Anti-vaxxers are now stalking physicians: Are restraining orders needed?

Echo essay published in MedPage Today, news by Vineet Arora, M.D., Tricia Pendergrast, MD and Regina Royan, MD:

While the nation has declared the COVID-19 public health emergency over, the politicization of healthcare and medicine continues to result in harassment of doctors and scientists.

Just this past weekend, vaccine scientist Peter Hotez, MD, PhD, became the target of significant online harassment after criticizing a Joe Rogan podcast episode featuring Presidential candidate and vaccine skeptic Robert F. Kennedy Jr. and debunking many of Kennedy's claims as misinformation. After being challenged to debate Kennedy, Hotez was approached unannounced outside his homeby a couple of anti-vax activis ts demanding answers. Whether it is about vaccination, reproductive rights, LGBTQ+ health, or advancing diversity, equity, and inclusion, doctors and scientists continue to face attacks online and off.

Among a sample of over 350 physicians and scientists online, over two-thirds reported being harassed on social media. The most commonly reported reason for harassment was advocacy, with those who advocated for public health issues more commonly facing harassment. While no one is "safe" from harassment, personal attacks on social media were not equally distributed. Those who identified as women, nonbinary, Black or Hispanic, LGBTQ+ or disabled were significantly more likely to report harassment due to their identity.

While "online harassment" may sound like annoying trolling, our study paints a much more nefarious picture of online harassment of physicians and scientists. In open-ended comments, many participants described detailed and targeted incidents of harassment for the expressed purpose of harming a professional's career (i.e. negative online reviews, reports to an employer) all the way to threatening violent bodily injury, including rape, against the professional or their family members. 

In a few cases, the harassers eventually moved offline and went so far as to physically appear at the professional's place of work, and in one case, even physically assaulted the victim. Our findings are strikingly similar to the escalation in the Hotez incident over the weekend.

Despite the harrowing nature of these incidents, physicians and scientists disclosed that when they did report these online threats to either law enforcement or their employer, it was to no avail. 

As a result, several stated they have started posting online less regularly or have stayed stay away from controversial topics due to fear of harassment. As one subject reported, "I've had to take a step back from a lot of health discourse. This constant battle is taking a lot out of me. Unfortunately, I tend to now stay out of it."

In light of these findings, it's important to consider the consequences of such online attacks on physicians and scientists.

First and foremost, online threats are not and should not be seen as harmless. As evidenced by the bomb threats to Boston Children's Hospital and children's hospitals around the country due to provision of life-saving gender affirming care, online threats can incite actual threats of physical violence that jeopardize the safety of both medical professionals and the communities they serve. 

Robert Kennedy Jr. is a politician, and writer who has promoted anti-vaccine propaganda and public health-related conspiracy theories.

Moreover, online attacks of medical and science professionals take an emotional toll on a workforce that is already facing a high degree of burnout and depression. 

Given that recent data suggest that 1 in 5 physicians already plan to leave the workforce, online attacks for those who continue to work will only exacerbate the problem. A telling example comes from a study of public health officials from last year. Of the more than 200 public health officials who had recently left their post, over one third had experienced some form of harassment.

Furthermore, these online attacks appear to be effective in silencing the voices of physicians and scientists. This is especially concerning given that those with minoritized identities are at greater risk of being silenced, at the time when we should be elevating and supporting their voices. Given the large health equity gaps and continued health challenges faced by women and minority populations, it is particularly important that physicians and scientists from these groups are supported. 

Retaining these individuals in our workforce is even more critical given the continued underrepresentation of women and minorities in STEM and the already high rates of attrition these groups face. Lastly, silencing the voices of medical and scientific professionals can also facilitate the unchecked proliferation of misinformation online. At a time when trust in scientific institutions is already low, it is essential to retain these trusted messengers within minority communities.

For these reasons, addressing the online harassment of physicians and scientists is paramount. Supporting physicians and scientists who are victims of online harassment is key.

Professional societies and employers can also facilitate support through rapid response mental health support for those experiencing online harassment, akin to the online harassment that has been produced by Pen America for journalists. 

Recently, the University of Chicago published a guide to managing online harassment, which includes steps you can take to report the incident as well as steps the university can take to mitigate the consequences. Leaders of professional societies can also lobby for stricter regulations of social media companies given the toll online harassment puts on their constituents. Social media companies should also be held responsible for the deliberate misuse of their platforms to harm individuals. While disheartening to see that Twitter disbanded its unit that previously tackled online harassment and misinformation, we are encouraged that YouTube is proactively labeling credible health information. Lastly, policymakers can intervene. For example, Colorado has recently criminalized doxxing of personal information of public health workers or their families. Similar legislation can easily cover a broader population of workers, including doctors and scientists.

As long as doctors and scientists continue to face death threats, doxxing (publishing private or identifying information), sexual harassment, and other forms of harassment online, we risk silencing their voices at a time they are needed most. It is time to condemn online attacks against physicians and scientists to ensure the health and longevity of our workforce, and to promote sharing of scientific knowledge freely and constructively. This will ensure we can ultimately reap the benefit of scientific progress in an equitable and just way.

Vineet Arora, MD, MAPP, is dean for medical education at The University of Chicago Pritzker School of Medicine. Tricia Pendergrast, MD, is a PGY1 anesthesiology resident at the University of Michigan Hospitals. Regina Royan, MD, MPH is an assistant professor of emergency medicine at the University of Michigan.