Health information | Iron in spinach, miracle cures and vaccination myths

The cartoon sailor Popeye (right) eats spinach to get superhuman strength. This propaganda for children is said to have worked for a time. Photo: imago/Everett Collection The incorrectly overestimated iron content of spinach could be seen as early misinformation in medicine or nutritional science. The story is more complicated than expected because it wasn't just a matter of a comma error that was written off for decades. Rather, at the end of the 19th century, a physiologist correctly determined the value for dried spinach powder. This was then incorrectly assigned to fresh spinach, and that was repeated over and over again. The misinformation had a lasting effect and, when uncovered, led to the equally false conclusion that spinach was not that healthy at all. It probably is - still a rich source of iron with three to four milligrams per 100 grams.

After all, decades later, this seems to be clear to most people. Nowadays, however, medicine doesn't just have to deal with misinformation. "It's clearly about disinformation, i.e. intentional misinformation," explains Susanne Johna. The chairwoman of the Marburger Bund (MB) is an internist, hospital hygienist and health economist. At the general meeting of the MB doctors' union currently taking place in Berlin, the discussion about medical fakes is also a topic.

“The population must be put in a position to question things.”

As in the spinach case, a correction "can't be done in a minute," Johna has to admit. And it requires a willingness to persuade. In medicine that is geared towards efficiency, there is hardly any time for this. Two aspects are important to the doctor and professional politician: On the one hand, patients harm themselves if they fall for the fakes. Your fears are being exploited. Especially shortly after a diagnosis, the tendency to believe simple and catchy messages appears to increase. “You then grasp at straws instead of trusting in effective medication.”

On the other hand, AI is also used to create so-called deep fakes, such as small advertising films in which supposedly real, real doctors give concrete therapy advice. “These can no longer be recognized as fakes,” says Johna. Here she calls for more political support for all those affected, not just those in medicine. You would have to be relieved of such posts if they were deleted. In addition, those responsible would have to be effectively punished, something that the injured parties could hardly afford. “We need more obligations for the platforms,” i.e. more regulation.

In addition, disinformation is harmful to science. From Johna's point of view, there are not always financial interests behind it, such as those of companies that sell nutritional supplements. There are others too, for example “persuaders from the ranks of anti-vaccination groups”.

There are many different ways to mislead. During the corona pandemic, for example, the deworming drug ivermectin was touted as a therapy against Sars-Cov2 for a long time. The idea for this goes back to laboratory experiments on cell cultures. Extremely high doses of ivermectin inhibited the replication of the virus. However, the amounts used are toxic to humans and the viruses cannot be safely reached in the body in this way. The result was quite a few poisonings of gullible users. Ivermectin is a safe medication in the approved dosage and when prescribed by a doctor, for animals - and also for people. In human medicine it is used specifically against certain parasites, such as scabies or river blindness in the tropics, which is caused by roundworms.

“The population must be put in a position to question things,” says Johna, which starts with media literacy in school lessons.

There are already special offers for the doctors themselves, including further training. The aim is to recognize misinformation in the first place. It also teaches how fakes can be corrected in a structured manner in practice, i.e. in conversation. It is also recommended to present your qualifications transparently, for example on the websites of doctor's practices. But it is also about documenting suspicious content and reporting options on digital platforms. “It’s all just starting slowly,” Johna summarizes.

One bright spot is that the General Assembly of the World Medical Association adopted a global guideline to combat medical fakes and misinformation in October. It calls on tech companies, AI developers, governments and doctors themselves to counteract the wave of disinformation. For example, platforms should stop algorithms that specifically flush out medical fake news. Doctors therefore have an ethical duty to provide patients and the public with scientifically based, easy-to-understand information.

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