“Mrs. Jones, based on your risk factors for having a heart attack, I recommend that
we start you on a statin.”
“No, thank you, Doctor, I've read too many scary things about those drugs on the internet.
Plus, I worry that some in your profession make these recommendations for reasons
of personal financial gain. I also found that online.”
Undoubtedly, the majority of cardiologists have had conversations just like this,
urging a patient to take a statin, a powerful cholesterol-lowering drug with robust
mortality benefit. Part of the reason these oftentimes no-brainer recommendations
are rejected derives from widely disseminated incorrect information that vastly over
states the risks of these drugs. (Of course, like anything in life, the use of statins
is not entirely risk-free; their application should always entail a thoughtful analysis
of risks vs. benefits.) Most patients do not recognize that the benefits of statin
use are invisible (“I didn't have a heart attack or stroke this past year”), whereas
the small and typically reversible risks (e.g., muscle pain) are readily apparent.
Many patients who would benefit from statin use do not take them.
Cardiovascular disease is the no. 1 killer of both men and women around the world.
Robust scientific advances, published in the pages of our journals, have fostered
significant improvements that benefit individuals and society. Yet, cardiovascular
disease continues to transform itself, emerging in new forms, such as heart failure.
The struggle has shifted to new battlefields.
These successes derive from an armamentarium of powerful tools, medicines, devices,
and awareness of lifestyle-related hazards, such as high blood pressure, high cholesterol,
and smoking. Sadly, however, we do not take full advantage of the tools at our disposal.
One significant cause of suboptimal utilization of our prodigious tool chest is medical
misinformation hyped through the internet, television, chat rooms, and social media.
In many instances, celebrities, activists, and politicians convey false information;
not uncommonly, authors with purely venal motives participate.
We can point to numerous other examples, including the entirely unfounded concerns
regarding vaccinations. The notion that MMR (measles, mumps, rubella) vaccination
causes autism was based on a single flawed study, long since refuted, with its publication
retracted. Seventeen much larger and properly controlled studies have proven otherwise.
Nevertheless, the internet shouts unfounded warnings. Once again, celebrities, actors,
activists, and politicians with no specific knowledge or training use their fame to
promote a message that causes serious harm. Individuals who are neither physicians
nor scientists, but often with a specific agenda, have outsized influence over our
lives. They dispute scientific evidence without ever having studied it.[1]
Recognizing that it is impossible to prove “never,” scientists appropriately couch
their statements in statistical terms which may come across to the public as equivocation.
The nuanced voices of scientists often do not resonate with the public as much as
the strident alarms sounded by people of fame, speaking in absolute terms.
Furthermore, scientists are appropriately skeptical because any individual scientist
or study can be wrong. Yet, science ultimately self-corrects. When a scientist gets
it wrong, as happens, people sometimes vilify the entire self-correcting scientific
enterprise. We trust aeronautical science when we board an airplane; we trust the
science buried within our cell phones; we trust mechanical engineering science when
we cross a bridge; yet, many are uniquely skeptical of biological science.
Sadly, we cannot exclude that some in the professions of science and medicine act
based on motives driven by financial considerations; incomplete declarations of potential
conflict of interest persist.[2] Recent examples of dramatic price hikes for important medications have reinforced
this notion. Indeed, many physicians have had conversations with patients who believe
that our recommendations stem, at least in part, from the prospect of personal financial
gain.
We, the editors-in-chief of the major cardiovascular scientific journals, around the
globe, sound the alarm that human lives are at stake. Pointing to the two examples
elaborated above, people who decline to use a statin when recommended by their doctor,
or parents who withhold vaccines from their children, put lives in harm's way.
