Getting rid of cancel culture in the pharmacy profession

Provided you haven’t buried your head deep, deep in the sand as a response to 2020 and early 2021, you’ve probably noticed a few disturbing trends in the media. No, I’m not talking about the plethora of Tik Tok dances, although yikes, they are bad in their own right.

I’m talking about misinformation and cancel culture.

The year 2020 was a challenging one. 2021 is somewhat more optimistic, but we're still not out of the woods. We’ve had a worldwide pandemic, economic turmoil and political scandals to boot. But possibly more disturbing than all of that is the rampant spread of misinformation. Spreading of false information is not a new concept. But in the last 10 years we’ve seen a disturbing trend of misinformation finding its way into our more sacred spaces. In 2016 we saw the emergence of fake news with the United States election. And  in 2020 we saw it grab a strong foothold in the healthcare space.

And who can be surprised. The COVID-19 virus caught the world off guard. The developments have been persistent and frequent and it has caused public health guidelines to switch seemingly overnight.  We healthcare practitioners are not surprised, knowing how swiftly best practices can change, but the public, who already had critical levels of mistrust in the system, are left baffled. Fuelled by fear, the public has sought out the internet for answers and what they have found online has made matters much, much worse.

Separate, but inextricably linked to the issue of misinformation, is cancel culture.

Cancel culture has no agreed upon definition, but according to dictionary.com, it refers to the withdrawing of support from a person or company after they have done or said something considered objectionable or offensive. It is generally an act performed online in chat rooms or on social media these days, but the idea of ostracizing a person who doesn’t fit with societal norms has been around throughout history (1).

In fact, we have an example from as far back as 1920 when John B Watson, a major player in the evolution of psychology, was forced to resign from Johns Hopkins University and thrown out of the profession after a highly publicized divorce scandal (2).

While this form of cancellation was different in many ways to the social media versions we are used to seeing these days, there are some interesting parallels. First, Watson was banished from practising psychology due to an event in his personal life which bears no connection to his professional work. Second, though Watson was banished from applying psychology in a professional setting where he was subject to oversight by his medical college, he took to publishing heavily on the topic of psychology, gathering a following and establishing himself as an expert in the media, thus becoming the first “pop psychologist.” (2)

A version of this story plays out frequently these days on social media. Back in August, a physician from Ontario caught fire from medical colleagues for pedalling the benefits of hydroxychloroquine for COVID-19 while at the same stating that there is no need for a vaccine. The response to her tweets was swift and intense, with public shaming on social media and major news outlets covering the story on their channels. The people involved in the response felt that they were doing the right thing by arguing vehemently with their colleague, but Psychology Today has a different take, arguing that shaming someone often does not curb their behaviour, but drives it underground where it is less easily detected and corrected. (3)

And this certainly seems to have been the case here: A news article from August 10, 2020 states that she had 22K Twitter followers at that time. Since then, the physician’s controversial tweets have continued, if not increased, and a Twitter search from today, February 11th, 2021, shows she has more than doubled her followers, which now sit at 53.1K. There are many factors at play here, but one could argue that the shaming of this individual only fuelled her desire to be heard and the public nature of the shaming only increased her audience.

Collegiality versus cancellation

But disagreeing with a colleague doesn’t have to be this way. Imagine if instead of being publicly shamed, the Ontario doctor were to have an open dialogue with her colleagues where they could discuss their opposing views without retweets, public insults and media coverage.  Imagine how different the outcome could have been.

I am reminded of a vignette I read recently about Gary Slutkin and the organization Cure Violence. An epidemiologist, Gary noticed that the way violence spreads is similar to the way a contagious disease spreads. He remarked that violence was often met with blaming, excluding and punishment of victims of violence, similar to the early days of contagious diseases when people thought diseases were caused by “bad people.” This approach did not cause behaviour change, and only increased suffering for the victim. He applied his contagious disease experience towards the spread of violence and hypothesized that most critical would be to stop the transmission of violence. He employed outreach workers, called violence interrupters, to go into delicate situations where violence had occurred and help to stop the spread of violence. Importantly, the outreach workers were real people, often from the same communities where the violence was happening. As a result, the people they served actually trusted in them. (4)

Shine a light

I believe we can further apply this logic to the issue of misinformation. As it stands, we blame and shame people for spreading information which they believe to be true. Social media algorithms cancel their posts, and we in the medical community “cancel” them from our sacred medical institutions, driving them away from any civil and balanced discourse. Instead, we could focus on bringing these ideas into the light, defusing the fear and panic, and stopping the transmission to the next person.  By focusing on the transmission of information, rather than the shaming of the individual presenting it, we can help to curb the spread of misinformation online.

While I certainly don’t have all the answers, here are some things that are important to remember when disagreeing with a colleague:

• We all care about our patients.

Regardless of individual opinions and points of view, we all got into this business because we care about people and their health. In this way, we all have the same goal. Try to frame the argument in these terms.

• Scientific consensus is constantly changing.

Look no further than the 2019 Global Initiative for Asthma (GINA) guidelines.  For 50 years, Short acting beta agonist (SABA) treatment has been the initial step for those diagnosed with asthma. But, after a comprehensive review of the literature by a panel of experts showed some serious adverse effects with regular or frequent use of SABA only therapy, the guidelines changed. The panel found that regular or frequent use of a SABA was associated with increased allergic response and eosinophilic airway inflammation, beta receptor down regulation, decreased bronchoprotection, rebound hyperresponsiveness and decreased bronchodilator response. Dispensing three or more canisters a year was associated with greater presentations to the emergency department, and dispensing 12 or more canisters a year (a common occurrence seen in community pharmacy) was associated with a higher risk of death! (5) Now that we have new guidelines and evidence, we are happy to change our ways and practise to the new standards. But consider this: before the studies were done to prove the harm of our old ways, the harm was still being done.  How many of us would have shamed a pharmacist or doctor for making a comment on overuse of SABAs prior to the guideline changes?

• Shaming and blaming is not helpful.

Instead, focus on healthy two-way discourse where both parties seek to learn from the other.

References

1. Cancel Culture. (2021). Dictionary.com. https://www.dictionary.com/e/pop-culture/cancel-culture/#:~:text=Cancel%20culture%20refers%20to%20the,the%20form%20of%20group%20shaming.
2. Weiten, W., & McCann, D. (2013). Psychology: Themes and variations (3rd ed.). Nelson Education.
3. Batcho, K. I. (2017, May 31). Why shaming doesn’t work. Psychology Today. https://www.psychologytoday.com/ca/blog/longing-nostalgia/201705/why-shaming-doesnt-work
4. Clay, A., & Phillips, K. M. (2016). The Misfit Economy: Lessons in Creativity from Pirates, Hackers, Gangsters and Other Informal Entrepreneurs (Reprint ed.). Simon & Schuster.
5. What’s new in GINA 2020. (2020). [Slides]. Ginasthma.Org. https://ginasthma.org/gina-reports/

Kimberley Kallio is an engineer turned community pharmacist working out of Castlegar, BC.  Since graduating from UBC in 2017, she has been drawn to preventative health, therapeutic nutrition and functional medicine.  She is passionate about educating the public about these topics, whether at the pharmacy counter or on her blog at www.kalliofunctionalpharmacy.com.