Science & Society

Health & social media

The crucial role of information hygiene in mitigating theory and infodemics

David Robert Grimes1,2,*

he satirist Johnathan Swift once linking 5G communications to COVID-19 army of healthcare workers using them lamented that “falsehood flies, and saw cell towers torched by arsonists. But without ill-effect has been no impediment to T truth comes limping after it”. Penned falsehoods about radiofrequency are not the propagation of such myths. These are three centuries ago, these words seem new—current assertions about ostensible not insubstantial gatherings. August saw alarmingly prescient: The paradox of the era harms of 5G are simply recycled from prior more than 17,000 protestors take to the we live in is that, despite having access to scaremongering about cell-phones, WiFi and streets of Berlin alone, with thousands more an enormous amount of information at our powerlines, and bereft of any substance in London, Dublin, Madrid, and elsewhere. fingertips, this same freedom allows poiso- (Grimes & Bishop 2018). But while the humble mask might be the nous fictions to aggressively perpetuate. In And while this might be a novel coron- ostensible focal point, the astute observer the midst of the COVID-19 pandemic, this avirus, the conspiracy theories flaunted cannot fail to notice the banners replete with has manifested as a parallel crisis of infor- around it are anything but long before all manner of health conspiracy, ranging mation—in the words of the WHO, we are YouTube cranks insisted COVID-19 was a from assertions that the virus is a to experiencing “an overabundance of informa- man-made virus, claims that AIDS was a the claim we are being microchipped by tion, some accurate and some not, that CIA bioweapon gained traction in the 1980s. vaccine manufacturers or Bill Gates (Fig 1). makes it hard for people to find trustworthy On this latter point, the fingerprints of ...... sources and reliable guidance when they Russian and Chinese disinformation under- need it”. In this, the first pandemic we face pinning current Coronavirus myths have “..., the rise of “anti-mask” in the social media era, we are glimpsing the historical echoes; at the height of the AIDs protests has seen disparate rise of a shadow problem—an “infodemic”, crisis, Soviet intelligence invested heavily in groups from anti-vaccine acti- the dissemination of disinformation across amplifying the claims the disease was an vists to 5G protesters to alter- social media. American weapon. This undertaking, the ...... notorious operation INFEKTION, was ulti- native health advocates unite mately derailed when the pandemic swept ...... under a single banner.” “In this, the first pandemic we the USSR, forcing to seek help from face in the social media era, American virologists. Such a spectacular we are glimpsing the rise of a volte-face underpins an inescapable truth: The grand health conspiracy shadow problem—an “info- Reality does not care one iota for our narra- tives. And despite being debunked for In normal times, it is easy to dismiss health demic”...” ...... decades, the myth still maintains significant conspiracies as a phenomenon confined traction. solely to the fringes, inconsequential for More recently, the rise of “anti-mask” most of us. But the sheer dominance of The viral nature of disinformation protests has seen disparate groups from anti- disinformation in science and medicine vaccine activists to 5G protesters to alterna- should disabuse us of the comfortable Claims of dubious veracity frequently go tive health advocates unite under a single notion; this is something we can disregard— viral on the internet. This pathogenic alle- banner. Lockdown restrictions are the chief and that this has been a serious issue long gory for modern information is not idly target of their ire. Masks, they claim, lead to before the emergence of COVID-19. This is made. We all too frequently act as vectors oxygen depletion and carbon dioxide perhaps most stark when we consider the for fictions, which can cause societal harm. poisoning. That this is easily refuted by resurgence in vaccine-preventable illness. In In the UK and beyond, conspiracy theories simple measurement or by observing the 2000, measles was declared eradicated in

1 School of Physical Sciences, Dublin City University, Dublin, Ireland 2 Department of Oncology, University of Oxford, Oxford, UK *Corresponding author. Emails: [email protected]; [email protected] DOI 10.15252/embr.202051819 | EMBO Reports (2020) 21:e51819

