Opinion>Vinay Prasad, MD, MPH

Down With the Social Media Platforms

— Simply policing misinformation doesn’t address the real issue at hand

by Vinay Prasad, MD, MPH August 10, 2021

https://www.medpagetoday.com/opinion/vinay-prasad/93976?xid=nl_mpt_DHE_2021-08-11&eun=g264520d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-08-11&utm_term=NL_Daily_DHE_dual-gmail-definition

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Many Americans, and especially healthcare providers, are frustrated as we watch yet another rise in COVID-19 cases. Severely ill and hospitalized patients are often unvaccinated, which is particularly disheartening, given the widespread availability — surplus — of mRNA vaccines in the U.S.

Naturally, frustration turns to anger, resentment, and blame.

One potential reason why a sizable fraction of Americans are reluctant to be vaccinated is the widespread availability of inaccurate, unbalanced, or irrational rhetoric.

This speech falls across a spectrum from overtly delusional — vaccines contain microchips so Bill Gates can track you — to lesser degrees of pejorative and doubtful comments.

Moreover, odd clusters of beliefs may emerge. Somehow enthusiasm for drugs under investigation, such as ivermectin, may pair with doubts about the efficacy of vaccines.

Major medical organizations and the White House have issued strong responses against medical misinformation. The Federation of State Medical Boards has announced that physicians who spread misinformation may face disciplinary action.

The Surgeon General has issued a Confronting Medical Misinformation report.

Moreover, the White House press secretary has announced the executive branch is flagging Facebook posts that are considered misinformation, and asking the platform to take action.

All of these actions miss the real problem. The problem is Facebook and Twitter themselves.

Instead of confronting social media, we are creating new problems, and politicians are serving the interests of their donors — these social media corporations, which have parasitized our minds, exploited our emotions, and distorted our discourse.

I will divide my comments in two. First, I’ll outline the problems with policing misinformation on these platforms, and second, I’ll discuss why social media must be brought to its knees.

Policing Misinformation Is Doomed

Regulating or policing medical misinformation is doomed. It’s easy for most (sensible) people to recognize that mRNA vaccines do not contain microchips that allow Bill Gates to track you.

But very quickly we find statements about vaccines that are unknown, disputed, and worthy of further dialogue. Lines between legitimate debate and misinformation become scientifically impossible to draw.

A long article in The BMJ is titled with the provocative question, COVID-19 vaccines: In the rush for regulatory approval, do we need more data?

Every sentence in the article has been meticulously fact checked and peer-reviewed, and yet, the mere publication of the article could be viewed as subverting vaccination efforts — could a peer-reviewed biomedical publication be labeled misinformation?

Similarly, Ramin Farzaneh-Far, MD, Wes Pegden, PhD, Venk Murthy, MD, PhD, Amy Beck, MD, MPH, and I wrote that the CDC should consider vaccination options for kids ages 12 to 17 besides just two doses of mRNA vaccine or nothing.

Since we wrote our column, the U.K. has adopted a one-dose strategy for kids ages 16 and 17, while withholding vaccination for younger ages until more data are available.

And yet, on social media, some physicians labeled our piece as “misinformation,” meaning, as far as I can tell, information they did not like.

Even on a social media website for medical professionals that restricts who can comment and regulates comments, as Doximity does, there are a number of erroneous statements, mis-statements and ill-informed comments, suggesting that regulating speakers is not an effective solution either.

Some doctors may say incorrect things, and some lay people may be spot on. Policing speakers can’t solve the content issue.

Because of this fine line between reasonable debate and misinformation, over-zealous censorship abounds.

Even discussing the lab leak hypothesis was banned from Facebook for several months — a verdict that was rescinded after the publication of two high profile pieces.

While the lab leak debate isn’t resolved, it seems deranged to literally prohibit people from considering and discussing it.

Next in my review of the issues with policing the platforms for misinformation comes the empirical question of whether banning speech or speakers actually works to diminish the strength of conviction in a certain belief.

