Healthcare and Hashtags: A Delicate Balance

Keynote address delivered at the 22nd Annual Academic Sessions of the Sri Lanka College of Oncologists, held on 23 August 2025 at Hotel Galadari in Colombo.

Good morning, and thank you for the invitation to speak at your annual academic session. I must confess, standing here in a room full of Sri Lanka’s leading oncologists, I feel rather like a complete fraud. Whilst all of you can, and often go on to actually save lives, the best I can do when someone's unwell is suggest they take a paracetamol, and sleep. I am, in other words, a doctor, but not of the useful kind.

But here's the thing. Whilst I cannot diagnose a tumour or prescribe chemotherapy, I specialise in diagnosing and treating something I’d argue is equally malignant: psychopathologies, and diseases that afflict entire societies. I study contagions of harmful content on social media. The cancers I study don't attack cells but social cohesion, democratic institutions, and shared realities that hold communities together.

This brings me to December 2020, when digital pathologies collided a ‘real world’ consequences in unprecedented ways. While the world grappled with the Covid-19 pandemic that had already claimed millions of lives, tens of thousands of Sri Lankans defied quarantine regulations to queue for a miracle cure. They weren't lining up at a hospital or pharmacy, but at the residence of a shaman called Dhammika Bandara, whose concoction of honey, and nutmeg had gone viral on Facebook, WhatsApp and other social media. Within just a couple of weeks, the "Dhammika paniya" had been endorsed by the Speaker of Parliament – who pictured himself on social media drinking it off the bottle - promoted by the Health Minister, and elevated to the status of a religious pilgrimage by very influential private TV stations in their terrestrial broadcasts, and social media output. By January 2021, several senior politicians who had publicly consumed this potion had contracted Covid-19, and the doctor who challenged its efficacy had been physically assaulted.

This wasn't just a failure of scientific, and medical literacy. It was a metastasis of disinformation throughout society, spreading through the same social media networks we had by then come to rely upon for meaningful connections during long periods of isolation, and restricted social bubbles.

Today, I want to talk to you about how social media is simultaneously the most powerful tool and the most dangerous threat to public health communication in our time, and why, as oncologists, you are uniquely positioned to understand and combat its harmful effects.

The parallel between cancer and online disinformation isn't merely metaphorical. Both begin with a single aberrant cell, or on social media, a single false claim delivered in a very believable manner. Both can remain dormant or spread rapidly depending on environmental conditions. And critically, both require early detection and aggressive intervention to prevent the worst outcomes. The study of how disinformation spreads through social networks mirrors the pathophysiology all of you observe regularly in patients: invasion of healthy tissue, evasion of immune responses, and the establishment of new colonies far from the original site. This design is mirrored in what I study, and how.

Permit me to present a few the statistics from my research into healthcare disinformation in Sri Lanka alone. In tracking the spread of the ‘Dhammika Paniya’ narrative across Facebook from October 2020 to January 2021, I identified over 47,000 posts, near exclusively in Sinhala, containing references to this fake cure. Of these, nearly 26,000 were produced in December 2020 alone, generating hundreds of thousands of interactions and reaching millions through shares, comments, and algorithmic amplification. The pattern was unmistakable: initial seeding by fringe accounts, amplification by influential private TV, and media platforms, legitimisation by leading political figures, and finally, mass adoption by a desperate, scared, and vulnerable public.

The complex mechanics of this spread reveal what’s called a "network contagion", which is distinct from a biological contagion but I’d argue is equally virulent. Unlike a virus that requires physical proximity, digital disinformation leverages psychosocial vulnerabilities: confirmation bias, where people seek information supporting their existing beliefs; echo chambers, where users interact primarily with those who share their worldviews; and emotional manipulation, where fear and hope override critical thinking.

I studied how content featuring the ‘Dhammika paniya’, and other fake cures including food supplements, and potions were seeded by prominent personalities through social media, almost immediately created echo chambers where they were uncritically accepted, and openly celebrated: “අවසානයේ හෙළවෙදකම තමයි කොයි කාටත් පිහිට..!”, “Covid  දැනගස්වූ විශ්මිත බෙහෙත!”. Existing trust in a person resulted in the firm belief that what they claimed, despite having no medical basis or medicinal value whatsoever, was completely true.

