NOT WHAT THE DOCTOR ORDERED


  • Nation
  • Monday, 14 Sep 2020

Nowadays doctors have to contend with patients who come armed with information they read online and they question the physician’s diagnosis and medical treatment.

MEDICAL misinformation is a dangerous thing. Fake, misleading and over-interpreted health news in social media has the potential to wreak havoc and be a very real threat to public health and safety – evident during this pandemic.

How many of you received WhatsApp messages asking you to get chloroquine or hydroxychloroquine to save yourselves?

Doctors often get the brunt of this sort of misinformation as they come into contact with patients on a daily basis, many of whom would have read up a little bit about a disease or cure online, and come to some conclusion about how to treat themselves, often disagreeing with the experts or refusing to listen to the actual science.

A little information in the wrong hands is dangerous, and the problem with social media is that it allows misleading medical information about a range of diseases to circulate widely, rapidly and often very efficiently.

Disinformation campaigns can even be deliberate and require collective efforts to avoid the dangers they represent.

Thankfully, there are many who are eager to ensure that trusted information is also made accessible to society.

Battling the spin doctors

Medical Mythbusters Malaysia (M3) is an online portal made up of certified medical personnel who tackle myths and fake news prevalent in the local health arena.

“M3 was formed in July 2016 and formally registered as an NGO in February 2017. We are a group of medical personnel from the private and public sector who are active and passionate about health education to the public, ” said its president and co-founder Dr Ahmad Firdaus Mohd Haris.

Medical Mythbusters Malaysia (M3) is an online portal made up of certified medical personnel who tackle myths and fake news prevalent in the local health arena, said Dr Ahmad.Medical Mythbusters Malaysia (M3) is an online portal made up of certified medical personnel who tackle myths and fake news prevalent in the local health arena, said Dr Ahmad.

He said there are 54 doctors onboard – from the fields of public health, family medicine, obstetrician and gynaecology, orthopaedics, ophthalmology, anaesthesiology, ENT, psychiatry, pediatrics and dermatology. There are also pharmacists, dietitians, dentists, psychologists and paramedics on hand.

“Our main area of expertise is creating content on health awareness on social media. We predominantly use our Facebook page to relay information which is easy for the public to understand. We try to avoid medical jargon and use elements of storytelling in our content.

“At the same time, we also engage with governmental and non-governmental agencies to enhance current health policies which will benefit the general population, ” said Dr Ahmad.

Outside of social media, the group also engages with the community through health talks and its special M3 Turun Padang programme. These interventions, according to the doctor, are very necessary because there are a lot of myths, false and fake information circulating.

“Some are harmless while others can be potentially harmful to public health. An example is the anti-vaccine movement. In 2019, WHO considered this movement one of the top 10 threats to global health. Its impact can already be seen by the sudden rise in vaccine-preventable diseases such as measles, diphtheria and pertussis. These diseases were almost unheard of since Malaysia started the national vaccination schedule. However, these once-almost eradicated diseases have made a comeback in line with the trending rise of anti-vaccine movements, ” he said.

According to the World Health Organisation, in 2019 vaccination prevented two million to three million deaths each year, and a further 1.5 million could have been avoided if global coverage was improved.

“It’s undeniable that the Internet has made this problem a lot worse. Nowadays, anyone can say anything, even without knowledge and credibility. Even ridiculous accusations such as ‘the world is flat’ can make headway on the Internet.

“Furthermore, sharing fake information is so easy. It’s just a click of a button on social media. The mantra nowadays is ‘share first, think later’, ” Dr Ahmad said.

M3 on Facebook also features videos and infographics.

“We create content based on whatever medical issue is trending and whenever someone gets an idea to create a video, ” he said.

Not a new problem

Medical misinformation is not a “modern” problem, according to Dr Varughese Koshy.

“Since I began practising medicine, this type of problem with false information has existed. Those days we just didn’t have the Internet so the news was not so extensive. It was usually just hearsay. Grandparents telling their sons and daughters how to cure or treat an ailment.

“Now with Google, and all sorts of online groups, these things have taken on a more concrete form. So many people tend to believe what they hear from others rather than what their doctor tells them, ” said the consultant paediatrician at Avisena Women’s and Children’s Specialist Hospital in Shah Alam.

‘Many of the parents of children I see have preconceived ideas thanks to the Internet, and often half-baked ideas, ’ said Dr Koshy.‘Many of the parents of children I see have preconceived ideas thanks to the Internet, and often half-baked ideas, ’ said Dr Koshy.

