Unmasking Fake News and Propaganda in the Healthcare System: Nurses Responsibility for Patients’ Safety

Abstract

Nursing practice in the 21st century is faced with a barrage of fake news and propaganda that makes it critical for nurses to have the necessary skills to identify truth and discern bias in the healthcare system. The ability to respond critically to fake news and propaganda is more than a safeguarding tool for nurses. However, it is also a crucial democratic competence in its own right. Analytical and critical thinking, knowledge, and critical understanding of the world, including the role of language and communication, lie at the heart of nursing. Therefore, the nurses' understanding of the nature and prevalence of propaganda, its seductions, aims, and consequences, and keeping critical thinking skills well-honed is vital in decreasing its influence in the healthcare settings and related harms, including lost opportunities to help patients.

Full text

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
52 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
UNMASKING FAKE NEWS AND PROPAGANDA IN THE HEALTHCARE SYSTEM:
NURSES RESPONSIBILITY FOR PATIENTS’ SAFETY
Asonye Christian Chinedu
School of Nursing, Babcock University, Ilisan Remo, Ogun State, Nigeria
Email: christianasonye1@gmail.com
ABSTRACT: Nursing practice in the 21st century is faced with
a barrage of fake news and propaganda that makes it critical for
nurses to have the necessary skills to identify truth and discern
bias in the healthcare system. The ability to respond critically to
fake news and propaganda is more than a safe-guarding tool for
nurses. However, it is also a crucial democratic competence in
its own right. Analytical and critical thinking, knowledge, and
critical understanding of the world, including the role of
language and communication, lie at the heart of nursing.
Therefore, the nurses’ understanding of the nature and
prevalence of propaganda, its seductions, aims, and
consequences, and keeping critical thinking skills well-honed is
vital in decreasing its influence in the healthcare settings and
related harms, including lost opportunities to help patients.
KEYWORDS: Fake News, Propaganda, Nursing Practice,
Healthcare System
Cite this article:
Asonye Christian Chinedu
(2021), Unmasking Fake
News and Propaganda in the
Healthcare System: Nurses
Responsibility for Patients’
Safety. African Journal of
Health, Nursing and
Midwifery 4(4), 52-58. DOI:
10.52589/AJHNM-
Z4YHSGMG.
Manuscript History
Received: 8 June 2021
Accepted: 7 July 2021
Published: 20 July 2021
Copyright © 2020 The Author(s).
This is an Open Access article
distributed under the terms of
Creative Commons Attribution-
NonCommercial-NoDerivatives
4.0 International (CC BY-NC-ND
4.0), which permits anyone to
share, use, reproduce and
redistribute in any medium,
provided the original author and
source are credited.

