Dr. Paul Malarik, a retired psychiatrist, now spends about 50 hours a month helping to administer Covid-19 vaccines at pop-up clinics near his home in San Luis Obispo, California. So he's particularly troubled when he logs onto Doximity, a site used by doctors, and reads anti-vaccine comments.
"You rarely get to the level of microchips in vaccines, but a lot of this stuff is pretty close to it," said Malarik, who volunteers his time to mix vaccines, put shots in arms and educate the public. "They're actively working against us."
Doximity, which has long described itself as LinkedIn for doctors, held its stock market debut in June and rocketed up to a $10 billion market cap. In its IPO prospectus, the company said it had 1.8 million members, including 80% of physicians across the U.S. They use the site to connect with one another, share research, stay informed on industry trends and securely communicate with patients.
Malarik, who worked in psychiatry for over two decades, said it's baffling to peruse Doximity's site and find the type of misinformation that he expects to see on Facebook and YouTube, where conspiracy theories run rampant.
Malarik read directly from several comments posted by people with the initials M.D. or D.O., which indicates doctor of osteopathic medicine, after their names. There's no anonymity on the site, so everyone is identified. In the posts, they refer to the vaccines as experimental, unproven or deadly and occasionally write "Fauxi" when talking about Dr. Anthony Fauci, the White House chief medical advisor.
Some commenters say that antibodies from contracting Covid are more effective than the messenger RNA, or mRNA, vaccines, which instruct human cells to make specific proteins that produce an immune response to the disease.
While the mRNA vaccines for Covid-19 are currently on the U.S. market under emergency use authorizations from the Food and Drug Administration, clinical trials have proven that they're highly effective against Covid-19. The FDA and the Centers for Disease Control and Prevention said they are safe, effective and recommended for everyone 12 and older, even for those who have had the virus. President Joe Biden and CDC Director Dr. Rochelle Walensky have described the current situation as a "pandemic of the unvaccinated."
As Malarik scrolls down the Doximity news feed, he stops on a New York Times story from June that's still featured prominently on his page. The headline reads, "A judge dismisses Houston hospital workers' lawsuit about vaccine mandates."
Below the article, hundreds of Doximity users posted comments. Here's what a surgeon wrote:
"Covid-19 vaccines have already killed over 4,000 adults who've received the vaccine," the post said, appearing to mimic a debunked claim made by Fox News host Tucker Carlson. "To mandate a vaccine that has already killed over 4,000 is akin to murder."
It's not an outlier. Dozens of screenshots and descriptions of posts shared with CNBC by other doctors were consistent with Malarik's experience. Articles about vaccines or masks have hundreds of comments, many that are factually inaccurate and often based on conspiracy theories, while stories on less politically divisive topics have just a few comments, if any at all.
"Everyone is jumping on the articles they can fight about," Malarik said.
Shares of Doximity were down more than 5% on Friday morning.
The content moderation conundrum
For Doximity, which stayed largely under the radar prior to its IPO, medical misinformation presents a distinct challenge as the San Francisco-based company seeks to grow its user base and remain a source for high-quality reliable data while also navigating the tricky waters of content moderation.
Doximity is scheduled to report quarterly earnings next week for the first time since going public, following a year of 77% revenue growth. The company has been profitable each of the last three years by keeping down operating costs.
Doximity is not an open social network: To join, users must be practicing U.S. health-care professionals. The company verifies members by photo identification of a medical license, a hospital badge, emails from medical institutions and through challenge questions, among other methods.
Like LinkedIn, the company makes money through sponsored content and from recruiters, who use the site to find talent. Because Doximity is entirely focused on medical professionals, the marketing dollars come largely from drug companies and hospitals targeting relevant users with treatments and services, including through sponsored articles and animated videos on the news feed. More than 80% of Doximity's revenue in its last fiscal year came from its marketing products.
Unlike LinkedIn, Facebook, Twitter and other popular social media platforms, Doximity doesn't allow users to post stories. The company posts articles from mainstream news outlets and medical and science publications, and every user's feed is customized based on area of medical practice and other personal details.
