SCCM Resource Library-Combating Misinformation in Medicine

Video Transcription

Hi there, thank you for this opportunity. My name is Ashish Khanna. Today I'll be talking to you all about misinformation in medicine, a new battle for the intensivists.  These are some of my disclosures. So I'm going to start with just presenting to you all what is known as the knowledge or wisdom knowledge information data hierarchy.  Information is different from data where data is just raw elements, words, numbers, code, so on.  Information links these raw elements into sentences, paragraphs, equations, concepts, and then further as we go up this hierarchical order, knowledge comes in, which is organized  information in the terms of chapters, theories, and so on. And then finally, wisdom is the actual application of knowledge into paradigms or systems or  in our world, you know, clinical work as we know it. So it's important to understand that when we talk about misinformation, we are right at the bottom of this hierarchy.  And if things go wrong at the level of information, everything else, including knowledge and wisdom upstream is disturbed.  There are also three closely related terms, namely misinformation, disinformation, and malinformation.  They are loosely intertwined into each other, but it is important to discern the discrete differences here.  Misinformation technically is false information without an actual intent to harm. Malinformation on the other end is genuine information intended to harm that includes  actual hate speech or harassment, for example. And then in this Venn diagram is this overlapping area, which is disinformation, which is still  false information with an intent to harm, which is a true combination of misinformation and malinformation.  Today, we are speaking only about misinformation, which is false information without an intent to harm.  We will see though how even though without an intent to harm, it actually does become fairly harmful, especially for the critical care doctor.  What are the types of myths and disinformation? So just broadly speaking, things like error, propaganda, imposter content, satire or parody,  false context, sponsored content, fabricated content, misleading content, manipulated content, and false connections, all could fall into the broad realm of misinformation  and disinformation. So let's look at misinformation in the intensive care unit. And why is it a problem?  So here, this table from this very nice article gives us the effect of fake news. So the effect of fake news, as we well know it during our ICU practice, is false hopes  for families, loss of trust in the care team, loss of attention to physician's words, tension towards the care team, and contrasting medical decision making.  And this is a really nice article because it provides some potential countermeasures. So countermeasures are really measures of sensibility, which is gentle deconstruction  of alternative truths, not to create a fighting and you versus them kind of atmosphere, avoid  letting relatives thinking of themselves as victims of situations, create a scene around the physician with medical books, information sheets, and official sources, let relatives  understand that the care team is needed to provide best care and less suffering, and then gently explain that it's not the idea of a single physician, but the whole care team.  This is a team process in the ICU, which consists of other humans that are trying to provide best care according to current science and ethics.  Understand though that it is very easy for families to feel misinformed in an ICU. I have personally been in a situation very recently where my own mother was a repeated  ICU admission most of last year. I felt, even though I practiced critical care, there were times I felt misinformed. I felt anxious. I felt disturbed.  Look at all those families who have no clue of our medical knowledge. Understand that talking to Dr. Google is okay.  So be willing to accept it and be willing to say that you will use your knowledge to actually help families step out of their own zone of Dr. Google, and you will encourage  families to discuss their online discoveries with you. That as intensivists is our way to cross this gap across Dr. Google.  There's lots of resources given in this nice little piece. It's actually Critical Care Society websites that are dedicated to providing information  specifically for families in different parts of the world. This is the real problem. The problem is what the media portrays on TV is a very different picture of the ICU  than the real ICU that we live in. This piece from New York Times really does justice to the same issue in how the media  can actually help us prevent misinformation trickling down, but that doesn't always happen.  I'm going to give you an example of our very familiar CPR, something that we do for a daily living in the intensive care unit.  There is a paper published that actually shows in this pie chart on the right that surrogates sources of CPR knowledge most commonly come from either CPR course or television.  If you look at the breakdown of the surrogates' knowledge of CPR, they will show that an astounding more than 75% of patients survive from CPR and able to go home.  Most of the surrogates in the survey said that that is the case. Most people believe that all of CPR ends up as great outcomes because they see it on TV.  This is actually a New England Journal of Medicine publication all the way back in 1996 that addressed this problem that the survival rates of CPR on media are way different than  actual survival rates of CPR. And they put this in a table, so here is a table that shows survival rate of CPR in  three relatively well-known television series, Chicago Hope, ER, Rescue 911. And look at Rescue 911, go across that horizontal line and see that 100% short-term survival  after CPR was possible in 50 episodes of this show and literally no patients died. This is what families come with. This is why there is misinformation. And then there is COVID-19.  So clearly COVID-19 has set up a lot of misinformation, but there is an opportunity to understand again why this happens.  So there are normal healthcare decisions which are based on high-quality evidence based on RCTs, an actual trustworthy clinical practice guideline, timelines for all stakeholders  to make decisions, and consideration of costs and resources. However, during the pandemic, if you look at the right side of the table up top, there  was indirect data coming from pathogens. There was case series or case reports that prompted us to make clinical decisions. Guidelines wasn't really available.  It was just based on what the experts said, what works in other hospitals, what works for someone somewhere in some part of the world, I might want to try it out.  All of this forced us into rushed high-intensity decisions without considering all vantage points.  We know that decisions must be triaged and resources, especially if large numbers are affected.  So clearly, the pandemic pushed us into a corner and actually because of us being pushed into that corner, we were partly responsible for the misinformation because we had to  make early decisions based on whatever was available to us. And this is a prime example of what really transpired all over the world.  I'm not going to go into the details of chloroquine versus ivermectin versus so on and so forth and how different parts of the world reacted to the misinformation.  I will say, though, that there's some interesting examples. There is one from India where we know when the Delta variant stuck and misinformation  was really common, especially on social media. So this was a social media flash in India where it was actually said that after extensive  research, our findings show that consuming alcoholic beverages may help reduce the risk of infection by the novel coronavirus COVID-19.  Vodka is the most recommended for drinking, cleaning, and sanitizing. This was actually signed off by a hospital system in Kansas City. Amazing.  This actually went around social media in India and not until in the bottom left corner of your screen you see an actual outlet had to come out and say, guys, hold on, fact check.  No, this US hospital did not say alcohol can keep COVID-19 at bay. That is how bad misinformation can get.  So please, this is not a problem that can be taken lightly at all. And it does affect us as critical care doctors, but it affects us in ways that we don't even know.  Anxiety, worry, and job satisfaction, symptoms of burnout in the ICU. I've personally been part of some of this work.  I will say, though, looking at this slide, the adjusted odds ratio for anxiety, for depression,  and for severe burnout are very high in this part of the world compared to some of the other parts of the world.  Part of it is definitely driven by misinformation, especially during COVID-19 in the ICU, but we weren't really aware that that was actually leading to anxiety.  The other part to all of this is Twitter, our very important Twitter, something that we live with most parts of the day, most days of the week.  This really nice infographic shows some pros of Twitter, and definitely there's lots and lots of pros, and coming from me, I'm a big user of Twitter and social media to spread  education. However, there are harms in terms of creating hysteria, in terms of spreading misinformation  at rapid speed, and in terms of too much information, which is literally like drinking from the fire hose.  This nice infographic also divides it up and tells you how to handle Twitter, and how to handle lots and lots of information that comes through from Twitter, and how to actually  assemble and process it. Social media has a responsibility. They are bearers of important information, and this is a really nice piece in critical  care that includes Dr. Bose from the Beth Israel system, as well as the senior authors, shows a very nice infographic of social media influencers for critical care, but highlights  importantly that among the top 50 influencers, only 28% had formal training in critical care medicine, though they were talking about critical care medicine.  So understand that yes, you go to social media for your information, but social media importantly has a responsibility as well.  SCCM has helped us and prepared us to handle misinformation, and the society page actually highlights the appropriate conduct, and what is regarded as misinformation, and what is  our responsibility as critical care professionals to hold up our expertise and professionalism,  and in fact, they clearly say that spreading information contradicts the ethical and professional  responsibilities of SCCM members, erodes public trust in our profession, and may violate the SCCM standards of professional conduct. And we need to step in.  This is me over the last two years or so. I've been talking to our local news media outlet here in the area, and every month trying  to spread as much information that is true and appropriate after talking to my hospital authorities and knowing what is the right thing to say, keeping the public abreast of  the COVID-19 situation. You can actually Google it, and you can see all of my posts with this media outlet, and  this is not to promote myself, but I think that I really felt gratified that I was able to act as a conduit and a liaison and not spread panic, but also appropriately alert  the public and spread, promote appropriate information, and that is responsibility that each and every one of us as critical care doctors has.  We did the same with the American Society of Anesthesiologists. We worked on something called the CSER Initiative, Coronavirus Disease Associated Emergency Scaling  of Anesthesiology Responsibilities, and we provided this large source of information with lots and lots of modules to look at for free to download all over the world, and it  was downloaded many thousands of times world over and utilized by healthcare professionals  of all sorts.  I come to the end. Thank you so much. I hope you continue to spread information in critical care, and I hope you continue to stay safe. Thank you. Open for questions.

