When Did Medicine Become a Battleground for Everything?

Tara Haelle

Medscape.com

Originally posted 18 July 23

Like hundreds of other medical experts, Leana Wen, MD, an emergency physician and former Baltimore health commissioner, was an early and avid supporter of COVID vaccines and their ability to prevent severe disease, hospitalization, and death from SARS-CoV-2 infections.

When 51-year-old Scott Eli Harris, of Aubrey, Texas, heard of Wen's stance in July 2021, the self-described "5th generation US Army veteran and a sniper" sent Wen an electronic invective laden with racist language and very specific threats to shoot her.

Harris pled guilty to transmitting threats via interstate commerce last February and began serving 6 months in federal prison last fall, but his threats wouldn't be the last for Wen. Just 2 days after Harris was sentenced, charges were unsealed against another man in Massachusetts, who threatened that Wen would "end up in pieces" if she continued "pushing" her thoughts publicly.'

Wen has plenty of company. In an August 2022 survey of emergency doctors conducted by the American College of Emergency Physicians, 85% of respondents said violence against them is increasing. One in four doctors said they're being assaulted by patients and their family and friends multiple times a week, compared to just 8% of doctors who said as much in 2018. Sixty-four percent of emergency physicians reported receiving verbal assaults and threats of violence; 40% reported being hit or slapped, and 26% were kicked.

This uptick of violence and threats against physicians didn't come out of nowhere; violence against healthcare workers has been gradually increasing over the past decade. Healthcare providers can attest to the hostility that particular topics have sparked for years: vaccines in pediatrics, abortion in ob-gyn, and gender-affirming care in endocrinology.

But the pandemic fueled the fire. While there have always been hot-button issues in medicine, the ire they arouse today is more intense than ever before. The proliferation of misinformation (often via social media) and the politicization of public health and medicine are at the center of the problem.

"The People Attacking Are Themselves Victims'

The misinformation problem first came to a head in one area of public health: vaccines. The pandemic accelerated antagonism in medicine ― thanks, in part, to decades of anti- antivaccine activism.

The anti-vaccine movement, which has ebbed and flowed in the US and across the globe since the first vaccine, experienced a new wave in the early 2000s with the combination of concerns about thimerosal in vaccines and a now disproven link between autism and the MMR vaccine. But that movement grew. It picked up steam when activists gained political clout after a 2014 measles outbreak at Disneyland led California schools to tighten up policies regarding vaccinations for kids who enrolled. These stronger public school vaccination laws ran up against religious freedom arguments from anti-vaccine advocates.

The info is here.

Resolving content moderation dilemmas between free speech and harmful misinformation

Kozyreva, A., Herzog, S. M., et al. (2023). 

PNAS of US, 120(7).

https://doi.org/10.1073/pnas.2210666120

Abstract

In online content moderation, two key values may come into conflict: protecting freedom of expression and preventing harm. Robust rules based in part on how citizens think about these moral dilemmas are necessary to deal with this conflict in a principled way, yet little is known about people’s judgments and preferences around content moderation. We examined such moral dilemmas in a conjoint survey experiment where US respondents (N = 2, 564) indicated whether they would remove problematic social media posts on election denial, antivaccination, Holocaust denial, and climate change denial and whether they would take punitive action against the accounts. Respondents were shown key information about the user and their post as well as the consequences of the misinformation. The majority preferred quashing harmful misinformation over protecting free speech. Respondents were more reluctant to suspend accounts than to remove posts and more likely to do either if the harmful consequences of the misinformation were severe or if sharing it was a repeated offense. Features related to the account itself (the person behind the account, their partisanship, and number of followers) had little to no effect on respondents’ decisions. Content moderation of harmful misinformation was a partisan issue: Across all four scenarios, Republicans were consistently less willing than Democrats or independents to remove posts or penalize the accounts that posted them. Our results can inform the design of transparent rules for content moderation of harmful misinformation.

Significance

Content moderation of online speech is a moral minefield, especially when two key values come into conflict: upholding freedom of expression and preventing harm caused by misinformation. Currently, these decisions are made without any knowledge of how people would approach them. In our study, we systematically varied factors that could influence moral judgments and found that despite significant differences along political lines, most US citizens preferred quashing harmful misinformation over protecting free speech. Furthermore, people were more likely to remove posts and suspend accounts if the consequences of the misinformation were severe or if it was a repeated offense. Our results can inform the design of transparent, consistent rules for content moderation that the general public accepts as legitimate.

Discussion

Content moderation is controversial and consequential. Regulators are reluctant to restrict harmful but legal content such as misinformation, thereby leaving platforms to decide what content to allow and what to ban. At the heart of policy approaches to online content moderation are trade-offs between fundamental values such as freedom of expression and the protection of public health. In our investigation of which aspects of content moderation dilemmas affect people’s choices about these trade-offs and what impact individual attitudes have on these decisions, we found that respondents’ willingness to remove posts or to suspend an account increased with the severity of the consequences of misinformation and whether the account had previously posted misinformation. The topic of the misinformation also mattered—climate change denial was acted on the least, whereas Holocaust denial and election denial were acted on more often, closely followed by antivaccination content. In contrast, features of the account itself—the person behind the account, their partisanship, and number of followers—had little to no effect on respondents’ decisions. In sum, the individual characteristics of those who spread misinformation mattered little, whereas the amount of harm, repeated offenses, and type of content mattered the most.

The research is here.