Medical misinformation may delay treatment for children, a case report warns.
The NZ study describes the case of a 9-year-old girl who developed serious complications when her parents didn’t follow the course of antibiotics prescribed to treat a cat scratch, instead using silver nitrate at home.
The authors say that clinicians should have open and empathetic conversations with parents about their children’s treatment, to help reduce parental hesitancy.
The SMC asked NZ experts to comment. Feel free to use these comments in your reporting or follow up with the contact details provided.
Dr Morgan Arnold, Ophthalmology Registrar, Health New Zealand, and author of this case study, comments:
“This case report highlighting the dangers of medical misinformation in New Zealand is relevant and important. As misinformation continues to be propagated both globally and domestically, trust in society as a whole is eroded. This trust is important in many areas of our lives but perhaps none more so than the medical field. The report explains that as medical misinformation increases and general distrust in institutions and science grows, the people who pay the biggest price, are the most vulnerable of our population.
“In this case, a kiwi tamariki had a life threatening complication of simple sinusitis. This disease – Pott’s Puffy Tumour – is rare in the modern age since the advent of antibiotics but, like many other diseases previously mostly seen in history books, it is seeing a resurgence due to modern medicine not being utilised. Diseases like syphilis and measles are back to levels not seen in this millennium and, similar to Pott’s Puffy Tumour, this disproportionately affects the young in our society who have no capacity or agency to make their own decisions about antibiotics, vaccinations and medical information. The report also focuses on where change can begin with medical professionals and the discussions and institutions they form to protect patients.”
Conflict of interest statement: Dr Morgan Arnold is one of the authors of the report.
Dr John Kerr, Senior Research Fellow, Department of Public Health, University of Otago, comments:
“Fortunately, the young person at the centre of this case study appears to have made a full recovery, which is good news. The ophthalmologists involved in this case refer to ‘medical misinformation’ as a contributing factor to the parents’ decision to not use the prescribed antibiotics. That might be a fair assessment, but it is probably not the whole story.
“But we often think of ‘misinformation’ as discrete bits of information, like a false claim in a Facebook post or a misleading online video. In this case, there also appears to be some parental distrust of the medical system as a whole. Misinformation and the online ‘rabbit hole’ may have played a role, but there might be other factors in the mix, such as previous negative experiences with the health system or government institutions.
“A simple starting point for tackling medical misinformation and its impact on patient decisions is for clinicians to be aware of some of the misinformed beliefs in their area of medicine and be prepared to talk them through with patients. There are some good evidence-based recommendations for these tough conversations, including being open-minded and empathetic, and validating wider values like critical thinking and healthy skepticism, while rebutting specific claims.
“But we shouldn’t let social media companies off the hook, there’s tons of medical bullshit being promoted on these platforms, and big tech companies could and should be doing more to prevent it.
Conflict of interest statement: “No conflicts to declare.”
Associate Professor Siouxsie Wiles, Microbiologist, University of Auckland, comments:
“This case report shows just how quickly misinformation and disinformation can turn a treatable cat scratch infection into a life-threatening illness, having influenced people’s beliefs about what medical treatments are best. In this particular case, a child’s parents rejected the standard evidence-based treatment for a simple infection – a short course of oral antibiotics. Instead they chose to treat the infection using silver nitrate. It didn’t work and left their child with a life-threatening infection that required surgery and a six-week course of intravenous antibiotics to resolve.
“Cases like this are difficult and heart-breaking. False and misleading information about medical professionals and evidence-backed treatments and vaccines has always existed, but it has been supercharged by the pandemic, social media, and generative AI. Anyone who expresses any scepticism about modern medicine will soon find themselves inundated with content that not only reinforces this view but pushes them even further. Often this content is created and/or pushed by people who profit from selling unproven and sometimes dangerous treatments and supplements.
“Silver is antibacterial and silver nitrate has a long history of being used to treat burns, ulcers, and infected wounds. But it is also very caustic and can burn and damage healthy tissue and skin. This is one of the reasons it fell out of favour when antibiotics became available. Yet the internet is awash with false and misleading information singing its praises. We desperately need better regulation of online spaces that share and promote such misinformation and disinformation.
“The child in this case was also unvaccinated. There are lots of reasons children may not be up to date with routine childhood immunisations – from a lack of access to routine healthcare to a lack of parental trust caused by a lifetime of difficult and/or harmful interactions with official organisations and agencies. Providing medical professionals with resources to have empathetic conversations with their patients or patient’s caregivers about their beliefs and feelings related to evidence-based medicine may also help prevent more cases like this.”
Conflict of interest statement: “No conflict of interest to declare.”
Associate Professor Stephen Hill, School of Psychology, Massey University, comments:
“Perhaps the most striking aspect of this case is the fact that it even relatively low levels of medical hesitancy can result in inflated health risk and a significant increase in demands on medical services. Happily, the child involved appears to have recovered from their ordeal, and, despite initial resistance, their parents allowed medical professionals to administer the necessary treatment when it became clear that the child’s health had deteriotated.
“Despite the positive outcome, the cost to the family, and the demand on health system and its personnel was much greater than it needed to be. It’s not actually all that clear from the NZ Medical Journal paper how misinformation is implicated in this case, but, reading between the lines, it appears that a general suspicion of, or uncertainty about, mainstream medicine, led to both a failure to take expert advice sufficiently seriously, and an erroneous belief that alternative options would be an adequate solution to the problem.
“This common ‘low key’ consequence of misinformation tends to fly under the media radar, despite the significant cumulative psychological, physical, and societal costs associated with it. Although the spotlight often tends to fall on examples of high profile, deliberate attempts at disinformation (such as Andrew Wakefield’s claims about the side effects of the MMR vaccine), it is likely that it is the more subtle, often unintended, spreading of incorrect claims that sew mistrust, that does the most damage. This kind of ‘misinformation-by-stealth’ works by increasing uncertainty about who to trust about health matters, and this can lead people to become hesitant about following expert advice.
“The danger of most misinformation is not that individual claims will persuade people to act inappropriately in specific instances, but that our information ecosystems become opaque and difficult to navigate; consequently it becomes harder to discriminate scientifically credible claims from those that are not. In such a world it becomes easier to drift into – almost inadvertently – engaging in risky health behaviours.
“Thus, addressing misinformation requires a multipronged response. The first challenge is to adequately resource those on the front line to deal with people who are already hesitant, uncertain, or misinformed in a respectful and empathetic manner. The second challenge is to work toward creating a better information ecosystem so that people are less likely to become hesitant and mistrusting in the first place.
“We can do this by making it easier for people to access reliable and accurate information and to understand misinformation when they see it. The latter requires institutional and regulatory change so that unproven treatments are not packaged to look like real medicines and therapies, frequent public correction and refutation of misinformation, and well-funded health literacy education.”
Conflict of interest statement: “No conflict of interest.”