On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jason Falvey on the show to discuss healthcare fake news. Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. In this episode, we discuss: -The definition of fake news as it relates to healthcare and medical disinformation -What Jason recommends you do when you encounter articles with a high comment to retweet ratio -How you can avoid falling trap to your biases by crowdsourcing to interpretate literature -The importance of seeking information not affirmation -And so much more! Resources: NY Times Fight Fake News Why Healthcare Professionals Should Speak Out Against False Beliefs Jason Falvey Twitter Jason Falvey Yale Email: jason.falvey@yale.edu The Outcomes Summit, use the discount code: LITZY For more information on Jason: Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. He holds a bachelors degree in English, and a doctor of physical therapy degree from Husson University in Bangor, Maine and a PhD in Rehabilitation Science from the University of Colorado, Anschutz Medical Campus. He is also a board-certified geriatric clinical specialist. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. To date, Jason has authored or co-authored 18 peer reviewed papers in widely read rehabilitation journals. Read the full transcript below: Karen Litzy: 00:01 Hey Jason, welcome back to the podcast. I'm happy to have you back on even though we're not talking about what we usually talk about when you're on these podcasts and we have our specials with Sandy Hilton and Sarah Haag but I think this is still a really great topic and I'm happy to have you on to dive into it. Jason Falvey: 00:24 It’s great to be back and I have been excited to present this topic for a couple of months. While it’s no sex podcast part five I think we can definitely got come up with some interesting points for the audience. Karen Litzy: 00:37 Yeah, I think so too. And so everyone today we are talking about fake news as it relates to health care. Because I know a lot of you that are listening are in the healthcare world and if you're not, this is also a great way for you to kind of understand that everything that you read on social media isn't true gasp, right. So, Jason, let's talk about first, what in your opinion, is the definition of fake news as it relates to healthcare and let's say medical disinformation? Jason Falvey: 01:19 Yeah, I like the term medical disinformation because fakes news is not nearly as common in medicine, you know, as far as the falsified information. But medical disinformation is much more common than people may realize. The context is most of the hundred shared articles of last year, over 50% of them are of poor evidence quality when experts have actually rated that. So when I talk about fake news and medical disinformation, I'm really kind of breaking it down to a handful of categories. So there's fake news that's rare, but it does happen that's false or completely inflammatory, you know, that is completely falsified data, or completely false claims that are created to either scare somebody into making different health care decisions or drive them towards a curative product that may be your marketing. So that’s not common, but that definitely is out there. I think the more common pieces of fake news and medical disinformation are hyperbolic and intentional. Jason Falvey: 02:34 So the splashy headline that says Bacon Causes Cancer, you know, where people are putting that headline so it’s clicked on and read when the real story behind a lot of that evidence is substantially more nuanced. And then there's also hyperbolic and unintentional where a well meaning university employee publishes a press release on investigators article and misstates or over-interprets the conclusions to be much broader, more sweeping than they are suggesting that a drug cures cancer or Alzheimer when really it was affective in early stage studies for one particular protein in a mouse model. So those are the three definitions I tend to stick with, but really it's medical information that's not fully accurate, that’s shared widely and may influence healthcare decision making. Karen Litzy: 03:32 When we talk about these flashy headlines and this medical disinformation whether intentional or unintentional, as healthcare professionals, sometimes we're responsible for sharing that. It's not just the lay public. Right. So when you look at these headlines and you read through let's say a press release, is that where it ends? Do you say to yourself, yeah, this sounds good. I'm going to share it. Jason Falvey: 04:05 I think that should be the focus of what we talk about today and that is how do we as health care providers recognize fake news? How do we kind of avoid unintentionally sharing it and how do we avoid intentionally sharing it? So I think my guiding principle for all of these things, for any healthcare professional, it's Hippocratic oath, it's do no harm. And then health care beyond what we do with patients and beyond the hands on care that we provide sharing misinformation, whether intentionally or unintentionally has the potential to cause harm. Patients for going standard of care treatment and in lieu of an alternative medicine or unproven other therapy that may actually cause their health to decline, you know, or causing them to participate in a treatment that is unlikely to benefit them and causes harm both financially or time and potentially health care harm. So I think Hippocratic oath above all else should really drive our decision making and the impetus for why we should care about this. And the other guideline I use is I really want patients and providers both to be looking at social media and healthcare information that they're sharing and really make sure that they're seeking information, not affirmation. So they're seeking to broaden or challenge their pre held assumptions and not just share things, read things and kind of propagates a worldview that just affirms that are already firmly held biases to harm a patient. Karen Litzy: 05:58 Okay. Yeah, but so you mean we can't cherry pick things to confirm our own biases to make ourselves look better? Is that what you're trying to say here? Jason Falvey: 06:16 Yeah, that sounds like a terrible polarizing thing to say, but I'm really going to stand by that I think and just say I really don't think we should be cherry picking evidence and just sharing evidence that is fully supporting our world view. We may have a brand to keep, you know, I don't think I would widely share studies that I think are well done that maybe say physical therapy isn't as helpful as other things, but I certainly would acknowledge that they exist. I don't think I would market them heavily, but I certainly wouldn't ignore them or basically say that they're not accurate either. But I think we have to be really careful, especially when we're talking about vulnerable patient populations, thinking about patients with dementia or patients with cancer who are really hanging on hope that there's something medically that can be done that's outside of what's already been offered to them and kind of have a cure. And I think it's really important that we choose our language and we choose what we share, how we share, and the quality of what we share very carefully. Karen Litzy: 07:29 Well, and you know, that goes back to do no harm. And I think goes back to being an