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
53 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
INTRODUCTION
Fake news and propaganda are not new concepts but are as old as recorded history. However,
recently these two concepts have become a subject of interests around the globe, especially as a
result of the 2016 U.S, Presidential election (Tandoc, Lim & Ling, 2018). These two concepts
often overlap in meaning, but in reality, they are different. They are used to describe how the
sharing of information causes harm intentionally or unintentionally - to control information flow,
manage public opinion, or manipulate behaviour.
Furthermore, because of the explosion in information/communication and technology in recent
times and the centrality of these factors in daily lives, healthcare consumers (patients and clients)
are particularly vulnerable to propaganda and fake news. Healthcare consumers rely heavily on
information circulated online for their knowledge of the health conditions and treatment
modalities. However, to understand the nuance between fake news and propaganda, one may
need to define each term and critically review these concepts.
Although there is no universal definition, fake news generally may refer to misleading content
found on the internet, especially social media. Fake news may be defined as false news stories:
the story itself is fabricated, with no verifiable facts, sources or quotes (Desai, Mooney & Oehrli,
2017). Fake news exists within a broader ecosystem of mis-and disinformation. Misinformation
is false or inaccurate information mistakenly or inadvertently generated or disseminated, and the
intent is not to deceive. Disinformation is information that is deliberately created and spread to
influence public opinion or obscure the truth.
Propaganda, on the other hand, is defined as “generally (connoting) the selective use of
information for political effect” (National Endowment for Democracy (NED), 2017). More often
than not, fake news does not meet the definition of propaganda. Its motives are usually financial,
not political, and usually not tied to a larger agenda.
Propaganda as Key in Quackery, Fraud, and Corruption in the Healthcare System
Nurses live in a sea of propaganda pitches, including propaganda in the healthcare system -
healthcare professionals, big pharmaceutical industries, biotech companies, and the health
insurance industry. Quackery entails the promotion and marketing of health products and
procedures that have not been tested, and often unnecessary, and sometimes produces deleterious
side effects by either healthcare professionals or others (Gambrill, 2010; 2012). Quackery often
comes in several propaganda methods designed to influence beliefs and actions with the slightest
thought possible in the healthcare system. Some of the indicators of quackery in the healthcare
system include the promise of quick cures and sometimes the use of testimonials to support
bogus claims of a particular product or procedure.
Clinical researchers are not left out of quackery, as they sometimes promote questionable
conclusions (Vul, Harris, Winkielman, & Pashler, 2009). These professionals trusted to guard the
interests of the masses are sometimes propagandized by material prepared by public relations
firms hired by pharmaceutical companies (Moynihan & Cassels, 2005; Gambrill, 2010; 2012).
Consumers are often bamboozled by these false claims in the various media about what is

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
54 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
beneficial and what is not. Ioannidis (2005) argues that most published research findings are
false. Indeed, it was partly because of bogus statements in texts, editorials, and professional
articles that evidence-based practice (EBP) was developed.
Evidence-based practice (EBP) encompasses the conscientious and explicit problem-solving
approach applied to clinical practice that incorporates available, current, valid and best evidence
from well-designed research, patient values and preferences, and a clinician’s expertise in
making patient care decisions. Such an approach requires that the patient be involved as
informed participants, whether this concerns a screening test for cancers or intervention for
cancers or other disease conditions. The process and philosophy of EBP were designed to
obliterate spurious claims by clinical researchers and involved all interested parties as informed
consumers.
Typical propaganda ploys that threatened the consistent use of the evidence-based practice (EBP)
in the healthcare system by researchers include the following: hiding limitations of research
studies (Altman, 2002; Rubin & Parrish, 2007); preparing uncritical, incomplete research
reviews related to practice or policy; ignoring counterevidence to views promoted (e.g., Barkley
et al., 2002); selective publication of research studies (e.g., Turner, Matthews, Linardatos, Tell,
& Rosenthal, 2008); ignoring well-argued alternative views and related evidence or
misrepresenting them; transforming risks into diseases (e.g., osteoporosis); biased estimates of
the prevalence of concerns; advocacy in place of evidence; arguing ad hominem (e.g., attacking
the critic) rather than ad rem (responding to the argument). These propaganda ploys by
researchers in healthcare professions result in inflated claims about “what we know” about
causes, the accuracy of assessment measures, risks, and the effectiveness of remedies.
Fraud is the intentional misrepresentation of the effect of specific actions, such as taking a
prescribed drug for a specific ailment, to persuade people to part with something of value, such
as their money. It does this employing deception and misrepresentation, drawing on a variety of
propaganda ploys, including the omission of relevant information such as harmful side effects
(Gambrill, 2010; 2012). In the healthcare industry, the propaganda promoted by pharmaceutical
companies has become so widespread, and conflicts of interests between academic/clinical
researchers and such companies so huge. Most of the big drug companies have settled charges of
fraud, off-label marketing, and other offences. However, the costs, while huge in some cases, are
still overshadowed by the gains generated by these illegal activities and are therefore not much
of a deterrent (Angell, 2009, p. 12).
Furthermore, corruption includes deceitful practices such as dumping unsafe drugs in third world
countries and conflicts of interest that permeate medicine (Angell, 2008, 2009; Lo & Field,
2009). It includes bribery of officials and kickbacks for referrals in the healthcare settings.
According to Angell (2009), drug companies have given gifts worth tens of billions of dollars a
year to some medical professionals (p. 8). This action has led the pharmaceutical industry to
exercise significant control over how some medical professionals evaluate and use their
products. This control and the conflicts of interest that permeate the enterprise tend to allow the
industry-sponsored trials published in medical journals to consistently favour sponsors’ drugs—
mainly because negative results are not published, positive results are repeatedly published in

