‘Media hype’ distorts public view on infectious diseases

Infections are capable of spreading as quickly as the panic that often accompanies them. However, many diseases can be slowed or even prevented if the proper steps are taken, and raising awareness of these precautions is often among the most important duties of the pediatric infectious disease specialist.

To explore these challenges, Infectious Diseases in Children spoke with several experts about the role of the media and how best to communicate important information to the general public about infectious diseases.

‘A core responsibility’

“The right message to the right person at the right time can save lives,” Barbara Reynolds, PhD, senior adviser of crisis and risk communication at the CDC, told Infectious Diseases in Children.

“It is a core responsibility in a crisis situation to work as hard as possible to share the information that people need, when they need it.”

Unfortunately, disseminating vital knowledge that could potentially save lives is not always an easy task. Intermediaries such as news organizations and social media can be useful tools for offering guidance during an outbreak, but accurate information often can be lost in the commotion of public discourse. Meanwhile, the transition of complex data into digestible public health messages continues to be an obstacle, even for the most knowledgeable experts.

Photo by Nathan Danskey

In recent years, education and training on how to communicate with the media and disseminate public health information has become an important part of medical education in pediatrics, according to William T. Gerson, MD, clinical professor of pediatrics at the University of Vermont College of Medicine and an Infectious Diseases in Children Editorial Board member.

“From a public health outbreak point of view, I think there is a training deficiency in how to respond to the media,” Gerson said. “However, at a recent pediatric gastroenterology fellowship training meeting, part of their 3-day conference was actually turned over to a media coach. I was impressed that it is a teachable skill, and I think it is a reasonable area to be included in our area of education at some point.”

Flaws in previous coverage

The relationship between infectious diseases and the media is nothing new. Public health scares surrounding HIV, anthrax, influenza A(H1N1) and other outbreaks frequently receive national attention in mainstream news. According to Gerson, the recent Ebola outbreak is a perfect example of how the media can distort the public health message.

“Like with Ebola, the media tends to focus on areas that might not be the best part of the public health message,” Gerson said. “With mainstream media and social media, they want to be noticed. So, they will sometimes exploit a certain avenue that might get them more viewers or get people’s attention, and then they elaborate as they go deeper into it, but by then people have lost that more subtle message.”

First identified in early 2014, growing case numbers and a high mortality rate quickly turned Ebola into an outbreak of international concern. By fall, the infection of two Dallas health care workers and debates concerning transmission risks had led to rampant misinformation about the Ebola virus, according to Donald Kaye, MD, professor of medicine at Drexel University College of Medicine.

“[News media] had people commenting on Ebola who had absolutely no knowledge of the disease,” Kaye said. “They had people who might have an MD after their name, but certainly had no knowledge or expertise in either infectious diseases epidemiology or anything that would give them the background or knowledge to comment on something like Ebola. But they were commenting, and saying things that, frankly, were inappropriate.”

Although faulty coverage can lead to misinformation, evidence suggests it also can lead to panic. In a recent study, researchers examined and quantified daily U.S. Google and Twitter data alongside television news coverage of the Ebola outbreak. They found that each Ebola-related news video appearing on a major television network prompted tens of thousands of related tweets and Internet searches, suggesting that increased news coverage of the outbreak was responsible for increased panic among the public.

Kaye described this “hype” as symptomatic of the fast-paced, 24-hour news cycle. Reynolds added that public health’s inexperience with Ebola made it difficult to quickly provide consistent, evidence-based advice.

“When Ebola became a true public health concern in the United States, there weren’t as many voices who could talk authoritatively about it,” Reynolds said. “So, it increased the uncertainty, and there weren’t as many consistent voices out there responding to it, and that left room for scientific debate to become inflated.”

Epidemics of relatively unknown pathogens may be a hotbed of misinformation, but they are hardly its exclusive home. According to Timothy F. Jones, MD, state epidemiologist for the Tennessee Department of Health, similar issues have plagued many well-known diseases for very different reasons.