ethical person because when you look at these vulnerable populations, like you said, the elderly people with possibly terminal diseases, people with chronic pain, these are people who are looking for things that they feel they have not gotten that will fix them. Right? And so that's where snake oil salesmen come in. That's where people sort of touting that they have this great flashy thing that isn't supported with evidence, but it sounds really, really good. And so how do we as healthcare professionals combat that without looking combative and turning off those people that we actually want to help? Jason Falvey: 08:22 Yeah. How do we combat that information without unintentionally propagating it either. I think when we evaluate information, I think one of the things I really encourage is time, take time to think about the information, take time to research the primary source of that information. Take time to recognize if there is potentially both sides of an issue. So outside of things like, you know, vaccinations causing autism, which is a clearly manufactured result. If you follow back the evidence or if you go ahead and follow back evidence about infant chiropractic work. But I guess generally falsified or highly, highly, highly biased to the point where there really isn't a pro side, but a lot of medical things have a potential pro and con side. So I think it's important to recognize the nuance and carefully layout reasons one why you disagree with something and two the rationale methodologically, not just your opinion of kind of how you came to that conclusion. Jason Falvey: 09:42 But I think you have to do that without validating what you think is a very poor quality or highly biased or dangerous source to share. If, for example, you saw a tweet about the harms of vaccination and it may be, it was for your older adult population getting the chicken pox vaccine and it caused them Alzheimer's, you know, caused them to get dementia. Let's say you just saw a story like that. Which is not true. How do you, you know, how do you combat that? Some people would just retweet it with a really dismissive comment, like this is garbage. Don't listen to them. Well then doing that, and I'm guilty of this in the past as well, we've actually unintentionally propagated that information. Right now I have not very many followers, so 2000 followers all of a sudden see that and potentially one more retweets it and then another 2000 people. So I unintentionally exposed 4,000 people. Even if I'm dismissing that information, I've lent it credibility by sharing yet. Jason Falvey: 10:51 I think what I have to do is write something about the study, not actually link or validate in some way and not unintentionally spread fake news. And there's not an easy way to do that. So I think you really have to toe the line between not sharing the primary sources, potentially providing that provider of fake news, financial revenue from clicks, which is a lot of times what they want. Or providing a really misguided researcher, a clinician validation that their technique is not loved by the general medical population because they're jealous of his success, you know, something that they can take it the other way to spin it as a positive for their business. Karen Litzy: 11:39 Right. And because if you're re tweeting this and clicking on it and retweeting it, you're giving it life, which is what they want. That's what we don't want to do. Jason Falvey: 11:52 Right. And I think that's one of the ways that propaganda is designed right from the early days of using propaganda as a war tool. It was shared not just for people that believed in it heavily. It was shared in outrage and passed along and whispered about which served the exact same purpose. So really it's hard to discipline ourselves in a really, like we see something, we feel like we immediately have to react on social media and immediately have to comment on it. And I've been guilty of sharing articles that are either satire and actually taking them seriously, which has happened once in a fatigue non-caffeinated state. And also information or studies, which I think in hindsight probably weren't high quality or perhaps overstated its conclusions. My own articles have had overstated conclusions written and press releases that weren't by me or interpretation of written press releases that are perhaps more definitive than I would have wanted, you know, not fake news, but certainly unintentionally declarative about the quality and strength of the evidence versus, you know, the hypothesis generating evidence that it was. Karen Litzy: 13:16 Yeah, absolutely. You sort of alluded to one way as healthcare providers that we can combat the fake news or the medical disinformation and that's taking time to read the source if it's a press release, to read the article, to maybe look at the methodology and to see how would rate this study? So that's one way we can combat it, which takes time. And like you said, on social media, people often react quickly because it's emotional. So maybe we need to take a deep breath and then take a moment and think about what we want to do. Do we want to share this misinformation or do we want to read it and come up with maybe another way to share more positive information? What else can we do as healthcare providers to get around this fake news? Jason Falvey: 14:14 When we encounter something that we think is fake news or unintentionally or intentionally hyperbolic to the point where we think it's harmful to patients. And I think that's the line I draw. If I think that potentially sharing or engaging with this information in any way which propagate information that's harmful to patients. I generally take a little extra caution. And one of the things I look at, you know, I see in politically or in health care news, if I see a that goes out that has a really high comments or retweet ratio. So there's this term ratioed and it's not scientific and it's not peer reviewed. But I find that the good starting point when you see a tweet from a government official or a healthcare provider, healthcare related source, and there's more than double the amount of comments, then there is retweets and the likes. Jason Falvey: 15:18 It makes me go and do a little bit more investigation. You know, sometimes those comments are positive and way to go. And sometimes there's a lot of skepticism or criticism of the findings or people really, you know, offering some real insight into some of the problems in methodologically or otherwise. And often a well done methodological study can be completely blown out of the water on Twitter by a very poorly written headlines. Right. We should care about storylines, not just headlines. And one of the ways we do that, looking at comments, retweets, and the likes, looking at that ratio and look at the source, right? Who's retweeting? And so I pay attention to that because most fake news on the Internet is actually propagated by bots. So there's a very high percentage of fake news that was propagated by automated accounts that are automatically set up to capture certain hashtags or certain language and amplify it. Jason Falvey: 16:23 You know, if you're a political audience would know that that's how the Russians basically designed the misinformation campaign to influence the 2016 election using bots to amplify certain messages. Well, that happens to a lesser extent