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PHILADELPHIA -- What's the best way to prevent health misinformation from spreading? Detect it early, Angelo Carusone, the president and CEO of Media Matters for America, said Tuesday at the Population Health Colloquium.

"You have to get in early, and that will require communications designed to slow or stop the spread or put more friction in the system," said Carusone, whose organization describes itself as "a progressive research and information center dedicated to comprehensively monitoring, analyzing, and correcting conservative misinformation in the U.S. media."

Correcting misinformation is more important now, he said, "because just about 7 months ago, in response to an enormous amount of pressure from anti-vax groups and right-wing groups, all the social media companies eliminated all of their COVID misinformation policies and probably will never ever put in place another piece of [these] medical misinformation policies again. What that means is that all of the little bits of friction and improvements that they made midway through COVID and beyond to tamp down on broad medical misinformation are gone."

"So [social media] is entirely vulnerable right now," he said. "And there's really nothing to stop it but the people in this room, the medical community, and the general public, but that's not going to happen without a little bit of a catalyst."

The spread of misinformation has accelerated rapidly in recent years, Carusone said, in part because until a few years ago, the way news was produced "was very static. You had some small news outlets, small TV operations that would tell some stories -- some of those were local news and some were investigative reporting. It would slowly make its way up to bigger outlets and then eventually some of the largest national news outlets would talk about it."

That system had some advantages, he continued, "because it meant there were gatekeepers. There were editors, there were newsrooms, there were systems around it; there was some friction in the system so things couldn't wildly spread out of control in the matter of hours. You didn't have to deal with a massive misinformation or disinformation crisis within the span of 90 minutes. There was some stability in the system."

But now, "one of the effects of social media is not just that it sped things up, but it did something really significant that very much played out during the COVID era of misinformation ... it allowed for totally fabricated things -- misinformation, extreme ideas -- to leapfrog all of the traditional gatekeepers and mechanisms for distribution," Carusone said. "So you can take something that was a wild conspiracy theory and a radical claim, even something that was fabricated as if it was a news article, and literally overnight, it could go from sitting in a random person's Twitter account to actually [being] read or viewed by 30, 40, 50 million people."

"And now you have not just a bunch of people that have been directly infected with that idea, but now [they're] going out there and spreading it to their own social networks, their family, and their friends -- overnight. That is a brand new phenomenon."

In addition to this "leapfrog" phenomenon, how social media companies decide which posts get boosted also has a major effect, he said. "What makes it feel so different is that you actually have these engines that are connecting otherwise disconnected people fast and then giving it to people that are very, very susceptible to it, because their systems know that ... Those two things radically change the landscape."

A lot of conversations center around whether misinformation should be banned, "and I think that's a ridiculous choice," said Carusone. "Actually, most of the time, you can leave it up there. The real difference-maker is not whether or not it exists. It does exist. It's whether or not the social media companies are amplifying it."

It's often helpful to look for "pivot points" -- "moments that would have made a really big difference" in spreading the misinformation, he said. In the case of COVID, there have been three such noteworthy moments:

"Plandemic": "The ground got seeded with a bunch of ideas in the form of a documentary called 'Plandemic,'" said Carusone. "This documentary came out that was seen on Facebook alone by 21 million people," as well as by several million more on YouTube, "all in the span of 2 days."

The documentary, which appeared in May 2020 before vaccines became widely available, included an interview with a former co-worker of Anthony Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases, claiming that COVID-19 vaccines were being produced that would damage the heart. "That was the first time that that was really introduced into the zeitgeist -- this idea that new vaccines are being produced that Anthony Fauci had a hand in, that Bill Gates had a hand in, and that they were doing something to people's hearts," he said.

The documentary was eventually taken down, but by then it was too late, Carusone added. "What everyone missed in that moment was that a very, very, very specific claim and narratives were starting to take hold."

Sudden deaths: When vaccinations first became available, a "totally fabricated" report began appearing in Spanish-language WhatsApp groups alleging that four Italian workers had taken the vaccine and experienced sudden death. The story "spread like crazy, and the claim wasn't really to get you to believe some conspiracy, something incredible, or something totally insane," he said. Instead, "it was to say, 'Something's off here'" and get people to hesitate about taking the vaccine.

VAERS database: In May 2021, "Tucker Carlson did a segment where he talked about the VAERS [the CDC's Vaccine Adverse Event Reporting System] database, and he said that tens of thousands of people are dying from the vaccine and the government wasn't telling people," said Carusone. At that moment, everything in the VAERS database -- which includes thousands of reports that are submitted by the public but not verified -- "everything there suddenly became fact; it suddenly became evidence for all sorts of adverse effects that didn't necessarily descend from the vaccine. It had a profound effect on trust."

What can be done about this? Carusone's group ran some tests in partnership with Voto Latino to try to fight misinformation about vaccines. "What happens if you say, 'Hey, here's the thing that's being said right now that's not true; Here's some information about it.' Let's just see how it plays out," he explained. "In both of the instances where we ran these tests against the control ... you are anywhere between 30 and 54 times more likely to get over your vaccine hesitancy and go get vaccinated ... That starts to shift the paradigm."

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