Pregnancy, contraception, and misinformation on social media

A recent article in the Washington Post, “Women are getting off birth control amid misinformation explosion” (March 21, 2024), by Lauren Weber and Sabrina Malhi, discusses a recent explosion of misinformation about contraception on the Internet. More important, it notes the more serious result – women getting pregnant when they didn’t want to be because they believed this misinformation and acted on it by not using effective contraception. In many cases, according to anecdotal reports, women have sought abortions but found themselves living in states that made this difficult or impossible.

The article is not paywalled but does require (free) registration to read, so I will include some of the other important points in it.        

•  Much of the misinformation is especially found on sites like TikTok and Instagram that are followed by young people.
• Many of these sites and posts are by people with no medical training or credentials, but who cite their personal experiences, and such ideas as “natural” (whatever that is or isn’t).
• Many of the latter are folks trying (or succeeding) in developing careers as social media “influencers"; in addition to the usual ways of making money (advertising or payment from companies for promoting their products) they also can actually sell their services (one “charges hundreds of dollars for a three-month virtual program that includes analyses of blood panels for what she calls hormonal imbalances.”).
• An OB/Gyn physician in DC says that many of the women he sees “have traveled from states that have completely or partly banned abortions, he said, including Texas, Idaho, Georgia, North Carolina and South Carolina.”
• A variety of experts have cited the particular vulnerability of “Women of color whose communities have historically been exploited by the medical establishment may be particularly vulnerable to misinformation, given the long history of mistrust around birth control in this country… [including] forced sterilizations of tens of thousands of primarily Black, Latina and Indigenous women happened under U.S. government programs in the 20th century”.
• Much of the misinformation is propagated by those with political, social, and religious agendas.

This is a lot of things. Some of them need to be addressed on an individual basis by doctors and other health professionals when beginning women on contraceptive treatment. Especially important is identifying, which requires asking about, any concerns women may have, what the source of that concern is, and honestly discussing potential side effects. The discussion should address what those side effects do, and do not, indicate, ways of treating them, and effective alternatives if they get too serious. The most important point about both hormonal (oral contraceptive pills, implants, and some IUDs) and long-acting reversible contraception (LARC, mainly IUDs and implants) is that they effectively prevent pregnancy and are generally are what women who are having sex and do not wish to become pregnant should use. But if there is not (or is insufficient) discussion about worries that women have about the other effects of contraception, and as a result they are not used, or not used appropriately (e.g., oral contraceptives must be taken daily), unplanned and undesired pregnancy may be the result.

It is true that there is a horrific history of medical experimentation (and exploitation) of Black people in the US. The most famous is the Tuskegee Study, which followed a group of Black men with syphilis to study its “natural history” for years after treatment was available – but not given to them. Black women were victims of forced sterilizations, long after slavery, carried out by leading American physicians such as J. Marion Sims, whose statue in New York City was recently taken down (photo in this excellent review in The Intercept) and continued until relatively recently. A New York Times article from 2022 focuses on two sisters who were only in their early 60s at the  time, and were sterilized in 1973 at 14 and 12. It is unsurprising that, given this history, that Black and other minority women may legitimately be suspicious of treatments that affect their reproductive capacity.

It is also important to remember that all pregnancies, even when desired, carry health risks greater than that from any contraception. A recent piece in The Hill reports that nearly 40% of Black women of reproductive age are very concerned about the risks to their health should they become pregnant, especially with the repeal of Roe v. Wade and the restrictions on or abolition of abortion in many states. There is a great disparity in maternal mortality. As the Hill article notes

Studies show Black people who give birth are three to four times more likely to die from pregnancy-related causes than their white counterparts, while Black infants are two times more likely to die within their first year than white infants. Reasons for the disparities are nuanced, but many point to systemic racism in the health care system that dismisses Black women’s symptoms.  

That these fears are not unwarranted is horrifying, but to the extent that people are aware of them suggests that the misinformation on social media is not the only message getting out, and that accurate information is being provided by knowledgeable and trusted groups such as In Our Own Voice.

