March 29, 2021
In a recent commentary in Drug Safety, Nabarun Dasgupta, PhD, MPH, explores the safety consequences of off-label use of drugs during the COVID-19 pandemic.
He examines earlier research suggesting immunosuppressant drugs increase vulnerability to the disease and other studies that show risks related to off-label use intensify during pandemics. According to Dasgupta, the “cavalier repurposing” of hydroxychloroquine, chloroquine and azithromycin during the COVID-19 pandemic are the latest examples of a worrying trend. More encouraging evidence suggests communication that embodies empathy and authority has the potential to combat misinformation.
The original research evaluates two important questions: “What are the consequences of off-label use of drugs such as hydroxychloroquine and azithromycin when treating COVID-19?” and “Can medications predispose one to an increased risk of acquiring SARS-CoV-2, the virus that causes COVID-19?” The answer to both questions, troublingly, appears to be “yes.”
A “scramble for cures” for COVID-19 bypassed standard channels for emergency use authorization within the U.S. Food and Drug Administration (FDA) and left an enduring legacy of disinformation. The original study found seven deaths from cardiac events had occurred related to the off-label use of drugs already proven ineffective in treating COVID-19, and according to Dasgupta, these are “the tip of the iceberg.”
“What really caught my attention is that we now have direct evidence that people died of side effects from hydroxychloroquine and other drugs used off-label for COVID-19,” he said. “It’s a stark reminder that, even in the midst of a pandemic, cavalier promotion of unvetted cures has consequences.”
Because scientific information is often presented in a way that is very focused – scientists have an incentive to confine their communication to a narrow research topic or question – it often fails to address broader personal concerns that occupy more of our worry-time. Misinformation, on the other hand, is often presented alongside other wellness topics relevant to the audience, such as articles about exercise and vitamins. This context creates the impression of a trusted source because it seems to respond better to the audience’s needs or interests, and, according to Dasgupta’s research: “They don’t need to hammer you with it to be sticky.”
“If you think about how we naturally acquire information, we think about what is relevant to us within the context of a broader conversation,” he said. “By focusing too heavily on one message, we can alienate audiences because we seem to lack empathy or understanding of what matters to them. If we can show that we’re interested in other aspects of their lives, they’ll be more willing to listen to what we say about our research.”
To combat misinformation, Dasgupta suggests medical professionals and researchers prepare to have broader conversations. Rather than confining their advice to the merits of a particular drug, he argues that they could, for example, explain the processes that ensure its safety, including the FDA’s requirements for continued monitoring, or pharmacovigilance.
He also notes that countering misinformation after it has already spread broadly is extremely difficult, and traditional fact-checking can backfire because audiences may not perceive the fact-checkers as credible. He suggests the more effective way to engage audiences is through sources people already trust – their own social networks.
“To make that happen, our lab focuses on identifying the value propositions that get people to share health messages on social media,” said Dasgupta. “We subtly shift the focus to social context, by pointing out how taking a positive health step will them achieve universal social goals.”
Dasgupta, who goes by “Nab,” earned a Doctor of Philosophy in epidemiology from the UNC Gillings School of Global Public Health in 2013. As well as collaborating on national emergency and pandemic surveillance systems – such as a visualization interface for influenza surveillance with the U.S. Centers for Disease Control and Prevention – he has also worked to better understand the opioid overdose pandemic. He strives for empathy in all his work, whether it’s creating data systems that allow users who typically only have a few minutes a day to access actionable information or striking at the heart of conditions that caused people to turn to opioids.
He notes that, in some ways, the COVID-19 pandemic represents a unique opportunity to counteract misinformation, including beliefs that drive vaccine hesitancy. But a lasting effect will require a different mindset.
“The curse of effective public health sets in, and the better we do our jobs, the less relevant we become in the public consciousness,” said Dasgupta. “It’s a routine cycle. To keep our work relevant, I emphasize our mission to improve population health through emotional connection; I try to share the underlying passion that drives our work, and audiences respond better to that than all the academic credentials.”
Follow @nabarund to stay up-to-date on Dasgupta’s work and research.
Contact the UNC Gillings School of Global Public Health communications team at email@example.com.