Health Misinformation: What’s the Big Deal?
In August 2020, a political activism group called Avaaz released a fascinating article about the dangers of health misinformation via social media (Facebook's Algorithm: A Major Threat to Public Health). The article makes the claim that an “infodemic” is taking place where the sharing of health misinformation is becoming more rampant in our society, particularly with the COVID-19 pandemic. According to the article, “the networks identified generated content reaching more than 130 million interactions, equivalent to 3.8 billion estimated views on Facebook, between May 28, 2019 and May 27, 2020”.
In a world where celebrity soundbites and social media posts have a high degree of influence on our decision making process, it is important to have someone in your corner who is dedicated to helping you filter out the misinformation. The Headquarters Physical Therapy team takes our role as information curators very seriously. It is our responsibility to make sure that we provide the best and most up-to-date information possible. This is arguably the most important service that we provide. One thing to keep in mind is that it is not just the un-qualified celebrities that get it wrong. Healthcare providers are not without fault and can be stuck in a fixed mindset with resistance to updating their narratives as better information becomes available. It is very tempting to rely on personal biases and experience when relaying information, however, we must avoid these traps.
What is the harm in a little misinformation? Let's look at a case example.
Imagine you are dealing with pain in the bottom of your foot. This has been going on for a few months and you decide that enough is enough. You go to your primary care physician who proceeds to diagnose you with plantar fasciitis and refers you to a physical therapist and an orthotist to make you custom orthotics. You begin doing the stretches that your PT prescribes based on the reasoning that “tight calves and poor foot mechanics” have led to your current situation. Your orthotist is quick to describe all of the faults in your foot mechanics. You learn that your “over-pronation” and collapsed arch are major contributors. You may even hear something like “I don’t know how you can even walk with those feet” or, “If I were you I definitely wouldn’t walk barefoot, that is going to make things even worse.” So here you are, armed with new custom orthotics to combat your horrible foot mechanics and stretches to lengthen those calves and plantar fascia. Initially, there may be some minor improvement that takes place but another month or two goes by and no significant change has occurred.
You are talking to your friend on the phone one day and you can’t help but vent your frustration with your foot pain. They are quick to mention that their cousin has dealt with plantar fasciitis for months and had great success through acupuncture! Your friend assures you that this person is an absolute miracle worker and will have you back to normal in no time! “Now this is where I need to be,” you think as you observe the zen art and take in the burning incense, just begging you to be healed. The soft and calming music plays and you are instantly relaxed. The healer emerges and feels your pulse and is quick to let you know that your energy is very out of alignment leading to your foot pain. Expertly placed needles will clear this right up. All you need to do is just sit back, relax, and feel the healing. You are optimistic as you complete your acupuncture. You immediately feel better after the first session and after a few weeks of treatment you notice slight improvement in your symptoms! But, most of the time the pain is still very obvious. Okay, you are now five and a half months into this whole ordeal. Flustered, you begin trying chiropractors, another PT referral, and even gong therapy (Google it - It’s really a thing!). BUT…
At just a little over 5 months into this process you finally find healing and relief by rolling the bottom of your foot with a golf ball! The golf ball starts to make a significant impact and your foot hurts less in the morning hours. You fearfully try 5 minutes of walking barefoot around your house and you tolerate it well. You’re happy and mad at the same time! “Why did I waste all of that time and money with needles, orthotics, physical therapy, adjustments, and gong therapy? All I needed was a golf ball.” As your pain goes away, you start to turn up the frequency and intensity of your physical activity like long walks, evening jogs, and weekend tennis matches. 3 months later, your pain returns and you begin the cycle again.
Embedded in this story are several examples of how misinformation gets propagated and is harmful to the consumer. Let’s break down and highlight three ways to tune your BS meter to reduce your susceptibility to misinformation.
