How to Battle Misinformation in Pharmacy

“To know what you know and what you do not know, that is true knowledge” — Confucius

Misinformation can affect any profession — even healthcare, and pharmacy practice. Misinformation in healthcare has direct, harmful consequences and the COVID-19 pandemic has brought this directly into the spotlight.

Health care is based on the scientific process which includes evolving evidence, new information, tests, and evaluations — all of which are necessary in making an evidence-based recommendations. We know a recommendation may change as new information emerges. Information disorder occurs when a previous recommendation (get vaccinated, no need for a booster) is replaced with new information (get multiple boosters) — and the healthcare provider isn’t up to date.

Health misinformation is a serious threat to public health, according to Dr. Vivek Murthy, the Surgeon General of the United States. Healthcare providers are now being asked to combat information disorder in order to ‘do no harm’ while providing evidence-based care to patients. For the rest of this article, the term information disorder when used is intended to be inclusive of all types of misinformation or disinformation — primarily because false information within healthcare may cause harm, even if unintentional or not malicious.

Health information disorder is not new. We’ve seen the impact of a paper — later retracted and proven false — link the MMR vaccine to autism. Again, false. However, over two decades later, measle outbreaks are occurring throughout the world. Or what about “AIDS denialism” impacting the lives of individuals with HIV/AIDS in South Africa in the 2000’s? What is new is the convergence of health information disorder with the big data of social media in 2016 as noted by Wardle. Information disorders have a new platform to spread and ‘infect.’

The World Health Organization and United Nations have described the copious amount of information related to the COVID-19 pandemic in a myriad of locations (news, public health guidelines, fact sheets, infographics, research, opinions, social media, falsehoods, rumors, etc.) as an infodemic. An Infodemic is a rapid and far-reaching spread of both accurate and inaccurate information about something, such as a disease. The United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. Exacerbating factors in the COVID-19 pandemic contribute to an evolving landscape and the sheer volume of information available, creating a unique situation for information disorder to spread.

Misinformation spread is driven by sociopsychological factors, often through social media. This is the proverbial echo chamber on social media — we use information to feel connected to others. And these ‘others’ can be members of political parties or those who subscribe to a particular political opinion, individuals of a particular vaccine status, or groups focused on climate change or even bots working with the intention to spread misinformation. Disinformation becomes misinformation when people share disinformation without realizing it is false.

Pharmacists, pharmacy technicians, and other healthcare team members face information disorder on two fronts — balancing patient care needs when patients request non-evidence-based care and ensuring your recommendations stay up to date. Both require pharmacy teams engage in relevant continuing pharmacy education and access to available drug information resources.

Photo: Scott Graham on Unsplash

What can you do? Combatting misinformation in pharmacy

Pharmacists and pharmacy technicians should approach information disorder like any other condition we routinely treat. What’s the diagnosis and how can we support the care journey?

First and foremost, pharmacists and pharmacy technicians must stay up to date on healthcare. Instead of viewing continuing pharmacy education (CPE) as a checkbox for re-licensure, pharmacy teams can view CPE as an opportunity to learn new skills, brush up on old ones, and ensure high quality care. Check out content by CEimpact as a way to learn pharmacotherapy updates through GameChangers Pharmacotherapy Podcast, clinical questions & cases, and Journal Clubs. Journal Club provides 1 hour of live CE, helps you stay up to date with the latest literature, and build confidence to evaluate the next landmark.

Second, sign up for lay press news alerts. For example, the Daily Skimm and the Wall Street Journal are two I use, but there are variety of other news outlets, including many pharmacy organizations offering weekly or daily email updates. They take a few minutes to read but provide an overview of what’s happening in the national and world. Maintaining an understanding of what is happening on the healthcare, political, and world news landscapes is valuable, if not critical. The professional-focused alerts may have more relevant topics for our vocation; however, misinformation can propagate everywhere.

Third, always provide evidence-based recommendations for patient care — with citations. Even if your recommendation is out of date, at least you are providing other members of the healthcare team the context for your recommendation. InpharmD is a state-of-art drug information service and resource that can ensure these recommendations are updated, cited, and maintained; And, can also provide evidence-based curated responses to any clinical inquiry a healthcare provider may have.

Pharmacists, pharmacy technicians, and other healthcare team members face information disorder on two fronts — balancing patient care needs when patients request non-evidence-based care and ensuring your recommendations stay up to date. Both require pharmacy teams engage in relevant continuing pharmacy education and access to available drug information resources.

Extra credit: Additional background and societal courses of action

Wardle and Derakhshan described information disorder as seven unique sub-types, but three are most important: misinformation, disinformation, and malinformation. Figure 1 highlights the differences among these three types. It’s important to note that misinformation is not intended to harm. Misinformation instead, describes unintentional mistakes such as inaccurate captions, dates, statistics, or translations. This is false information — but delivered in good faith. Disinformation is also inaccurate; however, delivered to cause harm. Finally, malinformation is accurate information, but used to cause harm.

Credit: Jen Christiansen; Source: Information Disorder: Toward an Interdisciplinary Framework for Research and Policymaking, by Claire Wardle and Hossein Derakhshan. Council of Europe, October 2017; Wardle C. Misinformation Has Created a New World Disorder. Scientific American. Aug 20, 2019.

While online misinformation has been prevalent since well before the birth of the internet, Claire Wardle noted in 2016 an exponential increase in the amount of misinformation and its subsequent spread. Automation, microtargeting, big data, coordination of information — these all lead to information campaigns designed to manipulate public opinion (disinformation) with the unintended consequence of increased misinformation.

For example, take a moment to complete the Worldview Upgrader quiz by Gapminder. I’ve read the book, presented on this material (although years ago) — and just got a 9 out of 18 correct. Whether my wrong answers are from disinformation, or misinformation, is irrelevant. I did not know the information — and may have spread incorrect information due to this.

Information disorder needs to be addressed by society through five primary courses of action:

1. Equip constituents with the tools to identify misinformation

2. Expand research that deepens our understanding of information disorder

3. Implement product design and policy changes on technology platforms, especially social media that can limit information disorder

4. Invest in longer-term efforts to build resilience against information disorder

5. Convene partners strategize and implement societal changes

Table created by Author

This in an InpharmD guest post, written by Jake Galdo, PharmD, MBA, BCPS, BCGP, Course Content and Developer, CEimpact

References:

Credit: Jen Christiansen; Source: Information Disorder: Toward an Interdisciplinary Framework for Research and Policymaking, by Claire Wardle and Hossein Derakhshan. Council of Europe, October 2017

Wardle C. Misinformation Has Created a New World Disorder. Scientific American. Aug 20, 2019.

Confronting Health Misinformation. The US Surgeon General’s Advisory on Building a Healthy Information Environment. 2021. Available at https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf.

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