Can Silencing and De-platforming Come to Healthcare?

January 25, 2021
Eric Postal, MD

What could happen if the subject of discussion is a widely used radiology exam?

Last week, I wrote about a communication-squelching trend that’s descended upon our social-media world. The first component was an ever-increasing ability to tune out voices one doesn’t wish to hear. Synergistic with this has been the (over?) eagerness of social-media providers and associated players to cut those unwanted voices off at the source.

Call it moderation or censorship. Ascribe it to good intentions, bad ones, or a complete lack of master-plan that’s blundering forward without considering where this might be headed. You can’t swing a digital cat online without hitting an argument over the issue.

An awful lot of people only start to find this concerning when it directly impacts them, or folks they know/like. So, if one doesn’t spend much time prowling Twitter or even Facebook, and hasn’t noticed friends getting “Zucked” or admired podcasters getting “canceled,” one might not perceive trouble.

Indeed, most of us healthcare folks are busy little bees, and haven’t got much spare time for such things. Why should we care if some conspiracy-theorists have a harder time getting their word out? After all, we’re told that only the “bad” voices are being targeted. Voices which, left unchecked, would propagate misinformation and possibly even threaten others’ safety and wellbeing.

My suggestion would be to look a little bit further down the road, and think about how this might apply to healthcare. Because there is nothing to stop it from coming to our doorstep, and if we wait until that happens, it’ll be too late to do anything about it. A scenario to consider:

The intermittent debate over whether screening mammography is worthwhile comes to a turning point. CMS and/or the insurance-conglomerate decide, whether based on data or dollars, that they don’t want routine screening mammos to be a thing anymore.

An awful lot of folks object to that – healthcare providers, patient advocates, maybe even professional societies. Pushing back against such a change is best done in the public square. Published articles, press releases, and, of course, social media to get the word out.

Unless, of course, CMS and the insurers convince enough of those venues that the case against screening mammos has been sufficiently proven. (Whether purely on the strength of the argument, or other, shall we say “persuasive pressures,” the government and insurance mega-corps can bring to bear.)

It, thus, becomes “settled science” that screening mammos are wrong. Anybody not accepting that is being unreasonable, possibly for self-serving reasons. Spreading such disinformation is bad; it might confuse the general public about whether mammos are good for them or not. And it might undermine confidence in the healthcare system, which would be dangerous.

So, labels get slapped on social-media comments advising friends, family, or the general public that breast-cancer surveillance is being kneecapped: “Disinformation warning!” “Healthcare professionals have determined that screening mammography is not a reliable means of preventing cancer, and, in fact, exposes you to unnecessary radiation!” Pro-mammo postings start getting summarily deleted. Particularly-vocal proponents’ accounts get suspended for repeatedly sounding an allegedly-false alarm.

Successfully “disappear” the folks who are trying to warn the public, and the only voices remaining are ones which agree that mammographic screening was wrong to do. The general population is left with a one-sided propaganda campaign. Any stray arguments to the contrary will look like con artistry or conspiracy-theory kookiness.

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This, alone, is enough to silence a whole lot of people who don’t want to lose their social-media presence. Even when not on COVID-lockdown, people depend on this stuff for a lot of their societal interaction, if not to help them make a living.

Of course, some determined docs might press the issue. Might even find a way to get the word out without social media. No problem; we’ve learned plenty of ways to cancel people. Pressuring medical facilities where the docs live should do the trick: Does your hospital really want to be associated with a screening-mammo insurrectionist? Because the social-media apparatus can be turned against you if you fail to disavow.

Suppose blackballing the intransigent doc with would-be employers isn’t enough to kill his livelihood. Why not go after his referrers? Pressure local insurers to drop him from their networks. Hell, start filing complaints with state Medical Boards – if this doc thinks he knows better than the rest of the industry, should he really be practicing?

Coming back from that dystopia, now let’s suppose you’re on the side wielding the power. Suppose you’re 100 percent in favor of mammographic screening. You (and healthcare as it currently stands) might not be happy when you hear dissenting voices, arguing against its efficacy or risk/benefit balance. Are you in favor of suppressing them, because they’re spreading bad information? Deleting their posts, suspending their accounts? Going after their livelihoods in real life if they persist, to make examples of them?

Or might it be better to keep those voices in the public square, where you can hear them? Be aware of their arguments and other actions, thus able to counteract them in front of a massive societal audience? Perish the thought, but suppose something they say turns out to have merit (on the subject of mammo, or something else)? Gives you a great idea you would not have otherwise had? Leads to some innovation that makes mammo even better than you ever thought it could be? A new modality altogether?

Screening mammos, of course, are just one possible subject of contention; feel free to substitute a topic of your own personal interest. Anything you feel strongly about, for or against. Or something central to your livelihood. Selective deafness and forced mutism, left unchecked, stand to threaten it all.

Follow Editorial Board member Eric Postal, M.D., on Twitter: @EricPostal_MD.