Physicians and scientists keep asking why so many Americans are so gullible as to believe in many absurd claims about COVID-19 and the COVID vaccine. For those of us who are taught to be able to read and interpret an article from a medical journal, the reality, epidemiology, treatment, and prevention of the viral infection just seems so obvious. The safety and efficacy of the COVID vaccines seems so indisputable. But many Americans are convinced that COVID infections are not very serious and that the COVID vaccines are more dangerous than the infection.
So, what happened?
There is clearly more than one answer to this question but one of those answers is that the medical community has made information about scientific development inaccessible to the general public whereas the architects of COVID misinformation have made their falsifications readily available to the public. They are winning the information war.
Education level is the strongest predictor of vaccination status
The June 2021 U.S. Census Pulse Survey has a wealth of information about the demographics of COVID vaccination. Although we hear a lot about racial inequities in COVID vaccination, the strongest predictor of whether or not a person gets vaccinated is education level. The survey found that 90.8% of Americans with a college degree have received a COVID vaccine but only 68.6% of those with less than a high school degree have received a vaccination. Not only have those people with lower education levels not yet received a vaccination, they also say that they are not getting one in the future. These are not people who are reading science journals, they are getting their information from social media. They trust media celebrities more than they trust doctors to know about COVID treatment. They trust political pundits more than they trust scientists to know about the science of coronavirus infection.
Physicians and scientists all too often speak a language that people with a high school education or less do not comprehend. Sometimes, it is not so much that they are gullible to what the purveyors of COVID misinformation are saying as much as they cannot understand what scientists are saying. When we open our mouths, confidence intervals, means, medians, and probability values come out. When COVID miscreants open their mouths, dogma comes out. Scientists are boring, miscreants are charismatic. If we are going to sway these Americans to get vaccinated and wear masks, we have to communicate with them in a way that they understand.
Science is not accessible to most people
For decades, physicians and scientists have communicated results of medical and scientific research through journals. Every university professor knows that to get tenured, you have to publish. Publishing does not just mean writing a post for a blog, it means getting an article accepted in a peer-reviewed medical journal. But not all medical journals are equal. For an academic physician or scientist to get promoted, it is not only the number of articles that they publish but it is also the quality of journals that their articles are published in. That quality is most commonly measured by the impact factor which is a measurement of how often articles published in those journals are cited (referenced) in other journal articles. In other words, the more times articles from a given journal are cited by other researchers, the larger the impact factor of that journal. Therefore researchers try to get their articles published in journals with the highest impact factors. The most commonly used impact factor measurement is the journal citation reports by Clarivate. Examples are in the table below:
Most medical journals are funded by a combination of reader subscriptions and paid advertising (usually medication ads). Because of the requirement for paid subscriptions, the articles in these journals are inaccessible to anyone without a subscription. As examples, the New England Journal of Medicine and JAMA both cost $199/year. As a consequence, unless you are one of the privileged few who can either afford to subscribe to a lot of medical journals or are a faculty member of a university with a library that has an institutional subscription, you cannot read these journals.
This has been a criticism of academic medicine for many years. As a result, Patrick Brown, MD, PhD (inventor of the Impossible Burger) and Michael Eisen, PhD created the Public Library of Science (PLOS) that publishes 15 open-access scientific journals that are free on the internet for anyone to read. One of these is PLOS Medicine, with an impact factor of 11.069. The PLOS journals are funded by fees paid by the authors when they get an article published; these funds generally come from the authors’ research grants. Although open-access journals, such as the PLOS journals, are a great idea, they only account for a tiny fraction of all of the current medical journals.
The purveyors of misinformation don’t charge subscriptions
In contrast to scientific journals, anti-vaxxers and other producers of misinformation about COVID do not rely on paid subscriptions for the public to access their propaganda. They make it freely and widely available using social media. Furthermore, articles in scientific journal articles are full of technical terms and complicated statistics that even physicians and scientists often do not understand. In contrast, COVID misinformation is written for the masses, usually at a grade school level, so that anyone can understand it.
Physicians and scientists do not get tenure and do not get promoted based on their tweets and number of Facebook posts. The purveyors of COVID misinformation count their success by their number of Twitter followers and Facebook friends.
They are not subject to the torment of peer review
Scientific journals require that articles submitted to them by researchers be peer-reviewed. This process involves sending the manuscripts out to volunteer scientists working in the same area who read over the manuscript and critique the article based on how rigorous the experiments were, how accurate the statistics are, how correct the conclusions are, and how important the findings are. I have reviewed dozens of articles as a peer reviewer and it takes a lot of time – at least a couple of hours per article and sometimes many hours. The reviewers are generally anonymous so that the author of the article does not know who the reviewers are. Sometimes, the reviews can be extremely harsh – many people will say much more negative criticisms when they are anonymous than they would if the author knows who is doing the reviews. Sometimes, the reviewers can feel threatened by the findings of an article under review if that article refutes the reviewers own work or if it will beat out publication of competing research that the reviewer is also working on. Bitter reviews can be very discouraging, particularly to younger scientists. Nevertheless, despite often being painful to the article authors, the peer review system is the best way of ensuring that the information that ultimately gets published in medical journals is accurate.