There is no question that right-wing, anti-abortion forces are behind much of the misinformation about contraception that is rampant on social media. But why? After all, if their concern is limiting abortions, the most effective way is to limit the number of unintended pregnancies, and this is what contraceptives do. While I have heard this argument made by a number of organizations and individuals who work for funding of contraception but not (necessarily) abortion, it doesn’t seem to get much traction with the bulk of the right-wing “anti-abortion” movement, which is also frequently are anti-contraception. What is this about?

There are a number of possible reasons. Perhaps it is related to the fact that often those providing contraception, such as Planned Parenthood, also provide abortions so that, in the thinking of these groups, contraception becomes tainted by association. It may also be a revulsion to sex, especially if undertaken for any purpose other than conception – in marriage.

But if sex is only ok if it is for conception and within marriage, why would they want to deny contraception to women who are having sex when they are not married and are not desiring to be pregnant? One answer is that they have an overall intent to control, restrict, and punish women, who they believe should have no agency. Men, of course, are just men and can be forgiven their “lack of control”, and even rape (like some presidents) but women are guilty and sinful even when they are the victims of that rape.

It is likely that the misinformation on social media is a result of all these factors, from “influencers” who are seeking fame and fortune to those promoting right-wing political and social agenda. Or maybe it is just all about providing misinformation so people can not effectively do what they want to. Whatever the reason, however, women should not be forced to risk pregnancy when effective and safe contraception is available, and certainly not be forced to find themselves requiring, and unable to get, an abortion.

Whatever the intent of the “misinformers” is, the result is the same, and bad.

TikTok, NyQuil, vaccines, the frontal cortex, and making wise decisions: something we all need to do better

“FDA warns against cooking chicken in NyQuil”, the title of an article from Family Practice News, and reprinted by MDEdge, may seem a little “Hey, what? Why would the FDA have to issue a warning about this?” It certainly caught my attention. I don’t claim to be a gourmet, or conversant with all the ways recipe books have to cook chicken, but I certainly never heard of using NyQuil. But, then again, I don’t spend a lot of time on TikTok. I read a bit more and caught the key phrases that largely explain why this is an issue, “adolescent” and “TikTok challenges”. Aha. It is not a celebrity chef who has been suggesting that we cook our poultry in a liquid designed to treat the symptoms of colds, and that includes a variety of drugs to treat pain (acetaminophen), suppress cough (dextromethorphan) and decrease sniffles (doxylamine, an antihistamine), which all are concentrated and made more toxic by cooking them down. It is, rather, morons on social media. Or how about the “One chip challenge”, which has led to hospitalizations of children eating a chip made with peppers with 400 times the capsacin (thus hotness) of jalapenos?

Or maybe they’re not morons; maybe they’re smart folks with an agenda, although the agenda is likely to simply be getting more views and becoming more of an “influencer” than intentionally trying to poison our young people. Although the impact can be the same. One question is “why do people (especially young people) get so ‘influenced’ that they do crazy, stupid things?” Actually, it’s easier to answer for young people. They have a biological, developmental excuse. Contrary to what we learned decades ago (or in the last millennium!) about brain development, that no new neurons grew after birth, the development of the brain is not complete until the mid 20s. And the last part of the brain to completely develop is the frontal cortex, which is associated with both executive function and judgement. Judgement is very different from intelligence or knowledge; it is the ability to integrate knowledge and come up with a wise plan of action. It is why a young adult or late teen, otherwise both very smart and even very knowledgeable, can often do something that seems, well, stupid. “Why did you drive into that crowded intersection? What were you thinking?” “Thinking?”…