in health care. There are certain pockets, you know, of health care professionals, and there may be some in our profession that provide certain treatments. There may be some in other alternative medicine professions, there may be some in mainstream medical professions that are physicians or nurses who use their medical expertise and propagate information about medical techniques like abortion or vaccines in a way that makes them seem more credible. So I look at who's retweeting what the population of people are retweeting is, who the person the primary sources coming from. Right. You said if it's a summary of an article from a press release or somebody's blog, like I want to go and find that primary source and then also look at the bias of the person who may be interpreting that information for me if they're a credible source. Karen Litzy: 17:40 Yeah. And I think you also want to keep in mind those hot button issues may have more misinformation about them. Like you said, vaccines, abortions, these are hot button issues, right? So you have to I think take a more examining eye to some of these hot button issues then with others. That's not to say that other issues in health care do not have as much misinformation surrounding them. But when you're talking about things that are really emotional for people, I think that's when you have to also take a good editing eye to some of this information being put out there. Jason Falvey: 18:26 Looking at the source of information is one thing you can see. Cleveland clinic has accidentally posted fake news before where they put in like a really positive result from an innovative experimental therapy for cancer. And they put it in a brain scan and said this person had a miraculous results forgetting to mention that they also were receiving the standard care and this additional therapy would, they didn't know if that was the cause or if it was just a normal reaction to the normal care. But then all of a sudden you created a demand for something that is at best maybe ineffective and at worse, we don't know if it's harmful. By having a high visibility site, your responsibility for news is even higher. So I think that's an important piece. Like know who's tweeting it, but then go back and make sure you have the whole story. If it sounds too good to be true. Jason Falvey: 19:38 This is the humanities education that a lot of PT students have complained that they've had to take history and literature and policy courses throughout their undergraduate degrees and some have suggested streamlining education to really eliminate those things. My counter argument is those skills you learned from critical thinking and critical reading and analysis and understanding of historical context and how to read hyperbole, how to read marketing and different kinds of language really with a critical eye, you tend to develop a radar for when you're suspicious of information and when you want to go and look a little deeper, even if it's from what you view as a pretty credible source. Karen Litzy: 20:27 Yeah, absolutely. So we've got taking your time really looking at not only the source of the article but who's re tweeting it and that retweet to comment ratio. Is there anything else that we should be doing as healthcare professionals to make sure that we're not propagating this misinformation? Jason Falvey: 20:54 Another thing I think would be really helpful is crowd sourcing, right? So most of us are networked on social media with a lot of other really knowledgeable professionals. You know, I know that on my Twitter feed alone, half the people are probably smarter than me. Karen Litzy: 21:10 Oh, I don’t know about that. Jason Falvey: 21:14 But that's intentional, right? Like I want to be in a community of really intelligent people who think about issues critically, who may have different opinions than me. And I could say, I just read a study about Xyz and the conclusion seems flawed. Who would want to, you know, and maybe I don't name the article, maybe I don't put a link to it. I just put the tweet and throw out a few names and say, Hey, I would love if some of my community would like to take a look at this and tell me what they think. Right. If I'm on the borderline of whether or not I think this is legitimate or I asked somebody in the profession, you know, lean on them to really make sure that I'm taking that extra step to not share information that is influencing medical decisions in a negative way. Jason Falvey: 22:03 And I teach my patients these same strategies, right when I'm talking to patients and caregivers who are googling information, WebMDing, looking at blogs, and I've had patients with significant neurological illnesses that are terminal. And one of the places I've practiced, and I won't name that place if it's a relatively rare disease, but this person searched the literature and she was very well educated person, searched the literature high and low for a cure for her neurodegenerative disease and found one that was highly controversial. Probably harmful. And she invested thousands of dollars and hundreds of hours of travel over three months for something that was not beneficial while she was askewing typical medical care. So you know, that kind of taught me how to teach patients, not just how to look for information, right? That's part of the problem. But how to evaluate information, how to triangulate information to make sure that the reference that they found is supported by expert opinion and maybe other articles and making sure that there's a critical mass of support for this particular treatment before they really make a major alteration to their course. Jason Falvey: 23:21 A single article about a vitamin supplement that might help that has little harm. You know, that may be something that I don't intervene on, but somebody who's thinking about making massive changes to their medical routine, whether it has directly to do with Rehab or not. I encourage people to look at the literature critically and I use the word triangulation and I draw it out. I'm just like, you should be able to verify this information should be similar between these three things. Right? And if they tell me that they've done that and they found those three things, I'm more comfortable, even if I disagree, at least I've done my diligence to make sure they looked at the issue in a robust way and not fallen victim to something that was purely a single tweet or Facebook post of medical disinformation. Karen Litzy: 24:15 That's a shame. And I think it's important that you brought up that as healthcare professionals, we should be talking to our patients about this and we should be teaching them stuff. Glad that you went through that. Yes, we should be teaching them what to look for. If we can have a more educated patient base and a more educated base of health care professionals that high in the sky view. Of course the amount of misinformation may be less. Jason Falvey: 24:45 Yeah. And I think there are certain countries that have done a lot of work. Norway for example, has done a lot of work from a country perspective on educating citizenry on medical and you know, general disinformation, both political and medical and teaching, how to recognize it. Giving a lot of the same strategies we've talked about of really time and a little bit of additional resource and that solves so many of the problems. If you don't