Social Media and Medical Misinformation

The illusory truth effect

Recently, I was invited to a medical conference to speak about medical misinformation, specifically what a nephrologist (kidney doctor) can do. In my talk, I explained how social media was the ideal media for misinformation and I laid out some specific strategies for providers, but as I was flying home I thought, you know, a lot of people could benefit from this information. Because let’s face it, we have sailed through the age of information and are stuck in a squall of misinformation.

Medical misinformation is a beast. It’s really like the mythical hydra, cutting off one head and then two (or more!) heads sprout as a replacement. But I also believe there are evidence based ways to tackle this, so let’s dig in. 

Know Your Enemy

With misinformation, I think of the enemy less as a specific individual like Gwyneth Paltrow or Dr. Christiane Northrup or Alex Jones, it’s more how their messages percolate. What I’m referring to is something called the illusory truth effect. The basic concept is that humans are predisposed to mistake repetition for accuracy. This is believed to be due in part to something called processing fluency, which is the ease at which humans can process a piece of information. If we have been exposed to something before, it’s easier to process when we see it again later and our brains prefer things that are easier. 

This seems to be an innate human behavior, because researchers studied the illusory truth effect comparing 5-year-olds, 10-year-olds, and adults, and found the effect was the same across all age groups.  

Social cues can make some information more persuasive than others. For example, it comes from a source that is believed to be credible (such as a medical professional) and, unsurprisingly, people are more likely to believe something if they find the source is attractive or powerful. This explains why celebrities can be powerful vectors of misinformation. 

The illusory truth effect has the greatest impact over shorter periods of time, which means social media is its playground. Think about how social media content goes viral, you see something once and if it hits, well, then it’s everywhere (hello Sbagliato!). Although, even when the misinformation is spaced out, it can have an effect.

While repetition is more effective on statements that seem more ambiguous, like vaccine safety in pregnancy (the COVID-19 vaccine is safe in pregnancy, my point is I understand how this might be a questionable statement for people who don’t know the research), the illusory truth effect even works on clearly false statements. For example, researchers exposed people to blatantly false statements that most people should know are untrue. After five exposures, they were able to push the needle to get people to start to give credence to the clearly false statements.

Just how wildly untrue were the statements in this experiment? So glad you asked. Here are some examples:

• The tallest person is 35 feet tall

• The earth is a perfect square

• Benjamin Franklin lived to be 150 years old

• The population of North Dakota is greater than the population of New York State

• George Washington was born in China. 

What’s even more concerning is knowledge doesn’t protect against the illusory truth effect. Meaning if you know something to be true, let’s take the fact that the vagina, meaning the inside, should not be cleaned, but you are repeatedly exposed to advertisements, and posts, and videos that suggest otherwise, you might start to wonder if maybe you should be cleaning the inside of your vagina. Basically, propaganda works.

What does protect against the illusory truth effect? Fact checking. Every single time. 

That’s Really Scary When You Consider How Instagram Works!

Yes, yes it is.

Every single day I am tagged or messaged with a statement that goes something like this “This can’t be true, can it?” I’ve tackled many of those here on The Vajenda. For example, in this post about boric acid profiteers, or this one about pill panics on Instagram. I see the posts from naturopaths, period coaches, menopause diet pushers, supplement scammers, and people who want you to stuff moth balls in your vagina (that’s the so-called “Yoni Pearls”). I know this garbage is also populating your feed as it is mine. Over and over again.

You read the post. Yikes! It’s either scary information or gives you FOMO (fear of missing out). You may read the comments. What do other people think about this? There you almost always find people replying, “I knew it, that happened to me!” or “that drug is poison” or “I've been suffering for years and that vaginal wash changed my life”. Comment after comment repeating the misinformation as gospel. You might even start to think, hey, those people are just like me. Which makes someone more vulnerable to the illusory truth effect.

Even if you say, “Okay, this is bullshit, there is no way I’m stuffing a bag of herbs in my vagina” and move on, now that you have engaged with that post, similar ones will pop up in your feed, because that is how the algorithm works. When you pause to read something or watch a few seconds of a video, bullshit or not, Instagram (and TikTok) assumes you must like it, finds something similar, and feeds that to you. Again and again. Now that bad content is flying by on your feed, but even if you don’t click, you likely see the headline. Or worse, you stop and read another post because sometimes you can’t help but rubberneck. (Hey, I’ve been there). And boom. You have five exposures in a a very short period of time.

I know sometimes people engage with the misinformation mafia, for example people who lie about the birth control pill or about the food you eat or about supplements, because they think it will help. But that won’t change the mind of the person who is posting. They are likely deep into the medical conspiracy theory, either because it’s profitable or they themselves have unwittingly been converted. And any comment that you leave that questions the original poster may be deleted, or worse swarmed, and then you get to see those mentions over and over again. And you’ve boosted their engagement. And if it’s a video, you may even have put money in their pocket by the additional views that came via the signal boost.

And of course, the more engagement they get, the more likely their content will get boosted and potentially go viral. You might know what they are posting is garbage, but someone else might not. 

The Solution to Pollution is Curation

In surgery we have a little saying, the solution to pollution is dilution. This refers to irrigating a wound or surgical field to remove as much bacteria as possible. Since you can’t bleach your Instagram (too bad, hey?), what you can do is limit the exposure to begin with. 