The media must do a better job. It is unacceptable to posit false equivalents in these
discussions, often done to foster debate and controversy. It is easy to find a rogue
voice but inappropriate to suggest that voice carries the same weight as that emerging
from mainstream science. (We can easily point to examples outside the medical domain,
as well, such as climate change, evolution, nutraceuticals, and genetically modified
foods, where false equivalents are frequently posited.) Furthermore, recent evidence
suggests that misinformation travels faster through social networks than truth.[3] We must work to enhance science literacy in our world; one place to start is by
doing a better job of teaching the scientific method in our schools so that the lay
public is aware that science is accomplished in fits and starts, but, in the end,
gets it right.
Purveyors of social media must be responsible for the content they disseminate. It
is no longer acceptable to hide behind the cloak of platform. We, as editors, are
charged with evaluating the validity of the science presented to us for possible publication,
and we work hard to fulfill this heady responsibility. Recognizing that lives are
at stake, we reach out to thought-leading experts to evaluate the veracity of each
report we receive. Here, we challenge social media to do the same, to leverage the
ready availability of science-conversant expertise before disseminating content that
may not be reliable. Without exaggeration, significant harm, to society and individuals,
derives from the wanton spread of medical misinformation. It is high time that this
stop, and we lay at the feet of the purveyors of internet and social media content
the responsibility to fix this.
Article Information
Authors
Joseph A. Hill, MD, PhD, Editor-in-Chief, Circulation; Stefan Agewall, MD, PhD, Editor-in-Chief, European Heart Journal Cardiovascular Pharmacotherapy; Adrian Baranchuk, MD, Editor-in-Chief, Journal of Electrocardiology; George W. Booz, PhD, Editor-in-Chief, Journal of Cardiovascular Pharmacology; Jeffrey S. Borer, MD, Editor-in-Chief, Cardiology; Paolo G. Camici, MD, Editor-in-Chief, International Journal of Cardiology; Peng-Sheng Chen, MD, Editor-in-Chief, HeartRhythm; Anna F. Dominiczak, DBE, MD, Editor-in-Chief, Hypertension; Çetin Erol, MD, PhD, Editor-in-Chief, Anatolian Journal of Cardiology; Cindy L. Grines, MD, Editor-in-Chief, Journal of Interventional Cardiology; Robert Gropler, MD, Editor-in-Chief, Circulation: Cardiovascular Imaging; Tomasz J. Guzik, MD, PhD, Editor-in-Chief, Cardiovascular Research; Markus K. Heinemann, MD, PhD, Editor-in-Chief, The Thoracic and Cardiovascular Surgeon; Ami E. Iskandrian, MD, Editor-in-Chief, Journal Nuclear Cardiology; Bradley P. Knight, MD, Editor-in-Chief, PACE and EPLab Digest; Barry London, MD, PhD, Editor-in-Chief, Journal of the American Heart Association; Thomas F. Lüscher, MD, Editor-in-Chief, European Heart Journal; Marco Metra, MD, Editor-in-Chief, European Journal of Heart Failure; Kiran Musunuru, MD, PhD, MPH, Editor-in-Chief, Circulation: Genomic and Precision Medicine; Brahmajee K. Nallamothu, MD, MPH Editor-in-Chief, Circulation: Cardiovascular Quality and Outcomes Andrea Natale, MD, and Sanjeev Saksena, MD, Editors-in-Chief, Journal of Interventional Cardiac Electrophysiology; Michael H. Picard, MD, Editor-in-Chief, Journal of the American Society of Echocardiography; Sunil I. Rao, MD, Editor-in-Chief, Circulation: Cardiovascular Interventions; Willem J. Remme, MD, PhD, and Robert S. Rosenson, MD, Editors-in-Chief, Cardi- ovascular Drugs and Therapy; Nancy K. Sweitzer, MD, PhD, Editor-in-Chief, Circulation: Heart Failure; Adam Timmis, MD, Editor-in-Chief, European Heart Journal: Quality of Care and Clinical Outcomes; Christiaan Vrints, MD, PhD, Editor-in-Chief, European Heart Journal: Acute Cardiovascular Care.
