Dr. Google or Dr. Quack: Health misinformation in the TikTok era

Since the monumental search engine Google was founded in 1998, it has been a running joke that instead of consulting their doctors about medical problems, many computer users go to “Dr. Google” for explanations and advice.

Now, it seems, the Chinese-owned TikTok social media platform is starting to take its place – raising the possibility that it should be called “Dr. Quack” instead.

TikTok has become an integral part of the lives of many around the globe, offering not just entertainment and catchy dances but also a wealth of so-called information on topics ranging from home improvement to world news. Many young people even prefer to use social media in place of traditional search engines like Google when looking for answers.

The dangers of quackery

Health information is no exception. Hashtags like #celiactok, #diabetestok, and #sinustok have millions of views, with each tag leading to countless videos about each health issue. “Every type of ‘Tok’ exists – that’s just how the internet works,” said Rose Dimitroyannis, a third-year medical student at the University of Chicago’s Pritzker School of Medicine. “Little tiny segments of the population find one another and make waves.”

TikTok has already become the sixth-most-popular social media platform with over 1.05 billion active monthly users and is expected to grow to 2.2 billion users by 2027.

It can be good for people who share questions about their medical conditions to find one another, but unfortunately, they and anyone else who views health-related social media content are also likely to come up with misinformation from ignorant informants or vested interests with something to sell.

While some trends are relatively harmless, such as when people were to “draw out toxins,” others can be dangerous, such as anti-vaccine content or videos that encourage people to drink borax with their morning coffee.

The team published the study in the journal Otolaryngology-Head and Neck Surgery under the title “A Social Media Quality Review of Popular Sinusitis Videos on TikTok.”

They identified 221 videos identified that collected over 300 million views and one million shares. Almost half of the videos were published by nonmedical influencers.

“There is high-quality and factual information out there on social media platforms such as TikTok, but it may be very difficult to distinguish this from information disseminated by influencers that can actually be harmful,” said Dr. Christopher Roxbury, a surgeon and rhinology expert at the medical school.

The University of Chicago researchers’ new study systematically analyzed health information on TikTok to see if they could identify trends in video quality – how much misinformation is out there, and does it come from specific types of content creators?

They found that nearly half of the videos they analyzed contained non-factual information, with a large proportion of misleading videos coming from nonmedical influencers.

The researchers’ analysis allowed them to offer advice to help lay audiences identify trustworthy health information on social media, along with insights that could help medical professionals disseminate high-quality health information that will reach more viewers.

To narrow the scope of the study for manageable analysis, the researchers focused on a specific health condition and performed their search during a single 24-hour period to limit the effects of TikTok’s ever-shifting algorithm. 

They searched TikTok using specific hashtags related to sinusitis, including #sinusitis, #sinus, and #sinusinfection, cataloged the videos based on uploader types, content categories, and content types, and assessed the quality of the videos using a range of metrics, including understandability, actionability, and reliability.

About 44% of the videos contained non-factual information. Videos from “nonmedical influencers” – content creators with over 10,000 followers who did not self-identify as medical professionals – accounted for almost half of all videos and were more likely to contain misinformation and have lower quality scores.

Laymen’s videos were more often about daily life or comedy rather than attempting to impart medical advice.

Medical professionals overwhelmingly produced educational content and received higher scores for video quality, factual information, and harm/benefit comparisons.

The proliferation of non-factual videos about medical conditions, treatments, or preventative measures can lead not only to confusion but can also result in harm to health. 

A young Israeli woman who recently went to a cosmetician to“improve” her eyelashes was hospitalized when she almost lost her sight. Some “treatments” promoted on social media are genuinely dangerous.

There are also subtler effects: people may miss out on getting much-needed medical care because they’ve turned to ineffective alternative treatments promoted online or because their trust in healthcare professionals and institutions has been eroded.

“I frequently have patients in the clinic asking me questions about things they saw online or on social media, and I have found that many times the information has steered patients in the wrong direction,” said Roxbury, the study’s senior author. 

“In some cases, I see patients who have already sought out and undergone such treatment without any benefit; in rarer cases, they’ve been harmed.”

For example, during the period when the researchers were analyzing sinusitis-related TikToks, there was a trend of people shoving whole cloves of garlic up their noses to relieve congestion.

Blowing one’s nose after inserting garlic does expel more mucus, but only because the garlic causes irritation, which increases mucus production. 

Meanwhile, people put themselves at risk of damaging nasal tissue or inhaling the garlic so far up their noses that it clogs the nasal passages. “Don’t put garlic in your nose,” Dimitroyannis warned.

“As a clinician, I know that many who come into my office have probably looked something up; it’s within their rights to try to understand their health,” said Dimitroyannis, the lead author of the recent paper. “At the end of the day, patients and physicians alike should understand the power of this tool, recognizing the downsides while acknowledging that there can be good quality information available as well.”

For the general public, the researchers said their results emphasize the importance of critically evaluating health information online, cross-referencing information with reliable sources, and consulting one’s own trusted healthcare professionals when in doubt.

“Medical professionals are people; they can still say wrong things,” she acknowledged.

 “But overall, health experts are posting more beneficial content.” In the study data, only 15% of videos from medical professionals contained non-factual information, compared to nearly 60% of videos from nonmedical influencers.

Even though nonmedical influencers’ videos generally had lower quality scores and contained more misinformation, they had greater visibility because they were by far the most prolific group in the study’s sample.

The researchers said this imbalance should prompt healthcare professionals to be more active on social media.