There has been a rise in many forms of science-rejection, ranging from vaccine hesitancy and refusal, antithesis to research investment, and legislation that would encourage factual-relativism. Unless this course is reversed, we can expect the future to include a return of basic diseases such as cholera, typhus, and yellow fever, as well as a reversal of the gains in reducing population morbidity and mortality of the last 2 centuries.


 

It would not be too outrageous to say that the “evidence-based” part of healthcare is a critical keystone, and that for medicine, facts are the coin of the realm. So, it is with alarm that clinicians might regard any growth in fantasy and anti-science behavior as the basis for the implementation of health policies, adoption of medical technology, or use of medical science.

While the national rate of science literacy has been stable, there is a sense that “woo” is growing, and perhaps winning. Although some small gains have occurred in overall science literacy in the US between 1992 and 2001, the overall rate has remained stable over time, despite efforts to bolster Science, Technology, Engineering, and Mathematics (STEM) education. Instead, we have seen a resurgence of belief in pseudoscience—according to a 2018 Pew Research Center report on “New Age” beliefs, almost 30% of Americans believe in astrology, and there is even resurgence in flat-earth beliefs. To be clear, there has been a steady erosion in the respect for expertise in any field, not just science and medicine. The rise of pseudoscience has been a shock to the scientific establishment and has already caused material risks to public health around the world.

There have always been strange belief systems out there, but the mechanisms by which they become organized and propagated are equally, if not more, salient to the current situation. The pervasive use of social media platforms by the public provides a golden opportunity for disinformation campaigns to establish themselves. One is the general disregard for scientific and medical expertise in favor of the cult of celebrity. We see public embrace of celebrities selling products based on mysticism and ignorance to enrich their own bottom line, while highly researched science published by authentic medical experts goes ignored. This could not take hold without the pervasiveness of social media and the lack of oversight to restrict the publication of commercially sponsored disinformation.

In that context, areas such as vaccination have seen negative effects. The rate of non-medical exemptions (NMEs) to vaccines increased since 2009, and the number of “philosophical-belief” NMEs rose in 12 of the 18 states that allowed it, resulting in increased morbidity. States that have legislated changes to reduce NME saw a reversal and improvement in health, but what if state legislators went the other way? What if state legislators embraced belief over evidence, and allowed factual relativism to be the law of the land—a state in which students were allowed to be given a Mulligan because they sincerely believed differently to the scientific facts?

CDC US Measles Cases and Outbreaks

The Ohio House embraced this level of factual relativism and passed a bill sponsored by state representative and ordained minister Timothy Ginter, allowing student answers to be scientifically wrong as a matter of religious belief without any grading penalty. If factual relativism becomes the law of the land in US states, US medical credentials could become worthless and medical training a hollow mockery. While this is an unlikely outcome, and (we trust that) saner heads will prevail, we should be alert to this attempt to undermine evidence-based education and push back on the purveyors of medical disinformation.

Social media allows individuals and groups with extreme views against childhood vaccination to organize, strategize, and propagate their ideology to a broader audience. Facebook put out a statement on March 7, 2019 stating that it would reject ads containing vaccine misinformation and “reduce the ranking” of sites that spread this kind of content. However, there was no commitment to block these sites as a danger to public health, which has become demonstrable with the number of measles outbreaks in the last 2 years.  There have also been concerted and organized efforts by foreign social media trolls to leverage these disputes in the service of their own political, economic, and military goals, and they actively help to spread anti-science propaganda to sow discord. According to an April 9, 2019 article in Foreign Policy magazine, “After combing through nearly 2 million tweets recorded between 2014 and 2017, the researchers found that Russian troll accounts were significantly more likely to tweet about vaccination than general Twitter users. They had turned to vaccines as a wedge issue in an effort to ramp up social discord, erode trust in public health institutions, and exacerbate fear and division in the United States.”

It is unclear to what degree the American public understands that much of social media content on these topics are meant to manipulate and increase suspicion.

Disinformation campaigns have been used throughout history as an intentional manipulation of a population, and they have been particularly effective in populations under stress and where trust levels in established institutions are low. We see this today as an assault on scientific expertise, and particularly on vaccine safety and efficacy. The methodologies to appeal to people vary, whether it is through religious or political ideology, celebrity endorsement and profiteering, or frank scapegoating. Social media has allowed these streams of propaganda to gain exposure at record rates, and physicians have scrambled to counter this messaging.

Meanwhile, there are public officials who have adopted these lines of disinformation for their own purposes. While it is highly unlikely that the Ohio law will survive, we should not ignore the intent and the tide of sentiment that brought it to be tabled and passed in the legislature of a major US state. We should not ignore that centuries of advancement in medical science could be reversed by ignorance and political chicanery, and we should protect evidence-based medicine wherever possible. A more active social media role by clinicians may be essential to dilute and refute the barrage of anti-science, as well as to protect patients’ best interests.