Sonya Collins
In the spring of 2021, protesters gathered outside Sentinel High School in Missoula, MT. They waved signs and held out flyers that claimed the COVID-19 vaccine caused miscarriage and infertility. They screamed “baby killer” at every parent and student who rushed by on their way inside to the vaccine clinic.
When clinic staff learned what was going on outside, they sent a mass text to everyone who’d scheduled an appointment for that day and advised them to keep their windows up until they parked and to come directly inside to the gym.
The infertility myth started making the rounds on social media almost as soon as the first COVID-19 vaccine became available. Alongside it were numerous other falsehoods that ranged from simple misunderstanding (e.g., the vaccine didn’t go through safety and efficacy testing) to conspiracy theories (e.g., the vaccines contain a microchip).
While medical misinformation and pseudoscience have been around for longer than the COVID-19 virus, the pandemic arguably exacerbated the problem.
“There were a number of things about that pandemic—so much uncertainty, some communication missteps on the part of the government and CDC, and people feeling a loss of control—that can make people double down on conspiratorial-style thinking. The problems were definitely already there, but it might have been easier for people to grasp onto misinformation in the pandemic,” said Sara Gorman, PhD, MPH, author of Denying to the Grave: Why We Ignore the Facts that Will Save Us and the forthcoming Modern Medicine: Conspiracy Theories and Distrust in the 21st Century.
Pharmacists have heard claims based on medical misinformation and conspiracy theories from both sides of their pharmacy counters since the start of the pandemic—and before. They can continue to play a critical role in debunking and “pre-bunking” these harmful myths.
Misinformation, disinformation
The Office of the U.S. Surgeon General defines misinformation as any information that is false, inaccurate, or misleading according to the best available evidence at that time. While some misinformation may be borne out of an earnest mistake or misunderstanding, some falsehoods—called disinformation—are knowingly fabricated and perpetuated.
“Whether it’s innocent or a coordinated, targeted sharing of misleading ideas, it’s hard to know anyone’s intent, especially online, so we need to have a multipronged strategy to tackle all of it,” Gorman said.
Effects of medical misinformation
Misinformation has numerous channels through which to travel. Social media and messaging apps are among the most robust. But with the increasingly widespread consumption of preprints during the pandemic, the mainstream media also fell prey to research findings based on flawed study designs or insufficient data.
In early 2020, a paper appeared on preprint server BioRxiv claiming that there were “uncanny” similarities between COVID-19 and HIV and implying that the virus might be man-made. The paper was removed from the server quickly but may have already had untold views.
Then misinformation hit social media, where there is no reeling it back in.
Research shows that the public is more likely to engage with misinformation than factual information, and that negative misinformation is harder to neutralize than positive.
Its effects are far-reaching, too. Medical misinformation can dissuade people from getting necessary health care in a timely manner, or at all. It can spur vaccine hesitancy, medication noncompliance, disease outbreaks, hospitalization, and even death.
Multiple studies in relation to COVID-19 and other vaccines have shown that exposure to misinformation weakens intent to receive vaccines.
In a 2014 study in PLOS One, participants were exposed to information that either supported or refuted an antivaccine conspiracy theory or a control condition. After exposure, they were asked to rate their intent to vaccinate a hypothetical child. Those who had seen the antivaccine conspiracy theory were less likely to have a child vaccinated.
In a 2021 randomized controlled trial published in Nature Human Behavior, a total of 8,000 participants (half in the United Kingdom, half in the United States) were asked about their intent to get a COVID-19 vaccine. Among those in the U.K., 54% planned to receive the vaccine and 42% of Americans did. But after exposure to vaccine misinformation, each group saw a drop in intent of about six percentage points.
Pseudoscience claims can lead people to rely on unproven alternative medicine and forgo conventional medicine altogether.
A 2022 study in the Journal of the National Cancer Institute found that 32% of the 200 most popular cancer-related articles shared on social media contained misinformation and 30% of the articles—nearly 77% of those containing any type of misinformation—contained harmful misinformation. User engagement with misinformation was greater than with factual articles, and harmful misinformation garnered the most engagement.
Misinformation and disinformation may also exacerbate existing health disparities as, according to a recent article in the Journal of the American College of Clinical Pharmacy (JACCP), it hits underserved populations the hardest. That includes patients who are Black, LGBTQ+, digitally disadvantaged, or who have lower health literacy.
“Marginalized populations may be more prone to believing misinformation due to historical distrust of government or organized associations. They may distrust the health care system, for example, due to past experiences with discrimination,” said Micheline Goldwire, PharmD, a professor and director of drug information at Regis University in Denver, CO, and coauthor of the JACCP paper. “As far as health literacy, people who are less adept at searching the Internet may be more vulnerable.”
No one is immune
Members of marginalized groups might be especially prone to accept misinformation as fact due to feelings of disenfranchisement.
A 2014 study in PLOS One found that belief in anti-vaccine conspiracy theories was a strong predictor of feelings of powerlessness, disillusionment, and mistrust in authorities.