Addressing this issue (helping learners to know how to integrate knowledge into a wise plan of action) is one of the key goals of education; and in my experience, in medical education. It is important, in making a diagnosis or deciding upon a treatment, to think critically, and this is not necessarily a skill that comes naturally. Before electronic medical records (EMRs) came into being, I would encourage learners to write the important laboratory and x-ray results in their chart notes, on the theory that in going from their eyes to their hands it would go through their brains and significant results that needed further investigation or action would trigger those brains to follow up. Now with EMRs, it is possible to block and paste all those results and insert them into the physician’s note, which does not have the same effect. It does make the notes a lot longer, but that in itself serves no purpose since the results could be seen elsewhere in the chart.  The goal was not to have them in the note (easy with cut-and-paste) but to have awareness of them in the physician’s brain. The traditional “SOAP” note includes “Subjective” (what the patient relates), “Objective” (what is found by physical, lab, imaging examination), “Assessment” (how the physician integrates that information into a decision on what is the most likely diagnosis or diagnoses, and what are the alternatives), and “Plan” (what are we going to do now to clarify the diagnosis and/or treat?). Assessment is by far the most important part; it is the part that requires that the data, relatively easily available, interact with the physician’s knowledge and experience. It is also, unsurprisingly, the one most often lacking in quality and thoroughness. It is, indeed, the one that require the most out of the frontal cortex.

The bigger question is not about adolescents and young adults, whether training in medicine or not, and why they cannot distinguish between a “challenge” that is a gimmicky fundraiser for a good cause (e.g., pouring ice water on your head so people will contribute money for ALS research) and one that is idiocy (e.g., cooking chicken in cold medicine). After all, we train children to irrationally believe things (Santa Claus, the Easter Bunny, parents are omniscient, good guys always win) so it is understandable that aspects of this may persist for a while. The bigger question is about adults. Why do they find it so easy to believe what should be obvious nonsense, and act on it, and have it determine not only what they do in a mildly risky manner (chicken and NyQuil, incredibly hot chips) but in their work, their relationships with others, their beliefs in the world around them, how they vote, and how that affects our world.  

Vaccines, for example, work to prevent disease both in the individuals who receive them and the communities of which they are a part. They are good. They are one of the few things (along with surgery) that healthcare workers can actually do to/for people that enhances their health, as opposed to making recommendations, whether for diet/exercise or giving small pieces of paper, which have to be taken somewhere and, with money, redeemed for medicines that have to actually be taken. But there  is still a lot of vaccine skepticism. Some of it is political; being skeptical of COVID vaccines has become de rigeur for many Republicans and conservatives and this has bled into distrust of other vaccines. But it also a belief of many who think of themselves as liberal, and are economically well off. It is just as wrong and dangerous. We read now that vaccine reluctance is now moving into people’s views about vaccinating their pets; we may soon face not only outbreaks of measles in children but rabies in dogs!

I understand and have written about the fact that all doctors are not always correct, that they sometimes are motivated by interests other than those of their patients’ health (their own financial interest or that of the corporation they work for), and that asking questions is good. But the dangerous irony is the same people who are suspicious of “mainstream medicine” are often far too willing to accept unproven and unlikely alternatives. Because something is recommended by those who are not mainstream physicians does not make it correct; in fact it is often quackery.

People often adopt behaviors, or either eat or eschew certain foods, or take supplements, that they believe will make them healthier. Maybe they do help. No one thing is going to make you healthy; there are too many factors affecting health. People usually choose those consistent with what they already believe and are things that they feel that they can do (thus the popularity of supplements; you don’t have to do anything hard like change your lifestyle). Unfortunately, people often think that doing the things they like or believe in or find easy cancels out other things – “if I take supplement X (or eat a lot of Y but no Z), I don’t have to do A or stop doing B!”

Near the end of Herman Hesse’s novel “Siddhartha”, the protagonist meets his childhood friend Govinda when they are both old men. Siddhartha shocks Govinda, a devotee of the Buddha, by saying that wisdom cannot be taught. Knowledge can be taught, he says, but wisdom must be acquired by the person themselves. I do not think we need less knowledge, but we do need more wisdom.

I’ll share some knowledge: Don’t cook your chicken in NyQuil. And get vaccinated, get your children vaccinated, get your pets vaccinated.

I’ll also try to share some wisdom: Because you want something to be true does not make it true. And if something seems too good to be true, it probably is.