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
55 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
slightly different forms, and a positive spin is put on even negative results (Turner et al., 2008;
Angell, 2009, p. 10; Lo & Field, 2009; Gambrill, 2010; 2012). Corruption in the health sector is
real and vast that an international organization, Transparency International was created to
decrease it (Busch, 2008).
The Consequences of Propaganda
The advertising and commercial search engine optimization techniques oftentimes promote
search results to the top of the page from sources that only have economic interests rather than
the most accurate and evidenced-based information (Beeken, Williams, Wardle, & Croker, 2016;
Fu, Zook, Spoehr-Labutta, Hu, & Joseph, 2016). This incorrect and misleading medical
information portends grave danger to the health of patients. Fake news and propaganda affect
individual patients both on a small scale and on a larger scale. Public health and health policy
decisions may be based on misleading or incorrect information for political and economic gains
rather than evidenced-based information (Speed, & Mannion, 2017), affecting the patients in the
long run. Health providers must also engage in critical and evidence-based evaluation of health
information.
Other possible consequences of propaganda in the healthcare system may include failing to
receive adequate services, creating bogus risks and alleged “diseases” and related worries, which
tend to deprive patients of life pleasures. Other consequences may include increased dependency
on specific healthcare professionals, thereby forcing patients to accept unneeded and perhaps
harmful diagnostic tests and other interventions.
Nurses’ Responsibilities in Exposing Propaganda and Avoiding Its Influence
Apart from providing care to patients with certain kinds of ill-health, the responsibilities of
nurses in society include political, social, and economic functions and interests. The most
important reason to be politically active is that politics is a means for nurses to advocate for
patients. Advocacy is vital for nurses because social justice is a core value of the nursing
profession. When nurses work in clinical settings, they can only help one patient at a time, and
this work is central to our profession. But when nurses vote, sign a petition or participate in a
political event, they can potentially help thousands of people at a time. The political activity
takes the work of nurses from being a discreet event in one setting and raises it to a societal level.
More so, that several social determinants of health can be impacted through political decisions.
Nurses can help to protect health care access for vulnerable populations.
Nurses do more than just the art and act of caring for individuals requiring their services at the
societal level. Nurses have always been at the forefront of changes in health care and public
health issues. Nurses help advocate for health promotion, educate patients and the public on
preventing illness and injury, providing care, assisting in the cure, participating in rehabilitation,
and providing support. No other health care professionals have such a broad and far-reaching
role. Nurses help families learn to become healthy by helping them understand the range of
emotional, physical, mental and cultural experiences they encounter during health and illness.
Nurses help people and their families cope with illness, deal with it, and, if necessary, live with it
(or die peacefully) so that other parts of their lives can continue.

