No one’s safe from the “Twitter bomb” – not even a public health campaign.

The Chicago Department of Public Health was subject to some serious astroturfing earlier this year, a new study found – Twitter users bandied about the state’s more stringent e-cigarette policy, but many were likely from false accounts to help strengthen the opposition’s voice.

That’s what astroturfing‘s all about – developing an internet persona that appears to be from a grassroots organization, when it’s really backed by a corporation. It’s a misleading practice that’s pretty widespread in business, and by extension the business of health care.

The paper, published in the Journal of Medical Internet Research, is a case study of the internet backlash against Chicago’s e-cigarette policy.

This past January, the Chicago City Council scheduled a vote to regulate electronic cigarettes as they would tobacco products. A week before that, the Chicago Department of Public Health, or the CDPH, tweeted out a number of messages about e-cigarettes, such as the tweet below.

Note the various responses to that one message.

Electronic cigarettes contain a dangerous, addictive drug & should be regulated like other nicotine products #ecigtruths — ChiPublicHealth (@ChiPublicHealth) January 8, 2014

The study found that of the 683 tweets that mentioned the CDPH that week, 609 went against the local e-cigarette policy. More than half of these discussed how using e-cigs are a healthier alternative to standard smokes. About a third of the dissenting tweets “asserted that the health department was lying or disseminating propaganda,” the report says.

But this is a touch disturbing:

Approximately 14% (96/683, 14.1%) of the tweets used an account or included elements consistent with “astroturfing”—a strategy employed to promote a false sense of consensus around an idea. Few Twitter users were from the Chicago area; Twitter users from Chicago were significantly more likely than expected to tweet in support of the policy.

Indeed, the paper continued to say that “four of the five central retweet network members were affiliated with e-cigarette businesses or advocacy groups, which may have credibility among supporters of e-cigarette use.” While emails and phone calls impact legislative voting behavior, evidence is starting to anecdotally show the enormous impact social media is having on public opinion, which by extension could impact public health policy. The entire discussion’s worth a read.

This isn’t the first instance of astroturfing in the health arena, of course. Lifestyle Lift, a cosmetic surgery company, pissed off the New York attorney general’s office in 2009 for creating falsified reviews for its facelift procedure. To make up for the false advertising, the company had to pay a $300,000 fine to the state. New York’s then-AG said the “attempt to generate business by duping consumers was cynical, manipulative and illegal.”

The same rules apply for a public health concern like lung health – or even for big pharma when they recruit patients to advocate on their behalf. It’s an important lesson to learn that in this era of social media everything, there’s a fine line between drumming up support and killing credibility. Gotta wonder though – where else is astroturfing making waves and changing opinions?

Of course, I’m not knocking everyone who went against the CDPH’s policy. Fair point: