Are your patients going down the rabbit hole?

Anti-vax groups on social media almost tripled in membership over the pandemic.

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The past year has seen medical misinformation proliferate, and much of its spread can be attributed to social media.

From January 2020 to March this year, not-for-profit tech research group Reset Australia monitored 13 Australian anti-lockdown and anti-vaccine groups on Facebook.

Over that time, the combined membership of the groups grew by 280% to more than 115,000 people.

This level of growth, said Reset Australia executive director Chris Cooper, spoke to the power of social media’s search algorithms.

“Our research tracked the growth of groups that push COVID misinformation and anti-vax content in order to highlight the way Facebook promotes that kind of content as part of their business model,” he told The Medical Republic.

“It leans into amplification of the sensational or the outrageous or the conspiratorial, and we know part of the growth of those groups are due to the recommendation engine of Facebook.”

This was more than speculation – a leaked 2016 internal memo from the social media giant acknowledged  that up to two-thirds of extremist Facebook group members joined only because they received a recommendation on their newsfeed, the Wall Street Journal reported.

Sydney-based GP Dr Brad McKay, who researched COVID conspiracies and misinformation for his book Fake Medicine, told TMR that anti-vaxxers often started out as just curious.

“Having everybody at home and isolated has driven people to go online to find answers, and if they’re looking at something like vaccination, sometimes the algorithm will lead you to weird and wacky sites,” he said.

“If you’re looking up ‘vaccine injury’ or ‘vaccine worry’ – those terms can point you towards some anti-vaccination groups on Facebook and online, so I’m not surprised that [vaccine hesitancy] has been growing over time.”

As the membership of these pro-conspiracy Facebook groups grew, vaccine hesitancy had also seen an uptick in Australia, leading to concerns that herd immunity would not be reached any time soon.

Reset Australia had proposed a reform policy that would compel social media platforms to release data on search terms and suspected fake accounts to approved researchers, journalists and policy makers.

This level of transparency would be a world first, setting the stage for tighter regulation.

“In the same way that we regulate traditional broadcast media, we should be thinking up the same kind of rules for social media,” Mr Cooper said.

“And that should start with transparency, so we can diagnose the problem.”

With that scale of reform unlikely to be possible for several years, Mr Cooper recommended encouraging patients to be more critical of their sources.

“A common thread that we see with people who believe or fall into a misinformation rabbit hole is that they tend to disbelieve mainstream media, and they think that mainstream media distorts narratives and doesn’t give them the full picture,” he said.

“I think that cynicism around mainstream media is healthy, but I think it’s worthwhile to have a conversation around the way that social media platforms are far more manipulative, and far more effective at shaping people’s beliefs.”

Dr McKay also had several practical suggestions for practitioners whose patients may have already gone down an internet rabbit hole.

“If you’ve got a patient in front of you who’s an anti-vaxxer and the head of the board of an anti-vaxxer organisation – well, for one, they’re probably not coming to see you anyway – but more importantly they’re not going to be swayed by the words that you say,” he said.

“A lot of the take on that is ‘don’t waste your time’.”

For patients who had just started down that path, though, Dr McKay stressed that engaging and trying to reason with them is an important part of being a GP.

“Part of a general practitioner’s role is to explain the nuance in news stories to people, because you’re often able to find a middle ground once they can see both sides and how it could be twisted in either way,” he told TMR.

He described one experience where a patient claimed that COVID was a hoax designed to trick the population into getting microchipped.

On further questioning, it emerged that the patient was getting his information from a YouTube video of an American preacher.

“I said ‘well, maybe you should be listening to more scientists than preachers on YouTube from America – maybe the scientists and health professionals and epidemiologists know a little bit more about the vaccines and COVID,” Dr McKay said.

“Often just being very black and white with people, not harassing them, not putting them down, just clarifying that maybe that person wouldn’t be providing you with the best information can be enough to make them think twice about what they’ve accepted as fact.”

Dr McKay did, however, point out that only a very small proportion of patients would be vaccine-hesitant, probably much lower than figures quoted in mainstream media.

This piece has one of the weirdest uses of data that I’ve seen in a long time

I think it really shows that Australians are quite keen to get vaccinated! 1/n https://t.co/fMzncGP77w

— Health Nerd (@GidMK) May 18, 2021

“The overall number of people who are purely, religiously anti-vax is a very, very, very small percentage of the population,” Dr McKay said.

“It may have increased by over 200% but we’re still talking about very, very small numbers.”