Online Information of Vaccines: Discussion

Table of Links

• Abstract and Introduction
• Methods
• Web search and content analysis
• Results
• Discussion
• Conclusion and References
• Table 1. Example of classification of webpages
• Table 2. Percentage of vaccine-negative webpages in different SERPs

Discussion

The aim of this research was to investigate whether search engines focused on privacy preservation ranked webpages with higher and/or lower levels of IQ (interpreted as EBM based content i.e. vaccine-positive rather than vaccine-negative) differently to the primary commercial search engines. In turn, this answered the research question “What is the current relationship between search engines’ approach to privacy and the scientific quality of the information they return?”.

The results indicate that currently privacy-enhancing search engines often give more visibility to webpages promoting vaccine hesitancy or with a clear anti-vaccine position than Google. This is in agreement with the findings from a recent study by the Economist which analyzed 175,000 news links returned by Google to demonstrate that the search engine’s algorithm favorstrustworthy publications 20. Reputation and trustworthiness are key factors included in Google’s ranking algorithm. In 2019, Google published search quality evaluation guidelines, 4 which define webpages containing information that may affect the users’ health or financial stability, as “your money your life” (YMYL) pages. These guidelines reveal that when rating YMYL webpages, Google looks at the three criteria of Expertise-Authority-Trustworthiness (EA-T) and states

“High E-A-T information pages on scientific topics should be produced by people or organizations with appropriate scientific expertise and represent well-established scientific consensus on issues where such consensus exists”.

Thus, in the case of Google, the bandwagon heuristic mechanism of assessing medical information credibility is working in favour of promoting IQ. This is perhaps because those responsible for driving up the ‘reputation’ of specific websites by, for example, linking to them, have higher levels of eHealth literacy and therefore act as pseudo-gatekeepers protecting those with lower eHealth literacy from poor IQ results by ensuring that websites providing inaccurate online health information have a low ranking in the search results.

In the case of privacy-preserving engines this appears not to be working – potentially because they do not track ‘reputation’ factors, which could be seen as proxies for IQ and credibility, e.g. clicks and bounce-rate, and so have no gatekeepers (pseudo or otherwise) working to limit the circulation of misinformation. To our knowledge, the algorithms used by these ‘alternative’ search engines are not public - Qwant states that they use their own algorithms5 - but despite this, we found a large overlap between the SERP of Qwant and those of Bing and Ecosia. Likewise, Ecosia and Swisscows showed a similar overlap (70%) with Bing. This means that it is not possible to check what factors determine the outcome of the decision making processes of the search engines algorithms, and hence identify those elements that contribute to circulate misinformation.

Even without being able to check the exact mechanisms for the overall poorer results, the results suggest that, currently, decisions made by search engines to prioritize privacypreservation may have a negative impact on the IQ of results returned to users in health contexts. The pledge to provide independent and unbiased results or not to promote or hide websites based on political or moral interests can be seen as ethically ambiguous, in view of the potential consequences of pointing to scientifically unsound health information.

Medical ethics requires that patients give informed consent before treatment and must, therefore, be informed accurately of the risks and benefits associated with treatment, something that is not possible if the search engine provider used by an individual is returning results with low IQ. From this consequentialist perspective, it is inherently unethical choosing not to interfere with a search engine’s ranking algorithm to ensure ‘manually’ that results of higher IQ are prioritized, whilst those of lower IQ are suppressed. This builds on arguments already made in the wider literature about algorithm ethics 21,22. For example, the Association for Computing Machinery (ACM) code of ethics and professional conduct includes, as a general principle, “avoid harm” along with that of “respect privacy” 23, which aligns with the Hippocratic oath. Specifically, the implication that the current design of privacy-preserving search engine algorithms underestimates the need for evaluation of IQ fits into the wider discussion about algorithmic design and how to ensure design decisions are made to protect and incorporate key values such as IQ. It is necessary, but insufficient, to design search engine algorithms that index purely on ‘relevance’, they must also be designed to index on quality. The challenge lies in the ability to do this in a way that balances the need to accept different perspectives (particularly those that are rooted in different cultural, religious or social ideals) whilst also filtering for IQ. Supporters of such arguments, including the authors, note that this requirement necessitates making the workings of search engine algorithms more transparent 24 to ensure their ethical compliance.

Providing information on vaccines that is based on misinformation or disinformation (including studies whose data or conclusions have been shown to be wrong) is a deceptive practice, which goes against the basic tenets of medical and business ethics 25. This is in line with those who argue that the promotion of ‘alternative medicine’ is unethical because it lacks evidence and transparency of clinical efficacy and should be considered ‘false advertising’ 26. Online service providers have a moral responsibilities to ensure that users access health information that is scientifically validate 27. Misinformation and disinformation concerning healthcare circulating on the internet can have severe consequences and lead to widespread harm. Consider the example of South African president Mbeki, who delayed introducing anti-retroviral drugs in favor of alternative medicine based on information obtained from HIV-denialist internet websites, a decision estimated to have resulted in over 300,000 deaths 28. More recently, a cancer patient died in China after following an alternative, non-approved therapy they found using a search engine 29. In response Chinese authorities issued new rules that require search engines to provide “objective, fair and authoritative results”.

Moral responsibility follows on the level of harm that misinformation and disinformation on healthcare may cause. It could be argued that there is a greater onus on Google – and other commercial search engine providers – than on alternative search engines to take these considerations into account when designing or interfering with algorithms for the purposes of promoting ethical compliance, given their larger market share. Google currently has over 90% of the worldwide market share6 and therefore has the potential to indirectly ‘cause harm’, through the potential promotion of low IQ webpages on vaccinations, to a great many more people than any of the alternative providers.

However, studies have shown that those who hold anti-authoritarian views, openness to (potentially) controversial opinions, and an interest in alternative medicine are, in some cases, already more likely to hold vaccine-hesitant beliefs 30. These are also the individuals who are most likely to use alternative search providers given their sensitivity to privacy and tracking concerns. Therefore, while the alternative providers might reach a proportionally smaller audience – they are reaching an audience that is already more receptive to antivaccine information 31, and therefore more vulnerable to its effects. In other words, unless the alternative providers take steps to rank vaccine-related search results according to IQ, they may cause greater harm to those they do reach, meaning that the net negative impact is still greater even though the number of individuals they reach is smaller.