change some of these decision making process and they still are firm believers in the medical information at that point then you go to some of the other strategies, you know, more targeted intervention. But I think as a general population strategy, those are great places to start and really just, I tell patients all the time, I am going to be telling you seek information, not affirmation. Jason Falvey: 25:45 If you have a friend who told you about this treatment, you need to remember that everybody responds individually, the medications and treatments and you know, cause I think we've all had patients that say my friend got this therapy and their knee got better, really inappropriate for that patient. But it's really hard to walk that back, you know, from just your professional opinion. So teaching them how to look for information and letting them look for it on their own instead of providing it to them I have found is sometimes a helpful strategy because it feels like I'm not forcing my view on them. At the end of the day you can rest knowing that you put tools in people's hands, you know, health care providers or patients teach them how to do these things. I mean, but it does take some effort on their part too. Jason Falvey: 26:37 You definitely have to want to read these things carefully and you have to have the mindset that you don't want to just look for information that validates what you already believe. And I've seen this, you know, I don't like to pick on dry needling, but I definitely have seen people who are very strong believers in dry needling, just cherry pick evidence that supports their worldview, without recognizing that there's a lot more nuance to that discussion. And I'm not anti or pro dry needling. I'm pro information. Looking carefully and realizing that there are patients who do benefit from it, but it is certainly not a blanket treatment that everybody should be using and it's a tool in your bag, like everything. So, I think it's really important to just have that seek information, not affirmation. If I can say something a few times on this podcast that will be what it is. Karen Litzy: 27:40 Well, and then my next question would be, after having this great conversation, is there anything we missed and is there anything that you really want people to stick in people's minds, which I think you just said it, but I'll ask the question anyway. Jason Falvey: 27:55 Yeah. And I think the other thing is like, when you are a healthcare professional, I think investing money in like high quality sources or whatever source. For me, I tend to read a newspaper in New York Times or Washington Post. I have a subscription to it. I try to support that kind of, you know, to provide financial resources to a place that I trust to provide good information because that is positive reinforcement, right? I try not to provide positive financial rewards to places that are providing this information. And you do that by clicking on their articles, right? You read a headline and it's like vaccines cause autism study says, and I clicked on that headline, I’ve unintentionally propagated and supported financially that fake news provider who now is incentivized to create more fake news. So I think it takes a lot of discipline to not fall victim to our need to read everything. Jason Falvey: 29:02 And you know, sometimes we have to think about the greater good is not clicking on that article. Shutting it down, blocking that news source or whatever, if you really feel like it's egregious enough and not engaging with it. Creating polarization. Polarization is what creates ratings on television. Polarization is what creates ratings on radio, polarization is what gets people to download podcasts and things that are highly controversial. Polarization, you know, sells books, right? The top selling books on New York Times bestseller lists are generally, there's political books that exist, sometimes multiple political books that are on that list from different points of view. So I think it's really important that we don't support agregious, you know, fake news providers or fake healthcare news providers and don't engage with them on Twitter because that's giving them a form of a positive attention. Even if you're criticizing their work, that they can go ahead and leverage to share more. Karen Litzy: 30:13 Yeah, I thank you for all that great information. And hopefully the listeners can really take this in and understand that what we do on social media has ramifications one to our profession and two to the people we serve. So before we leave, I have a last question and normally I ask people, what advice would you give to yourself as a new Grad? But I'm going to ask you, what advice would you give to yourself as a new Grad physical therapist in light of fake news? Jason Falvey: 30:50 Oh, that's a great question. Beyond the sentence I said of seek information not affirmation, which I think is helpful for research and beyond, I think one of the things I would tell myself as a new Grad physical therapist in this era is I would be incredibly thankful for my English education, my bachelor's degree in English, all of the humanities and critical thinking classes that I took and all of the writing that I did because trust me, I wrote enough papers as an undergraduate that probably could have qualified this fake news cause I didn't really read the books very carefully and really had some made up opinions about what I thought was happening. So I think I can recognize the difference in that writing now. And I would tell myself, be appreciative of the education in humanities and the historical context that you've gained and use those skills. Don't forget about them. They are valuable parts of your tool bag. They are not direct patient care skills, but there among the most critical soft skills you can obtain to really do a good service to your patients and teaching them how to use those skills and taking healthcare into their own hands. Karen Litzy: 32:13 Awesome. Well, thank you so much. This was a great discussion. I'm glad we finally got to do this. Where can people find you if they want more info or to ask you questions? Jason Falvey: 32:26 Yeah, so I am listed on the Yale site, I am not officially representing Yale now just to put that out there, but my email address is on the Yale division of geriatrics site. I'm also on Twitter at @JRayFalvey and I'm sure you'll put that in your show notes. Those are the two things. And hold me accountable. Do you see me sharing something that you think is not a great source of information? Tell me about it. Right. And I think holding each other accountable is part of this process and doing that in a professional way is all the better. Karen Litzy: 33:07 Thanks again for coming on. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jason Falvey on the show to discuss healthcare fake news. In this episode, we discuss: -The definition of fake news as it relates to healthcare and medical disinformation -What Jason recommends you do when you encounter articles with a high comment to retweet ratio -How you can avoid falling trap to your biases by crowdsourcing to interpretate literature -The importance of seeking information not affirmation
On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jason Falvey on the show to discuss healthcare fake news. Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness.
