Google, WebMD, YouTube, Facebook, Twitter, Instagram — the Internet possesses an endless wealth of information that is easily accessible to individuals in every corner of the world, but how does one know whether information accessed over the Internet is accurate? Medical information is widely disseminated over the Internet on healthcare and social media websites, among many other sources, and many individuals seek out these resources to help guide their healthcare decision-making.^1,2 Accessing accurate and high-quality medical information has become a challenge in today's era of self-purported experts propagating medical information, or likely misinformation, with limited evidence-base over the Internet.^3,4

Media portrayal of medical treatments, procedures, and healthcare experiences has a profound impact on patient perceptions and preferences. An estimated 40% of individuals state that social media impacts their healthcare decisions and 90% of young adults indicated that they would trust information that is shared by others on social media networks.² The effects of popular media on healthcare decisions has had mixed consequences. The American Heart Association's (AHA) Rise Above Heart Failure campaign was promoted on Twitter, Instagram, and Facebook among other popular media outlets with the goal of increasing public awareness on the impact of heart failure and to decrease heart failure hospitalizations. This resulted in a substantial positive impact on community awareness. On the other hand, we have all seen adverse effects of patients accessing media sources with questionable reliability. Controversies on the efficacy and safety of statin therapy and vaccinations are just a few examples of the detrimental effects that social media can have not only on public health perceptions, but also on healthcare decisions that have direct and substantial consequences.^5-7

The importance of disseminating vetted sources of medical information to preserve the clinician-patient relationship and shared decision-making has recently been highlighted in the scientific community.^3,8,9 As a medical community, it is our responsibility to advocate for patients by providing an accessible stream of high-quality, evidence-based materials that enable them to independently weigh pertinent healthcare information to make decisions. With a large number of people relying on the Internet and popular media outlets for medical information, a reliable framework is needed to ensure that the needs of patients and healthcare professionals alike are being met.

Beyond its impact on the general public, social media platforms have become a venue for medical professionals to interact with each other and foster a sense of community. Roughly 65% of healthcare professionals report using social media for professional activities including networking, keeping abreast of scientific news, and professional development.^10-12 Cardiology- specific Twitter hashtags such as #Cardiotwitter, #EchoFirst, and #RadialFirst have helped to unify thousands of clinicians via social media where educational materials from institutional programming, conferences, and publications can be shared with ease.¹³ Undoubtedly, this creates an additional layer of complexity when structuring professional interactions between healthcare professionals and patients.

Effects of Popular Media on the COVID-19 Pandemic

A recent example of the widespread effects of popular and social media that resonates is that of the Coronavirus Disease 2019 (COVID-19) outbreak. This global pandemic is sweeping across the world, catching unprepared healthcare systems off guard and devastating millions. As COVID-19 ravages across continents, numerous accounts of "treatments" and "cures" have surfaced from self-purported experts.^14,15 In the absence of clinical trials or sound evidence, these so-called "miracle treatments" such as vitamin infusions, homeopathic cures, breathing exercises and so forth are touted as the cure-all. The hysteria created by misinformation contributes to a great deal of anxiety, mass hoarding of essential supplies, and critical shortages of personal protective equipment for healthcare workers on the front lines. In several instances, inappropriate usage of medications and suggested treatments has even resulted in unintended poisonings and death.¹⁶ As misguided information permeates through the Internet and social media platforms, it often overshadows the voice of clinical experts and professional organizations creating confusion amongst patients and healthcare professionals alike regarding recommendations for personal protection and effective treatments.

The physical, emotional, and socioeconomic toll of the COVID-19 pandemic continues to be felt across the world and has permanently altered the fabric of society. This global pandemic is one of the rare times in history where nearly the entire world's population has been affected regardless of race, gender, creed, socioeconomic status, or ethnicity. If we take a step back and revisit the steps that may have led to the present predicament with widespread shortages, one may consider the notion that the dissemination of up-to-date and accurate information regarding virulence, treatments, and protective measures may have prevented some of the panic and hoarding that has ultimately led to detrimental effects on society — death, devastation, and grief.

It is in times of great vulnerability that fear manifests itself in rational and irrational ways and that the true power of popular and social media is realized. It is in times like these that having a sound, unified voice of reason based on scientific evidence to guide those who are anxious, confused, and uninformed is of the utmost importance.

In a recent publication, we propose such a framework for optimizing the popular media experience for all of those involved.⁸ There are four key stakeholders in this process: (i) patients, (ii) clinicians, (iii) medical journals, and (iv) online resources (social media platforms, blogs, search engines, etc.). Figure 1 highlights the proposed optimal interplay of these stakeholders.

Figure 1: The optimal interplay of healthcare stakeholders with popular media

Patients and Clinicians

Clinicians should engage with patients to learn more about sources they use to obtain medical information and, when appropriate, guide them towards high-quality, evidence-based resources that assist them in making decisions best suited to their needs. Several institutions and professional societies publish patient-oriented materials online. These include the American Heart Association's Health Topics and the American College of Cardiology's (ACC) CardioSmart, among many others. Resources of this type are evidence-based, easily accessible, and curated to a general level of health literacy. In addition to encouraging the use of these resources, responsible use of media outlets by clinicians has tremendous potential to foster healthy professional relationships that allow for open communication and enhance shared decision-making.

