As healthcare professionals nationwide try to provide care during a pandemic, many have taken on the additional task of using their social media platforms to stop the spread of misinformation and to directly address people’s questions and concerns. But in an attempt to serve the public, many healthcare workers face cyberattacks that threaten their life, family, livelihood, and even the people they serve.
In January 2021, JAMA published a research letter revealing the astonishing number of doctors on social media who are being cyberbullied. The data, collected in 2019 before the pandemic started, demonstrates that 1 in 4 physicians who use social media reported being personally attacked, most frequently from posts advocating for vaccinations. Additionally, 1 in 6 female physicians reported being sexually harassed online.
The attacks often come in the form of a few angry or threatening comments, but some have evolved into all-out coordinated campaigns to harm the physicians, their practices, and even their families.
One solution might be for physicians to avoid posting about vaccinations or pull away from social media altogether, but Chad Hermann, communications director at Kids Plus Pediatrics in Pennsylvania, argues that physicians must continue to fill social media with evidence-based health information or risk being drowned out by harmful misinformation. “If we throw up our hands and stop posting, that creates a vacuum, and the anti-vaxxers are very happy to step in and provide you with the information,” he says.
Hermann has helped Kids Plus’s three offices earn a national reputation for being a pioneer when it comes to patient engagement, social media work, and communication at every level. The practice launched its Facebook page in 2010 when there probably were only a half dozen such pediatric pages in the country. Beyond building a strong reputation, Hermann emphasizes how their work online allows evidence-based medical information to, as he puts it, “pre-bunk” the misinformation.
“Pre-bunking” happens when people are regularly exposed to good, science-supported information from a trusted provider. According to Hermann, data show that when this happens, people are less likely to be swayed by misinformation. “The good information essentially inoculates them against the BS, either fully or until they come back to their provider and get what I call an ‘informational booster,’ ” he says.
“It’s a Horrific Thing to Go Through”
That said, Hermann empathizes with physicians who are afraid of being attacked, as he endured one of the first coordinated cyberattacks ever launched against a pediatric practice. In August 2017, Hermann produced and posted a 90-second PSA video across all of the Kids Plus social media channels that promoted the HPV vaccine. It was wildly successful and received praise from a number of national organizations, including the American Academy of Pediatrics, the American Cancer Society, and the Centers for Disease Control and Prevention (CDC), according to Hermann. More importantly, Kids Plus was inundated with messages and phone calls from parents asking when and how they could get the vaccine.
Three and a half weeks later, protestors launched a 24/7 attack on Kids Plus. They began by posting threats and misinformation, then inundated Facebook, Google, and Yelp, assigning the practice fraudulent one-star reviews. They attacked parents and supporters of the practice on their personal Facebook pages and posted the phone numbers of the three Kids Plus offices as part of a cyberattack to render the offices’ services and information inaccessible to patients.
“We’re used to being questioned and trolled,” says Hermann. “But we knew immediately that the volume and tenor were different.” Moles inside two of the largest anti-vaccine private Facebook groups took screencaps to reveal that these groups were simultaneously engaging in attacks coordinated in real time across states and countries. “It was proof that this attack was coordinated almost as if from a war room,” Hermann adds.
After 4 days of cyberbullying, a private Facebook group called Physician Moms Group came to the aid of Kids Plus, activating thousands of members to block offenders from making comments on their page and to refute false claims. Seeing this, even more supporters of Kids Plus came to their defense to drown out misinformation. “They were this impromptu, serendipitous calvary, and we learned that day that anti-vaccine bullies, like all bullies, tend to lose interest in punching people when they start getting punched back,” says Hermann. After eight grueling days, the attack subsided.
“It’s a horrific thing to go through, but you can’t just pull down the post,” says Hermann. “When you do that, the attacks stop and everything gets better except, of course, for vaccine advocacy and public health, both of which suffer greatly.”
When Negative Comments Turn Into Physical Threats
The vast amount of misinformation spread online has caused people to question or mistrust science. According to a recent PLOS research article, this happens, in part, because people who oppose the findings of scientists backed by data instead lean on emotive language, opinion, and anecdotes in their posts — things that easily resonate with readers. Social media platforms attempt to refute, flag, or take down misinformation, but they haven’t yet been successful.
After the attack, Hermann and Kids Plus CEO Todd Wolynn, MD, were determined to create an organization that could come to the aid when cyberbullies strike medical professionals. Together they co-founded Shots Heard Round the World, a rapid-response digital cavalry of volunteers working to protect healthcare providers and practices from online bullies. They also developed a toolkit that includes all the best practices and strategies for how to prepare for, defend against, and then clean up after a cyberattack.
Pediatrician Nicole Baldwin, MD, first learned about Shots Heard Round the World at a conference in 2019 and immediately joined the group. One year later, she experienced an attack so large in scope and scale that it dwarfed the previous campaign against Kids Plus.
Baldwin had been on social media as a physician since 2014. She added TikTok in January 2020, and the second day on the platform, she posted an 11-second video promoting vaccines that went viral. Baldwin then shared a still shot of the video on Facebook along with additional information about vaccinations.
Within 24 hours, cyberbullies launched their attack. Baldwin recalls how it started off with a few negative comments. She blocked those users and hid their comments, but things quickly escalated.
“The next day, I was sitting at my computer, and my notifications were constantly dinging,” Baldwin says. “Some of the comments were threatening, and a lot of them were calling me awful names.” She got her husband and friends to help her block the derogatory comments, but by that evening, it was out of their control. Her reputation and practice were being threatened with plummeting Google and Yelp reviews, and people started calling Baldwin’s office, making threats to shut it down. “It was 24/7,” says Baldwin.