In this episode, we discuss:
-The definition of fake news as it relates to healthcare and medical disinformation
-What Jason recommends you do when you encounter articles with a high comment to retweet ratio
-How you can avoid falling trap to your biases by crowdsourcing to interpretate literature
-The importance of seeking information not affirmation
-And so much more!
Resources:
Why Healthcare Professionals Should Speak Out Against False Beliefs
Email: jason.falvey@yale.edu
The Outcomes Summit, use the discount code: LITZY
For more information on Jason:
Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. He holds a bachelors degree in English, and a doctor of physical therapy degree from Husson University in Bangor, Maine and a PhD in Rehabilitation Science from the University of Colorado, Anschutz Medical Campus. He is also a board-certified geriatric clinical specialist. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. To date, Jason has authored or co-authored 18 peer reviewed papers in widely read rehabilitation journals.
Read the full transcript below:
Karen Litzy: 00:01 Hey Jason, welcome back to the podcast. I'm happy to have you back on even though we're not talking about what we usually talk about when you're on these podcasts and we have our specials with Sandy Hilton and Sarah Haag but I think this is still a really great topic and I'm happy to have you on to dive into it.
Jason Falvey: 00:24 It’s great to be back and I have been excited to present this topic for a couple of months. While it’s no sex podcast part five I think we can definitely got come up with some interesting points for the audience.
Karen Litzy: 00:37 Yeah, I think so too. And so everyone today we are talking about fake news as it relates to health care. Because I know a lot of you that are listening are in the healthcare world and if you're not, this is also a great way for you to kind of understand that everything that you read on social media isn't true gasp, right. So, Jason, let's talk about first, what in your opinion, is the definition of fake news as it relates to healthcare and let's say medical disinformation?
Jason Falvey: 01:19 Yeah, I like the term medical disinformation because fakes news is not nearly as common in medicine, you know, as far as the falsified information. But medical disinformation is much more common than people may realize. The context is most of the hundred shared articles of last year, over 50% of them are of poor evidence quality when experts have actually rated that. So when I talk about fake news and medical disinformation, I'm really kind of breaking it down to a handful of categories. So there's fake news that's rare, but it does happen that's false or completely inflammatory, you know, that is completely falsified data, or completely false claims that are created to either scare somebody into making different health care decisions or drive them towards a curative product that may be your marketing. So that’s not common, but that definitely is out there. I think the more common pieces of fake news and medical disinformation are hyperbolic and intentional.
Jason Falvey: 02:34 So the splashy headline that says Bacon Causes Cancer, you know, where people are putting that headline so it’s clicked on and read when the real story behind a lot of that evidence is substantially more nuanced. And then there's also hyperbolic and unintentional where a well meaning university employee publishes a press release on investigators article and misstates or over-interprets the conclusions to be much broader, more sweeping than they are suggesting that a drug cures cancer or Alzheimer when really it was affective in early stage studies for one particular protein in a mouse model. So those are the three definitions I tend to stick with, but really it's medical information that's not fully accurate, that’s shared widely and may influence healthcare decision making.
Karen Litzy: 03:32 When we talk about these flashy headlines and this medical disinformation whether intentional or unintentional, as healthcare professionals, sometimes we're responsible for sharing that. It's not just the lay public. Right. So when you look at these headlines and you read through let's say a press release, is that where it ends? Do you say to yourself, yeah, this sounds good. I'm going to share it.
Jason Falvey: 04:05 I think that should be the focus of what we talk about today and that is how do we as health care providers recognize fake news? How do we kind of avoid unintentionally sharing it and how do we avoid intentionally sharing it? So I think my guiding principle for all of these things, for any healthcare professional, it's Hippocratic oath, it's do no harm. And then health care beyond what we do with patients and beyond the hands on care that we provide sharing misinformation, whether intentionally or unintentionally has the potential to cause harm. Patients for going standard of care treatment and in lieu of an alternative medicine or unproven other therapy that may actually cause their health to decline, you know, or causing them to participate in a treatment that is unlikely to benefit them and causes harm both financially or time and potentially health care harm. So I think Hippocratic oath above all else should really drive our decision making and the impetus for why we should care about this. And the other guideline I use is I really want patients and providers both to be looking at social media and healthcare information that they're sharing and really make sure that they're seeking information, not affirmation. So they're seeking to broaden or challenge their pre held assumptions and not just share things, read things and kind of propagates a worldview that just affirms that are already firmly held biases to harm a patient.
Karen Litzy: 05:58 Okay. Yeah, but so you mean we can't cherry pick things to confirm our own biases to make ourselves look better? Is that what you're trying to say here?
Jason Falvey: 06:16 Yeah, that sounds like a terrible polarizing thing to say, but I'm really going to stand by that I think and just say I really don't think we should be cherry picking evidence and just sharing evidence that is fully supporting our world view. We may have a brand to keep, you know, I don't think I would widely share studies that I think are well done that maybe say physical therapy isn't as helpful as other things, but I certainly would acknowledge that they exist. I don't think I would market them heavily, but I certainly wouldn't ignore them or basically say that they're not accurate either. But I think we have to be really careful, especially when we're talking about vulnerable patient populations, thinking about patients with dementia or patients with cancer who are really hanging on hope that there's something medically that can be done that's outside of what's already been offered to them and kind of have a cure. And I think it's really important that we choose our language and we choose what we share, how we share, and the quality of what we share very carefully.