ª 2020 The Author. Published under the terms of the CC BY NC ND 4.0 license EMBO reports 21:e51819 | 2020 1 of 4 EMBO reports David Robert Grimes

12% Water fluoridation is a conspiracy to dump chemical waste in water

12% GMOs are a plot to control the world population

12% The CIA deliberately infected people with AIDS

15% COVID-19 is caused by 5G radio-frequency

19% Will refuse the coronavirus vaccine if/when it is available

20% Vaccines cause autism and other disorder which doctors cover up

20% Cell phones cause cancer and the government cover it up

29% COVID-19 was manufactured in a laboratory

37% The FDA is suppressing a cancer cure to protect pharma profits

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

© EMBO © Respondents agreeing with statement

Figure 1. Commonly encountered conspiratorial beliefs in medicine. Estimated proportion of population subscribing to common medical conspiracy theories. Based on data from Oliver and Wood (2014) and surveys from the Université de Sherbrooke (https://www.usherbrooke.ca/actualites/relations-medias/communiques/communiques-details/c/42738/) and the Pew Research Center (https://www.pewresea rch.org/fact-tank/2020/07/24/a-look-at-the-americans-who-believe-there-is-some-truth-to-the-conspiracy-theory-that-covid-19-was-planned/).

the USA. Twenty years later, the situation frequently avoid immunisation. Even now, as than twice as likely to die in the same period has deteriorated alarmingly, with record researchers try to derive a vaccine for the as those relying on conventional therapies outbreaks recorded around the country. In novel coronavirus, anti-vaccine campaigners (Johnson et al, 2018). The dark irony is that 2018, Europe recorded 84,462 cases, up have already begun to spread falsehoods such conspiratorial narratives induce an from only 5,273 cases in 2016. suggesting that trial participants are dying. inherent distrust of conventional medicine, ...... The dark renaissance of conquerable providing a cloak for charlatans to operate diseases is accordingly symptomatic of a under. Some common reasons for the perpet- “...the sheer dominance of deeper problem: The triumph of emotive fic- uation of health conspiracy are given in Box. disinformation in science and tions over reality. False narratives have an alluring simplicity for believers, but they do medicine should disabuse us of Box 1. Some motivations for perpetuat- substantial harm; the staggering popularity ing health conspiracy the comfortable notion this is of false or unsubstantiated cancer cures is something we can but one example. Social media is rife with Epistemic: Health conspiracies offer simple ... narratives for complex phenomena and disregard ” dubious claims: In 2016, more than half of provide a perverse sense of security against ...... the 20 most shared articles about cancer on uncertainty for believers (Douglas et al, Facebook involved medically discredited 2017). A similar cocktail of scaremongering claims. Purveyors of false remedies accuse Egotistic: More narcissistic individuals are claims spread about the HPV vaccine in Japan the medical and scientific community of more likely to be conspiracy theorists, and the illusion of special knowledge rendering saw uptake collapse from 70 to 1% in suppressing cures for cancer, despite this one superior to others can be alluring months, a deplorable situation estimated to being totally implausible (Grimes, 2016). (Douglas et al, 2017; Imhoff & Lamberty, cost upwards of 11,000 lives (Simms et al, This sadly cannot be dismissed a mere fringe 2017). 2020). Anti-vaccine also mark- belief: A staggering 37% of Americans Political: Some health conspiracies have edly pushed down rates in Denmark and believe the FDA is doing precisely this. political dimension, when their propagation is deemed damaging to an enemy power Ireland, a situation only being reversed in the These claims of alternative treatments are by undermining public trust. latter country thanks to Herculean efforts by at best useless, but they do harm far beyond patient advocates, scientists, and physicians. their intrinsic lack of efficacy. When effective Exposure to ubiquitous online anti-vaccine interventions such as radiotherapy and conspiracy theories has, perhaps unsurpris- chemotherapy are dismissed as “poisons” Availability heuristics, illusory truth, ingly, substantial impact on parental intention and alternative or unsubstantiated treat- and dubious amplification to vaccine (Jolley & Douglas, 2014): Faced ments touted in their stead, it comes at terri- with a plethora of worrying claims and ble cost. Evidence suggests patients who It is crucial to note that this is problem that unsure what to believe, apprehensive parents subscribe to alternative approaches are more affects us all, and not a simple function of

