Ep. 101: Truth or Trend: Tackling Medical Misinformation on Social Media with Dr. David Stukus

According to the Centers for Disease Control and Prevention (CDC), nearly 60% of Americans use the internet for health information. A GoodRx survey indicates that more than 70% of those people have been exposed to medical or health-related misinformation, with social media cited as the most common source.

Nationwide Children’s pediatric allergist David R. Stukus, MD, FAAP, believes pediatricians can play a key role in countering medical misinformation on social media, both in the exam room and on their social media platforms. He presented on the topic at the American Academy of Pediatrics Experience 2024, training his colleagues on how to tip the balance toward evidence-based information for 21st-century parents.

Interested in hearing more? Check out Conversations From the World of Allergy, a podcast from the American Academy of Allergy, Asthma & Immunology (AAAAI) moderated by Dr. Stukus, AAAAI Social Media Medical Editor.

And, if you’re a parent looking for reliable health information, visit Nemours KidsHealth®, the world’s most-visited site for trusted health information with content specific to parents, teens and kids.

Guest:
David R. Stukus, MD, FAAP, Pediatric Allergist & Director, Division of Allergy and Immunology, Nationwide Children's

Host/Producer: Carol Vassar 

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Announcer:

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast, produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.

Carol Vassar, host/producer:

Each week we're joined by innovators and experts from around the world, exploring anything and everything related to the 80% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you are here, let's go.

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Let's go well beyond medicine.

Carol Vassar, host/producer:

When you're looking for health information, where do you turn? Did you say the internet? Well, you're not alone. According to the CDC, nearly 60% of Americans turn to the internet for health info. According to a GoodRx survey, over 70% of those people have been exposed to medical or health-related misinformation, many confused about how to tell the good information from the bad, with social media cited as the most common source of misinformation.

Newscaster 1:

Misinformation has real consequences for the public's health.

Newscaster 2:

People are going on TikTok for more than funny videos. They're now using it for medical advice.

Newscaster 1:

Within the medical community, there is a new push to get more health professionals engaged in social media, both to combat misinformation and really get good information out there to people who are looking for it.

Carol Vassar, host/producer:
Enter Dr. David Stukus, a professor of clinical pediatrics at Nationwide Children's Hospital in Columbus, Ohio. Dr. Stukus, who has studied and published on this issue, rallied and educated his fellow pediatricians at the American Academy of Pediatrics Experience 2024 in Orlando, Florida about their role in countering social media misinformation with a presentation he called “So You Think You Can Dance? Why Parents Trust TikTok More Than Their Pediatricians.” A great name, right? Here’s how he came up with it? 

Dr. David Stukus, Nationwide Children's Hospital:

I was thinking like an influencer and I wanted a clickbait title to get people in the room.

Carol Vassar, host/producer:

Our podcast team spoke with Dr. Stukus about the ways in which parents today receive medical information on behalf their children, which has truly changed with the explosive growth of social media since the early 2000’s. We also discussed the important role pediatricians play in pointing today’s parents toward evidenced based practices both in the exam room and online.

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Carol Vassar, host/producer:

So, let's talk about traditionally where parents get information about their children's health. You're handed a baby and you're pretty much on your own. Where traditionally do parents find out information if their child is sick or about preventive care?

Dr. David Stukus, Nationwide Children's Hospital:

It's been a moving target over the last decade. If we look at 10 years ago, a lot of their information came from their pediatrician, somebody that they trust and that they would see on a somewhat regular basis or parenting books, articles online, things like that. That has shifted dramatically. And now parents are often turning to social media and they're going to places like Facebook and Instagram, even TikTok, and they're getting their information from there, often from other parents, often from people with no medical background or expertise whatsoever, which is why I think it's important for healthcare professionals to really stay abreast of this and understand how our patients and their parents are being influenced.

Carol Vassar, host/producer:

Now, if you look at people who are becoming parents right now, they are digital natives. I remember my daughter, who's now a mother herself, sitting on my lap. We would play Disney games, rudimentary Disney games. This is very natural for them to turn to the computer and now their phone. Is there a generational aspect to all of this consideration? I recall calling my mother or my mother-in-law for advice or my pediatrician. Is there a generational aspect?

