The AAS Ethics Committee held its first annual Artwork and Essay Contest in 2021 – the topic for the essay contest was “What is the most challenging ethical issue, personal or professional, you have encountered in the COVID era?” The winning essay and artwork were selected by the Ethics Committee and will be published in the October issue of the Journal of Surgical Research. But we also want to share many of the powerful entries we received for this contest, so look for more of these essays to post as blog articles between now and the 2022 ASC – thank you to everyone who participated in the contest!
Krista Haines, AAS Committee Chair & JJ Jackman, AAS Executive Director
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“Primum non nocere”, Do No Harm, what does this mean to you? Until recently, the feeling has largely remained a visceral understanding between the basic concepts of right and wrong. However, with the rise of the internet and social media physical harm is no longer the only concern. Indeed, misinformation – both the provision of incorrect information and the withholding of correct information – has become a significant danger to modern medicine. But which is worse? With the advent of the pandemic, my experiences both personally and as a provider, have made this internal debate an unbearable paradigm.
One of the largest instances of medical misinformation in history is the belief that the MMR vaccine causes autism. Despite data coming from a single poorly conducted study followed by seventeen stronger controlled trials, the damage was done. Soon true medicine and data was dwarfed by public fear exponentially augmented by internet, television, social media and even celebrities and politicians. Studies since have shown evidence that misinformation can travel faster in social media than truth. Literature has thus focused on identifying methods of combatting misinformation including careful dissemination of information, fact-checking by experts, and healthcare advocates. The COVID pandemic however led to the perfect storm of circumstances – rapid progression of disease, provider uncertainty, and public fear – that made medical misinformation thrive. This led to major effects in three areas of healthcare: (1) prevention, (2) treatment, and (3) minority care.
The CDC guidelines clearly stated that social distancing, wearing a mask and avoiding unnecessary travel or group activities would limit the spread of infection. In the early stages, reports of hot baths could affect one’s body temperature and prevent infection were heard. Or the claims that the pandemic was not real and simply a political scam to control the masses. These to any healthcare provider should be readily apparent as false; however, the impact of this knowledge on the community is undeniable. But the territory becomes more gray when we talk about early habits of using a surgical mask when N95s were in short supply. Or how to avoid anti-vaxxers due concern that the mRNA in a vaccine can genetically alter the recipient. Or the highly publicized by small numbers of fatal blood clots after the Johnson&Johnson vaccine causing mass amounts of public fear. This evolution in prevention knowledge, both true and untrue, has been experienced by us all.
The treatment of the infection has also undergone multiple cycles of change. All have been driven by data, with early case studies and later randomized controlled trials. Early finding on the mixed data of the efficacy of hydrocholoquine and support by multiple influential figures led to increased prescribing despite later evidence of significant cardiotoxicity. A rash of studies for over twenty treatments (e.x. convalescent plasma, steroids, remdesivir) were claimed as efficacious on social media by medical providers despite limited evidence. These rumors spread even within the medical community, causing misinformation amongst providers, hospitals and their feeding communities.
Medical distrust in the minority populations dates back to the era of medical malpractice and research to current ongoing heath care disparities. However, the impact on minority communities of medical misinformation is acutely felt in the fear and death with the COVID pandemic. We clearly see the consequence of fewer vaccinations in current minority populations Black, Indigenous, and People of Color (BIPOC) in the resulting disparate death toll. Due to the publicized lack of medical resources and appropriately trained providers globally, patients in India have chosen to stay at home and not seek medical treatment.
The damage of medical misinformation in COVID-19 prevention, treatment and management of minority care was and is felt in suffering and death all around the world. The CDC even released a statement addressing how to respond preemptively and responsibly. However, the dilemma exists in deciding whether we as providers are part of the disease or the cure. Is it better to speak up and inform with possibly false information or withhold unknown truths? What does “Do No Harm” mean to you?