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October 1, 2019 1131 Samuel P. Trethewey, MBChB, BSc The importance of understanding factors that drive the spread of medical misinformation has been highlighted by recent discourse.1,2 In response to the growing and pervasive threat of medical misinformation, editors of leading cardiology journals collaborated to shine a spotlight on this issue.3 In their commentary, Hill et al3 highlight the responsibility of purveyors of web-based media content to help address medical misinformation. But what motivates an individual or organization to share a specific scientific or healthcare narrative? Motivations are likely to be multifactorial and may be influenced by individual or organizational biases and competing interests. A news organization may be motivated by the need to generate readership, and therefore income, using sensationalist, inaccurate headlines regarding new medical treatments. An additional contributing factor is that individuals may be motivated to share information that they perceive to be both accurate and of social value. For example, misinformation surrounding Cough CPR has been perpetuated for almost 20 years, which, in part, has been facilitated by social media.4 People who share articles endorsing Cough CPR may do so with good intentions because of a perception that the medical advice may benefit others. This is a powerful idea because the perceived validity of information shared online is likely related to the level of trust the reader has in the source. Information shared by friends and family may be more likely to be perceived as accurate by a layperson than an article shared by an independent organization. Moreover, social media can create echo chambers of misinformation where ideas are not challenged and users of social media fall foul to confirmation bias and polarized viewpoints within their social networks.2 Historically, the onus has been on clinicians and academics to moderate the dissemination of medical information. However, dissemination goes beyond conference presentations and publications in peer-reviewed journals; the general public plays a key role. This second stage of dissemination is unregulated and unfiltered and is therefore subject to a high risk of bias. There is no 90% rejection rate after peer review for comments posted on social media platforms such as Twitter, Facebook, or Instagram; comments are available instantly without restriction and are accessible to all indefinitely. In some ways, comments on social media platforms are like a sort of pseudo-peer review: unfiltered comments and unsubstantiated claims or critiques, often made by nonexperts. Anyone can comment on a social media post without giving their credentials. Social media platforms therefore act as an open access publishing forum, with users having instant access to preprints with no mechanism in place to formally moderate claims. This can result in information overload from many sources of variable quality, with Internet search engines such as Google facilitating dissemination. The sheer volume of medical information shared on social media can make it increasingly challenging for laypeople to distinguish fact from fake news. © 2019 American Heart Association, Inc. ON MY MIND