Dr. David Stukus, Nationwide Children's Hospital:

Absolutely, yeah, and you hit the nail on the head. This is how they grew up. They're so well versed in using our smartphone devices and using all the resources at their fingertips, and they're really good at it as well. The hard part is in really understanding how to apply critical thinking skills to the information that they find online, and that's where misinformation creeps in and things like that. So, yeah, and I don't blame them. They're really good at it, and that's all they've ever known, so of course they're going to go on their devices to look for information.

Carol Vassar, host/producer:

So, what do parents today need to know to find accurate information?

Dr. David Stukus, Nationwide Children's Hospital:

I mean, boy, this really came to light during the COVID-19 pandemic, where we saw that misinformation was absolutely impacting public health efforts, individual decision-making regarding vaccines and things like that. And I think we have to take those lessons we learned from there and learn how to critically think about the information we're seeing. So, it's up to all of us to help teach people that, but it's really up to everybody. If you're going to go online and use social media, you have to be savvy now, especially with artificial intelligence and all the deep fakes and the videos. I mean, we're recording this in a political election cycle, and it's more prevalent than ever. So, all of us need to really be aware of how these powerful influences are shaping our lives.

Carol Vassar, host/producer:

As we look at what is read and consumed on social media in particular, it's short, it's sharp, it's very much, here's the comment and we're onto the next thing. How does that influence what people are picking up in terms of information for health for their children or even themselves?

Dr. David Stukus, Nationwide Children's Hospital:

I'm glad you asked that. That's one of the most powerful aspects of social media. So, you have healthcare professionals and physicians, and traditionally we have not been taught how to communicate science and science is messy and complicated, and we dive into the weeds and we talk about statistics, and nobody wants to hear that, their eyes roll over. But you go on social media and you see these emotional snippets, where people either show dramatic examples of children behaving in a certain way or responding to certain treatments or who knows what. And what social media does is it promotes the outliers, all of the middle ground.

So, in healthcare, we know there's a bell-shaped curve to everything. There's outliers on both ends, but most people fall in the middle in regards to their presentation of certain illnesses, response to treatment. But on social media, it rewards the outliers. So, if you go online and you see these emotional stories and anecdotes, not only will you relate to those other parents that are sharing that, or influencers, but you're led to believe that those outliers are the reality, which is not the case.

Carol Vassar, host/producer:

Let's talk about influences. Mom influencers are huge. What role do they play in spreading good information and perhaps misinformation?

Dr. David Stukus, Nationwide Children's Hospital:

I often think about what does it take to become an influencer, and your whole goal is to get as many clicks and followers as possible because that's how you generate income from that. So, it becomes a slippery slope very quickly of how do you maintain attention. Everybody's competing for attention online, and when we think about these influencers, regardless of their intent, that's their goal, is they want to get as many people to share their content, dive into the algorithm to promote it, and so on and so forth. So, as they're competing for attention, you're going to see more extreme information being presented. Oftentimes, it's not evidence-based. Nobody wants to listen to the boring old, "If your child has asthma, take their inhaled corticosteroids twice a day to help control things." People want to know the all-natural ways to heal them. They want to talk about this diets that treat your inflammation and all the buzzwords of today.

And if you do this long enough, as we have, you're going to see these trends change over time. It used to be anti-GMOs just a few years ago. Remember the gluten-free industry? It's a billion-dollar industry because people were led to believe that gluten is causing all that else [inaudible 00:07:37] humanity. So, learning how to spot these trends, that's where you can see what these influencers are doing, and a lot of them have good intentions, but you also have to realize that a lot of them don't actually have medical expertise either, so you have to take it with a grain of salt.

Carol Vassar, host/producer:

Now, this may be a fairly obvious question. What are the dangers of parents relying too much on social media sources for health information?