Or, if instead, it paradoxically fuels concerns of a conspiracy theory and strengthens the belief in unregulated spaces. Ultimately, no one can police what you think.

Third comes the legal challenge. The First Amendment applies to government actors who wish to suppress speech, but allows for-profit corporations to exclude speech that violates norms on its platform.

And yet, if the White House starts directing Facebook toward questionable posts, then arguably the government has exploited the private status of the company to prohibit speech. Naturally, this may face legal scrutiny.

Finally, it is easy to feel that some erroneous views should not be permitted on social media, but the hard part is to define what should not be allowed.

Notably, despite the Surgeon General’s report and much debate on the issue, no one has actually delineated what counts as misinformation.

I suspect that it cannot be done. No one can create a rule book that separates black and white because the world we live in is only gray. You can’t outlaw what you can’t define.

Destroy Facebook and Twitter

In 50 years, social media in 2021 will look like the tobacco industry in 1960 — they knowingly offered an addictive product, and, worse, hid the damage the addiction caused, while actively tried to deepen the dependency.

Social media companies try to keep you using the platform longer, baiting you with content to trigger your rage, disgust, lust, or hatred.

These companies offer products that have been linked to anxiety and depression among users.

In fact, de-activating Facebook is linked to improved well-being among modest users.

When it comes to information, social media does three things. First, it drives people into irrational poles.

On one side are folks who think SARS-CoV-2 is not real or just another seasonal flu.

These individuals are often suspicious of vaccination as a path out of the pandemic.

On the other side are folks who believe we should lock down until there isn’t a single case of COVID left.

They think a mild or asymptomatic case of SARS-CoV-2 will definitely cause permanent neurologic damage and massive loss of IQ.

They believe the only way to deal with the virus is heavy restrictions, enforced by police or even military presence.

The very nature of social media drives individuals into further extreme positions, possibly aided by bots, sock-puppet accounts, or foreign intelligence agencies. The middle ground is lost.

Second, a good or bad idea on these platforms can reach millions of individuals.

An anecdote (of dubious validity) of a vaccinated individual suffering a bizarre harm, or one of an unvaccinated person begging for vaccination before the endotracheal tube is placed (a situation where generally talking is limited) are both powerful psychological stories that reach millions. This is heroin of the mind.

Third, social media causes deterioration of discourse and harsh proposals.

Sensible people may argue that people who decline vaccination should pay greater healthcare premiums or be denied care if they become sick.

In life, many of our behaviors — from tobacco use to diet and exercise to whether we go out when we feel ill — have health implications for ourselves or others.

But an inviolable principle of medical ethics is to not hold a person’s actions against them when we provide care.

In the swirling churn of social media, we easily become disinhibited.

We may even start to find sick pleasure in the misfortunes of individuals who make different healthcare decisions than we do.

We no longer see individuals with whom we have policy disagreements as people.

The solution is inevitable. Social media of 2021 must be dismantled and crippled like the tobacco industry.

These digital tools have hijacked our neurotransmitters, just like tobacco.

Denying the pernicious role of these platforms on our society is similar to those who denied the harms of tobacco. Just like tobacco, social media offers pleasures.

But, just like tobacco, the industry that supports it has pushed too far, lusting for profits and domination.

Public Failure

Our politicians are failures. They lack the courage to break apart these trillion-dollar companies that enslave the minds of our children and turn professors into toddlers, while stuffing their pockets with donations to fuel their campaigns.

They are dividing us and profiting from those divisions.

Our leaders offer toothless solutions like policing or removing information they view as particularly egregious.

This introduces countless problems and immense potential for abuse. In our lifetimes, a strategic politician can exploit censorship to achieve total political control.

Instead, the platforms need to be crushed, broken up, and regulated.

Rather than just censoring specific ideas, measuring attention and trying to capture more of it must be prohibited. Ironically, the debates on misinformation — my view versus those who think we must police it more seriously — are itself a dispute weaponized and fueled by social media.

The platforms must be brought to their knees, just like Big Tobacco, while human ideas — good, bad, sublime, horrible, true, false, and everything in-between must be free.

Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.

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