“Many of the parents of children I see have preconceived ideas thanks to the Internet, and often half-baked ideas. They don’t really know the fundamentals of why we give vaccines, for example, ” he said, referring to his patients whose parents are anti-immunisation.

“It has been very difficult to ‘convert’ those who have an anti-vaccination mindset because they already have a prefixed idea that this is something bad for them, ” Dr Koshy added.

“From about seven years ago, we began observing that the numbers in this group were steadily rising. But now slowly, in the last one or two years, this trend has started to change. People are now realising that they made a mistake and they are returning to vaccinate their kids. I’ve had patients who have come here at three years of age, and their parents ask for forgiveness, then ask me to vaccinate their child. I view that as a good turnaround.”

According to Dr Koshy, the immunisation schedule was reworked because of the anti-vaxxer movement which resulted in outbreaks of measles, mumps and rubella in the last three years.

“Before, a child would receive the MMR immunisation at one year then again at seven years. However, this was changed to babies getting it at nine months and then at one year because there was an outbreak. And why the outbreak? Because of these defaulters, ” Dr Koshy said, adding that their reluctance or refusal to vaccinate despite the availability of vaccines was due to several reasons including the fear of autism and other complications, and questioning the need for abnormal immunity.

He tries his best to explain to his patients and their parents the mechanics of how treatment and medication work. He says parents are usually quite forward when it comes to asking questions. If he has to refer them to a resource he would suggest the Malaysian Paediatric Association website.

“But we always equip them with the knowledge that they need. I always tell them that any intervention comes with a risk but the benefits of immunisation far outweighs the side effects – you’re talking about a slight fever, swelling, irritability for one of two days... for saving a child’s life, ” he said, adding that the hospital also provides antenatal classes for first time parents every fortnight, which primes them for what’s in store.

Social media pressure

There are two types of misinformation that Dr Tang Boon Nee encounters daily in her work – information that a patient obtains which is driven by sales, and information that is in the general realm, usually driven by overzealous advice.

“The first type is, for example, dietary supplements or medicines that are unproven, ‘traditional’ therapies, or even hypnobirth/natural birthing classes conducted by unqualified personnel, ” said the consultant obstetrician and gynaecologist at Subang Jaya Medical Centre.

Patients are made to feel that ‘they are not good enough’ if they don’t follow what a social media group suggests, said Dr Tang.Patients are made to feel that ‘they are not good enough’ if they don’t follow what a social media group suggests, said Dr Tang.

“Usually this type of information, and often misinformation, targets groups of patients who have a particular, and desperate, need. For example to be cured of cancer, to be able to walk again after a stroke or to have a ‘pain free’ natural childbirth.”

With over 20 years of experience in the field, Dr Tang said that patients with these needs are genuine, but vulnerable, and therefore open to all sorts of suggestions.

“I tell patients if a particular unfounded remedy is sold to you (that is you have to pay money for it, and usually a huge amount of money), then it probably will not work. I have met patients who have spent thousands of ringgit to ‘get rid’ of their fibroids, patients who wish to follow a natural therapist (and pay large sums of money) for cancer, but end up dying, ” she shared, citing other examples including companies that encapsulate placenta claiming that consuming baby placenta has medical benefits, and those that sell vaginal medications to reduce risk of cancer and STD.

Dr Tang sais there’s also overzealous advice on social media, for example, from breastfeeding support groups and gentle births support groups, pain free labour using hypnobirth and others.

“The content may be well-meaning, but it puts ‘subtle’ pressure on those who are in difficult situations. I have seen patients crying, post delivery of their firstborn, asking why they aren’t able to produce as much breast milk as the other mothers in the support group. Or why they ended up using an epidural when they followed all the advice from the gentle birthing group.”

Dr Tang said that patients are made to feel that “they are not good enough” if they don’t follow what the FB group suggests, and they come under tremendous pressure that way.

While the Internet is the source of so much information today (good and bad) and almost everyone has access to this information, it is learning how to filter the information that is important.

Dr Tang advises that when it comes to medical information, look out for these “warning signs”:

> A personal medical testimony of a patient who has been “cured” from a disease by consuming or using a certain product.

> The information is directly from the company that promotes or sells the said product.

> The idea seems “out of this world” for example homebirth without supervision.

> If it is something that your parents would never subscribe to always check with your mother.

All said, the best rule of thumb when it comes to symptoms, medicines and treatments, is that if you are ever in doubt about something you read online, just consult your doctor.

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