Dr. David Stukus, Nationwide Children's Hospital:

Well, if we want to take a page from the playbook of social media, I mean, there's extreme examples of children dying because parents actually trusted other parents on their Facebook page in regards to how to treat their influenza infection, and they ignored the advice of their pediatrician. I mean, these are well-documented, and that's the extreme example of this. If you're trusting these people that have no medical expertise and you're not going to your personal pediatrician or healthcare professional, you're going to get bad advice. And if you follow that bad advice, you could have bad outcomes.

Best case scenario is there's going to be a delay to proper diagnosis, and we all know that self-diagnosis is filled with incorrect answers. When I was in medical school, I diagnosed myself with about 75 different conditions as I learned about them, which I didn't have. I think I had cancer 17 times at one point. So, we have to help people understand that when you're relying on social media, you can't trust all the information that's out there, but hopefully take that back to your own pediatrician and see if it actually pertains to your child.

Carol Vassar, host/producer:

I want to ask about the role of the pediatrician. Pediatricians, do they need to be online or what's the connection there? Are some online and putting out the best information that they have in front of them? Or what's the relationship there, of having pediatricians on social media to kind of debunk what's going on?

Dr. David Stukus, Nationwide Children's Hospital:

Yeah, there's absolutely a role. We're very much needed. There's great examples of pediatricians that have good content. They get it. They know how to relate to people today and technology, and they're very creative in the way that they present it, and they're trustworthy, and they provide links to evidence-based information, but they can't keep up with the influencers. There's just too many of them and they're too powerful.

So, what I'd like to do in this presentation that you invited me to talk about is really talk about even if people don't feel comfortable going online as a medical professional or going on social media with their own accounts and things like that, we need to be aware of this, and we need to proactively address this with every single family that we're seeing in the office setting, because they are going online, they are being influenced. So, if we're not aware of that, we can't help them navigate these waters. So, even if you don't want to go on yourself and go on TikTok and do silly dances and things like that, you need to be aware of what's going on out there.

Carol Vassar, host/producer:

In terms of best practices for making sure that medical professionals are out there developing their online presence, what do you suggest to them?

Dr. David Stukus, Nationwide Children's Hospital:

Yeah, there's a whole sort of toolkit for this. At our institution, we actually started an elective rotation and we wrote a textbook on this eight, nine years ago, to help fellows and residents learn how to navigate these waters.

So, a couple basic things. One is you have to be aware of HIPAA at all times. You can never, ever, ever violate patient privacy. That is huge. Number two, you can never give individual medical advice on social media. If anybody does that, it's a giant red flag. Even if you're my patient, don't come to me on Instagram and ask me about your child's rash. That is not an appropriate way to use social media. So, those are the big ones you have to be aware of.

You have to know what your institution or your organization's regulations are regarding social media. So, you have to play by their rules as well. So, it's worth a conversation if you want to do that. And then, it really is making sure that you're providing good, vetted evidence-based information. If you can back it up with a good resource from a professional organization or from published peer-reviewed literature, then it's really hard to go wrong. So, those are some of the key basics to keep in mind.

Carol Vassar, host/producer:

What advice do you have for parents or even grandparents today to help them recognize what is good evidence-based information versus what is not?

Dr. David Stukus, Nationwide Children's Hospital:

One of my favorite quotes is from Carl Sagan, "Extraordinary claims require extraordinary evidence." So, if it sounds too good to be true, it probably is. Pediatricians and healthcare professionals, we're not hiding things from you. We're not the evil industry that a lot of folks lead you to believe. We want to help. So, if you read something online and you're like, "Why have you not discussed this with me?" Bring it back to your pediatrician and ask them. More often than not, it's going to be because it's not evidence-based and it can actually cause harm in some ways.

If you're reading information from somebody who's trying to sell you something, whether it's a supplement, a subscription, whatever it is, that's a giant red flag. That's conflict of interest. So, you have to take that with a grain salt as well. And then, really question the source. Who is giving the information? What are their credentials? When is it from? A lot of stuff gets recycled from five, six years ago and it's no longer relevant. Can you back this up with another source? If you can't find another source to corroborate that, that's another red flag as well. So, we have to do our homework these days.

