Note: This is a slightly revised version of a talk I delivered at the recent CVCT Conference in Washington, DC. Why are we vulnerable to fake news and why is it so hard to get rid of it? This is a complex question, but one important factor is that fake news delivers clear and simple messages that people want to hear. By contrast, real news is limited by, well, reality, and can often only deliver difficult, complex, and confusing messages that people often don't want to hear. To turn specifically to health and medicine, fake medical news achieves success because it delivers hope and promises attractive, easy and readily available solutions to common health problems or concerns. By contrast, real medical news often only can deliver, at best, a far more nuanced perspective, offering tentative hope for more modest success. Even worse, sometimes real medical news dashes the hope of people who are desperate for good news. No wonder people turn to fake news. Sometimes it's easy to identify fake medical news, at least if you have some level of sophistication about scientific and medical matters. But millions of scientifically unsophisticated people are vulnerable to its promises and hopes and are susceptible to countless swindles and schemes, often promulgated by famous, telegenic charlatans like Dr. Oz, Gwyneth Paltrow, Andrew Wakefield, Stephen Mercola, and others. But the issue is not always so simple. It’s not always easy to distinguish between fake and real medical news, even for highly sophisticated and scientifically literate people. Let me illustrate this idea with a few examples, taken from cardiology stories I’ve covered in the past. First, let’s think for a moment about the TACT trial. In case you don’t remember TACT was an NIH-funded trial testing chelation therapy for coronary disease. Chelation was a popular alternative therapy that was universally disparaged by the mainstream medical community. If the term had existed then chelation would have been considered fake news. The idea behind TACT was to bring rigorous scientific testing to a popular alternative therapy. Trial supporters believed that the trial would expose chelation's lack of efficacy and could then be used to discredit it. At the same time there were a fair number of skeptics who were outraged by the very idea of the trial. They insisted that the trial was unethical. While the trial was still underway they insisted that it be stopped and they nearly succeed in getting it shut down. But eventually the trial was finished, and the investigators, to the astonishment of many, reported findings that supported chelation. The results were published in JAMA, under extraordinary scrutiny, but many of these same skeptics insisted that the results be dismissed or ignored. There’s much more to be said about this incident. For our purposes here I think we can take away the idea that this episode shows that the line between fake news and real news isn’t always so easy to establish. Another story worth thinking about in the context of fake news is cardiac stem cell therapy. Twenty years ago research by Piero Anversa and colleagues turned cardiac stem cell research into the hottest thing in the cardiology research community. We now know that this hope was founded, at best, on extremely questionable research. The collapse of the field raises troubling questions about how we should think about and use words like “fake news.” In retrospect perhaps we should say that stem cell stories aren’t an example of “fake news” but “fake research.” If the medical establishment validates and endorses a major line of research, it’s hard to put the blame on news reports. If the media is guilty of hyping stem cells then this was largely a product of the original hype emanating from the scientific community. And boy was there a lot of hype. To understand the growth of the stem cell story it is important to understand that the researchers first achieved recognition not from the general public but from the medical and scientific community. And the reason why their research achieved acceptance in this more sophisticated community was identical to the reason why the general public accepts fake news: they were being told something they desperately wanted to believe. Stem cell therapy was not an easy sell to the general public, at least initially, since it required a certain minimum degree of scientific or semi-scientific understanding of biology. The fake news about stem cells was able to spread to the general media and the general public only because of the initial early and enthusiastic endorsement from the supposedly expert medical and research community. The general principle here, going even beyond the fake news discussion, is that we are all capable of being seduced by something we want to believe. (To cite yet another prominent example current in cardiology, it may well be that the faith of cardiologists in the efficacy of stents in stable angina may well be a result of their believing news that they desperately wanted to hear.) I use these examples to illustrate the point that it is not always easy to distinguish between fake medical news and real medical news. You can have fake research that leads to real reporters being swindled. In such a case the fake news can only be detected retrospectively, after the house of cards has tumbled. Or, as in the chelation story, you can have what appears to be fake research resulting in real research and real news. Unfortunately I can offer only so much clarity on this topic. If this presentation had been a fake news report I would be able to offer you a satisfying and neat conclusion. We would all feel terrific, confident in our ability to distinguish between real and fake medical news. But in all good conscience I can’t do that, because it’s not always easy to identify fake news, and sometimes what seems fake may be real and what seems real may be fake. My main point is that there’s simply no way to avoid critical thinking. There are no shortcuts to the truth. So I can’t tell you what you want to hear. Let me make one more very important point. Fake news is not just a failure of the media, though the media certainly deserves intense scrutiny and criticism. Fake medical news exists with the support, both active and passive, of the entire medical and scientific establishment. Too often scientists play a passive role and do nothing to prevent the spread of fake news. Or, even worse, they actively support dubious claims, while reaping financial benefits. To cite just one recent example, in the last few years a group of top scientists, including Nobel Prize winners and other academic superstars, have endorsed an anti-aging supplement developed by a top MIT biologist. Most scientists find that there is no reward, and often considerable penalties, for serving as a guardian of scientific values in the public sphere. They are encouraged from the very earliest stages of their careers to “stay in their own lane.” Taking an even wider perspective, fake medical news is an inevitable consequence of the catastrophic failure of our entire educational system and the larger culture in which it exists. This culture has failed to inculcate in the minds of the general population even the most basic and essential scientific concepts and principles. Most people are far more interested in astrology than astronomy. We’ve simply given up efforts to instill an informed, skeptical or common sense perspective about medicine and science. A civilization based on science and technology can not exist for long without an understanding or respect for its underlying foundation. Source