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
56 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
Professional nursing practice today ranges from the provision of health services based on the
latest evidence-based nursing research, in which patients are involved as informed participants.
Therefore, the nurses’ understanding of the nature and prevalence of propaganda, its seductions,
aims, and consequences, and keeping critical thinking skills well-honed is vital in decreasing its
influence in the healthcare professions and related harms, including lost opportunities to help
patients. In addition, because propaganda is an essential part of the technological society that
nurses live and work, it, therefore, means that nurses may not escape its influence. Nurses only
recourse will be to understand how propaganda works, how it may influence their lives and duty,
how it may influence the lives of their patients/clients, and how they may mute its effects.
To reduce the influence of fake news and propaganda, nurses will no doubt require varieties of
tools and courage. Avoiding fake news and propaganda requires constant questioning of “is this
true?” “What is the evidence?” The nurse requires courage, as he/she may be viewed as a
troublemaker or a difficult person by colleagues, other healthcare professionals, and employer.
The nurse sometimes may even get sued by a pharmaceutical company or be sacked.
Nevertheless, the nurse must remain resolute, as his/her obligation is first to the patient.
Nurses must advocate and use evidence-based practice to weed out bogus claims, increase
transparency regarding the uncertainty associated with making life-affecting decisions, and
involves all parties as informed consumers in the delivery of healthcare services. Nurses can
become aware of the power and pervasiveness of propaganda and develop fluency in recognizing
indicators of propaganda and cultivating and using critical thinking to navigate through. Also,
nurses need to create and maintain contacts with others, who value critical thinking, cultivate
resistance to intimidation and blow the whistle on propaganda, fraud, and quackery in the
healthcare system irrespective of persons involved. Furthermore, nurses should endeavour to
read and accept primary sources of information (do not rely on secondary sources) and take
advantage of valuable and trusted internet sources (such as Alliance for Human Research
Protection (www.ahrp.org), www.criticalthinking.org, fallacyfiles.org, healthyskepticism.org,-
Innummercy.com, National Council Against Health Fraud).
Furthermore, nurses may use the Gricean maximums to decrease self-propaganda as well as to
avoid propagandizing others (Grice, 1991; Ronald, 2006):
1. Maxim of Quantity: Quantity of Information. Make one’s contribution as informative as is
required (for the current purposes of the exchange). Do not make one’s contribution more
informative than is required.
2. Maxim of Quality: Be Truthful. Do not say what is believed to be false. Do not say that for
which one lacks adequate evidence.
3. Maxim of Relation: Relevance. Be relevant (i.e., state things related to the current topic of
the conversation).
4. Maxim of Manner: Be Clear. Avoid obscurity of expression, avoid ambiguity, be brief (avoid
unnecessary prolixity/wordiness), be orderly.

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
57 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
Nurses can keep in mind that in conversations where seeking the truth is the goal, efforts to avoid
or block critical inquiry, so integral to propaganda, are never appropriate (Walton, 2008).
Therefore, nurses can hone their critical thinking skills by virtue of their training and experience
and become more aware of self-propaganda, such as the illusion of knowledge and certainty and
related self-inflated assessments of their competence that foster uncritical acceptance of
propaganda from external sources (Gambrill, 2010).
SUMMARY AND CONCLUSION
It is high time nurses pay more attention to propaganda in the healthcare system. An assessment
of media sources and professional literature illustrates a continuing need for nurses to be vigilant
about propaganda’s pervasiveness and its effects, especially on patients’ health. As propaganda
methods have become more sophisticated, the influence of propaganda is more pervasive and
more difficult to resist. Failure to educate nurses about the forms, aims, and consequences of
propaganda in the healthcare system is a significant deficit in their education, resulting in
avoidable harms to patients.
Conflict of interest statement
None declared.
REFERENCES
Altman, D., G. (2002). Poor-quality medical research: What can journals do? Journal of the 41-
American Medical Association, 287, 2765-2767.
Angell, M. (2008). Industry sponsored clinical research: A broken system. Journal of the
American Medical Association, 300, 1069-1071.
Angell, M. (2009). Drug companies & doctors: A story of corruption. New York Review of
Books, 1/15
Barkley, R. A., Cook, E. H., Diamond, A., Zametkin, A., Thapar, A., Teeter, A., et al. (2002).
International Consensus Statement on ADHD. Clinical Child and Family Psychology
Review, 5, 89-111.
Beeken, R. J., Williams, K., Wardle, J., & Croker, H. (2016). “What about diet?” A qualitative
study of cancer survivors’ views on diet and cancer and their sources of
information. European Journal of Cancer Care, 25(5), 774–783.
Busch, R. S., (2008). Healthcare fraud: Auditing and detection guide. Hoboken, NJ: John Wiley
& Sons Death sparks probe into China's Baidu. (2016, May 3). BBC News.
Eileen Gambrill (2010). Evidence-Informed Practice: Antidote to Propaganda in the Helping
Professions? Research on Social Work Practice, 000(00), 1-19.
doi:10.1177/1049731509347879

