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SPRING 2022
Renal & Urology News 27
Ethical Issues in Medicine Physicians have a professional obligation to combat medical misinformation in the interest of the public good BY DAVID J. ALFANDRE, MD, MSPH
Akin to an Epidemic So-called infodemiologists have begun approaching the problem of misinformation from an epidemiologic vantage point by preventing it from going “viral.”1 They conceptualize misinformation as analogous to an infectious disease outbreak that must have its origin, virulence, transmission patterns, and potential “treatments” rapidly identified, along with a need to inoculate people against these deceptions. When misinformation, like an epidemic, is
Health care professionals’ trusted position in society provides them with a valuable platform to inform the public. They are licensed by their state and often boarded by a professional society who have professional obligations to their patients and the public to disseminate evidence-based information.
Call Out Misinformation Promotion of the public good and a commitment to integrity and competence is central to the ethics of the health care profession. These obligations include avoiding the release or propagation of mis- and dis-information, calling misinformation out when they see it, and not promoting it either with their patients or on social media outlets. Rather than a clear right or wrong duality to scientific debates, there is often a slowly evolving consensus about what we clearly know from what we do not. Society must protect legitimate scientific discourse, free expression, and openness to new ideas, but significant professional consequences are justifiable when spreading misinformation that is not firmly grounded in evidence especially when it has real and serious public health implications. Some health care professionals’ goal in sharing what could be considered
The COVID-19 pandemic exposed how easy it is for non-authoritative sources to spread wrong and possibly dangerous medical information. not promptly identified and contained, it spreads so rapidly within a population that it takes far greater effort and resources to counteract. While public health professionals, scientists, and journalists are all working to deliver healthier “media diets” that serve accurate, reliable information to the public, health care professionals are sometimes operating at both the public and individual patient level to ensure good healthy practices for their patients.
misinformation may be rooted in a desire to respect patient autonomy and individual liberty and avoid coercion. In this case, misinformation should be distinguished from legitimate shared decision-making, the latter being when there is reasonable debate about a range of acceptable medical options. For example, because there is sufficient empirical data that SARS-CoV-2 vaccination is associated with a very small risk of self-limited myocarditis, it could
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he COVID-19 pandemic has stressed the health care system and the public like no other event in the last century. Responding to the public’s needs for clear, authoritative, continually evolving information has required an extraordinary commitment from public health authorities, elected officials, scientists, and other health care professionals. Regrettably, misinformation from a variety of sources has challenged an effective response to the information needs of the public. Although misinformation is not a new phenomenon, social media and other internet outlets have expanded the potential for disreputable, nonauthoritative sources to achieve an outsize immediate effect on the public.
be part of a shared decision-making conversation. The same could not be said for infertility and vaccination, as no such data exist for that association. Although the risk of COVID-19associated myocarditis is greater than the risk of vaccine-associated myocarditis, vaccine-associated adverse events remain a concern for some patients. Again, for some patients, the public health benefits may be greater than the individual ones — the largest benefit for some patients may be the reduction in community disease burden leading to less strain on their local health care system. When hospitals are not overwhelmed, everyone benefits.
Medical Organizations Speak Out After a series of events that involved promotion of COVID-19 misinformation from health care professionals, the Federation of State Medical Boards as well as professional societies and the American Board of Medical Specialties all released public statements that its members’ board certification could be sanctioned or their license could be suspended or revoked if they are involved in disseminating misinformation to their patients or the public. This was an important step to demonstrate to the public and remind all health care professionals of their professional
obligations to provide high-quality evidence-based information to the public. The statements from professional societies and state medical boards were not intended to quell legitimate scientific debate or the free exchange of ideas among health experts, but rather to prohibit the dissemination of information that lacks a clear evidence base and is contrary to the efforts of halting the pandemic. Although physicians are patient advocates first and must continue to promote individual liberty, there are circumstances when their public health role is relevant and important. Physicians must continue to act in the best interest of all members of their community. ■ David J. Alfandre, MD, MSPH, is a health care ethicist and an Associate Professor in the Department of Population Health at the NYU School of Medicine in New York. The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the VA National Center for Ethics in Health Care or the US Department of Veterans Affairs. REFERENCE 1. Scales D, Gorman Jamieson KH. The COVID-19 infodemic—Applying the epidemiologic model to counter misinformation. N Engl J Med. 2021;385:678681. doi:10.1056/NEJMp2103798