Anti-vaxxers, anti-maskers, and other curators of COVID misinformation are not subject to peer review. They can say anything they want and if it appears in print or on the internet, then to the average lay person, it seems just as legitimate as a peer-reviewed scientific article. Twelve people are responsible for 65% of all of the COVID misinformation on the internet. These are the so-called disinformation dozen:
- Joseph Mercola, DO
- Robert F. Kennedy, Jr.
- Ty Bollinger
- Sherri Tenpenny, DO
- Rizza Islam
- Rashid Buttar, DO
- Erin Elizabeth
- Sayer Ji
- Kelly Brogan, MD
- Christiane Northrup, MD
- Ben Tapper
- Kevin Jenkins
These 12 operate businesses and organizations that financially benefit from COVID misinformation such as selling potions and “natural” remedies on-line or selling books and classes about COVID misinformation. In other words, they are professional anti-vaxxers and anti-maskers who make their living by producing COVID misinformation content. The more outrageous the claims they make on social media, the more attention they get. The more attention they get, the more stuff they sell. The more stuff they sell, the more money they make.
In contrast, scientists do not get paid anything for the articles that they publish. Indeed, many journals charge the authors of scientific articles a publication fee (especially open access journals). Furthermore, if the author of a scientific article has a conflict of interest that would result in them profiting from the publication of their experiments, then they have to publicly acknowledge that conflict of interest and the editor of the journal may not allow publication.
Five of the disinformation dozen are physicians and having “Dr.” in front of their names gives them instant credibility. So who are the Doctors of Disinformation? Joseph Mercola, DO has claimed that mobile phones cause cancer and HIV does not cause AIDS; he has an alternative medicine business that sells tanning beds to prevent skin cancer. Sherri Tenpenny, DO famously testified to the Ohio Legislature that COVID vaccines cause people to become magnetized. Rashid Buttar, DO practices alternative medicine and uses intravenous hydrogen peroxide and EDTA to treat cancer. Kelly Brogan, MD practices “holistic psychiatry” and advocates using coffee enemas to treat depression. Christiane Northrup, MD is a gynecologist who uses Tarot cards to diagnose disease and believes that her wisdom comes from her experiences in her previous life in Atlantis. A sixth member of the disinformation dozen, Ben Tapper, is a chiropractor who introduces himself Dr. Ben Tapper to claim legitimacy for his beliefs that face masks cause disease.
So, how do we get the truth out?
It costs a lot of money to operate a medical journal. You have to pay the editors and the staff salaries. You have to rent office space. You have to pay print and mailing expenses. To cover those costs, the journal either has to sell advertising, sell subscriptions, or charge the authors publication fees. I’ve always been a bit uncomfortable with the fact that much of the costs of our journals are paid for by medication advertisements by pharmaceutical companies that at some level seems itself like a conflict of interest. Subscription fees create a barrier for dissemination of scientific information to the general public. Charging the authors of scientific articles seems like the least bad funding mechanism. Whatever the solution, making journal articles open access for anyone to read is needed.
If if science eventually becomes freely available to everyone, the medical profession needs to beat the purveyors of COVID misinformation at their own game. If the general public gets its information about COVID from Facebook and Twitter, then we need to use these same forums for spreading information about the benefits of vaccines and masks.
As physicians, we should demand that doctors who profit from creating misinformation, such as Sherri Tenpenny, be reviewed by their state medical boards to determine if their medical licenses should be revoked. In 1998, British transplant surgeon, Dr. Andrew Wakefield, falsified research claiming that the measles, mumps, and rubella (MMR) vaccine caused autism; he was struck from the UK medical register and barred from practicing medicine ever again. Those doctors who profit from disseminating COVID misinformation should be treated the same. They are a stain on our profession.
The public also bears responsibility to advocate social media business, such as Facebook and Twitter, to ban those who profit by marketing misinformation. Just as journal editors reject articles using bad science, social media companies should reject account applications from individuals such as the disinformation dozen.
Whether you are trying to sell a product or win a political campaign, there are few things more powerful than advertising. To date, advertising about COVID has relied on public service announcements. With the approval of the Pfizer COVID vaccine, I hope that Pfizer will contract with American advertising companies to create vaccine advertisements. Advertisers know how to sell products better than doctors or scientists. I look forward to the day that Pfizer vaccine ads appear on the Fox News Channel.
September 1, 2021