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Physician propagation of COVID-19 misinformation on social media -- primarily discouraging people from getting the COVID vaccine -- was limited but still potentially harmful, a mixed-methods study suggested.

In this study, the propagation of COVID misinformation was attributed to 52 U.S.-based physicians in 28 different specialties across the country: 80.8% posted vaccine misinformation and 38.5% posted misinformation on five or more platforms, reported Sarah L. Goff, MD, PhD, of the University of Massachusetts in Amherst, and co-authors.

Major themes among social media posts included that the vaccines were unsafe or ineffective, the promotion of unapproved medications and treatments, the ineffectiveness of wearing masks, and "other," which included unsubstantiated claims about virus origin, government lies, and other conspiracy theories, with 76.9% of these physicians propagating misinformation in more than one category, they noted in .

Most of the physicians used Twitter (71.2%) and had a median of 67,400 followers; about 77% appeared on five or more third-party platforms, including news outlets.

"This study was the first, to our knowledge, to identify the types of COVID-19 misinformation propagated by U.S. physicians on social media and the platforms they used, as well as characterize the physicians who spread the misinformation," Goff and team wrote, pointing out that while misinformation about the pandemic is prolific, spread by doctors is particularly impactful.

"Physicians are often considered credible sources of medical and public health information, increasing the potential negative impact of physician-initiated misinformation," they noted. "Understanding the extent of this phenomenon, its potential impact, and associated professional, ethical, and legal ramifications may help to better understand the role that physician-propagated COVID-19 misinformation may have played in preventable COVID-19 deaths and mistrust in institutions."

Among the 52 physicians, 50 were or had been licensed to practice medicine and two were non-practicing researchers. Of those licensed, primary care was the most commonly represented specialty (36%), and California was the most highly represented state. Most had an active license (88%), while 6% did not; 8% had their license revoked or suspended. One had an active license in two states but also had a revoked or suspended license in two different states.

Of note, 16 of the 52 physicians were affiliated with groups accused of spreading medical misinformation, such as America's Frontline Doctors.

Becky Smullin Dawson, MPH, PhD, of Allegheny College in Meadville, Pennsylvania, told MedPage Today that the findings are a call to action.

"We have long suspected that it was a few 'bad apples' tied to America's Frontline Doctors, who were at the epicenter of COVID misinformation," said Dawson, who was not involved in the study. "This study provides the evidence to support that suspicion."

While alarming, Dawson added that it is helpful and encouraging to know that so few physicians are the source of misinformation.

"Knowing that most of our colleagues are sharing accurate information should encourage others to share accurate information," she said. "There are a few people out there spreading misinformation; this needs to be combated with an army of physicians sharing accurate information."

Nick Sawyer, MD, MBA, an emergency physician in Sacramento, California, said the study findings are "extraordinarily damning" for medical specialty societies, board-certifying bodies, state medical boards, and federal agencies with jurisdiction over these doctors.

"The fact that this core group of doctors has been spreading misinformation completely unopposed from March of 2020 up until today is a very significant finding and truly representative of the reality of what is happening in American medicine today," he told MedPage Today.

He encouraged people reading this new research to ask "why were these specific individuals not stopped at the very beginning?"

Goff told MedPage Today that this research was partially inspired by a conversation with a relative in which she realized how impactful misinformation could be. The consistency of misinformation "wasn't surprising, but I think was important ... because that also reinforces the misinformation," she added, noting that future research will look into the effects of physicians posting misinformation.

The study authors searched high-use social media platforms, including Twitter, Facebook, Instagram, Parler, and YouTube, and news sources such as The New York Times and NPR to identify COVID misinformation communicated by U.S.-based physicians from January 2021 to December 2022. Misinformation about COVID was defined as "assertions unsupported by or contradicting" CDC guidance on COVID prevention and treatment during the period assessed or "contradicting the existing state of scientific evidence for any topics not covered by the CDC."

On Twitter, Goff and colleagues specifically began on America's Frontline Doctors' profile "because of the volume of COVID-19 misinformation in its Tweets, its large following, and the potential for physicians propagating misinformation to follow the page." Followers of that account with MD or DO in their header were then traced across platforms and doctor status was confirmed with internet searches.

The researchers characterized the type of COVID misinformation, the platform on which it appeared, and details about the physicians, including name, specialty, state in which they were licensed, licensure status, and total number of online followers.

Goff and team noted several limitations to their study, including that it took place after many social media platforms had enacted policies to limit COVID misinformation.

"A coordinated response by federal and state governments and the profession that takes free speech carefully into account is needed," they concluded.

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