African Journal of Health, Nursing and Midwifery
ISSN: 2689-9418
Volume 4, Issue 4, 2021 (pp. 52-58)
58 Article DOI: 10.52589/AJHNM-Z4YHSGMG.
DOI URL: https://doi.org/10.52589/AJHNM-Z4YHSGMG.
www.abjournals.org
Fake news advertisements promoted by Baidu, China’s biggest search engine, may have
contributed to the death of a 21-year-old student. Wei Zexi, who was diagnosed with a rare
form of cancer, pursued an experimental treatment that was featured at the top of his search
results.
Fu, L. Y., Zook, K., Spoehr-Labutta, Z., Hu, P., & Joseph, J. G. (2016). Search Engine Ranking,
Quality, and Content of Web Pages That Are Critical Versus Noncritical of Human
Papillomavirus Vaccine. Journal of Adolescent Health, 58(1), 33–39. (U-M Library
Access; PubMed Central)
Gambrill, E. D. (2012). Propaganda in the helping professions. New York: Oxford University
Press. (U-M Library Access)
Ioannidis, J. P., A. (2005). Why most published research findings are false. PLoS Medicine, 2,
e124.
Lo, B., & Field, M. J. (Eds.). (2009). Conflict of interest in medial research, education and
practice. Institute of Medicine. Washington, DC: National Academy Press
Moynihan, R., & Cassels, A. (2005). Selling sickness: How the world’s biggest pharmaceutical
companies are turning us all into patients. New York: Nation Books
National Endowment for Democracy, (2017). DISTINGUISHING DISINFORMATION FROM
PROPAGANDA, MISINFORMATION, AND “FAKE NEWS” retrieved from
https://www.ned.org/issue-brief-distinguishing-disinformation-from-propaganda-
misinformation-and-fake-news/
Paul Grice (1991). Studies in the Way of Words. Cambridge, MA: Harvard University Press, pp.
78-79.
Rubin, A., & Parrish, D. (2007). Problematic phrases in the conclusions of published outcome
studies: Implications for evidence based practice. Research on Social Work Practice, 17,
592-602.
Shevon Desai, Hailey Mooney, & Jo Angela Oehrli (2021). "Fake News," Lies and Propaganda:
How to Sort Fact from Fiction. University of Michigan Library, Research Guides, retrieved
from URL: https://guides.lib.umich.edu/fakenews
Speed, E., & Mannion, R. (2017). The Rise of Post-truth Populism in Pluralist Liberal
Democracies: Challenges for Health Policy. International Journal of Health Policy and
Management, 6(5), 249–251. (U-M Library Access; PubMed Central)
Tandoc, E. C., Lim, Z. W., & Ling, R. (2018). Defining “fake news”: a typology of scholarly
definitions. Digital Journalism 2018; 6: 137–153.
Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective
publications of antidepressant trials and its influence on apparent efficacy. The New
England Journal of Medicine, 358, 252-260.
Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective
publications of antidepressant trials and its influence on apparent efficacy. The New
England Journal of Medicine, 358, 252-260
Vul, E., Harris, C., Winkielman, P., & Pashler, H. (2009). Puzzlingly high correlations in fMRI
studies of emotion, personality and social cognition. Perspectives on Psychological
Science, 4, 274-290.
Wardhaugh, Ronald. (2006). An Introduction to Sociolinguistics. Blackwell.