Ok, so how?

Algorithms can be manipulated. For example, my partner DrJenAdjacent follows me on Instagram. He often does research for me on specific posts that I’m debunking and so his feed gets filled with garbage about inserting garlic vaginally (never do this) or tampons being toxic (really, they aren’t). To counteract this he regularly watches posts about puppies, and so the garbage posts that are fed to him by the algorithm, quickly get replaced with puppies. If he never looked things up for me and only clicked on puppies, he’d have a lovely little corner of the Internet.

The approach to take is to not use Instagram mindlessly, which is hard. I’ve been sucked into video after video for ages, before I think, why am I watching videos of the scariest rollercoasters on earth…that have clearly been stollen from other accounts? Don’t let the algorithm be the driver, the approach here is to direct the algorithm. 

Report and Block.

If you see something you KNOW is incorrect and harmful, report the post. Yes, I know things rarely happen, but you never know. Then block that account. Do not give them a second chance. If they are telling you one obvious medical lie, they are not worth following, no matter how amazing their make-up tips or yoga poses or novels or podcasts. Just block. Don’t interact. They aren’t going to change their mind, and most times it just leads to a pile on in the comments from followers of the original poster screaming how you are wrong (remember, you are in THEIR neighborhood if you leave a comment refuting them, so there are lots of them and only one you) which is algorithm boosting engagement. That person isn’t posting that information because they care, if they cared they would have fact checked with a reliable source. If they don’t know about fact checking with a reliable source, you don’t want their medical content, ya know? 

Don’t Snitch Tag

If I write about misinformation and disinformation, I don’t tag the source. There is zero point. By tagging them, more people might go to their page and get exposed. And often they bring their army that swarms my feed and direct messages and I’ve got to spend a few hours restricting or blocking or dealing with people who send me nasty direct messages. While I don’t know for sure, I suspect tagging an account feeds the algorithm, which is based on the assumption that more is better and that similar material is what you want. The algorithm just know about engagement and volume.

But I am not sure if what I read is true? Now what?

Remember what I said earlier, about what works against disinformation? Fact checking. Screenshot the post, don’t follow or engage. You can go back and do that after you have fact checked.

Ok, so how to fact check? Just Googling can be a nightmare, because people who spread misinformation are also very good at search engine optimization, so often bad content rises to the top. One way to defeat that is to enter your question or a topic into the search bar and then add the name of a reliable source. Basically, you are doing your own search engine optimization, because the content written by that reliable source will come to the top. For example you can add “DrJenGunter” or “thevajenda.com” and if I’ve written on that topic your mini search engine filter will find it. You can also add “NAMS” (North American Menopause Society) for something about menopause, or “ACOG” for American College of OB/GYN for a general OB/GYN topic.

Here’s an example. I know people see posts recommending hormone testing for menopause hormone therapy all the time. FYI, private doctors do this because it’s a way to boost their revenue, it’s a scam. However, to find that answer yourself, simply Google “Hormone testing menopause hormone therapy NAMS”. 

Follow the 3rd link (the one that mentions hormone testing) and you get this:

Another strategy, which works well with vaccine questions, is to Google the question and add the words “fact check.” Numerous reputable sites will come up, like Reuters.

If you send an Instagram post to me via DM, as many people do, if I know it’s false, I just delete the message because the urge to click is real. If you send me a screenshot, I might use that for a post, but I’m not going to look that person up on Instagram. I may look up the information and later write a post on the subject. But I am doing my very best to defeat the algorithm. 

Protect Yourself, Curate Your Social Media

Blocking is your friend. Really. 

It doesn’t take long to curate your feed. It’s as easy to block as it is to scroll on. And follow good sources.

If your feed does get corrupted with too much junk, don’t forget about PUPPIES! Or baking or Italian tourism.

Remember, propaganda works, that’s why people use it. And repeating medical misinformation is simply propaganda. And sadly it’s profitable. 

Resist the temptation to click and read, or worse, argue. It’s taken me a long time to break that habit and I am happier for it. 

References

1. Henderson EL, et al. The Trajectory of Truth: A Longitudinal Study of the Illusory Truth Effect. Journal of Cognition, 2021:4.

2. Fazio LK, et al. Repetition increased perceived truth equally for plausible and implausible statements. Psychonomic Bulletin & Review Aug 2019;26.

3. Fazio LK, et al. Knowledge Does Not Protect Against Illusory Truth. Journal of Experimental Psychology:General. 2015;144.

4. Fazio LK, Sherry CL. The Effects of Repetition on Truth Judgments Across Development. Psychological Science.2020.

5. Lacassagna D, et al. Is Earth a Perfect Square? Repetition Increases the Perceived Truth of Highly Implausible Statements. June 2021 PsyArXiv

6. Nyhan B, et al. Effective Messages in Vaccine Promotion: A Randomized Trial Pediatrics 2014;133:e835–e842.

7. Ecker Ullrich KH, Lewandowsky Stephan, Cook John, et. al. The psychological drivers of misinformation belief and its resistance to correction. Nature Reviews Psychology. 2022, Jan Volume 1.