“There’s a lot of familiarity with flu, so a lot of people think they’re experts,” Jones said during an interview. “Everyone’s willing to comment about it, and so there can be very mixed messages that come out. That’s the tender situation where things can get a little bit sticky.”

An irreplaceable tool for communication

Regardless of these criticisms, news media can be an invaluable public health tool. Reynolds said that time and again news media have been the CDC’s go-to resource during emergency situations.

“I find the news media to be very responsible and responsive when there’s a true threat,” Reynolds said. “We know early on in a crisis situation, when lives are truly at risk, that the media are very critical to helping the response officials get the word out. There’s no question about it.”

Despite the growing number of outreach options that are now available, health experts would be unable to reach large portions of the population without the pre-established network of communications that news media can offer.

“If we don’t have that support, it makes it so much more difficult for us to work through the clutter of information and try to share what we know,” Reynolds said.

To best collaborate with news media, it is important to understand the pressures and limitations many outlets face. Chief among these is the need to release information as quickly as possible, which Diana Olson, vice president of communications for the Infectious Diseases Society of America, said in an interview that her organization takes into account whenever coordinating with reporters.

“We recognize that media outlets — especially when there’s a breaking news situation — are under the gun, they’re pressed for time,” Olson said. “We do try to develop resources, press releases, fact sheets ... those simple tools to help reporters relay the information to their audiences.”

First and foremost, the goal of many news organizations is to accurately convey information to its audience. Despite witnessing gaps in media coverage firsthand when asked to contribute during past outbreaks, Amesh A. Adalja, MD, FACP, senior associate at the Center for Health Security at the University of Pittsburgh Medical Center, believes this goal is evident now more than ever.

“We’ve seen since Ebola that there definitely is much more interest in the general media regarding infectious disease stories,” Adalja said. “There’s still some room for them to improve, but they’re actually paying attention to infectious diseases now ... is a testament to the fact that they realize it’s important to get these stories right, and to not be sensationalistic and drive the world into a panic.”

Speaking to an uninformed public

In the midst of an emergency, the layperson may not only lack direction, but could also be unable to contextualize vital information. This frequently can lead to panic, an outcome Jones said is crucial for pediatric infectious disease specialists and public health officials to avoid.

“We view ourselves as scientists and epidemiologists of the health department ... but a lot of the time I feel like society’s psychiatrist,” Jones said. “Probably the most important part of our job is translating science and data into something that the public can understand correctly.”

Gerson said the role of the pediatrician can become confusing in situations related to public health because the messages often need to be delivered differently.

“The interplay of public health and what we do in pediatric offices, which I often think of as private health, are really two different spheres,” Gerson said. “I see our job to interpret for our individual patients what the public health implications of whatever the issue might be. That becomes quite difficult in an outbreak, because there’s just so many patients, and trying to get that word out is hard because those individual conversations are better than a public announcement.”

There are important differences in speaking to individual patients and the general public, and Jones warned that practitioners may need to tailor their message in the right context before contributing. Research presented at this year’s American Psychiatric Association Annual Meeting by Daniel Witter, MD, PhD, of the University of Florida, highlighted this point by examining three Ebola news briefings held by CDC Director Thomas R. Frieden, MD, MPH. Transcripts from these events were analyzed to identify instances where Frieden’s presentation followed or violated risk communication guidelines published by WHO in 2004. Although Witter and colleagues determined Frieden to be “at his best in establishing humanity and acknowledging deficiencies about specific aspects of how the Ebola crisis was handled,” they identified several areas in which his message was unrefined and could potentially provoke anxiety in audiences.

Olson said the presentation of information is one of the leading challenges for medical experts addressing the public, and advised that all specialists seek out media training to avoid potential misunderstandings.

“Physicians and scientists are used to speaking to other physicians and other scientists,” Olson said, “and they’ll phrase things in a certain way that makes sense to their colleagues, but could easily be misconstrued by the general public.”

These concerns are not exclusive to the general public, but extend to some members of the media.