Carol Vassar, host/producer:

As people are on various platforms, be it TikTok, Snapchat, Twitter, X, Facebook, Instagram, is one platform more notorious for misinformation in terms of health than any other?

Dr. David Stukus, Nationwide Children's Hospital:

X, once it got taken over by its current owners sort of got deregulated and the algorithms got changed a little bit. So, it absolutely pushes bad content, because that's what generates the most clicks and what do you call them now? Retweets or re-Xs, I don't know. So, that is notorious for sort of not being a good place to find good, credible health information. I think they all have certain pros and cons to them. TikTok is sort of this Wild, Wild West of... None of these things are regulated. Nobody's going out there. They tried this during the pandemic, but all the social media platforms are too powerful. They shut it down. They said, "We're not going to regulate the content." If somebody wants to put something out there, that's up to you to figure out whether it's real or not, regardless of the platform, you have to be aware of what's going on.

Carol Vassar, host/producer:

Considering parent influencers, mostly mom influencers I think is the more popular term, is there a way to partner with pediatricians, have them work together to get real information, vetted information out there?

Dr. David Stukus, Nationwide Children's Hospital:

Yeah, this is something I've done. There's folks that are doing a really good job and they know they have their boundaries. They know if they overstep their bounds, they don't want to do that. They want to vet things. It's in their interest to have experts on as guests to discuss things, whether it's a podcast or Instagram Live or who knows what, because then it gives them credibility as well, and it's in our interest to partner with them because we're going to reach a very large target audience that we're not going to reach on our own. So, yeah, those partnerships are crucial moving forward.

Carol Vassar, host/producer:

How would you encourage pediatricians to develop those partnerships? I know within an institution, you often have to go through a marketing communications PR, but it sounds like it's a critical role for them to play to get that vetted information out there to really work with influencers.

Dr. David Stukus, Nationwide Children's Hospital:

Yeah. And I like what you brought up because this is media. Traditionally, it's a local reporter or a national... Somebody contacts your institution, they want to give an interview on such and such, and then you vet it and they say yes or no. Well, the same rules apply now. So, we really need to be going through an institution to make sure that they're on board with who we're speaking with and the platform we're going on and things like that. Because sometimes if you don't take a deep enough dive, you may not realize that some of these folks, even on the surface, that they look like they're credible, maybe they've done some not-so-nice things in the past in regards to strong opinions and excluding certain groups or things like that.

So, if you want to get more involved, work with your institution or employer first and see if they have any advice or connections. Or if you have your own presence established on social media, you can just reach out, "Would you like to collaborate?" And this has been great. And this is what people use social media for. So, there's professionals all over the place, they love to collaborate. So, you just kind of have to go out and reach out and see if people want to join forces.

Carol Vassar, host/producer:

Tell me the really good people out there and what they do pediatrician wise to become as large as they've become.

Dr. David Stukus, Nationwide Children's Hospital:

A lot of them have their own team. They have a staff. They have people that can actually film their videos and edit them and upload them for them. They have folks that can market it, and that's kind of what it takes today unfortunately. You can reach a pretty large platform. I've never done that. And I have 30,000 followers on Instagram, which is great. That's sort of my core target audience that I want to reach. But frankly, I don't have the time to post every day or on a regular basis. I don't have the time to make videos for TikTok. So, if you want to really reach a large platform, which many great pediatricians have, you have to dedicate yourself to it, and you have to work that into your career. So, some people, they love it and they're really great at it. Other people say, "That's just not something I can do right now." So, you have to think on a smaller scale. But not right or wrong, but that's just kind of what it takes these days.

Carol Vassar, host/producer:

But they do have a team behind them?

Dr. David Stukus, Nationwide Children's Hospital:

Yes, many do, yeah. Which when I found out at first, I said, "Oh, that makes sense." Because it's like, "Oh, how do these people have 300,000 followers?" And that's what it takes.

Carol Vassar, host/producer:

Because editing video is not easy.

