In the study, more politically knowledgeable people with positive views of Sarah Palin were likely to harden their opposition to the Affordable Care Act (ACA) when presented with information debunking Palin's "death panel" claim, according to the study by Brendan Nyhan, PhD, of Dartmouth College and his colleagues Jason Reifler, PhD, of Georgia State University and Peter Ubel, MD, of Duke University. They write, "These results underscore the difficulty of reducing misperceptions about health care reform among individuals with the motivation and sophistication to reject corrective information."

Can Aggressive Fact-Checking Correct Health Care Misinformation?

The researchers conducted an online experiment to determine if more aggressive media fact-checking could help to correct false beliefs about the ACA. The study focused on "perhaps the most prominent example of misinformation about health reform" -- Palin's 2009 claim that the ACA would create a "death panel" in which bureaucrats would determine whether seniors are "worthy of health care."

One group of survey participants read a news article reporting on Palin's "death panel" claim. The other group read the same article, but with an additional paragraph stating that "non-partisan health care experts have concluded that Palin is wrong."

Participants were then asked about their belief in death panels and support for the ACA. Responses were compared for participants with favorable versus unfavorable views of Palin and for those with differing levels of political knowledge, which was measured using a simple five-question test (e.g., How many times can a person be elected President?).

The participants' feelings toward Palin and their political knowledge both affected their responses to the correction. Among participants who viewed Palin favorably but had low political knowledge, the paragraph correcting the death panel myth led to reduced misperceptions and increased support for the ACA.

But the correction had the opposite effect among Palin supporters who scored higher on political knowledge. "Specifically, among high-knowledge respondents with very positive Palin feelings, corrective information about death panels made misperceptions worse and opposition to ACA stronger," Nyhan and colleagues write.

Difficulties in Overcoming 'Motivated Reasoning' Factual misperceptions are a major problem in debates over controversial health issues, especially health care reform. Several years after passage of the ACA, many people still believe Palin's claim about death panels, even though it has been repeatedly debunked.

Some have argued that the media should be more aggressive in correcting misinformation about health policy. One problem is the difficulty of overcoming "motivated reasoning" -- people have a bias toward uncritically accepting claims that agree their pre-existing attitudes and beliefs, while resisting information that contradicts those attitudes.

The new results suggest that, even with more aggressive fact-checking, it's hard to overcome motivated reasoning. Among partisans who are more politically sophisticated, attempting to correct misperceptions may have opposite of the intended effect, increasing misperceptions about death panels and disapproval of the ACA.

The study has some important limitations, especially the fact that the Internet survey was not representative. "Nonetheless, our findings raise questions about whether corrections can successful overcome entrenched misinformation about health care reform and other controversial health issues," Nyhan and colleagues write.

"As we have seen with issues ranging from diabetes to vaccines, providing correct information may not be effective for members of the public who are inclined to reject the information that is being offered," Nyhan and coauthors add. "It is therefore essential to improve our understanding of misperceptions and how to most effectively correct them."