“There’s a huge difference when it becomes a general public story, and instead of just dealing with the science reporters, you’re dealing with the general reporters,” Adalja said. “It’s a very different tack you have to take. There’s a lot of context you can take for granted when you’re talking to a medical or science or global health reporter that you can’t when you’re talking to a general features reporter.”

Combating misinformation

Perhaps the most important way to avoid confusion in the public is to present a unified message, Olson said. Even if medical advice is presented well, too many competing ideas can confuse audiences and obfuscate important information.

“Close coordination with CDC and other public health authorities is essential,” Olson said. “If we have disparate messages coming from different institutions or different experts ... that really contributes to confusion among the public.”

More vexing are situations when even the best possible guidance is rejected by members of the public. Reynolds described encounters with those reluctant to accept the reassurances of sound medical science as an ongoing problem.

“That’s where the disconnect can sometimes happen,” she said. “When you have expert knowledge and confidence in the science and others don’t, how do you bridge that gap? What we shouldn’t do is to arrogantly believe, ‘Because we say it, it must be accepted as true.’ The onus is always on us to be as credible and empathetic as possible in our messaging so that people can receive it no matter where they are, no matter what their social pressures might be.”

Unfortunately, this problem is compounded when those whose opinions do not align with proven science are public figures. For example, during a Republican presidential primary debate last fall, candidates discussed the link between vaccines and autism — an association that has been disproven in numerous studies — as well as “alternative” immunization schedules and the potential benefit of delayed vaccination. Concerns of personal freedom to vaccinate and possible connections between vaccine manufacturers and the government superseded peer-reviewed evidence, prompting those in the medical community to speak out.

“Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. It is dangerous to public health to suggest otherwise,” Karen Remley, MD, MBA, MPH, executive director and CEO of the AAP, said in a press release.

However, according to Paul A. Offit, MD, chief of the division of infectious diseases at The Children’s Hospital of Philadelphia, and an Infectious Diseases in Children Editorial Board member, the swift response by the AAP and the mainstream media to combat the misinformation presented at the GOP debate was commendable.

“Anytime that a professional organization that represents the health and well-being of children puts forward a statement that gets accurate information out there, it is a good thing,” Offit said. “The media response to that debate was phenomenally good — basically recognizing Donald Trump, Ben Carson and Rand Paul as making a series of misstatements. Ten years ago, I think they would have had quotes from ‘the other side,’ who would have defended Donald Trump when he said vaccines cause autism. But this time, the media was actually incredibly responsible with how they handled it.”

Instead of a single, centralized message, dissenting opinions can stir debate and confuse those searching for information. Gerson said the message often can be exaggerated in the interest of increased attention, which can result in a muddled public message.

“I can’t tell you how many times I get a little frustrated when the media shows a vaccine clinic and they choose to show the picture of the screaming child getting the vaccine, as opposed to a smiling child getting a vaccine,” Gerson said. “The screaming child makes a better picture, but doesn’t do great things for pediatricians trying to reassure families that it’s not bad to get a vaccine.”

According to Adalja, when speaking to the media, the best advice is simply to repeat the facts and defend them with the available data in a way that is easy for viewers to understand.

“You have to remember, when you’re the medical expert, you have the facts on your side,” Adalja said. “You are the sober professional there to communicate public health information to the general public. The other people are there for entertainment value.”

An emerging resource

The almost unlimited resources available on the Internet can be a blessing and a curse to the mission of public health, Offit said.

“I think the Internet is the place to go for inaccurate information, but it is also the place to go for exceptionally accurate, up-to-date, scientific information that is presented in a powerful manner,” he said. “So I think it is important to keep in mind that the Internet is both a place for good and awful information.”

Among the most influential arenas for these debates is social media, with services like Facebook and Twitter now allowing for two-way conversations between experts and the general public.

“One of the aspects of social media that’s really important to us is that it gives us a way to interact with the public in terms of their true fears or concerns or misunderstandings,” Reynolds said. “It is, of course, a place where misinformation can move quickly — but correct information can move quickly, also.”