Dr. David Stukus, Nationwide Children's Hospital:

No, I mean, just the time. Even for me, like one Instagram post, and I've been doing this for a long time. I mean, that's 30 minutes of my time to make sure... I want to make sure I get it right and edit and things like that. And then you get all the comments and the replies, and it's so much to keep up with.

Carol Vassar, host/producer:

AI is on the rise. We see videos that are AI generated, that are concerning. You mentioned the election. We've seen some AI generated videos that are of concern there. Is there anything about AI that concerns you in terms of providing good information or misinformation to parents?

Dr. David Stukus, Nationwide Children's Hospital:

Just like anything else, it's all about how it's utilized. And with AI, the information it puts out is only as good as the information it has to gather from. I think it's getting better. I've actually used this in some of my presentations over the last couple of years, and you can see the evolution of it. I've just listened to a podcast before we recorded this. It was entirely AI generated. It took three articles on nasal polyps. It generated both voices from the host and the guest. And they just basically created a 16-minute podcast that accurately reflected the content in those articles. That's ridiculous. That's scary. I think a lot of us think of this as Skynet from the Terminator movies. So, it has a lot of potential for bad, but there's really good potential as well. We have to have disclaimers. My goodness, if we can't find a way to figure out what's real and what's not, and make it so that there's repercussions if you don't disclaim it, that's going to be a real, real problem moving forward.

Carol Vassar, host/producer:

Do you think policymakers have a role here?

Dr. David Stukus, Nationwide Children's Hospital:

Oh, without a doubt. Oh, my gosh. I dive into this a little bit in my presentation, but I've done this in other publications and things like that. The human brain was never designed to deal with social media algorithms. And if you look at interviews with the people who develop these platforms, they're so good at what they do, and they knew what they were doing. They were tapping into our dopamine reward system. They were getting us addicted to these devices and these platforms. And the more we learn about this, the more we can sort of self-regulate.

Think about the endless scroll. The endless scroll, you never get to the end Instagram. There's no end to it. You just scroll infinitely and it is more content. Whereas if you read an article online, you get to the end and you're done. So, all of these things, we have to be aware of how this is impacting us. Absolutely how it's impacting adolescents and children in regards to just the way that they're developing and their brain development. So, yes, we need to rely on policymakers to regulate this in some way. At the very least, with providing disclaimers about what type of content there is, who's generating it and where it's coming from. But yeah, it's really becoming problematic in many ways.

Carol Vassar, host/producer:

You mentioned the algorithm. Now, when somebody clicks on an article that has misinformation on it, it sounds like they're more likely to be served up more of the same. Does that spin into a misinformation cycle for people?

Dr. David Stukus, Nationwide Children's Hospital:

Oh, yes. So, I mean, there's lots of examples of violent extremism happening online. I'll give an example. I'll use my own son for example. He's 14 years old and he recently went to a youth leadership conference and he came back and he was very excited, had a great experience. He said, "Dad," he's like, "Some of my friends were arguing about different conspiracies." I said, "Okay, tell me more." And he'd tell me about that. He's like, "I love to argue back. And I was watching these videos on YouTube about these different conspiracies." And I said, "Whoa, buddy. Do you know what happens when you watch those videos on YouTube? YouTube thinks that you like those conspiracies. It thinks that you agree with them. So, it's going to promote other videos along those lines, because it says if you like these other users that watch these also liked this content, and that's where it leads to actually more extremism and hate in these really dark areas of the internet.

So, the algorithms are watching us, comparing us to everybody else, and then they make recommendations based upon that. If you hover over a video on Instagram, not even clicking on it, liking it, sharing it, if you hover for a millisecond longer than other videos, the algorithm catches that and then they send it to you. We got a dog two and a half years ago. He's a little Corgi named Apollo, which I love. I resisted for a long time, but we have him and he's great. My Instagram feed is filled with Corgi videos. It's not because I'm liking things. It's just because you watch one, and then my daughter takes over every once in a while. So, we need to be aware of how these algorithms are watching us at all times and what they're recommending to us.

Carol Vassar, host/producer:

What's the future look like? How do you see the dynamic between medical professionals and social media evolving in the years to come?

