Dr. Salvo Di Grazia is known on the web under his nickname 'MedBunker'. His blog and his presence on various social networks have made him an authoritative bulwark in defence of medicine and the scientific method against the attacks of so-called alternative medicine, pseudo-medical practices and fake news.
Article translated from the original Italian version
The esanum Global Series is a collection of articles that brings together esanum's German, Italian, English and French-language editorial teams to provide a global perspective on the contemporary issues and stories impacting physicians' lives. In our first series, "Physicians in Social Media, the digital frontline", we interview physicians whose daily work, activism, or social media presence, have sparked a full array of responses from within their own professional communities, media platforms, and beyond. Solidarity, harassment, fame and threats, and the human stories behind the controversies, are the focus of this interview series.
Dr Salvo Di Grazia was born in Catania (Italy) in 1967. He is a gynaecologist specialising in human reproductive pathophysiology and colposcopy. For over a decade he has been writing a blog focused on debunking so-called alternative medicines, pseudo-medical practices and myths related to health, with recurrent themes being issues related to homeopathy and vaccinations. His activities to support scientific and medical rigour are a platform to dismantle braggarts and charlatans, who often also have economic interests in circulating fake news around medical discourses, medical news coverage and public opinion.
Dr. Di Grazia has been active on the internet since the days when the web itself could be reached only with a 56k modem. A digital and internet enthusiast, he is known in the cyberspace as the MedBunker, the nickname under which he has signed all the articles on the blog "MedBunker - Le scomode verità" ("MedBunker - The Inconvenient Truths") since 2009. His blog and his presence on various social networks have made him an authoritative bulwark in defence of medicine and the scientific method. We talked to him about his digital activities, his role as a Med-Influencer, the 'haters', and much more.
Nothing was planned, this activity was born a bit by chance. I have always enjoyed surfing the web, I did it even when social networks had not yet taken hold, in the era of blogs and forums. I used to read, get information and take part in discussions. One day, around 2008 I found, on a forum of a fairly well-known website that still exists, a video of an alleged healer who cured tumours and other serious diseases with sodium bicarbonate. This video also contained evidence and testimonies, which I began to analyse and dismantle, pointing out that there was nothing true in that video. A lot of people insulted me for daring to make a scientific analysis of the contents of that video, and I was banned from the forum.
It was then that I realised how naïve internet users were and how dangerous it was for the less health-aware. So I created a blog, a very effective communication tool at the time, which is now a bit out of fashion. It was (and still is) a sort of personal diary where I began to publish the results of my research into the various hoaxes and fake news that were circulating on the web about medicine. In a short time the blog was very successful. At that time, I was one of the first to deal with science on the net. The figure of the med-influencer did not exist.
The advent of social networks and the spread of smartphones has changed a lot the way of providing information and exchanging views on the web. The Internet is now much more present in people's lives, much more within reach. There is a lot more interaction and that makes everything different from when I started. Probably, as far as the possibility to get useful information in the health field is concerned, the Internet today is a worse place than a few years ago.
In fact, on the one hand there are many more physicians, scientists, competent people who have tried their hand at scientific dissemination. On the other hand, however, thanks to the explosion of social networks, the spread of hoaxes, legends, and various falsehoods is now rapid and constant. It is complicated, almost impossible, to succeed in fighting all this fake material that invades the Internet, and social networks in particular, every hour.
Today, compared to when I started, my activity on the web is definitely more demanding. It has lost the hobby dimension it had at the beginning, because the commitment it requires to be done well is really remarkable. When I try to disprove false news, I start studying, delving deeper, looking for updates in the scientific literature. This activity has taken on the dimensions of a second job.
I spend time on it every day. Sometimes a few dozen minutes, sometimes 2-3 hours. It all depends on the free space my professional activity leaves me. Two hours every day is a likely average. It is not my job, it is not required. It is a personal passion that results in a free service that I feel I am rendering to the community.
At the beginning of my activity I was much more optimistic about the results I could achieve. Perhaps I was a little more deluded and idealistic than I am today. I thought, naively, that the presence of a physician on the Internet providing a denial of a hoax, would be enough to destroy it. In reality, hoaxes, fake news, continue to circulate on the web, despite everything.
Over time, my objective has changed. Today, the objective of my web presence is no longer to convince someone, but to inform, to explain why a certain piece of news is false. I think the presence of physicians on the Internet is necessary. Many people who follow me ask for further explanations, clarifications. Many people thank me, especially young mothers, because my information makes them feel reassured when they have to have their children vaccinated, for example. Considering this new objective I have set myself, I can say that my activity is certainly useful.