A volunteer from Shots Heard Round the World reached out to help, temporarily taking over Baldwin’s Facebook page and bringing in 16 trustworthy volunteers to block the influx of anti-vaxxers. “They really stepped up and helped so that I could function — so that I could work and sleep,” Baldwin recalls.
After receiving several severe threats, Baldwin had police patrol her house and practice. The attack lasted about 2 traumatic weeks. The team blocked 5400 individuals from her Facebook page and another 600 from her other channels.
The plot to silence Baldwin ultimately backfired. “I kept posting throughout the attack because I feel like when they picked me, they picked the wrong girl,” she says. “They use these awful tactics to shut us up, but it actually fueled me to post more.” Baldwin had 16 followers on TikTok when she first posted the video. At the end of the 2 weeks, she had over 10,000. Today she has more than 40,000.
COVID Ups the Stakes on Standing With Science
Baldwin shares her story not as a cautionary tale but to encourage others to be an even bigger voice for science. “When I share my story, I don’t want to ever scare anyone away,” she explains. “I want them to understand the importance of having voices on social media that promote evidence-based content. People are going to follow what they see, and if they’re not seeing us, then they’re getting funneled into these pools of misinformation.”
It’s not difficult to imagine how the politicization of mask mandates and the COVID-19 vaccine has made things even worse for doctors on social media. “When COVID hit, and the anti-vaccination propaganda machine had already begun churning at full speed before a vaccination even existed, we knew we were in for a serious fight,” says Hermann.
Shikha Jain, MD, FACP, who is also one of the authors of the JAMA research letter on physicians and cyberbullying, saw the writing on the wall as early as March 2020 when she and a group of six physicians started a text thread after watching St. Patrick’s Day revelers partying in the streets and realized that the CDC messaging to shelter in place wasn’t being heard.
Jain and Vineet Arora, MD, MAPP, collaborated to form the Illinois Medical Professionals Action Collaborative Team (IMPACT), an organization that advocates for science-based, evidence-based policy, amplifies the voices of healthcare workers, and creates social media campaigns. Anticipating the backlash to their messaging, they also positioned themselves to create a community for healthcare workers to protect each other on social media, much like Shots Heard Round the World.
Similar to Hermann and Baldwin, Jain has experienced the wrath of cyberbullies. She was targeted by a conservative morning radio show host in Chicago with a very large following after she made a COVID post. When the attack started getting some national traction, she posted it in a thread on IMPACT. “Those members started posting, as did other healthcare organizations around the country, and it became a much larger conversation,” says Jain.
Jain says she’s developed a thick skin over the years, but threatening attacks can take their toll. A mother to three young children, Jain often has conversations with her husband about at what point her health advocacy on social media goes too far. “My husband tells me all the time that if this gets to a point where our children or family is in danger, then you need to stop engaging,” she says. “I agree with that, but at what point do you say, ‘This is getting out of hand’?”
While most cyberbullying resources instruct a person not to engage with the bully, Jain has found that it’s not a hard and fast rule. She concedes that there’s no reason to engage with those who are totally against you because you will never change their minds.
“However, we need to target the people who we describe as ‘fence sitters,’ ” Jain says. “I really try to lead with the science, the evidence and the studies, but if I’m able to counter some of the bad information with good information, maybe I’ll be able to change the minds of other people who are reading the comments.”
A Duty to Protect Others vs Protecting Yourself, Your Family
But finding the balance between your duty as a health practitioner and protecting yourself, family, and practice can be a tricky line to walk.
Recent medical school graduate Allison Neitzel, MD, earned national attention when she posted an open letter to NFL quarterback Aaron Rodgers after he publicly shared misinformation about the COVID vaccine, including his own vaccination status, but it came at a price.
The backlash was swift and furious. “The first 24 hours, I was terrified,” Neitzel recalls. “The death threats, the people trying to find me; it was very frightening.” Eventually, she had to stop looking at the comments, but she hasn’t let up on her mission to hold public figures accountable for spreading misinformation. Most recently, Neitzel took Joe Rogan, a comedian with one of the most popular podcast personalities in the country, to task, posting on his Twitter feed:
“….we would love to continue to talk to you and your followers about what they know and COVID and the vaccines, listen to your/their concerns, educate you and your followers on what we know from years of specialized training and study, and work on putting an end to this nightmare….”
Neitzel’s post was swiftly deleted, not before she took a screenshot and shared the post on her Instagram account.
Healthcare workers like Neitzel are up against what may seem like an insurmountable wall when it comes to correcting the misinformation spread across the internet. “The anti-vax movement is much better at this than the pro-science and evidence-based medicine folks,” says Hermann. The anti-vaxxers are louder, they are much more passionate, energized and galvanized.”
But he’s quick to point out that they are also a very small minority of the population, grossly outnumbered by those who support vaccinations. “Data shows over and over again that 75% of people are pro-vaccine,” says Hermann. “About 23% are vaccine hesitant but will get a vaccine when given a clear, concise recommendation from a trusted provider. The anti-vaxxers are about 1% to 2% of the population. And the most fervent anti-vaxxers who attack are a very small percentage of that. They are incredibly outweighed.”
Hermann says this to remind healthcare workers that there is an extensive cavalry behind them ready to amplify their voices through support, resources, and advocacy in order to have science-based information outpace the production of misinformation that floods our social media platforms.
But to do this, physicians must not back down. “We have to do this to protect our own communities,” says Hermann.
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