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Redefining Medicine's Relationship With the Media in the Era of COVID-19

Published:September 26, 2020DOI:https://doi.org/10.1016/j.amepre.2020.08.016

      INTRODUCTION

      Pandemics and health disasters are as old as civilization and have continually posed considerable public relations and communication challenges for medicine. Determining which pieces of public health information should be disseminated to the public, as well as when and how, are decisions long fraught with difficulty. The nature of health communication has transformed substantially in recent years as social media has proliferated, making fact and opinion harder to disentangle. The national challenges surrounding communication during the coronavirus disease 2019 (COVID-19) pandemic highlight some of these difficulties. The authors argue that this calls for public health professionals to be more conscientious than ever before about information dissemination during health emergencies and for the adoption of universal training for those professionals who create and distribute content during said emergencies, ranging from reporters to health professionals.

      PANDEMICS AND THE MEDIA

      There is a substantial literature on the ways in which media entities, including those from professional (TV, newspapers, and other established nonuser-generated platforms) and social (primarily user generated) sources, can both educate and communicate important information but also sow fear and misinformation.
      • Merino JG.
      Response to Ebola in the U.S.: misinformation, fear, and new opportunities.
      This has always been the case in the context of health emergencies,
      • Beaudoin CE.
      Media effects on public safety following a natural disaster: testing lagged dependent variable models.
      • Moeller SD.
      “Regarding the pain of others”: media, bias and the coverage of international, disasters.
      • Larson HJ.
      The biggest pandemic risk? Viral misinformation.
      but the rise of Facebook, Twitter, and other social media as the de facto news sources for millions has heightened these challenges, transformed the ways in which news about pandemics is consumed, and contributed to the reconceptualization of news itself.
      • Chou WS
      • Oh A
      • Klein WMP
      Addressing health-related misinformation on social media.
      • Crowe A.
      The social media manifesto: a comprehensive review of the impact of social media on emergency management.
      • Sharma M
      • Yadav K
      • Yadav N
      • Ferdinand KC
      Zika virus pandemic-analysis of Facebook as a social media health information platform.
      • Chew C
      • Eysenbach G.
      Pandemics in the age of Twitter: content analysis of tweets during the 2009 H1N1 outbreak.
      Social media has diminished the role of professional media, substantially increased the number of sources where consumers can get information, and facilitated unprecedented speed of information dissemination. It has also allowed news to be presented digitally through a social lens and contributed to the polarization of thought by allowing users to self-select into bubbles composed primarily of others holding similar sentiments. Although researchers have rightfully described how the advent of social media has increased access to potentially helpful information during emergency scenarios,
      • Lindsay BR
      Social media and disasters: current uses, future options, and policy considerations.
      much has also been written about the potentially deleterious impacts of misinformation, ranging from hostility or suspicion toward health workers
      • Chou WS
      • Oh A
      • Klein WMP
      Addressing health-related misinformation on social media.
      to avoidance of necessary medical treatment and flouting of public health directives,
      • Earnshaw VA
      • Katz IT
      Educate, amplify, and focus to address COVID-19 misinformation.
      all of which were, for example, observed during the Ebola outbreak in 2014.
      Beyond its propensity for supplying misinformation, social media have both driven and been altered by dramatic changes in attention spans, communication, and information consumption preferences in recent years.
      • Carr N.
      The Shallows: What the Internet Is Doing to Our Brains.
      The modern social media experience rests on a foundation of often decontextualized photos, text phrases, and brief videos. News and entertainment content, once distinct entities, are juxtaposed or even indistinguishable in this medium. As the lines between them increasingly blur, the discernment of objective truth from opinion or nonsense—a reflection of the collective epistemology—becomes more complicated. Consequently, today's rapid spread of fluid data instills an ephemeral, rather than permanent, notion of truth, which has come to be associated with an equally unstable world view. It also increases vulnerability to the harmful effects of misinformation and disinformation.