This phenomenon extends far beyond COVID-19. Recent research examining cancer-related content on social media reveals an equally troubling picture. A comprehensive review of the 200 most popular social media articles about the four most common cancers - breast, prostate, colorectal, and lung - found that 32.5 per cent contained misinformation, and amongst these, 76.9 per cent contained potentially very harmful information. These weren't obscure posts. They were the most engaged-with content, receiving significantly more shares, and reactions than factually accurate articles. The median engagement for articles containing disinformation was 2,300 interactions compared to 1,600 for factual content, a stark reminder that in the attention economy of social media, sensationalism trumps solid science.

The categories of social media harm are particularly relevant to your practice. Disinformation leads to harmful inaction, where patients delay or avoid seeking treatment for what could be curable conditions, at least initially. It promotes harmful actions through unproven therapies with potential toxicities. It creates economic harm through expensive, ineffective treatments. And perhaps most insidiously, it can cause harmful interactions with proven therapies, compromising the very treatments that could save lives. These aren't abstract risks. I am sure they manifest in your consulting rooms when patients arrive with advanced disease after months of pursuing alternative cures promoted on social media, or when they refuse proven therapies based on viral messages warning of exaggerated side effects.

The sophistication of modern disinformation campaigns compounds these challenges. The Russian term ‘dezinformatsiya,’ from which we derive disinformation originally described deliberate intelligence operations to mislead adversaries. Today's digital landscape has democratised these tactics. Individuals, and malign organisations instrumentalise algorithms to micro-target vulnerable populations with customised disinformation. Coordinated networks of accounts amplify false narratives until they achieve viral status. AI now generates convincing but entirely fabricated medical studies. The infrastructure of deception has become so sophisticated that even well-educated individuals, like yourselves in the audience, often struggle to distinguish fact from fiction.

Yet we must also acknowledge the profound benefits social media has brought to healthcare. During the COVID-19 pandemic, these platforms enabled rapid dissemination of public health guidance, facilitated contact tracing, and maintained vital connections between isolated patients and their care teams. In oncology specifically, online communities provide invaluable peer support, with platforms like the breast cancer social media community offering emotional sustenance and practical guidance to thousands navigating their cancer journeys. Social media has democratised access to medical expertise, allowing patients in remote areas to connect with specialists, and enabling researchers to collaborate across continents in real-time.

The challenge, then, isn't to abandon these tools but to wield them more effectively than those who would weaponise them against public health. This requires understanding that we're not fighting individual pieces of disinformation but an entire ecosystem that produces and sustains them. When I examined the debunking of the ‘Dhammika Paniya’ in May 2021, after clinical trials conclusively proved its ineffectiveness, I found that corrective information reached only a fraction of the audience that had consumed the original misinformation. The pages sharing the debunking were entirely different from those that had promoted the cure—two parallel universes of information that rarely intersected.

This asymmetry reflects a fundamental challenge in combating health misinformation: the truth is often complex, nuanced, and hedged with scientific uncertainty, whilst lies can be simple, absolute, emotionally compelling, and manipulative. A false claim that turmeric cures cancer can be stated in a sentence. Explaining the difference between in-vitro and clinical studies, and the importance of bioavailability requires paragraphs of careful exposition that few will read or comprehend, and fewer still will share.

The former US Surgeon General, and physician Vivek Murthy’s advisory on social media, and youth mental health provides a sobering assessment of the scope of this crisis. Adolescents spending more than three hours daily on social media face double the risk of anxiety and depression symptoms, with average daily use now approaching five hours. Nearly half report that social media makes them feel worse about their bodies. These statistics should alarm us not just as healthcare professionals but as parents, caregivers, and members of a society watching its young people struggle with unprecedented levels of psychological distress.

This is a real problem, and it is getting worse at pace.

For oncologists, the implications are particularly acute. Cancer patients are amongst the most vulnerable to health dis-, and misinformation, driven by the existential threat of their diagnosis and the limitations of conventional treatments for advanced disease. They search desperately for hope in digital spaces where charlatans and well-meaning but misinformed individuals promote everything from alkaline diets to cannabis oil as miracle cures. Other fake cures I’ve studied widely promoted on social media include consuming in large doses dog dewormers like Fenbendazole, Vitamin C, baking soda, colloidal silver, essential oils like oregano oil, apricot kernels, ginger, or dandelions, and rectal ozone therapy.

