key: cord-0795646-tdp89gkt authors: Marwitz, Kathryn K. title: The pharmacist’s active role in combating COVID-19 medication misinformation date: 2020-11-04 journal: J Am Pharm Assoc (2003) DOI: 10.1016/j.japh.2020.10.022 sha: 9eeb7af7e38a009ea4ae16426c259a07c467cd52 doc_id: 795646 cord_uid: tdp89gkt Pharmacists listen to and dispel medication misinformation daily. Because of the accessibility of pharmacists, pharmacists have the opportunity during pharmacist-patient interactions to begin a dialogue with their patients and provide critical education to improve patient safety and public health. Current examples of pharmacists intervening with medication misinformation includes addressing the anti-vaccination community, educating on the safety of generic drugs, and using evidence-based medicine for antimicrobial stewardship. However, combatting medication misinformation in pharmacy practice with patients takes on many forms and can pose a number of challenges. Most recently during the Coronavirus Disease 2019 (COVID-19) pandemic, a concurrent infodemic has led to claims of pharmacotherapeutic superiority and efficacy unsubstantiated by scientific evidence. Misinformation and partisan politics have also created a distrust in COVID-19 vaccine development. In addition, rogue internet pharmacies and companies have marketed new and unverified COVID-19 treatments and tests. Pharmacists must actively combat these instances of medication misinformation and educate their patients on how not to fall victim to convincing marketing and misinformation schemes. Pharmacists can help patients recognize misinformation by vetting sources of information and communicating how negative emotional information circulates. Additionally, pharmacists combat misinformation with patients by providing accurate alternative explanations in patient-friendly language. While it is easier to stay silent and let misinformation circulate, pharmacists must work with their healthcare team members to actively reject misinformation pertaining to medications, COVID-19 pharmacotherapy and vaccinations, and in any future public health crisis. Funding support: 15 This research did not receive any specific grant from funding agencies in the public, commercial, or not-16 for-profit sectors 17 18 The author declares no relevant conflicts of interest or financial relationships 20 21 Previous presentation: None 22 23 Disease 2019 (COVID-19) pandemic, a concurrent infodemic has led to claims of pharmacotherapeutic 48 superiority and efficacy unsubstantiated by scientific evidence. Misinformation • Pharmacists must take an active role in combating medication misinformation in their roles and as 69 it pertains to COVID-19. • Actively combatting misinformation as a pharmacist is a professional responsibility. • Pharmacists must work with patients and interdisciplinary colleagues to combat medical and 72 medication misinformation during COVID-19 and in future public health crises. information including the wide-spread dissemination of accessible misinformation. 1 Taking advantage of 85 mass uncertainty, anxiety, and political divisiveness, infodemics undermine creditable science and erode 86 trust in public health. 1 The WHO recently convened numerous experts in policy and science for its first 87 Infodemiology Conference to discuss the global impacts of misinformation during the COVID-19 88 pandemic. 1,2 There, it was determined that while infodemics cannot be eliminated, they can be managed. 2 89 In 1918, the influenza pandemic infected nearly five-hundred million people and killed at least 50 million 90 people. 3 This influenza pandemic is often referred to as the Spanish flu but this misnomer demonstrates 91 the ubiquity of misinformation at that time. Since Spain was a neutral party during World War I, they 92 were free to report influenza cases in their newspapers. Many other countries active in war enforced 93 media blackouts and very little influenza-related information including the extent of the pandemic was 94 reported. While the origin of the 1918 influenza pandemic is contested, one of the first documented cases 95 was discovered not in Spain but in a crowded army camp on American soil. 3 In addition, the scope and 96 severity of the 1918 influenza pandemic was underplayed in the media and by various governments. A 97 second wave of influenza later that year enhanced by an under-informed and misinformed public meant 98 scores of lives, some possibly preventable, lost. 4 While infodemics are not new, when paired with a large-99 scale public health crisis, dire consequences arise. 100 Pharmacists listen to and dispel medication misinformation daily. Patients frequently report myths and 102 misinformation about influenza vaccines and dietary supplements to their community pharmacists. 5,6 103 Pharmacists during these pharmacist-patient interactions have the opportunity to begin a dialogue with 104 their patients and provide critical education to improve patient safety and public health. 