Members of marginalized groups are not the only people who may be susceptible to believing medical misinformation.
A number of factors can cause anyone to lower their defenses against false claims about health or science.
People might be more prone to believing misinformation when they find themselves in a distressful situation that does not have a medical explanation or solution.
The COVID-19 pandemic has been the most recent and universally understood example of this. Terrified of contracting and dying of COVID-19, people were willing to believe in unfounded claims about treatments, cures, or preventatives. Others leaned on denial of the scope of the pandemic altogether.
In October 2021, more than two-thirds of Americans believed or were unsure about at least one of eight false statements about the COVID-19 pandemic or COVID-19 vaccines. Among the eight statements were claims that the government was exaggerating the number of COVID-19 deaths, that the vaccine causes infertility, and that pregnant women should not get the vaccine.
Individual circumstances, too, such as infertility or a serious diagnosis with an unknown cause or no cure, can push anyone to grasp onto unfounded explanations or solutions.
“When something negative happens and you’re looking for a solution. You start to ask yourself, ‘What did we do before my child got this diagnosis?’” said Chana Davis, PhD, founder of Fueled by Science and contributor at Those Nerdy Girls.
This might explain why people are drawn into false claims about childhood vaccines, since children may receive these around the same time that signs of developmental delays commonly arise.
No one is immune to believing and spreading false information. Even medical professionals buy into and share misinformation with patients or via social media. The problem became so apparent during the pandemic that the American Medical Association has developed policies and protocols for addressing it. Pharmacists interviewed for APhA’s Vaccine Confident initiative have shared that members of their own staff, including fellow pharmacists, were reluctant to receive the vaccine due to false beliefs about its safety profile.
“It’s important to be humble and recognize in ourselves that we all have a tendency to overweight our own beliefs as correct or to underappreciate how often we are wrong ourselves and the extent to which our decisions have an emotional component to them,” Davis said. ■
What pharmacists can do
Pharmacists are at the frontlines of the battle against misinformation. Over the course of the pandemic, and long before that, they have fielded numerous misinformation-based questions. Here are best practices for addressing these myths and misunderstandings:
Pre-bunking is better than debunking. Once a person has been exposed to misinformation, even when it’s later corrected, it can be very difficult to disabuse the person of that belief.
Some organizations are exploring ways to surveil misinformation and create pre-emptive messaging to debunk it. Ideally, there would be a system for this. Until that time, pharmacists could inoculate their patients and communities against rumors they hear. “In the waiting room at the pharmacy, there could be signs or videos that say, ‘You might hear this about the COVID vaccine, and here’s how people will try to convince you that’s true,’ and then you could debunk it,” said Sara Gorman, PhD, MPH.
Check your own biases. Anyone can be swayed by a myth or pseudoscience. Pharmacists should approach conversations with patients who believe false claims with an open mind. “When a patient shares misinformation, that doesn’t mean they are uneducated,” Gorman said. “It doesn’t say anything in particular about that individual.”
Listen first. Before pharmacists start to counter the misinformation with fact, they should listen to understand why the patient believes the false information and where they might have learned it. “The number-one lesson we learned from the pandemic is to always listen. Listening and empathy come first,” Gorman said. “There is no conversation if it starts with an adversarial tone.”
Ask open-ended questions. Pharmacists can gain the trust of patients and better prepare themselves to counter misinformation when they ask open-ended questions. Ask why the patient believes what they do. Ask where they heard or read that information.
Ask for permission to share your own thoughts. Pharmacists can continue to build trust by asking for permission to share facts that counter the patient’s beliefs rather than simply correcting the patient.
Present information in a convincing way. Use stories, examples, and analogies as much as possible. These may stick with people better than data do. “You can tell someone a statistic from a study, but it may not mean as much as concrete examples,” said Chana Davis, PhD. “Even though it’s less scientifically rigorous, if it helps communicate your message, it’s worth doing.”
Point patients toward credible sources. Whether or not pharmacists can change a patient’s mind in a single exchange, they can make patients aware that their sources of misinformation are not the same sources health care professionals use. “You might say, ‘Unfortunately, those concerns are misinformed. That’s not a credible source. Can I tell you about the resources we rely on as pharmacists?’ ” Davis suggested.
Consider misinformation as a social determinant of health. Along with other health screening questions, pharmacists can ask patients where they get health information and probe to learn why they hold certain beliefs. “You can then target your recommendations for them,” Gorman said, “If they want further information, for example, you could suggest things they could read from the types of sources they would trust.”
Play the long game. Often, it takes more than one encounter to change the mind of a patient who holds false beliefs. Pharmacists should approach conversations with patients with this in mind. A patient might not roll up his sleeve for a vaccine that day, but the pharmacist can begin to sow the seeds of doubt in whatever misinformation the patient has shared. “You’re not necessarily changing minds on the spot,” Davis said. “But with time, you’ll change a lot of minds. You just won’t necessarily see it in every interaction.” ■
APhA offers resources to address misinformation and disinformation surrounding COVID-19 at apha.us/Misinformation