      PUBLIC COMMUNICATION CHALLENGES FOR HEALTH PROFESSIONALS

      This shifting media landscape has created public relations challenges for health professionals in recent years. Previous research has demonstrated that health professionals remain an influential source of information for the general public, trusted by >90% of adults in the U.S.
      • Earnshaw VA
      • Katz IT
      Educate, amplify, and focus to address COVID-19 misinformation.
      At the same time, these individuals often have differing motives and must also grapple with rapidly changing data (with a study estimating that medical knowledge in 2020 doubles every 73 days
      • Mehra MR
      • Ruschitzka F
      • Patel AN
      Retraction-hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis.
      ) while facing a variety of audiences.
      When commenting on health disasters, including pandemics, health professionals may implicitly or explicitly be tasked with informing both policymakers and the general public. This can create numerous challenges, including finding ways to present technical data and extend their message to vulnerable groups, which are not commonly emphasized in higher education or clinical training. To fill this skill gap, some academic centers have developed specific curricula for health professionals to communicate effectively in the setting of disaster scenarios,
      • Friedman DB
      • Rose ID
      • Koskan A
      Pilot assessment of an experiential disaster communication curriculum.
      but these have not yet been implemented widely.
      Although the underlying motives of health professionals may vary during health disasters, they appear well intentioned in most cases, often helping to debunk misinformation or advising people to adhere to precautionary behaviors to avoid requiring the services of an overburdened health system. At the same time, there have been examples of health professionals using the spotlight and media moment of health crises such as COVID-19 to quickly advance their careers or personal financial interests. These ill-intentioned efforts have at times been rightfully and publicly denounced by professional societies, although not in all cases.
      American College of Emergency Physicians
      ACEP-AAEM joint statement on physician misinformation.
      In addition, given the increased scrutiny regarding questionable data analyses, scientists have recently self-retracted studies from high-profile scholarly journals.
      • Mehra MR
      • Ruschitzka F
      • Patel AN
      Retraction-hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis.
      ,
      • Mehra MR
      • Desai SS
      • Kuy S
      • Henry TD
      • Patel AN
      Retraction: cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med.

      NOVEL AND HEIGHTENED CHALLENGES IN THE ERA OF COVID-19

      The occurrence and global scale of the COVID-19 pandemic at the beginning of the third decade of the 21st century has exacerbated longstanding health communication challenges through media while also highlighting new ones. Because user-generated media have increasingly been intertwined with professional media sources, pandemic-related news content has become more ubiquitous than ever before. Although the propagation of frank misinformation has been rightfully identified and discussed in recent months,
      • Earnshaw VA
      • Katz IT
      Educate, amplify, and focus to address COVID-19 misinformation.
      far less consideration has been devoted to the societal impact of modern media consumption itself and the ways in which health professionals can effectively navigate the public health challenges posed by the changing public preferences and epistemologic shifts in the digital age.
      A total of 2 sentinel difficulties have resulted, with the first being large-scale media overconsumption.
      • Rosenberg H
      • Syed S
      • Rezaie S
      The Twitter pandemic: the critical role of Twitter in the dissemination of medical information and misinformation during the COVID-19 pandemic.
      Throughout the COVID-19 crisis, many forms of media have been invaluable in assisting with widespread, real-time dissemination of essential guidance as public health circumstances have changed (e.g., social distancing directives). However, once such critical information is transmitted, the utility of further media consumption for most people is unclear, no matter how well intentioned its source is. For example, although healthcare workers have been true heroes in the fight against COVID-19, the public health value of repeatedly inundating the masses with their near-apocalyptic front-line accounts is questionable. In addition, the media's focus on COVID-19, as with past pandemics, has peaked asynchronously with the pathogen's actual epidemiologic spread, leading to the previously described public health pandemic paradox
      • Reintjes R
      • Das E
      • Klemm C
      • Richardus JH
      • Keßler V
      • Ahmad A
      “Pandemic public health paradox”: time series analysis of the 2009/10 influenza A/H1N1 epidemiology, media attention, risk perception and public reactions in 5 European countries.
      where public behavior is better explained by the news cycle than scientific logic.
      • Reintjes R
      • Das E
      • Klemm C
      • Richardus JH
      • Keßler V
      • Ahmad A
      “Pandemic public health paradox”: time series analysis of the 2009/10 influenza A/H1N1 epidemiology, media attention, risk perception and public reactions in 5 European countries.
      This phenomenon, which was notably described during the H1N1 pandemic, led to an awareness that the media moment often arrives and leaves long before relevant data become available.
      • Reintjes R
      • Das E
      • Klemm C
      • Richardus JH
      • Keßler V
      • Ahmad A
      “Pandemic public health paradox”: time series analysis of the 2009/10 influenza A/H1N1 epidemiology, media attention, risk perception and public reactions in 5 European countries.
      The second is the challenge of data misinterpretation through the media. COVID-19 has led to a sudden and intense global focus on the health sciences, with complex data, difficult-to-interpret graphs, and dense tables, once confined to esoteric medical journals, rapidly entering the public domain. Although the pandemic has created a welcome opportunity for experts to meaningfully educate the public, the rapid influx of often decontextualized COVID-19 data has overwhelmed the general population and political leaders, leading to misinterpretation and confusion.
      • Paulos JA
      We're reading the coronavirus numbers wrong.
      ,
      • Galea S
      • Merchant RM
      • Lurie N
      The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention.
      To highlight this, one needs to look no further than the recent widespread sharing of conflicting pandemic mortality and time-course predictive models,
      • Jewell NP
      • Lewnard JA
      • Jewell BL
      Caution warranted: using the Institute for Health Metrics and Evaluation Model for predicting the course of the COVID-19 pandemic.
      which have informed consequential political action that has not been grounded in the rigorous appraisal of available evidence. The presentation of these models as having near-prophetic certainty has led many to expect catastrophic death counts, generated critical shortages of resources (e.g., disinfecting products and masks), and steered large-scale policy efforts, all without due consideration of alternative or more nuanced approaches.
      • Jewell NP
      • Lewnard JA
      • Jewell BL
      Caution warranted: using the Institute for Health Metrics and Evaluation Model for predicting the course of the COVID-19 pandemic.
      Effectively interpreting complex predictive models requires sophisticated statistical knowledge, especially during disasters such as COVID-19, where data are changing and incomplete. That does not, however, stop the instantaneous spread of decontextualized model findings through sound bites and text excerpts in all forms of media. Before long, this leads to a catastrophized, subjective truth—one that contributes to high-level decision-making challenges, a blunted capacity for the assessment of relevant scientific input—and worsening of population mental health.
      • Garfin DR
      • Silver RC
      • Holman EA
      The novel coronavirus (COVID-2019) outbreak: amplification of public health consequences by media exposure.