105 One recent and important example is that of the anti-vaccination and vaccine-hesitant communities. As 106 discussions around vaccination and autism are re-amplified, pharmacists have the opportunity to 107 reeducate their patients and debunk incorrect scientific conclusions. 7 Pharmacists must connect patients 108 with reliable sources of information and make professional recommendations to ensure the patient's 109 health is prioritized. 7 110 Pharmacists also hold a responsibility in educating patients about the safety of generic drugs within the 111 US drug supply chain and notifying patients of any related medication recalls or concerns. 8 Current events 112 of nitrosamine-related impurities in several legend and over-the-counter medications have brought 113 questions about the safety of specific generic medications. Pharmacists are at the frontline to respond to 114 medication recalls and address those patient concerns. 9 Despite internet misinformation about generic 115 drug safety and constant news coverage around medication recalls, pharmacists are still the best sources 116 for medication safety-related information and their expertise can ensure patients receive safe, effective, 117 and affordable medications. 118 Pharmacists also discuss evidence-based medicine with prescribers. Working together, pharmacists and 119 prescribers can practice antimicrobial stewardship in the inpatient and outpatient settings. As the use of 120 antibiotics is often requested by patients and proper testing to rule out bacterial infections in cases that are 121 likely viral are not done, inappropriate outpatient antibiotic prescribing and usage continues. 10 Pharmacists may be asked about unregulated over-the-counter drug, supplement, vaccine and testing kits 167 for COVID-19 by patients and providers. 24-25 Many of these products seek to deceive consumers and may 168 even be marketed by rogue internet pharmacies. [24] [25] Past examples of vitamin C and zinc, marketed for 169 common cold symptoms, make extensive claims about treating and curing common colds but the data do 170 not fully support safety and efficacy of these agents. [26] [27] [28] Ironically, these agents are being promoted as 171 unsubstantiated treatments or preventives for COVID-19 today. 26 Pharmacists can help patients avoid 172 falling victim to these marketing ploys and online misinformation schemes by ensuring that unapproved 173 testing devices are not sold within licensed pharmacies or promoted by licensed pharmacists. Pharmacists 174 might also include signs and educational information for over-the-counter options, inappropriately 175 promoted for COVID-19 but used for other purposes. If patients come looking for these items, 176 pharmacists can share the latest known information and remind patients to stay alert for "too good to be 177 true" claims. Pharmacists can also report suspicious and potentially unlawful websites making fraudulent 178 COVID-19 or other therapeutic claims to the US FDA. 25 179 Identifying misinformation and distinguishing between verified and unverified claims can be time-181 consuming and challenging. However, pharmacists have a professional responsibility to take the time in 182 vetting therapeutic claims particularly during an infodemic by preventing misinformation proactively and 183 correcting misinformation reactively. 184 Negative emotional arguments stick: Information that best circulates during and because of an 186 infodemic often plays into the negative emotions of the population. 29 When individuals are 187 fearful, frustrated, or hurt, common emotions during COVID-19, the information that claims to 188 address these concerns rise in prominence. People want to be heard and want their feelings and 189 emotions validated. Pharmacists can recognize these emotions when speaking with patients, 190 particularly when patients brings up sources of misinformation. Misinformation is political. Accurate information is public health: A decrease in scientific trust 193 has increasingly less to do with communication problems and more to do with mechanisms, 194 platforms, and processes available to spread misinformation. 6 Partisanship and animosity globally 195 for any party or candidate drives how scientific information is communicated, misconstrued, and 196 spread. 15 Pharmacists, like other healthcare professionals, have a responsibility to actively combat 197 misinformation through clear and repetitive communication and active denouncement of 198 misinformation. It is easier to stay quiet on misinformation but for the sake of public health, 199 providers and clinicians must speak up. 200 Check the source: The most obvious of these roles for pharmacists involves evaluating the source 202 of the information from which questions and data originate. Pharmacists should examine the 203 currency, relevance, authority, accuracy, and purpose of a source, also known as the CRAAP test. 204 This test can help ensure that data pharmacists are evaluating and patients are reviewing is 205 reputable. 