1. Understanding correlation and causation
2. Beware the hero healer
3. Knowledge of prevalence rates in healthy populations
UNDERSTANDING CORRELATION VS. CAUSATION
It is important to note that the natural history of conditions plays a huge role in recovery and this is something we must be honest about. Let’s take the same story from above and insert Headquarters Physical Therapy into the equation. Rather than the golf ball at 5½ months into your plantar fasciitis saga you walk through our doors. We discuss your symptoms, your goals, and work together to devise a treatment plan that seems feasible for you that incorporates self-management techniques along with exercises to target the body tissues in question. After a few weeks you start to notice not only relief but improved ability to tolerate exercise, walking, etc. And because you are feeling better you may start to think that you found “the one exercise” that can help you with your plantar fascia pain and keep it away forever. I can guarantee you that we would not just leave it there as symptom resolution is simply the tip of the iceberg. It is important to note that the natural history of plantar fasciitis typically takes around 6 months to improve regardless of intervention. Now, there is some obvious nuance to this as every individual and how they respond to treatment is unique. However, in general, 6 months is reasonable to assume for plantar fasciitis recovery. So, in theory, it wouldn’t matter what we did at the 5½ month mark, you would be on your way to recovery. Was it really the golf ball that healed you? Probably not. Is it ever any singular intervention? Probably not. Now, that doesn’t mean there aren’t some great evidence based interventions that can help improve function, quality of life, and speed up the process. But the truth is, unfortunately, that the list of low level interventions that are not strongly supported by the evidence is much longer than the list of well-researched, efficacious interventions - the research is just not very robust in this area!. However, if an intervention is causing you to be more reliant on that intervention or practitioner and is making you feel more broken than healed, then we have a problem that needs to be addressed.
BEWARE THE HERO HEALER
Okay, it may be unfair but, the acupuncturist got to play the part of the hero healer in our earlier example. That person could very well be another physical therapist, chiropractor, stretch therapist, energy healer, FDM, NDT, (insert acronym for specific methodology here)…the list goes on. From the consumer perspective this is definitely something to be aware of! The hero healer has a huge potential to propagate a narrative of reliance on a specific treatment or individual than a message of empowerment. A great way to tune the BS meter is to ask yourself “Is this practitioner the star of the show or am I?” We believe that all practitioners have the opportunity to empower the individuals they treat through a more person-centric approach. A patient-centric approach seeks to fix sick people while a person-centric approach is a movement toward relationships built on collaboration without bias or agenda. All people have the internal resources and tendency to advance, improve, and grow personally.
If a practitioner is thwarting your autonomy or self-efficacy, then your BS meter should be going off. Reliance on the practitioner is something that rarely benefits the consumer. In fact, you are probably a lot more resilient than you realize.
KNOWLEDGE OF PREVALENCE RATES IN HEALTHY POPULATIONS
In the world of health, performance, and rehab it is becoming apparent that many clinical findings that were once assumed to be harmful are actually completely benign. Take the foot biomechanics analysis that the individual in our story underwent in order to get custom orthotics. Through extensive research we know that there is a huge population of people who have a higher degree of pronation, supination, any number of differences in foot mechanics that do not cause a pain experience. In fact, we know that large percentages of the healthy, non-painful population will have significant structural changes to their spine upon observation with MRI. These changes include disc degeneration, disc bulges, nerve impingement, etc. What does this mean? It means that you do not equate to findings in an examination or imaging on a screen. We hear countless stories of physicians telling patients that they have the “spine of an 80 year old” or that their knee is “bone on bone”. As a result, patients become fearful to move, reduce their exercise, and sacrifice positive, long-term health outcomes as a result. While, at first glance, our imaging results may look concerning, we have a good body of evidence to support that notion that appropriately dosed loading joints can significantly improve outcomes and quality of life in individuals with osteoarthritis.
We will continue to provide information in a person-centric way that makes you the star of the show! We truly believe that everyone has the internal resources and capacity to better their situation. Most clinicians and practitioners who are propagating outdated narratives are not out to purposefully harm the individuals that they treat. However, we do have a great responsibility to understand the nuances of the power that our words and narratives hold.
Ultimately, we want to help you sift through the noise and help you make long-lasting, purposeful changes in your day to day function. If we can help you do that then click the contact button below and let us know what we can do for you.