Karen Litzy: 07:29 Well, and you know, that goes back to do no harm. And I think goes back to being an ethical person because when you look at these vulnerable populations, like you said, the elderly people with possibly terminal diseases, people with chronic pain, these are people who are looking for things that they feel they have not gotten that will fix them. Right? And so that's where snake oil salesmen come in. That's where people sort of touting that they have this great flashy thing that isn't supported with evidence, but it sounds really, really good. And so how do we as healthcare professionals combat that without looking combative and turning off those people that we actually want to help?
Jason Falvey: 08:22 Yeah. How do we combat that information without unintentionally propagating it either. I think when we evaluate information, I think one of the things I really encourage is time, take time to think about the information, take time to research the primary source of that information. Take time to recognize if there is potentially both sides of an issue. So outside of things like, you know, vaccinations causing autism, which is a clearly manufactured result. If you follow back the evidence or if you go ahead and follow back evidence about infant chiropractic work. But I guess generally falsified or highly, highly, highly biased to the point where there really isn't a pro side, but a lot of medical things have a potential pro and con side. So I think it's important to recognize the nuance and carefully layout reasons one why you disagree with something and two the rationale methodologically, not just your opinion of kind of how you came to that conclusion.
Jason Falvey: 09:42 But I think you have to do that without validating what you think is a very poor quality or highly biased or dangerous source to share. If, for example, you saw a tweet about the harms of vaccination and it may be, it was for your older adult population getting the chicken pox vaccine and it caused them Alzheimer's, you know, caused them to get dementia. Let's say you just saw a story like that. Which is not true. How do you, you know, how do you combat that? Some people would just retweet it with a really dismissive comment, like this is garbage. Don't listen to them. Well then doing that, and I'm guilty of this in the past as well, we've actually unintentionally propagated that information. Right now I have not very many followers, so 2000 followers all of a sudden see that and potentially one more retweets it and then another 2000 people. So I unintentionally exposed 4,000 people. Even if I'm dismissing that information, I've lent it credibility by sharing yet.
Jason Falvey: 10:51 I think what I have to do is write something about the study, not actually link or validate in some way and not unintentionally spread fake news. And there's not an easy way to do that. So I think you really have to toe the line between not sharing the primary sources, potentially providing that provider of fake news, financial revenue from clicks, which is a lot of times what they want. Or providing a really misguided researcher, a clinician validation that their technique is not loved by the general medical population because they're jealous of his success, you know, something that they can take it the other way to spin it as a positive for their business.
Karen Litzy: 11:39 Right. And because if you're re tweeting this and clicking on it and retweeting it, you're giving it life, which is what they want. That's what we don't want to do.
Jason Falvey: 11:52 Right. And I think that's one of the ways that propaganda is designed right from the early days of using propaganda as a war tool. It was shared not just for people that believed in it heavily. It was shared in outrage and passed along and whispered about which served the exact same purpose. So really it's hard to discipline ourselves in a really, like we see something, we feel like we immediately have to react on social media and immediately have to comment on it. And I've been guilty of sharing articles that are either satire and actually taking them seriously, which has happened once in a fatigue non-caffeinated state. And also information or studies, which I think in hindsight probably weren't high quality or perhaps overstated its conclusions. My own articles have had overstated conclusions written and press releases that weren't by me or interpretation of written press releases that are perhaps more definitive than I would have wanted, you know, not fake news, but certainly unintentionally declarative about the quality and strength of the evidence versus, you know, the hypothesis generating evidence that it was.
Karen Litzy: 13:16 Yeah, absolutely. You sort of alluded to one way as healthcare providers that we can combat the fake news or the medical disinformation and that's taking time to read the source if it's a press release, to read the article, to maybe look at the methodology and to see how would rate this study? So that's one way we can combat it, which takes time. And like you said, on social media, people often react quickly because it's emotional. So maybe we need to take a deep breath and then take a moment and think about what we want to do. Do we want to share this misinformation or do we want to read it and come up with maybe another way to share more positive information? What else can we do as healthcare providers to get around this fake news?
Jason Falvey: 14:14 When we encounter something that we think is fake news or unintentionally or intentionally hyperbolic to the point where we think it's harmful to patients. And I think that's the line I draw. If I think that potentially sharing or engaging with this information in any way which propagate information that's harmful to patients. I generally take a little extra caution. And one of the things I look at, you know, I see in politically or in health care news, if I see a that goes out that has a really high comments or retweet ratio. So there's this term ratioed and it's not scientific and it's not peer reviewed. But I find that the good starting point when you see a tweet from a government official or a healthcare provider, healthcare related source, and there's more than double the amount of comments, then there is retweets and the likes.
Jason Falvey: 15:18 It makes me go and do a little bit more investigation. You know, sometimes those comments are positive and way to go. And sometimes there's a lot of skepticism or criticism of the findings or people really, you know, offering some real insight into some of the problems in methodologically or otherwise. And often a well done methodological study can be completely blown out of the water on Twitter by a very poorly written headlines. Right. We should care about storylines, not just headlines. And one of the ways we do that, looking at comments, retweets, and the likes, looking at that ratio and look at the source, right? Who's retweeting? And so I pay attention to that because most fake news on the Internet is actually propagated by bots. So there's a very high percentage of fake news that was propagated by automated accounts that are automatically set up to capture certain hashtags or certain language and amplify it.