"Our platform uses both algorithms and clinical editors to select content from a variety of sources based on a member's profile and reading interests," the company said in its prospectus. "We are able to aggregate connections to relevant content from a variety of different sources, such as medical journals and specialist websites that a member might otherwise have to search for separately."
One added draw is that users can earn continuing medical education credits by reading certain eligible articles. Some states require doctors to obtain a specified number of credits each year to keep their licenses.
However, users are allowed to comment on these stories — and that's where medical misinformation can proliferate. On the same news feed as those articles, users are finding an abundance of commentary that's anything but educational.
For example, a recent article on masking mandates for kids caught the ire of some of the same doctors who oppose the vaccines. A general surgeon commented that "masking children is absolutely ridiculous and a form of child abuse." Another said that "50 years of data accumulated by the CDC and [World Health Organization] demonstrated those masks to have made no difference. None."
Scientists and public health organizations have repeatedly said that masks can help slow the spread of Covid-19. The rise of the delta variant and resurgence in hospitalizations across parts of the country led several states to reinstitute mask mandates.
Doximity has rules that should put a lid on misinformation. In its community guidelines, the company lists 11 things that can lead to content being removed, including "spreading false or misleading information."
The guidelines page has a separate section addressing "content that contradicts widely accepted public health guidelines." Seven bullet points cover the type of posts that will be taken down. They include content that "promulgates unverified claims about the effectiveness, side effects, or implications of vaccination with FDA-authorized vaccines" and that "promulgates false data about deaths, hospitalizations, infection rates associated with infectious disease."
Doximity said in an emailed statement that while it supports the exchange of ideas "about emerging science and the latest medical news" among its users, posting medical misinformation is explicitly prohibited.
"Like most virtual communities, we have community guidelines in place to ensure that Doximity remains a safe and respectful environment," the company said. "We employ a rigorous clinical review process, staffed by physicians, to evaluate member comments that are flagged as being potential misinformation."
Doctors have a 'powerful platform in society'
The risk to doctors goes well beyond any potential action taken by Doximity. Last week, the Federation of State Medical Boards, a nonprofit representing medical boards across the country, released a statement telling doctors they can lose their license for such activity.
"Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license," the FSMB said. "Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not."
The FSMB said it was responding to a "dramatic increase" in the dissemination of false information by doctors on social media and elsewhere. But the group isn't actively scouring sites for abusers.
Joe Knickrehm, a spokesperson for FSMB, told CNBC in an email that state medical boards operate on a "complaint-driven" system, typically taking action when tipped off by patients, health systems, other doctors or members of the public. He said the group runsa free tool called Docinfo.org that allows anyone to look up information on a doctor and to file a complaint.
As a company, Doximity has tried to keep users informed about Covid-19 developments, treatments and vaccines. Early in the pandemic, Doximity launched a private Covid-19 newsroom for clinicians to find updates and recommendations and to discuss best practices. It also offered its new video telehealth service for free, through early 2021, to help doctors work with patients remotely.
Doximity also has a site called Op-Med, where members publish opinion pieces and their personal stories. Numerous doctors have written pieces touting the vaccines with headlines like "How the COVID-19 vaccine has changed my life (so far)" and "How giving vaccinations rekindled my love of practicing medicine."
But determining where to draw the line between providing an outlet for healthy online debate and letting harmful misinformation proliferate is a problem that's befuddled social networks for years. It's particularly important on matters of life and death.
As it is, some anti-vaxxers already think they're being silenced by Doximity. In one recent comment to a vaccine story, an anesthesiologist said he'd been offered the opportunity to invest in Doximity's IPO, which included up to 15% allocation to doctors on the platform.
He wrote that Doximity had censored a prior post because it didn't fit within the company's "position on vaccination." Thus, he had no interest in IPO shares.
"I will not invest in your directed information highway with your thought control bulls---," he wrote in the comment. "Have a good day."
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