I was left traumatised after investigating what that last one entailed!

The cruel irony is that those who most need accurate medical information are often least equipped to evaluate it critically, their judgement clouded by fear, anxiety, desperation, and the cognitive effects of their disease and treatment.

So what can we do?

First, oncologists (and all doctors) must recognise that combating health disinformation is not peripheral to clinical practice but central to it. Every consultation is an opportunity to address not just what patients know but where they learned it. You must create space for patients to share what they've read online without fear of judgement, understanding that their engagement with dubious sources often stems from legitimate needs for hope, control, and comprehension that the medical profession has failed to address adequately.

Second, you must become more sophisticated in your own use of social media. The medical community's traditional reluctance to engage with these platforms (also because of a lack of time!) has created a vacuum filled by those with fewer scruples about evidence and accuracy. We need clinicians who can communicate complex medical concepts in accessible, shareable formats, and media.

Third, we must collectively advocate for structural changes to how social media platforms operate. The current model, where engagement metrics drive algorithmic amplification regardless of content accuracy, is incompatible with public health. We need transparency in how health information is moderated, accountability for platforms that profit from dangerous disinformation, and investment in tools that help users evaluate source credibility. Social media companies are profiting from the suffering, and eventual death of their consumers. They must be held accountable.

Fourth, we must invest in digital literacy as urgently as we invest in new treatments. Teaching patients to evaluate online health information should be as routine as teaching them to manage their medications. This includes understanding how to identify credible sources, recognise common manipulation tactics, and navigate the emotional triggers that make disinformation so compelling. We must move beyond simply telling patients not to believe everything they read online to actively equipping them with the tools to distinguish signal from noise. This involves creating networks of trusted voices across communities – like individuals on social media vetted by the Sri Lanka College of Oncologists - establishing rapid response systems for emerging false narratives, and developing prebunking strategies that inoculate populations against disinformation before it spreads.

As I conclude, I want to return to the story of the ‘Dhammika Paniya’. When clinical trials finally debunked this supposed cure, the harm had already been done. Not just in the false hope given to desperate families or the resources wasted on a useless potion, but in the deeper erosion of trust between the public and medical establishment. Every patient who believed in that cure and felt betrayed by its failure became a little less likely to trust the next piece of medical advice, a little more susceptible to the next charlatan promising simple solutions to complex problems.

I wrote as far back as 2017, in relation to Sri Lanka, that “disinformation is a cancer, and it is growing.” This wasn't hyperbole. It was a clinical observation based on years of tracking how information disorders metastasise through our society. The pattern is consistent: disinformation works best when deep socio-political divisions are present by expanding them, seeding doubt, creating fear and violent othering. We've seen this playbook deployed repeatedly in post-war Sri Lanka. Whether during election campaigns, communal violence, or public health crises, the same malignant tactics spread through our information ecosystems.

This is why I've argued that we all need to join this fight, because it is our collective future at stake. Cancer doesn’t care about gender, religion, and who you voted for. Likewise, disinformation is a party blind threat to all of society. The parallels between cancer and disinformation that I've drawn aren't merely academic. They're a call to action based on empirical observation of how information disorders destroy societies from within, just like cancers destroy healthy bodies. Just as one wouldn't ignore a suspicious growth, we should not ignore the malignant spread of disinformation. It requires the same vigilance, the same early intervention, and the same commitment to treatment that you bring to your oncology practice. Because whilst you treat individual patients, the cancer I study threatens the entire body politic of our nation. The young, and the old. The rich, and the poor. Those in cities, and villages. No one is immune. And unlike biological cancers that may go into remission, information disorders, once established in a society's DNA require constant attention to prevent recurrence, and are nearly impossible to eradicate fully. The question is not whether we will face worsening disinformation. This is inevitable. The question is whether we'll be prepared with the regulatory frameworks, diagnostic tools, treatment protocols, and societal antibodies necessary to fight it.

Oncologists, and medical professionals are at the forefront of how societies deal with harmful disinformation, impacting the quality of life for millions. I hope you are moved to reflect on how you can strengthen the vital role you play to fight malignancy, whether in our bodies or in our minds.

Thank you.

Dr Sanjana Hattotuwa