Jason Falvey: 16:23 You know, if you're a political audience would know that that's how the Russians basically designed the misinformation campaign to influence the 2016 election using bots to amplify certain messages. Well, that happens to a lesser extent in health care. There are certain pockets, you know, of health care professionals, and there may be some in our profession that provide certain treatments. There may be some in other alternative medicine professions, there may be some in mainstream medical professions that are physicians or nurses who use their medical expertise and propagate information about medical techniques like abortion or vaccines in a way that makes them seem more credible. So I look at who's retweeting what the population of people are retweeting is, who the person the primary sources coming from. Right. You said if it's a summary of an article from a press release or somebody's blog, like I want to go and find that primary source and then also look at the bias of the person who may be interpreting that information for me if they're a credible source.
Karen Litzy: 17:40 Yeah. And I think you also want to keep in mind those hot button issues may have more misinformation about them. Like you said, vaccines, abortions, these are hot button issues, right? So you have to I think take a more examining eye to some of these hot button issues then with others. That's not to say that other issues in health care do not have as much misinformation surrounding them. But when you're talking about things that are really emotional for people, I think that's when you have to also take a good editing eye to some of this information being put out there.
Jason Falvey: 18:26 Looking at the source of information is one thing you can see. Cleveland clinic has accidentally posted fake news before where they put in like a really positive result from an innovative experimental therapy for cancer. And they put it in a brain scan and said this person had a miraculous results forgetting to mention that they also were receiving the standard care and this additional therapy would, they didn't know if that was the cause or if it was just a normal reaction to the normal care. But then all of a sudden you created a demand for something that is at best maybe ineffective and at worse, we don't know if it's harmful. By having a high visibility site, your responsibility for news is even higher. So I think that's an important piece. Like know who's tweeting it, but then go back and make sure you have the whole story. If it sounds too good to be true.
Jason Falvey: 19:38 This is the humanities education that a lot of PT students have complained that they've had to take history and literature and policy courses throughout their undergraduate degrees and some have suggested streamlining education to really eliminate those things. My counter argument is those skills you learned from critical thinking and critical reading and analysis and understanding of historical context and how to read hyperbole, how to read marketing and different kinds of language really with a critical eye, you tend to develop a radar for when you're suspicious of information and when you want to go and look a little deeper, even if it's from what you view as a pretty credible source.
Karen Litzy: 20:27 Yeah, absolutely. So we've got taking your time really looking at not only the source of the article but who's re tweeting it and that retweet to comment ratio. Is there anything else that we should be doing as healthcare professionals to make sure that we're not propagating this misinformation?
Jason Falvey: 20:54 Another thing I think would be really helpful is crowd sourcing, right? So most of us are networked on social media with a lot of other really knowledgeable professionals. You know, I know that on my Twitter feed alone, half the people are probably smarter than me.
Karen Litzy: 21:10 Oh, I don’t know about that.
Jason Falvey: 21:14 But that's intentional, right? Like I want to be in a community of really intelligent people who think about issues critically, who may have different opinions than me. And I could say, I just read a study about Xyz and the conclusion seems flawed. Who would want to, you know, and maybe I don't name the article, maybe I don't put a link to it. I just put the tweet and throw out a few names and say, Hey, I would love if some of my community would like to take a look at this and tell me what they think. Right. If I'm on the borderline of whether or not I think this is legitimate or I asked somebody in the profession, you know, lean on them to really make sure that I'm taking that extra step to not share information that is influencing medical decisions in a negative way.
Jason Falvey: 22:03 And I teach my patients these same strategies, right when I'm talking to patients and caregivers who are googling information, WebMDing, looking at blogs, and I've had patients with significant neurological illnesses that are terminal. And one of the places I've practiced, and I won't name that place if it's a relatively rare disease, but this person searched the literature and she was very well educated person, searched the literature high and low for a cure for her neurodegenerative disease and found one that was highly controversial. Probably harmful. And she invested thousands of dollars and hundreds of hours of travel over three months for something that was not beneficial while she was askewing typical medical care. So you know, that kind of taught me how to teach patients, not just how to look for information, right? That's part of the problem. But how to evaluate information, how to triangulate information to make sure that the reference that they found is supported by expert opinion and maybe other articles and making sure that there's a critical mass of support for this particular treatment before they really make a major alteration to their course.
Jason Falvey: 23:21 A single article about a vitamin supplement that might help that has little harm. You know, that may be something that I don't intervene on, but somebody who's thinking about making massive changes to their medical routine, whether it has directly to do with Rehab or not. I encourage people to look at the literature critically and I use the word triangulation and I draw it out. I'm just like, you should be able to verify this information should be similar between these three things. Right? And if they tell me that they've done that and they found those three things, I'm more comfortable, even if I disagree, at least I've done my diligence to make sure they looked at the issue in a robust way and not fallen victim to something that was purely a single tweet or Facebook post of medical disinformation.
Karen Litzy: 24:15 That's a shame. And I think it's important that you brought up that as healthcare professionals, we should be talking to our patients about this and we should be teaching them stuff. Glad that you went through that. Yes, we should be teaching them what to look for. If we can have a more educated patient base and a more educated base of health care professionals that high in the sky view. Of course the amount of misinformation may be less.
