Even before COVID-19, doctors faced online harassment, including death threats. The pandemic makes it worse

The first troll Dr. Shikha Jain encountered was angry about vaccines.

The person responded a few years ago to Jain's tweet about getting a flu vaccine with a message criticizing her appearance and telling the doctor she obviously didn't know anything about medicine.

Even before COVID-19, doctors faced harassment just for sharing health information. Now, in a pandemic where even evidence-based suggestions such as wearing masks and socially distancing have become political, doctors open their social media in a weary time only to find more anger.

"It's unfortunate that this has become such a commonplace issue," said Jain, an oncologist and assistant professor at the University of Illinois College of Medicine.

Jain said she and her colleagues have been labeled socialists or liberals, and accused of profiting off the pandemic. "We're getting attacked, and it's getting put into the political sphere, where this really shouldn't be a political conversation," she said.

A new study co-authored by Jain and other doctors at Northwestern University and the University of Chicago revealed physicians are sexually harassed and personally attacked online on the basis of their religion, race or recommendations. About one quarter of doctors said they had been harassed online, according to the study released Monday in the JAMA Internal Medicine journal.

Data was collected before COVID-19, but the authors noted that the harassment has only intensified during the pandemic.

"It's more and more obvious that the type of rhetoric and attacks that were happening prepandemic seem to have ramped up in the very polarized and stressful time that we've been living in over the last year," Jain said.

She said she has received angry messages about vaccines, as well as sexually explicit direct messages. Too many to count, she deletes them and blocks users.

Anticipating the pandemic would make for a tough year online, Jain co-founded a COVID-19 advocacy group, the Illinois Medical Professionals Action Collaborative Team, in March. The group came to Jain's defense when a radio station criticized her for encouraging people to stay home.

This type of harassment is damaging for people already at a disadvantage, including women and people of color, historically left out of the upper echelons of the profession. Social media might become one more way that women are weeded out, Jain said, if they leave online platforms because of harassment.

Dr. Vineet Arora, assistant dean for scholarship and discovery at the University of Chicago Pritzker School of Medicine, also co-authored the study. She emphasized that physicians use their own free time to offer public health information—often at the request of institutions or officials urging doctors to help promote the safety of vaccines—and that the harassment adds more stress.

"You're trying to do the right thing," Arora said. "But we can't let people feel like they're alone."

In the study, which researchers said was to their knowledge the first to assess physician experiences with online harassment, 1 in 6 women reported they'd been sexually harassed. This echoes data that shows women and people of color are attacked more online. According to Pew Research Center data, Black and Hispanic people reported being targeted more than white people, and women were twice as likely as men to be targeted as a result of their gender.

In the physician study, doctors reported everything from death threats to trolls contacting employers and certifying boards with fake complaints.

Of the 464 participants who responded to the 2019 survey—which asked two questions: Have you ever been personally targeted or attacked on social media? Have you ever been sexually harassed on social media?—42% were men, and 58% were women or nonbinary.

Examples of personal attacks included a doctor who recounted that anti-vaccine people wrote negative reviews and sent a death threat. Another doctor said people called their place of employment, demanding the doctor be fired for political posts on Twitter.

One doctor received racial threats, including someone saying they should leave the country. Another doctor was sent images of Holocaust victims after posts related to being Jewish.

Women reported receiving sexually explicit messages, including pornographic images. Two described threats of assault, including a Black woman threatened with rape by white supremacists after her civil rights advocacy.

As people remain skeptical of the vaccine—especially in communities of color where distrust in the medical system runs deep—real risks exist if Black doctors do not want to engage online and emphasize safety, Arora said.

"If they're worried about speaking up because of social media attacks, that's going to be a problem where we all lose," she said.

Employers and professional societies should support doctors who experience harassment and seek ways to help, the authors wrote, especially as social media plays a role in networking, medical education and research.

A group formed before the pandemic, Shots Heard Round the World, helps health care providers who are being attacked by anti-vaxxers.

"Physicians (are) extending themselves to advocate online for public health issues, and they're receiving threats that go as extreme as death threats," Arora said.

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