The presence of an ever-increasing number of competent professionals who make themselves available to the media should lead to an ever-increasing level of accuracy in the medical and scientific information that is broadcast, especially in the generalist media. In this way we should see an increase in the number of news items based on reliable sources. This would have a number of positive repercussions in various areas, including the medical field. In principle, therefore, the presence of physicians in the media is positive for medicine.
The problem is that some of these professionals, however capable and competent they may be in the medical and health fields, have communication difficulties. Communication through the media is different from other types of communication. Moreover, each media is different from the others. In order to be able to communicate well, one must have skills, knowledge, experience.
During the last year we have seen several problems arising from miscommunication, which have led to a real distortion of the message. It happened that the scientific communicator was wrong not in the arguments, but in the way he proposed them. Sometimes even a single word can carry a lot of weight. The appearance of doubt about a vaccine is enough to spread a general fear and undermine an entire vaccination campaign.
Some physicians have studied communication, have experience with the specific tools they use, so they can be effective in sending the message and are not misrepresented. Others, on the other hand, risk their messages having the opposite effect to that intended. This can be dangerous, especially in an age like the one we are living in.
There is more and more a talk of polarisation. It happens that, at a certain moment, when the discussion gets heated, fan sides are created. It happens in every field on the web, and medicine is no exception. It is an approach that does not depend on the subject. Just as there are anti-vaccinationist extremists, there are also the science-centred equivalents. Both reason on the basis of untouchable dogmas. This is not good because it creates opposition, the famous polarisation, which does not benefit anyone, because no one ever moves from their position, even in the face of evidence. In fact, discussion is of no use to anyone or anything. But this is an element inherent in the structure of a social network. Those who manage social networks enjoy polarisation, enjoy the opposition between sides. The more fans we have, the more stadiums are filled.
The short answer is no. If I wanted to give a more detailed answer, I would say that although social networks are not the right place to discuss medicine, physicians must be present because medicine is discussed there. If physicians were not there, many questions would only be answered by those who do not have the expertise, and social networks would be fed to swarms of charlatans spreading false news even more than they already are. Counteraction is needed, and it must be done by those who are competent.
Lots of them.
I used to try a friendly approach in the beginning, even when confronted with aggressive words or tones. I thought that if I was helpful and polite, the other person would tone down the attacks and we would be able to talk in a civilised way. In reality this never happened. Probably those who are violent on the web are also violent in other areas of everyday life, so it is difficult to have a calm discussion. Over time I have realised that there is little I can do about people who are immediately aggressive. Today I ignore them, I don't waste time on them. When they become very insistent I stop them.
Years ago I was insulted and threatened on the web by someone. It was regarding vaccines and autism, if I remember correctly. Then, some time later, I happened to meet this person by chance at a conference. He came up to me and offered me a coffee. He told me that he had reread better what I had written to him, that he had gone deeper into the subject we were discussing and he agreed with me, apologising. Today he has become one of my most active supporters. This is an episode I remember because it happens very rarely.
Absolutely. In some cases the situation is glaringly obvious. Some time ago I criticised an alternative cure for cancer, which was a complete fabrication. The creator of this alternative cure launched a kind of fatwa, pushed his followers against me, telling them to persecute me so that I would disappear from the web and could no longer harm him. Hundreds of people obeyed, a sort of sectarian obedience, and for weeks I received all kinds of insults and threats, some of them very violent. This is one of the many episodes that happened to me. Fanatics who accept some figure as their guru to such an extent that they follow his words obsessively, they even go as far as using emails, Facebook messages to destroy and discredit the opponent, losing all critical capacity.
In the past I used to get a lot of threats. I used to get a lot of worrying messages, threats that more than once made me think and wonder whether it was worth going ahead. I still get them, but today the number has decreased. Today my business is better known, people have probably started to perceive me as a real person who could also react legally. The threats have decreased. The threats I still receive today almost always come from people who do not realise that threats, even serious ones, made on the web are actionable. People who are often not culturally elevated and who, when confronted in person, reduce themselves and many times apologise immediately.
I received many threats, but I never changed my behaviour. I always tried to go my own way, despite everything. But one day I was impressed by an e-mail from someone who had tracked my daily schedule. He had written down exactly what I had done, where I had gone, who I had spoken to. He was an anti-vaxxer who had followed me for a whole day, and what he wrote in the email was actually a true description of what I had done. I recognise that I was quite shaken by that email. Not because I was afraid of that person, I thought he was disturbed, but not dangerous. I was frightened by the idea that, for a purely ideological reason, a person could spend a whole day following me.