      OPTIMIZING PUBLIC COMMUNICATION FROM HEALTH PROFESSIONALS DURING HEALTH DISASTERS

      What then is the best way to optimize public communication from health professionals when inevitable health disasters occur in this novel information age? Although media outlets are obligated to regulate misinformation or disinformation presented or shared through their platforms,
      • Earnshaw VA
      • Katz IT
      Educate, amplify, and focus to address COVID-19 misinformation.
      the question of who should lead the effort to rationalize information overconsumption and misinterpretation remains open. With medicine on its biggest stage, part of that responsibility must fall on the medical experts generating media content.
      Although health professionals and thought leaders cannot fully control the ways in which their words or data are shared and understood, they are not free from responsibility. It must be acknowledged that the media no longer simply reports news or facts, it delivers a truth subjectively interpreted through the eye of each beholder. With this in mind, health professionals and others in positions of authority should carefully contemplate whether to speak on camera or craft an online post. They must balance the temptation to offer an opinion with the risk of having it misconstrued and the public's insatiable appetite for COVID-19 content with its true need for objective data.
      This unprecedented moment underscores the need for professional schools and other health sciences training programs to teach responsible engagement with media outlets and mindful use of social media. Given the well-described public trust in physicians, which has been noted to be higher than that of the government, media, or politicians,
      • Earnshaw VA
      • Katz IT
      Educate, amplify, and focus to address COVID-19 misinformation.
      medical trainees should be taught what is suitable to share with the public as well as how and when to share it. Examples of high-profile professionals who do this well and what can happen when things go awry may help in this regard. Medicine must also disseminate and expand upon ongoing efforts by the American Medical Association and other organizations to develop clear guidelines for how medical professionals can interact with the media to best inform the public about health disasters.

      Physicians in the media: responsibilities to the public and the profession. American Medical Association.https://www.ama-assn.org/delivering-care/ethics/physicians-media-responsibilities-public-and-profession. Updated April 17, 2020. Accessed May 21, 2020.

      Such standards are already widely used to stem contagion after high-profile suicides
      • Sheftall AH
      • Tissue JL
      • Schlagbaum P
      • et al.
      Newspaper adherence to media reporting guidelines for the suicide deaths of Kate Spade and Anthony Bourdain.
      and should be more widely adapted for this and future contexts.
      It is also essential that health organizations and delivery systems bridge the medicine–media gap by venturing into journalism education and partnering with university communications departments, especially those with medical journalism programs. Learning directly from medical researchers would provide student journalists with a stronger foundation in interpreting and communicating scientific data and expose them to points of view they would not otherwise encounter in their training programs. Hospital public relations departments should also take a more proactive approach to holding press conferences and helping journalists craft media releases about studies from their institutions that are informed by the investigators themselves.
      The collision between COVID-19 and the Information Age should compel medicine to carefully reconsider its relationship with the media at large. Although research findings are now publicly circulated in the ways prior generations never imagined, numerous potential pitfalls accompany this progress. In the era of the tweet and sound bite, truth faces challenges not only from misinformation but also from opinion, sensationalism, and misunderstanding. This transition poses a burden of responsibility on health professionals to carefully craft a message grounded in unshakable fact, to provide perspective on the limitations of current knowledge, and to recognize their role in monitoring what they say and how they say it. Medicine's unwavering aim must be to advance a data-based narrative that can, insofar as possible, transcend the vicissitudes of the media moment.

      ACKNOWLEDGMENTS

      ADC was supported by a postdoctoral fellowship from the NIH ( 6T32 MH073553-15 ).
      No financial disclosures were reported by the authors of this paper.

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