Trusting in Magical Fairy Dust

This isn't going to be about artificial intelligence (A.I.).  I promise.  There have been a raft of cautionary articles lately about A.I. in general and in healthcare in particular -- David Shaywitz did a nice job of summarizing several of latter in Forbes recently -- but I only want to reference it in order to borrow a great suggestion from Tim Hwang, director of the Harvard-MIT Ethics and Governance of AI Initiative.

In an article in IEEE Spectrum about how to separate hype from reality, Mr. Hwang:

...suggests mentally replacing all mentions of “AI” in an article with the term “magical fairy dust.” It’s a way of seeing whether an individual or organization is treating the technology like magic.

That seems like good advice for lots of claims in healthcare, because healthcare has a lot of magical fairy dust - and not just with A.I. or even technology.

What started me thinking about this, oddly enough, was an expose in The Wall Street Journal about Amazon.  According to the investigation, Amazon has "thousands of banned, unsafe, or mislabeled products" on its site.  It compares Amazon to a flea market, exercising limited control over what third party sellers are selling or how they describe products.  

After calling attention to 4,152 problematic products, Amazon changed or took down the listing for 57% of them, although at least 130 had reemerged within two weeks.  Amazon defended itself in a blog post, citing its various efforts to monitor products on its site and to protect customers, but admitted: "There are bad actors that attempt to evade our systems."  

No kidding. 

The Journal sees this as not a problem for Amazon, but a problem for tech companies generally: 

Amazon’s struggle to police its site adds to the mounting evidence that America’s tech giants have lost control of their massive platforms—or decline to control them. This is emerging as among the companies’ biggest challenges.

The lack of control over tech platforms is why many think we're living in an era of misinformation.  Dr. Claire Wardle, co-founder of First Draft, argues in Scientific American that we're living in a "new world disorder" due to the influence of misinformation.  Technology, she believes, has helped remind us "...that humans are wired to respond to emotional triggers and share misinformation if it reinforces existing beliefs and prejudices."  

Credit: Jen Christiansen, from Wardle/Derakhshan

She distinguishes misinformation, which is false information spread by people who do not realize it is false, from disinformation, which is false information shared to cause harm, or malinformation, which is true information spread in a way designed to cause harm (e.g., leaked emails).  

Dr. Wardle is no Luddite, but she points out: "In a healthy information commons, people would still be free to express what they want—but information that is designed to mislead, incite hatred, reinforce tribalism or cause physical harm would not be amplified by algorithms."

Our world of "disorder" is, unfortunately, our "new normal," Dr. Wardle fears, and suggests: "Understanding how each one of us is subject to such campaigns—and might unwittingly participate in them—is a crucial first step to fighting back against those who seek to upend a sense of shared reality."

And, unfortunately, healthcare is a major victim of misinformation, as the anti-vaxx movement has shown.  We're always looking for that magical fairy dust that will improve our health, and all-too-often we end up trusting misinformation.

People like Dr. Jen Gunter or epidemiologist Gid M-K, Health Nerd spend much of their time trying to debunk health misinformation, Dr. Gunter usually on women's health issues (Goop is a favorite target) and Gid M-K pointing out out flaws in studies/reports of studies.  

Dr. Gunter recently issued a "call to arms" about medical misinformation and the internet, describing her personal journey through misinformation and her subsequent efforts to combat it.  She laments:

It is hard for people to wade through the quagmire that is the medical internet. Bad information is everywhere, fear sells, and the lure of the cure is real. In our 24/7 news cycle a misleading medical story can spawn many erroneous articles. Sometimes the content is actually accurate, but the headlines are incorrect. And let's face it many of us, doctors included, don't always read to the end of a story. 

We also all mistake repetition for accuracy, a phenomenon called the illusory truth effect. And social media, with retweets and reposts, is the very model of repetition.

She urges medical professional to do their part in fixing the medical internet, such as by guiding patients towards good medical information, sharing it on social media, even creating it.  Dr. Gunter urges:

"We in science are the people who developed surfactant, the measles vaccine, and safe blood transfusions...We know how to do great things with science. Helping people have access to quality information so they can make informed decisions is also one of those great things, because you can only be empowered with your health if you are accurately informed.

Credit: Axel Pfaender/The Atlantic

The really scary thing is that misinformation in healthcare is not always easy to discern.  It's not always obviously false, or even widely agreed to be false.  Austin Frakt, of The Incidental Economist fame, reminds us that a 2013 study of thousands of medical treatments found only 40% were had actual evidence to support them.  At least 3% were believed to be ineffective at best and harmful at worst.  Most surprising: "But a whopping 50 percent are of unknown effectiveness. We haven’t done the studies."

They are, in essence, magical fairy dust. 

Professor Frakt says of the fight against this kind of common health misinformation:

It’s an uphill battle. Even when we learn something doesn’t make us better, it’s hard to get the system to stop doing it. It takes years or even decades to reverse medical convention. Some practitioners cling to weak evidence of effectiveness even when strong evidence of lack of effectiveness exists.

It's important to do the science, as Professor Frakt says, to analyze it correctly, as Gid M-K strives to ensure, and to get the word out widely, as Dr. Gunter urges.  It's important not to blindly believe in something that might be misinformation.  But when it's our health, or the health of one of our loved ones, on the line, the temptation to put our faith in unproven claims, new technologies, or alternative treatments is easy to do.  

Just try to make sure you're not believing in magical fairy dust.