According to Gerson, as a growing number of adults who grew up in the age of social media become parents, the importance of social media and Internet communication with patients will increase drastically.

“We still see patients who get information from television, local news and newspapers,” Gerson said. “However, I think it is generational. The amount of younger parents who get most of their information from Facebook pages and social media links is growing at an exponential rate.”

Reynolds explained that social media outreach is a growing area for the CDC, and was an especially useful tool to reduce panic during the height of the Ebola outbreak. Olson added that these services are a resource for organizations and individual practitioners to harmonize their recommendations with those of health agencies through retweets and shares.

Gerson attributed this outcome to the speed and easily digestible messages characteristic of the service. The ability to point a concerned parent to a resource online can make the life of a pediatrician easier, while improving both public and private health.

“Our point of access is so narrow, with our limited ability to see only a certain number of patients in a day, whereas, with a public announcement on social media, you can potentially hit a large number of patients, and at any time, they just need to click and get that information,” Gerson said. “That ability to have a known social media website that you can refer patients to is often extremely helpful, and also might translate to the public health message for both a parent-friendly and a pediatrician-friendly audience.”— by Dave Muoio and David Costill

• References:
• Towers S, et al. PLoS One. 2015;doi:10.1371/journal.pone.0129179.
• Witter D, et al. P1-208. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.

• For more information:
• Amesh A. Adalja, MD, FACP, can be reached at ameshaa@aol.com.
• William T. Gerson, MD, can be reached at William.Gerson@uvm.edu.
• Timothy F. Jones, MD, can be reached at tim.f.jones@tn.gov.
• Donald Kaye, MD, can be reached at donjank@aol.com.
• Paul A. Offit, MD, can be reached at offit@email.chop.edu.
• Diana Olson can be reached at dolson@idsociety.org.
• Barbara Reynolds, PhD, can be reached at bsr0@cdc.gov.

Disclosures: Adalja, Gerson, Jones, Kaye, Offit, Olson, Reynolds and Witter report no relevant financial disclosures. Infectious Diseases in Children was unable to confirm Remley’s disclosures at the time of publication.

Is social media helping or harming the dissemination of information about infectious diseases?

Social media is helping to disseminate ID information.

I strongly believe social media is helping to spread information on infectious diseases.This is based on my personal experience with Twitter and published studies. To the doubters saying, “Show me the evidence!” look no further than the Ebola outbreak.

As the world watched in fear, the front-line health care providers, WHO and the CDC turned to Twitter to disseminate information in real-time. The Nigerian Minister of Health and CDC announcement of the first Ebola case was tweeted on July 24, 2014 and reached 1,196,793 people. Publications on emerging resistance and antimicrobial stewardship in ID journals do not reach a large percentage of physicians who prescribe antibiotics, so I turned to Twitter to educate, engage, advocate, collaborate and network with others globally.

My own tweets are focused on antimicrobial stewardship and resistance. After 1 year of active tweeting, I have over 1,400 “followers” from over 34 countries. That’s more than any article I have published. I have learned more from the people and organizations I follow on Twitter than any other method. Most importantly, surgeons have embraced Twitter. As frequent users of antibiotics, surgeons are important stakeholders in stewardship. I used Twitter to educate surgeons during the recent outbreak of carbapenem-resistant Enterobacteriaceae during endoscopic procedures. Tweets with links to articles provided surgeons with real-time information. A study I presented at IDWeek 2015 titled “Using Twitter to Engage Surgeons in Antimicrobial Stewardship” showed that 31 ID tweets retweeted by surgeons reached over 15,000 surgeons.

The power of Twitter should not be underestimated. National organizations and patient advocacy groups have learned how to effectively use Twitter to provide education on various ID topics. The Peggy Lillis Foundation has an effective Twitter feed providing education and patient stories on Clostridium difficile. The NationalFoundation for Infectious Diseases regularly tweets on vaccinations. The CDC posts tweets daily on various ID topics. IDWeek 2015 had over 4,000 tweets sent during the conference.