Jason Falvey: 24:45 Yeah. And I think there are certain countries that have done a lot of work. Norway for example, has done a lot of work from a country perspective on educating citizenry on medical and you know, general disinformation, both political and medical and teaching, how to recognize it. Giving a lot of the same strategies we've talked about of really time and a little bit of additional resource and that solves so many of the problems. If you don't change some of these decision making process and they still are firm believers in the medical information at that point then you go to some of the other strategies, you know, more targeted intervention. But I think as a general population strategy, those are great places to start and really just, I tell patients all the time, I am going to be telling you seek information, not affirmation.
Jason Falvey: 25:45 If you have a friend who told you about this treatment, you need to remember that everybody responds individually, the medications and treatments and you know, cause I think we've all had patients that say my friend got this therapy and their knee got better, really inappropriate for that patient. But it's really hard to walk that back, you know, from just your professional opinion. So teaching them how to look for information and letting them look for it on their own instead of providing it to them I have found is sometimes a helpful strategy because it feels like I'm not forcing my view on them. At the end of the day you can rest knowing that you put tools in people's hands, you know, health care providers or patients teach them how to do these things. I mean, but it does take some effort on their part too.
Jason Falvey: 26:37 You definitely have to want to read these things carefully and you have to have the mindset that you don't want to just look for information that validates what you already believe. And I've seen this, you know, I don't like to pick on dry needling, but I definitely have seen people who are very strong believers in dry needling, just cherry pick evidence that supports their worldview, without recognizing that there's a lot more nuance to that discussion. And I'm not anti or pro dry needling. I'm pro information. Looking carefully and realizing that there are patients who do benefit from it, but it is certainly not a blanket treatment that everybody should be using and it's a tool in your bag, like everything. So, I think it's really important to just have that seek information, not affirmation. If I can say something a few times on this podcast that will be what it is.
Karen Litzy: 27:40 Well, and then my next question would be, after having this great conversation, is there anything we missed and is there anything that you really want people to stick in people's minds, which I think you just said it, but I'll ask the question anyway.
Jason Falvey: 27:55 Yeah. And I think the other thing is like, when you are a healthcare professional, I think investing money in like high quality sources or whatever source. For me, I tend to read a newspaper in New York Times or Washington Post. I have a subscription to it. I try to support that kind of, you know, to provide financial resources to a place that I trust to provide good information because that is positive reinforcement, right? I try not to provide positive financial rewards to places that are providing this information. And you do that by clicking on their articles, right? You read a headline and it's like vaccines cause autism study says, and I clicked on that headline, I’ve unintentionally propagated and supported financially that fake news provider who now is incentivized to create more fake news. So I think it takes a lot of discipline to not fall victim to our need to read everything.
Jason Falvey: 29:02 And you know, sometimes we have to think about the greater good is not clicking on that article. Shutting it down, blocking that news source or whatever, if you really feel like it's egregious enough and not engaging with it. Creating polarization. Polarization is what creates ratings on television. Polarization is what creates ratings on radio, polarization is what gets people to download podcasts and things that are highly controversial. Polarization, you know, sells books, right? The top selling books on New York Times bestseller lists are generally, there's political books that exist, sometimes multiple political books that are on that list from different points of view. So I think it's really important that we don't support agregious, you know, fake news providers or fake healthcare news providers and don't engage with them on Twitter because that's giving them a form of a positive attention. Even if you're criticizing their work, that they can go ahead and leverage to share more.
Karen Litzy: 30:13 Yeah, I thank you for all that great information. And hopefully the listeners can really take this in and understand that what we do on social media has ramifications one to our profession and two to the people we serve. So before we leave, I have a last question and normally I ask people, what advice would you give to yourself as a new Grad? But I'm going to ask you, what advice would you give to yourself as a new Grad physical therapist in light of fake news?
Jason Falvey: 30:50 Oh, that's a great question. Beyond the sentence I said of seek information not affirmation, which I think is helpful for research and beyond, I think one of the things I would tell myself as a new Grad physical therapist in this era is I would be incredibly thankful for my English education, my bachelor's degree in English, all of the humanities and critical thinking classes that I took and all of the writing that I did because trust me, I wrote enough papers as an undergraduate that probably could have qualified this fake news cause I didn't really read the books very carefully and really had some made up opinions about what I thought was happening. So I think I can recognize the difference in that writing now. And I would tell myself, be appreciative of the education in humanities and the historical context that you've gained and use those skills. Don't forget about them. They are valuable parts of your tool bag. They are not direct patient care skills, but there among the most critical soft skills you can obtain to really do a good service to your patients and teaching them how to use those skills and taking healthcare into their own hands.
Karen Litzy: 32:13 Awesome. Well, thank you so much. This was a great discussion. I'm glad we finally got to do this. Where can people find you if they want more info or to ask you questions?
Jason Falvey: 32:26 Yeah, so I am listed on the Yale site, I am not officially representing Yale now just to put that out there, but my email address is on the Yale division of geriatrics site. I'm also on Twitter at @JRayFalvey and I'm sure you'll put that in your show notes. Those are the two things. And hold me accountable. Do you see me sharing something that you think is not a great source of information? Tell me about it. Right. And I think holding each other accountable is part of this process and doing that in a professional way is all the better.
Karen Litzy: 33:07 Thanks again for coming on. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
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