Remember that time when cow urine was suggested as a remedy for Covid-19? Or cow dung and mud bath were promoted as cure for virus infection? Health misinformation is not new but the Covid-19 pandemic really revealed the troubles of "infodemic", a term that the World Health Organisation (WHO) coined for the spurt in fake news and misinformation.
A bunch of vegetables, some fruits and a dash of herbs and there it is--internet's remedy for any health condition from acne to respiratory and gut issues. Social media is full of instances where influencers (with no qualification) promote diets, foods and supplements as cure for health conditions. Too often, they are fads and can even be potentially risky. While all the remedies may seem accessible and easy, health experts keep warning about the consequences of such unfounded health hacks.
One such health myth buster on the Internet is the @TheLiverDr, who has 121,9000 followers on Twitter and over 7,500 followers on Instagram. @TheLiverDr, whose real name is Dr Cyriac Philips, a Senior Consultant at The Liver Institute at Kerala's Rajagiri Hospital. On Twitter and Instagram, he often counters health misinformation and questions the viability of alternative medicines like ayurveda, unani and homeopathy. Philips' tweet on the "huge quantity of alcohol" in homeopathic medicine went viral recently.
He claimed that homeopathy medicine called Sativol contains 40% alcohol and cost Rs 65 for 100 ml, while a bottle of Chivas Regal 12-year-old blended whiskey also contained 40% alcohol and is being sold at Rs 3,300 for 1000ml. "This alcohol is same quality, cheaper and comes to your home directly," he wrote.
"Homeopathy is just alcohol everything everywhere all at once," Philips further said in a long tweet.
According to Google Scholar, Philips did his MD from Nilratan Sircar Medical College, Kolkata and MD from Institute of Liver and Biliary Sciences, New Delhi. He has authored over 165 scientific publications in national and international journals with focus on side effects of alternative medicine on liver.
Speaking to Decode, the Kerala-based doctor explained how dangerous is health misinformation, where it stems from and how it can be controlled.As a vocal critic of ancient and alternative medicine systems. he dubs AYUSH as being "pseudoscience". Ayush is the Centre's initiative to "revive" ancient systems of medicine in healthcare such as ayurveda, yoga, unani and homeopathy.
The Kerala-based doctor received the Gold Medal for Academic Excellence in Hepatology by the President of India in 2016. Philips, 41, has also won the American Association for Study of Liver Disease Award 2015, 2016, 2017 and 2021.
Here are the edited excerpts from Decode's interview with the @TheLiverDr:
How has social media added to health misinformation? What are the sources of misinformation?
The growth of social media has been the single most pivotal event in medical science history that snowballed into the deeply rotting health-related misinformation we have to battle daily. People suddenly had access to every aspect of healthcare - whether preventive or therapeutic, without the actual knowledge to understand and assimilate that information at hand. This has resulted in confusion among the people regarding their right to healthcare. Scientific medicine takes the back seat while promoted and advertised forms of healthcare become primary care. Science does not require advertisements as it is universal and beneficial for all, irrespective of where they come from or where they belong to. The other major source of health misinformation is the print and visual media. The print media has been single handedly destroying medical science, sowing science denialism, increasing "chemophobia" within the general and patient communities since decades. Visual and print media have become slaves to advertisements which negatively impact public health. This I believe is the biggest challenge in medical care in the current times.
Which places across the world are most affected by health misinformation?
Every country and region is affected with some form of health misinformation in mild or severe degrees. For example, the anti-vaccine movement and misinformation is probably the worst in the United States, while the acceptance of alternative medicine, especially Ayurveda as preventive therapy would be considered highest in India because of the untiring and unscientific promotion of the same from public and private stakeholders in this country. A recent study showed that health misinformation was highest not in a country, but on Twitter.
What are some of the worst cases of homeopathy/ayurveda side effects that you have witnessed?
The worst cases are always the ones that end up in death or an organ transplantation of the patient. There have been so many of those. The worst case of a patient on Homeopathy was for kidney stones and fatty liver. He developed acute severe hepatitis which then evolved to affect his bone marrow also. Eventually his liver and bone marrow both failed, leaving him in a condition called aplastic anemia where blood cells do not form and he eventually died, miserably and with a terrifying ordeal after getting multiple grave opportunistic infections. A fungal infection took his life eventually, leaving behind his wife and a young child
When it came to Ayurveda, I think the worst I saw a young girl who developed severe alcohol-associated liver disease and chronic arsenic poisoning due to the alcohol and heavy metal content she was exposed to in her Ayurvedic herbal supplements given for seizure control. Even though we got her better and she survived, she is now on life-long follow-up as part of surveillance for development of skin, liver and lung cancers due to the chronic arsenic exposure she faced from the Ayurvedic herbals.
Is there a specific group in terms of age, gender or economy that falls for health misinformation more?