Yes, I have filed complaints. In particular, I remember a person who had insulted and defamed me, attacking my profession. As soon as he was informed of my complaint, he immediately contacted me through his lawyer to apologise and to offer me financial compensation. At that time I withdrew the complaint after this person, on my instructions, donated a sum of money to a cancer research association.
It happens all the time. Luckily I have a brother who is a lawyer and I am giving him a lot of work. I often get sued for what I write, but so far all the complaints have been resolved with nothing happening. I never write personal opinions, I write information supported by scientific evidence and bibliographic references. This has always been my strength, and my protection against complaints. When I try to dismantle fake news, I never do so by stating what I think, but by precisely stating the data and facts to support what I want to say.
I have noticed that, recently. Many physicians, individually or in groups, are inventing cures to solve the pandemic, cures that differ from the scientifically established ones. And they are clamouring for the limelight. This is my personal opinion, based on my experience. I think it is a very human, albeit dangerous, attempt to get noticed. Faced with a new disease, caused by a new virus, without an effective standardised cure, many physicians felt entitled to have their say. There was the physician who had no deaths among his patients in intensive care, the physician who treated everyone at home, the physician who gave everyone vitamin D, and so on. As it happens, none of these physicians work in big hospitals, is a renowned luminary, or is an experienced researcher.
The people who find the miracle cure are mostly anonymous physicians, who nobody knows, who sometimes don't even deal with infectious diseases. Without social networks, we would never have heard of them. Social networks give them the audience they need, who wallow in the various 'alternative' groups. My personal opinion is that these people are looking for fame and notoriety. Physicians who are looking for revenge, because maybe life has led them to not become top professionals. At the same time, there is a public hungry for easy-going, easy-to-digest news.
My activity on the web has had a major impact on my daily clinical practice and this is among the elements that motivate me to continue this activity of scientific dissemination there. I am a specialist in gynaecology and obstetrics, but I also cover other topics on the web. During medical school, you study many different topics, but not all of them are covered specifically. Medicine is vast, when you finish university you have general skills, you don't know everything about everything. So to be able to discuss a topic on the web and to do it properly, my basic knowledge is often not enough, I have to go deeper. This web activity is pushing me to review, revise, update on many medical topics. I think that if it were not for this activity, I would hardly have done it so constantly.
The issue of vaccines is one of the most debated topics on the web, so I have been doing a lot of research. I have studied a lot to counter the arguments of the no-vaxers. My knowledge on the subject today is much more extensive and up-to-date than it was a few years ago. I have never positioned myself as a physician who is in possession of the truth. I have always studied, studied in depth, learned, before going so far as to oppose the theories, even the most bizarre ones, found on the Internet. Clearly, in my clinical activity, this work of continuous updating has had nothing but benefits. My hobby of surfing the internet has led me to be a better prepared professional.
I don't remember ever being criticised. It may be that many colleagues have criticised me, but not by talking directly to me. Similarly, I have never received encouragement. To tell the truth, I think my web activity is perceived by most colleagues with a lot of indifference. It is an activity that physicians are not familiar with. The digital world for many physicians, especially Italian ones, is still an unknown world unfortunately. If they use social networks, they mostly use Facebook. From their mobile phones they send a few messages, play a few games, read what their friends or relatives write. They are very far from the idea that through the various social networks they can inform themselves and discuss medicine. They have no idea that with the various social networks you can talk about the same subject, but in a different way and with different people.
Years ago I happened to talk to a colleague about the scientific dissemination I was doing on Facebook. He asked me how much money I was getting. For many colleagues it is very difficult to conceive the idea of a physician who makes himself available to the community in a totally disinterested way to explain medicine. Lately, it has happened that younger colleagues, whether residents or new specialists, recognise me and congratulate me. There is a new generation of physicians emerging in Italy who will probably use the web much more, and I hope much better, than Italian physicians have done so far.
The most important lesson I have learned is that we can all be victims of medical fraud. Everyone, without exception, can become a victim of the various charlatans on the web. There are many variables that can deceive even those who think they are immune from this, including the desperation caused by illness and the fragility of a given moment in one's life.
For those who want to try their hand at this activity on the web, I advise them to always tell the truth and to base themselves on data. It may happen that you misinterpret the data, but if you start from the data, the error will be detectable and circumscribed. If the starting point is not personal opinions, but objective data, studies recognised and validated by the scientific community, it will be difficult to make a mistake.
We hope to inform, inspire, and encourage our readers with these interviews, and we look forward to sharing more fascinating stories from physicians around the world in the next instalments of our esanum Global Series, a joint editorial effort by the teams from esanum.de, esanum.fr, esanum.it and esanum.com.