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intelligence or education. Evidence suggests that it has focused the world’s attention upon Further Reading that we are collectively poor at differentiat- the vital importance of physical hygiene. The ing between sources reputable and repre- importance of rigorous hand-washing and Attitudes to COVID conspiracy hensible. Compounding the noxious social distancing to stem the tide of the virus is https://www.bbc.com/news/technology- influence of , it also something we collectively understand. But in 53083341 persists longer and diffuses much further tandem with this, we need to recognise that than reliable medical and scientific informa- health disinformation goes viral too and does The Infodemic World Health Organization (2020). Novel tion. We can also fall victim to the phenom- serious harm. If we are to protect ourselves coronavirus (2019-nCoV). Situation Report, enon of illusory truth, where mere repetition against the ramifications of these rapidly 28 of a claim induces us to accept it more read- increasing fictions, we must practice a new ily, even if we know it to be false on an protective measure, a form of Informational Illusory truth and the spread of disinfor- intellectual level. The availability heuristic Hygiene. Rather than risk unprotected expo- mation — plays an important role too we afford more sure, we need to recognise that a healthy scep- Brady WJ, Wills JA, Jost JT, Tucker JA, Van weight to easily recalled assertions than ticism is our best protection against damaging Bavel JJ (2017) Emotion shapes the diffusion more sober-headed analysis, and it is unsur- fictions about our health. of moralized content in social networks. prising that frightening stories perpetuate ...... Proc Natl Acad Sci USA 114: 7313–7318 wider than more careful claims. Del Vicario M, Bessi A, Zollo F, Petroni F, “Long term, the only lasting Scala A, Caldarelli G, Stanley HE, Quattro- As humans, we emote first and reflect ciocchi W (2016) The spreading of misinfor- after; this propensity to react before vaccine against this onslaught mation online. Proc Natl Acad Sci USA 113: reflecting is a trojan horse for devious fic- of poisonous fictions is to 554–559 tions to become established. Social media, of Fazio LK, Brashier NM, Payne BK, Marsh EJ improve our societal critical- 2015 course, cannot be blamed entirely for this ( ) Knowledge does not protect against thinking skills.” illusory truth. J Exp Psychol Gen 144: 993 phenomenon of “dubious amplification” ...... Grimes DR (2020)The irrational ape - why (Grimes et al, 2020)—any media magnifi- flawed logic puts us all at risk and how cation of an unsubstantiated claim on any We must recognise that exposure to critical thinking can save the world, 1st platform can cause harm. To take but one is harmful, take precautions edn. London: Simon & Schuster contemporary illustration, US President to prevent ourselves becoming infected, and Johnson NF, Velásquez N, Restrepo NJ, Leahy R, Gabriel N, El Oud S, Zheng M, Donald Trump’s promotion of hydroxy- avoid vectors of misinformation in the Manrique P, Wuchty S, Lupu Y (2020) The chloroquine for COVID-19 led to a massive sound and fury of bogus health claims. online competition between pro-and anti- increase in use around the world, despite a Before we perpetuate claims we encounter, vaccination views. Nature 1–4 paucity of evidence for efficacy, and emerg- we ought to ask ourselves whether they are ing data pointing to severe harms. But while reputable and verified before we infect dubious amplification is a ubiquitous prob- others. In much the same way, we take lem on all platforms, social media is unparal- precautions with potential pathogens, and it not recognise it. A more cynical reading is leled in its capacity to distort. A 2018 study is crucial that we become aware that misin- that they simply do not care—to social in Science (Vousoughi et al, 2018) analysed formation and conspiracy theory are not media companies all engagement is profit, 126,000 contested news stories between harmless: Even if it does not affect us badly, and the consequences for public health and 2006 and 2017, with the alarming conclusion it may put others at serious risk. understanding utterly inconsequential to that hoax and rumour completely eclipse them. truth, and that fictions consistently dominate A wider responsibility ...... the narrative...... But the onus for this cannot solely be placed “Regulation of social media is at the feet of the public—social media a solution which must be seri- “But while dubious amplifi- companies cannot shirk their responsibility ously considered...” cation is a ubiquitous problem for the deplorable situation in which we ...... on all platforms, social media now find ourselves. In the last few months, is unparalleled in its capacity companies such as Facebook, YouTube, and Whatever the reason, it is clear is that we Instagram have pledged to crack down on cannot rely on social media giants to self- to distort.” everything from anti-vaccine propaganda to regulate their platforms, despite their implo- ...... COVID-19 conspiracy theories and 5G scare- rations to the contrary. How we best counter- mongering. But it is hard to interpret this as act the dangerous reality we now find Information hygiene and anything more than shallow lip-service, as ourselves in is not immediately obvious. It is critical thinking dangerous disinformation remains dominant a problem that demands more research, as across these channels. The most charitable we are sorely in need of evidence-based Long term, the only lasting vaccine against interpretation is that social media compa- policy to counteract the dangerous fictions to this onslaught of poisonous fictions is to nies are completely ineffectual at counter- which we are constantly exposed, before improve our societal critical-thinking skills. If acting the volume of dangerous nonsense they do further harm. Regulation of social there is a silver-lining to COVID-19, it might be hosted on their platforms, or so inept as to media is a solution which must be seriously