Clinicians with Other Clinicians

Clinician presence on popular media is an invaluable asset for education, collaboration, and career development and should be encouraged to foster personal and professional growth. While sharing personal perspectives on social media can make clinicians seem more relatable and personable, interactions, even those that remain among clinicians, are easily viewed and judged through the public lens, and caution ought to be exercised with regard to professionalism and patient privacy.

Medical/Scientific Journals and Professional Societies

Scientific publications are valuable sources of medical information but may be too technical for those who are not well versed in the field. We propose that medical and scientific journals take a stance against medical misinformation by publishing patient-oriented articles and infographics that are widely available and easily tailored to the knowledge level of those who may not be medically inclined.⁸ These may be voluntarily published by journals and made available free of charge to the public or may be published via pre-existing platforms such as the ACC's CardioSmart.

Search Engines and Social Media Platforms

Search engines and social media platforms are powerful players in the dissemination of medical information. The initial results that appear from an internet search in a search engine and topics that are frequently trending are most likely to get the greatest public attention, regardless of whether the information may be accurate or not. There is a robust role for interaction between search engines, popular media platforms, medical journals, and professional organizations to participate in search engine optimization (SEO) so that the most credible sources of medical information are likely to have the highest visibility.

The interplay of patients, clinicians, popular media, and scientific advancement is fluid and ever-changing. There is therefore a need for qualitative and quantitative research to better understand interactions between the key stakeholders, differences in health information seeking behavior, and what a successful sharing of medical knowledge looks like.

The use of popular and social media to assist with healthcare decision-making has been both an asset and a detriment. There is great potential for improvement to optimize and streamline the delivery of accurate and quality medical information and transform this double-edged sword into an educational tool for the dissemination of healthcare information.

References

1. Enberg J. Facebook's 2018 Year in Review (eMarketer website). 2018. Available at: https://www.emarketer.com/content/facebooks-2018-year-in-review. Accessed 06/04/19.
2. Honigman B. 24 outstanding statistics & figures on how social media has impacted the health care industry (getreferralMD website). 2018. Available at: https://getreferralmd.com/2013/09/healthcare-social-media-statistics/. Accessed 06/04/19.
3. Hill JA, Signatories HG. Medical misinformation: vet the message! Eur Heart J 2019;40:404-5.
4. Offit PA. Bad Advice or Why celebrities, politicians, and activists aren't your best source of health information. New York, NY: Columbia University Press; 2018.
5. Nissen SE. Statin denial: an internet-driven cult with deadly consequences. Ann Intern Med 2017;167:281-2.
6. Agarwala A, Kulkarni S, Maddox T. The association of statin therapy with incident diabetes: evidence, mechanisms, and recommendations. Curr Cardiol Rep 2018;20:50.
7. Chang LV. Information, education, and health behaviors: evidence from the MMR vaccine autism controversy. Health Econ 2018;27:1043-62.
8. Agarwala A, Kohli P, Virani SS. Popular media and cardiovascular medicine: "with great power there must also come great responsibility". Curr Atheroscler Rep 2019;21:43.
9. Yeh RW. Academic cardiology and social media: navigating the wisdom and madness of the crowd. Circ Cardiovasc Qual Outcomes 2018;11:e004736.
10. Househ M. The use of social media in healthcare: organizational, clinical, and patient perspectives. Stud Health Technol Inform 2013;183:244-8.
11. Fogelson NS, Rubin ZA, Ault KA. Beyond likes and tweets: an in-depth look at the physician social media landscape. Clin Obstet Gynecol 2013;56:495-508.
12. Thackeray R, Crookston BT, West JH. Correlates of health-related social media use among adults. J Med Internet Res 2013;15:e21.
13. Parwani P, Choi AD, Lopez-Mattei J, et al. Understanding social media: opportunities for cardiovascular medicine. J Am Coll Cardiol 2019;73:1089-93.
14. Graham-Harrison E, Phillips T, Ellis-Peterson H, Burke J. As Coronavirus spreads around the world, so too do the quack cures (The Guardian website). 2020. Available at: https://www.theguardian.com/world/2020/apr/16/as-coronavirus-spreads-around-the-world-so-too-do-the-quack-cures . Accessed 04/01/20.
15. Snowdon W. Cow urine, bleach, oregano oil: medical COVID-19 quackery has big ramifications for public health (CBC website). 2020. Available at: https://www.cbc.ca/news/canada/edmonton/false-advertising-covid-19-fake-medical-advice-1.5520301. Accessed 04/01/20.
16. Lovelace BJ. FDA issues warnings on chloroquine and hydroxychloroquine after deaths and poinsonings reported (CNBC website). 2020. Available at: https://www.cnbc.com/2020/04/24/fda-issues-warnings-on-chloroquine-and-hydroxychloroquine-after-serious-poisoning-and-death-reported.html. Accessed 04/01/20.

Clinical Topics: COVID-19 Hub, Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Primary Prevention, Social Media, COVID-19, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, Pandemics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hysteria, American Heart Association, Health Literacy, Search Engine, Personal Protective Equipment, Public Health, Ethnic Groups

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