Another form of social media helping to spread ID information is Instagram. Posts on Instagram are shared as an image, which may be paired with a text of up to 2,200 characters. One ID physician and ID pharmacist together have over 15,000 followers. Both of them provide a unique way of educating others with valuable, accurate ID information.

Social media does have risks. Whatever you say on social media stays on social media, forever. Health care professionals are held to a higher standard and must use social media responsibly. We must find ways to engage all health care providers who use antimicrobials. Antimicrobial resistance is a global health care problem, and social media can help spread ID information globally. United together on Twitter or Instagram, we can make a difference.

Debra A. Goff, PharmD, FCCP, is a clinical associate professor of pharmacy and infectious disease at The Ohio State University Wexner Medical Center. She can be reached at Debbie.Goff@osumc.edu. Disclosure: Goff reports no relevant financial disclosures.

• References:
• Gauthier TP, et al. Clin Infect Dis. 2015;doi:10.1093/cid/civ248.
• Goff DA, et al. Clin Infect Dis. 2015;doi:10.1093/cid/civ071.
• Odlum M, et al. Am J Infect Control. 2015;doi:10.1016/j.ajic.2015.02.023.

Online networking tools show early promise, but additional assessment is vital for public health.

Any global pronouncement about the good or ill of social media is likely to be wrong. The online networking tools/applications emergent in the early 21st century both create and address problems in contemporary society, and we must exercise restraint in our assessments of such a complex phenomenon. That said, in reflecting on the question at hand, it is instructive to think about the ways social media, in its relative infancy, have already begun contributing to public health.

Tools such as Twitter and other geo-tagging applications have been used — quite impressively — to coordinate responses to emergency situations such as natural disasters (eg, earthquakes, hurricanes, tsunamis, etc.), terrorist events (eg, the Boston Marathon bombing), and state violence against citizens (eg, Arab Spring, Iranian Green Revolution, etc.). And although much-maligned for its abuses of user privacy, the social network Facebook helped generate a 23-fold surge in donor pledges in 2013 after rolling out a feature to allow users to pledge as donors on their timelines. Research has also established that Facebook groups and pages can be useful tools in achieving salutary outcomes on such public health issues as smoking cessation, weight loss and HIV prevention. Moreover, organizations such as the CDC, American Red Cross, WHO and others have used popular social media tools like Facebook, Twitter and Instagram to amass enormous networks for dissemination of credible information. Creation of this infrastructure has built a global audience for public health messaging that is utterly unprecedented in human history.

Therefore, if it were to be argued that social networking tools are not yet helping in the infectious disease world, the question we must ask is — why not? From an epidemiological standpoint, are we using the right methods to aggregate data relevant to the spread of infectious diseases and outbreak? Are we using proper techniques to draw actionable “intelligence” from the data? If not, how might the emerging era of “big data” inform improvements in the infectious disease domain? And from a leadership standpoint, are we employing sound strategies to disseminate useful information? Are we engineering this information in ways that promotes its viral effects and countervails against the misinformation that we know can travel around the world before the truth gets out of bed (see the anti-vaxer movement)? Are we devoting enough resources and manpower to our efforts in the social media space, or are we still reticent because of fears or biases we might harbor toward the technology?

Ultimately, epidemics have the potential to unite us around our common frailty and capacity to experience pain and loss, and social media are already showing themselves to be a means through which we may respond to crises with greater empathy and powerfully mitigate human suffering. Learning how to best leverage these evolving tools/applications in the service of public health is a commitment worthy of the best minds of our generation.

Daniel R. George, PhD, is an assistant professor in medical humanities at Penn State College of Medicine. He can be reached at dgeorge1@hmc.psu.edu. Disclosure: George reports no relevant financial disclosures.

• References:
• Rovniak LS, et al. BMC Public Health. 2013; doi:10.1186/1471-2458-13-753.
• Young SD, et al. Sex Transm Dis. 2013;doi:10.1097/OLQ.0b013e318278bd12.
• Phua J. J Commun. 2013;doi;10.1111/jcom.12054.