Video Summary

Ashish Khanna discusses the problem of misinformation in medicine, specifically in the field of critical care. He explains the hierarchy of knowledge, information, and data, and highlights the distinction between misinformation, disinformation, and malinformation. Misinformation refers to false information without an intent to harm. Khanna emphasizes the harmful effects of misinformation in the intensive care unit (ICU), such as false hopes for families and loss of trust in the care team. He suggests countermeasures to combat misinformation, including providing accurate information from official sources and encouraging families to discuss their online discoveries with medical professionals. Khanna also discusses the impact of misinformation during the COVID-19 pandemic and provides examples of false information related to CPR and COVID-19 treatments. He highlights the role of social media in spreading both accurate information and misinformation, and calls for responsible conduct from healthcare professionals in combating misinformation.

Asset Subtitle

Quality and Patient Safety, Professional Development and Education, 2022

Asset Caption

This session will delve into the pervasive amount of medical misinformation that has permeated our society and how it affects the critical care medicine professional. The vast amount of misinformation that has been spread via vehicles such as social media and government officials leads to a skeptical public when medical professionals give advice on how to combat medical issues. The COVID-19 pandemic and the vaccination process will be main topics of discussion.

Meta Tag

Content Type Presentation

Knowledge Area Quality and Patient Safety

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Evidence Based Medicine

Tag Healthcare Delivery

Year 2022

Keywords

misinformation

critical care

harmful effects

trust

COVID-19

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