30 Cross-checking this information with additional journal articles, news outlets, 206 websites, and abstracts can ensure that the information being sharing is not unnecessarily slanted 207 or politically-motivated. 208 Provide the alternative explanation: During a time of extensive uncertainty, providing an 209 alternative explanation is a simple and effective way to combat misinformation. 31 Most people are 210 just looking to understand and explain the pandemic's resulting chaos and replacing a 211 misunderstood belief with an accurate explanation can fix the patient's knowledge gap. 31 212 Psychology research supports that people favor simple explanations over complex ones so the 213 way the alternative explanation is communicated matters. 31 Aim to combat misinformation by 214 providing patient-friendly, scientifically-backed explanations and using the teach-back method to 215 assess understanding. 216 If the role of the pharmacist is to be the medication expert, pharmacists must correct misleading and 218 incorrect medication information and identify where needed information is unknown. When medication 219 misinformation arises, the pharmacist should be looked to as the expert. However, pharmacists are not 220 expected to be content experts on all things public health, healthcare, and medicine. Pharmacists should 221 work together with interdisciplinary colleagues to educate mutual patients, one another, and the general 222 public by sharing evidence-based medicine and identifying areas of uncertainty. This can be challenging 223 in practice as pharmacists and prescribers often lack access to mutual patients' electronic health records 224 and may not be privy to the patient education provided by other healthcare team members. 32,33 However, 225 strengthening relationships between pharmacists and other healthcare providers and positioning 226 pharmacists with other providers to speak out against medication misinformation can support accurate, 227 evidence-based information that is accessible to the public. 228 Pharmacists must actively combat and correct medication misinformation. Actively combating 230 misinformation is a professional responsibility and public health goal especially during a concurrent 231 pandemic and infodemic. While it is easier to stay silent, pharmacists must work with their healthcare 232 team members to actively reject misinformation pertaining to medications and vaccinations, COVID-19 233 pharmacotherapy, and in any future public health crisis. 2. 1st WHO Infodemiology Conference. World Health Organization The Spanish Influenza Pandemic: a lesson 256 from history 100 years after 1918 Shades of gray in vaccination decisions -259 understanding community pharmacists' perspectives of, and experiences with, influenza vaccine 260 hesitancy in ontario Barriers to pharmacists adopting professional 263 responsibilities that support the appropriate and safe use of dietary supplements in the United 264 States: Perspectives of key stakeholders Dispelling vaccine myths: MMR and 267 considerations for practicing pharmacists What do people really think of generic medicines? A systematic review 270 and critical appraisal of literature on stakeholder perceptions of generic drugs Outpatient Antibiotic Prescribing for Acute Respiratory 276 Infections During Influenza Seasons Antimicrobial Stewardship in Outpatient Settings: 279 Leveraging Innovative Physician-Pharmacist Collaborations to Reduce Antibiotic Resistance The NC Tars Project: students leading the way to educate 282 patients about proper use of antibiotics The essential role of pharmacists in antibiotic stewardship 285 in outpatient care: An official position statement of the Society of Infectious Diseases 286 Pharmacists Scientific communication in a post-truth society public-health/joint-statement-ordering-prescribing-or-dispensing-covid-19 298 18. Frequently Asked Questions about COVID-189 Vaccination. Centers for Disease Control and 299 Prevention Vaccines and Related Biological Products Advisory Committee Guidance for PREP Act Coverage for Qualified Pharmacy Technicians and State Guidance for Licensed Pharmacists and Pharmacy Interns Regarding COVID-19 Vaccines and 315 Immunity under the PREP Act Beware of Fraudulent Coronavirus Tests, Vaccines and Treatments. US Food and Drug 320 Administration Fraudulent Coronavirus Disease 2019 (COVID-19) Products. US Food and Drug Administration Myth Busters: Dietary Supplements and COVID-19. Ann 328 Pharmacother Zinc for the treatment of the common 330 cold: a systematic review and meta-analysis of randomized controlled trials Vitamin C for preventing and treating the common cold. Cochrane 333 Misinformation and Its 339 Correction: Continued Influence and Successful Debiasing Electronic health record adoption and use by 342 Nebraska pharmacists Community pharmacists' lack of access to health records and 344 its impact on targeted MTM interventions