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considered, and legislation that compels Grimes DR, Bishop DV (2018) Distinguishing Oliver JE, Wood T (2014)Medicalconspiracy them to enforce fact-checking and remove polemic from commentary in science: some theories and health behaviors in the dubious content is perilously overdue. guidelines illustrated with the case of Sage and . JAMA Intern Med 174: However, this is likely to take time, and Burgio. Child Dev 89: 141 – 147 817 – 818 given the sheer size of these giants, unrelent- Grimes DR, Brennan LJ, O’Connor R (2020) Simms KT, Hanley SJ, Smith MA, Keane A, Canfell K ing international pressure. In the interim, we Establishing a taxonomy of potential hazards (2020) Impact of HPV on must acknowledge that it remains an envi- associated with communicating medical cervical cancer in Japan: a modelling study. ronment thoroughly contaminated with viral science in the age of disinformation. BMJ open Lancet Public Health 5:e223 – e234 misinformation, and basic information 10:e035626 Vosoughi S, Roy D, Aral S (2018) The spread of true hygiene is the only means we must protect Imhoff R, Lamberty PK (2017) Too special to be and false news online. Science 359: 1146 – 1151 ourselves and each other. Pandora’s box is duped: Need for uniqueness motivates already open—it is imperative now we learn conspiracy beliefs. Eur J Soc Psychol 47: 724 – 734 to mitigate the consequences. Johnson SB, Park HS, Gross CP, James BY (2018) Complementary medicine, refusal of License: This is an open access article under the References conventional cancer therapy, and survival terms of the Creative Commons Attribution- Douglas KM, Sutton RM, Cichocka A (2017) The among patients with curable cancers. JAMA NonCommercial-NoDerivs License, which permits psychology of conspiracy theories. Curr Dir Oncol 4: 1375 – 1381 use and distribution in any medium, provided the Psychol Sci 26: 538 – 542 Jolley D, Douglas KM (2014) The effects of original work is properly cited, the use is non- Grimes DR (2016) On the viability of conspiratorial anti-vaccine conspiracy theories on commercial and no modifications or adaptations beliefs. PLoS One 11:e0147905 vaccination intentions. PLoS One 9:e89177 are made.

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