Dr. David Stukus, Nationwide Children's Hospital:

I think we have to be aware that there is growing distrust from medical professionals. Recent research shows that from the pandemic it's gotten worse. And people, we're losing our expertise. We are losing the battle. We're losing to influencers and we're losing to the social media algorithm. So, we have to be aware of that. And then, that means we have to change the way that we're trying to reach people. That means we have to go to where they are. We have to embrace technology, embrace social media, get more involved. It's unfortunate that it's such a negative message, but that's the reality of where we are today, that there's hope, right?

If we can better understand this and better communicate, we have an advantage here because when we have that patient and family in our office, or we're meeting them in the hospital setting, we can have that one-on-one connection. We can listen. We can show empathy. We can monitor body language. We can have these nuanced conversations. The more we can help people understand that social media lacks two important things, it lacks nuance and it lacks context. Those are extremely important when we're talking about health and any medical condition and treatment and response to treatment and shared decision-making. So, we have to be aware that, we have to embrace that. That's where we need to go.

Carol Vassar, host/producer:

You seem to think we're losing the battle, but is there hope that we will have a return to parents trusting the experts over social media?

Dr. David Stukus, Nationwide Children's Hospital:

Oh, there is, absolutely. But I think we have to change the way that we're approaching everything. The world is changing. We're seeing just the ability to see your doctor. Do you have to wait six weeks to see them for an acute visit because you have concerns about your health, your child's health? That's not going to work, because guess what they're going to do in those six weeks? They're either going to go online looking for information and get really bad information, or they're going to seek alternative practitioners, who really aren't trained well to treat them, and they're going to listen to them and offer all kinds of non-evidence-based treatments. So, yeah, we have to evolve and change.

It's a topic filled with nuance and context, of course. Honestly, I think the most important thing is just to reinforce, for every one of us, us included, we have to be aware of what's going on with these algorithms and how they're influencing us and how they work. And we have to become very good at critical thinking. I get fooled. Part of my career and part of my job, I've been doing this for over a decade, I get fooled all the time because it's getting better and better. So, the more we learn about this, the better off we can be and hopefully navigate with good thoughts and intentions.

Carol Vassar, host/producer:

I'm going to go off on a little bit of a tangent here. You also have a podcast. Tell us about that.

Dr. David Stukus, Nationwide Children's Hospital:

I'm the host of a podcast for the The American Academy of Allergy, Asthma & Immunology. It's called Conversations from the World of Allergy. I think we have over 125 episodes at this point. And what we do is we bring in thought leaders from the world of allergy and immunology or outside our walls, and we talk about common topics that are of interest either to allergists, immunologists, healthcare professionals, or the general public, or people with certain conditions. So, I appreciate you bringing that up, and I encourage anybody out there with questions about allergies and allergic conditions to check it out.

Carol Vassar, host/producer:

Dr. David Stukus is a professor of clinical pediatrics at Nationwide Children's Hospital in Columbus, Ohio.

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Well beyond medicine.

Carol Vassar, host/producer:

Thanks to Dr. Stukus for a truly marvelous conversation, and thanks, as always, to you for listening. If you’re looking for clinician-vetted, evidence-based information on topics related to pediatric health, check out our sister website, kidshealth.org. There you’ll find easy-to-follow articles, slideshows, videos, and health tools designed to help kids, teens, and families learn and grow. There’s even a dedicated section for educators. That’s kidshealth.org. 

Our podcast team was at AAP's 2024 meeting too. In the coming weeks, you'll be hearing from national experts about topics including firearm safety, the risks to children and youth of dark design interfaces, the safety and efficacy of obesity medications for children and adolescents, the integration of mental health services into primary pediatric care settings, and next week, the AI virtual care platform that will revolutionize pediatric hospital care. Don't miss an episode. Go to nemourswellbeyond.org to subscribe to the podcast and leave a review.

Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta and Steve Savino. I'm Carol Vassar. Until next time, remember, we can change children's health for good, well beyond medicine.

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Let's go well beyond medicine.