we have to come at it from every direction – responses from regulatory bodies, teaching critical thinking and media literacy at all stages of life, “prebunking” (warning people about misinformation before they encounter it), and debunking and correcting misinformation when we see it. How can you best do this?

• Talk about good science. Explain the scientific consensus, how it works, and why scientists have made the evidence-based decisions and recommendations they have.
• Speak out on social media. If you want the people who are seeing misinformation to also see the truth, you have to go where the misinformation resides – and, these days, it resides on social media.
• Make your content shareable. You want it to grow beyond the confines of your network.
• Be creative. I always like to say, “Creativity wins.” Use humor; use stories; use art; use all of the strategies that the people pushing misinformation also use.
• Be empathetic. The research on tone is mixed (and, in fact, some even suggests that a little bit of snark can be okay) but, if you want to have a long-term conversation with an audience, it’s important to be respectful – and to be upbeat.
• If possible, feature a diversity of voices to ensure that a variety of communities feel heard and addressed.
• Don’t let the backfire effect scare you away. I hear a lot of people say, “We shouldn’t try to counter misinformation, because it causes people to become more entrenched in their views.” Most of the recent evidence tells us that the backfire effect is less common than people think (and is often context-specific) – so don’t let it stop you from getting out there and engaging.

Where can people find you on social media?
 

You can follow me at @caulfieldtim on Twitter and Instagram – but the initiative I really want to highlight is #ScienceUpFirst, which is @scienceupfirst on Twitter, Facebook, Instagram, and TikTok.

#ScienceUpFirst involves a wonderful and diverse team of science communicators, artists, and video producers who create content that we hope is shareable and relevant to a wide range of communities. We consult independent scientific experts to make sure that our information is accurate. And we try to tackle misinformation broadly, not just in the context of COVID-19, so that people know what to watch for and how to make sure they’re not inadvertently spreading misinformation. The initiative has been incredibly successful, especially in Canada, but increasingly around the world. We would love for everyone to join the #ScienceUpFirst team and help it become a self-sustaining movement.

What one take-home message do you want to give scientific and medical professionals about misinformation?
 

Get out there. Don’t be afraid to counter misinformation. I know that I’m speaking to incredibly busy professionals who may not have the time – or the passion – to debunk misinformation. If that’s you, what you can do to help the cause is go to sources that aggregate science in a responsible manner and share their content.

People often ask me if there’s one message that you should give the public about how to recognize misinformation – and I think it’s fair to give healthcare professionals the same advice. Ask yourself, “What kind of evidence is being used to support this claim? Is it an anecdote? A testimonial? Primary research? Does it truly reflect the body of evidence at play? Is the source just cherry-picking data? What kind of science is being used?” Just asking those questions every time can go a long way to solving the problem of misinformation.