It seems that from the much high-quality literature available on this, the most important factors driving people to be victims of health misinformation include conservative thinking, religious ideologies, lack of scientific literacy, science-denialism, placing culture and tradition-based emotions above evidence and both identification with racial majority as well as minority within religious ideologies also affect how people accept health misinformation. A large part is also played by the inactivity from public healthcare authorities to confidently promote scientific rationality within the communities and also positive thinking associated with alternative medicine, mostly driven by anecdotal personal experiences. Supposedly, higher age groups are less prone to health misinformation, but any age is at risk in my honest opinion.
How do you keep a track of health misinformation on social media?
The most important source for me to track health misinformation are my peers, friends, colleagues and social media followers. A lot of people have benefitted from understanding how to identify health misinformation through interactions with me on social media. When such people identify a potential source, they tag me or message me on the same for me to opine on. Another way I do this is to follow other major science communicators on social media and update myself on the latest trends and topics on health misinformation.
What are the ways by which common people can keep a check on health myths?
The most important aspect here is to discuss with a domain expert. If there is a myth that needs to be debunked or understood rationally, say for example with regards to liver disease, then a Hepatologist or a Gastroentertologist with experience in Hepatology should be approached or such a person's opinion can be sought on social media. Following the real experts on medical health information instead of half-baked "health-influencers," or alternative medicine practitioners, fitness freaks, self-made nutritionists or those who portray themselves as medical doctors, but are not (eg: Eric Berg, who is a chiropractor) would be ideal to busts myths and know what is real and unreal.
What is the role of the government in quelling or creating health misinformation?
Government sources or entities who have high stakes or are invested in promoting healthcare related misinformation purely due to the business, political and cultural and traditional aspect of it are the biggest players in promotion of unscientific and pseudoscientific information among the people. Classical example is AYUSH. Central Govt promoted it as an integrated approach for Covid-19 when there was absolutely no data to support the same just to push the Indian traditional-healthcare business. Similarly, the Kerala government promoted Homeopathy very aggressively as a Covid-19 prevention even in children because the only public funded Homeopathy-formulations factory in the nation is in Kerala. They both have high stakes involved in promotion of AYUSH from a business point of view and never a public health point of view. This is called the "sunk-cost-fallacy" which means - "the phenomenon whereby a person/group is reluctant to abandon a strategy or course of action because they have invested heavily in it, even when it is clear that abandonment would be more beneficial."
There has been an aversion to scientific temperament over the years. Has it fueled health misinformation as well?
I guess it's both ways. Health misinformation that promotes science denialism (example: viruses do not exist) and misinterprets scientific care (example: vaccines killed more people than Covid) has resulted in an aversion towards scientific temperament in the society. And once the scientific temperament is taken out of the equation, then more health information will be imbibed by the person which then get carried to others. A large number of people are unaware than science is made for them. Science changes its opinions as new findings and new facts emerge. It is dynamic and it caters to the people, it gives and does not primarily aim to take. The reasons for scientific temperament being badly bruised in this country is due to poor role played by the media in promoting fear among the masses towards scientific care and promotion of health-related information which are unscientific but drenched in nationalistic attributes which attract traditionally and culturally inclined people without required logic and rational towards approaching a situation.
Do you feel that social media posts on health and medicines should be regulated?
The government finds it difficult to regulate actual medical care, drugs/medicines and right to proper scientific information on the ground and so I am not very hopeful if they can actually regulate anything on the social media with respect to posts and information on medicines. In that sense, the first is to strictly control and curb misleading advertisements on medical care and healthcare promotions from non-medical or pseudoscience spreading entities on social media. Not just the Government, but the public and private stakeholders associated with the social media must also ensure that only the nest and realistic information on health must be available for people to assimilate for informed decisions. The perfect bad example of this is the action taken by Elon Musk on Twitter, restoring/reinstating and unleashing all sorts of monstrosities of health-misinformation (such as Naomi Wolf, Donald Trump, and Jordan Peterson) who were previously banned from posting on Twitter.
Modern medicine also has side effects and that is why people turn to alternate medicines. As a health expert, where do you think people should draw a line?
People must learn to see and distinguish the very broad line that separates scientific information from pseudoscientific or unscientific information. Modern medicines do have side effects and well-identified benefits. There lies the difference.
David Colquhoun elegantly defined alternative medicine as: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety. Modern medicine is exactly the opposite of this, which means, even with the known risks, the medical science community does know how to unlock the beneficial potential of drugs for the betterment of humanity. Alternative medicine is like asking a blindfolded person to shoot in the dark, at an unknown target. People do turn to alternative medicines thinking they are safer and cheaper when in fact, they are as much or even more expensive and not safe at all. Considering the fact that alternative medicines have no known benefits and safety, cleared through elegant and validated studies, their use is always a gamble, never a surety. In fact many of the patients I have treated because of alternative medicine-related adverse events had to pay much more than they bargained for; when they could have managed their disease condition in a much more cheaper way if they followed the way of the medical science.