The Spread of Health (Mis)Information Through Social Networks

Can we talk about Dr. Oz for a second?

You know the guy. Oprah-recommended, television-ready, handsome and white-toothed Dr. Mehmet Oz, who delivers health and wellness information on an international scale to an audience ready to try the solutions he endorses. As a Columbia professor and practicing physician, Dr. Oz is in a position to have his finger on the pulse of the latest medical innovations.

Except, it turns out he doesn’t always.

Dr. Oz was recently called before a US Senate Subcommittee investigating false advertising for weight loss products. They were specifically questioning a product Oz had recommended which lacks scientific evidence that it actually promotes weight loss. Oz denied fraud or falsehood, but admitted that in his entertainment persona, he strays from the strict science of a product. He said,

My job, I feel, on the show is to be a cheerleader for the audience, and when they don’t think they have hope, when they don’t think they can make it happen, I want to look, and I do look everywhere, including in alternative healing traditions, for any evidence that might be supportive to them.

OK, that’s understandable, but many audience members believe wholeheartedly that a recommendation from Dr. Oz is a guarantee of efficacy. As a result, his “supportive evidence” becomes transformed into fact, and any gray area around scientific validity is magnified. [See John Oliver’s take on being entertaining without causing harm.]

Why does this happen? How does Dr. Oz’s “supportive evidence” turn into the next big health care hoax? And how do questionable health care products–some verging on hoaxes–gain popularity and even earn money through crowdfunding?

The psychology of persuasion and network dynamics

It would be easy to blame social media, but I’m not going to do that. At least, not exactly. I think social media is the mechanism for medical myths to gain popularity, but the real culprit is human nature. Specifically, the way we operate socially and the way we look for signifiers of truth makes it easy to use social networks to spread information, true or false. The good news is that the medical information shared online contains some accuracy. For example, one study of Twitter updates including the word “antibiotic” showed a mix of correct and incorrect information shared via the social network.

A few of the psychological principles at work behind the persuasiveness of seeing information through a social network include:

• The power of word-of-mouth. We look to our peers for recommendations for products to buy, providers to see, and treatments to try. Word-of-mouth recommendations are very powerful, driving a minimum of 20% of buying decisions, especially when they are consistent. The human brain evolved to take shortcuts to conserve energy and effort, and what could be a better shortcut than trusting a friend’s word?

• Social proof. One of the signifiers of truth that people look for is popularity or social proof; if other people are doing it, it must be good. Unfortunately with information shared through social networks, this rule of thumb may be more suspect than ever before. Social proof works not just through pure numbers, but also when famous or admired individuals take a particular position, meaning individual social network users who are well-known or respected can have undue levels of persuasiveness.

• Reverbations through the social network. Nicholas Christakis and James Fowler, in their book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, bring together compelling evidence across many domains that people three degrees deep in our social network influence our own attitudes and behaviors. This means that how we’re exposed to health information online and how we respond to it is partially a function of how our friends’ friends’ friends present it. Think about how many Facebook friends or Twitter followers you have, and now imagine the size of the influence network operating on you every day. Big, huh?

• We need to be consistent. Our old pal cognitive dissonance is at work here again; if we have beliefs that tend in a certain direction, we’re likely to agree with additional statements that are consistent with those beliefs, and not likely to be persuaded by statements that contradict them. Moreover, when we believe something, we sometimes cling more firmly to it when it’s disputed. So if we think it’s possible to lose weight through supplements, we won’t be easily persuaded by naysayers.

• We’re eternal optimists. Human beings want the fairy tale to come true. We really want to be able to cure diseases with a pill, lose weight with a supplement, and become beautiful with a skin cream. Even when our brains know better, sometimes our hearts take control.

Given the way our brains operate, it’s no wonder that we’re quick to believe health information we find online. But don’t despair, with some deliberate thought, we can become better consumers of online health information.

How can we do better?

If we approach the consumption of information online deliberately and with certain rules of thumb in place, we can help vaccinate ourselves against inaccuracies. Here are a few suggestions of how:

• Enter the conversation. If there is an area where you have knowledge or expertise, speak up when you see false information online. People who speak up online are already making a different in research; Social media has provided a mechanism for pointing out and disseminating information about critical methodological flaws in peer-reviewed research. Be sure to let people know why you are qualified to make your statement, and focus on facts rather than emotional arguments.

• Think critically about information before sharing it. It’s so easy to share a friend’s Facebook status on your own wall or retweet a compelling URL. Even if you realize later that you’ve shared something inaccurate and recant or remove it, the damage is likely done. Only re-share information you feel confident about, because you are a source of influence to your friends (and their friends’ friends).

• Look to the heroes of social media. These are the subject matter experts who are harnessing the medium to evangelize science. Clearly, this is not perfect; many people trusted Dr. Oz, and he has the bona fides to make a credible spokesperson. But combined with a skeptical starting outlook and attention to the balance of agreement, designating specific trusted experts can be a powerful tool to sift through an ocean of information.

Speaking of heroes, some bloggers, like Dr. Howard Luks, are calling for people with medical training to harness social media to share correct and timely health information. Some medical personnel are seizing such opportunities. Kevin Pho, M.D., has branded himself as KevinMD, “social media’s leading physician voice.” And comedic news shows such as Last Week Tonight with John Oliver and The Daily Show with Jon Stewart occasionally target popular inaccuracies for correction; a comedy with a side serving of journalism is ok by me.

A postscript

I feel compelled to say I don’t intend this to dump on Dr. Oz. As others have pointed out, he does many times offer a credible viewpoint and has helped “countless people.”  The guy is clearly smart and devoted to medicine. That doesn’t mean he’s always right, or that he’s not subject to a really lucrative endorsement deal.