Mistrust and Misinformation in Medicine—Causes and Consequences

November 08, 2022

Information

October 6, 2022

Dhruv Khullar, MD, MPP

ID8239

To CiteDCA Citation Guide

00:00My name is Mark Mercurio.
00:01I'm the director of the
00:03program for Biomedical Ethics.
00:04And on behalf of myself,
00:06our associate directors,
00:07Jack Hughes and Sarah Hall,
00:09and our manager,
00:10Karen Cole, welcome.
00:11This is, as I mentioned a few minutes ago,
00:13our first hybrid session for the year.
00:15And I am very grateful to those
00:17of you who came here in person so
00:19we can have a live studio audience
00:20for Drew and also grateful for
00:22those of you who run the zoom call.
00:24So thank you very much for those of
00:27you who are new to our format here and
00:29new to our seminars we do this about.
00:31Twice a month and there is a schedule you
00:33can access at biomedical ethics at Yale,
00:36on the Internet,
00:37and we have a mailing list.
00:39You can certainly reach out to me or
00:41to Karen to to get on the mailing list.
00:44We
00:45are very happy for your participation,
00:47and I'm particularly happy about tonight.
00:49And I know Jack is too.
00:52A few years ago now,
00:53more than a few years ago,
00:54Jack and I together led a
00:57trip called fast Speed Trip.
00:59This is the fellowships at all.
01:01This is for the study of professional ethics,
01:03which is a bit of a longer story,
01:05but it's a marvelous opportunity for
01:06a select group of medical students
01:08from all over the country to spend 2
01:10weeks overseas studying professional
01:11ethics as well as the history of the
01:14physicians complicity and participation
01:15in the atrocities of the Nazi era.
01:18And this is a a marvelous program that Jack
01:20and I have been involved with for years.
01:21And in fact one of the academic leaders
01:23of this is our own Nancy Angoff,
01:25who's also here tonight.
01:26And some years ago,
01:28we were very fortunate to make
01:30the trip with a truly outstanding
01:31medical student named Drew Kular.
01:33And and just watch how things go.
01:35When Drew was a medical student here at Yale,
01:37he had gone to college here at Yale.
01:39So a lot of you are wondering
01:40that anybody who went to college
01:41at Yale ever amount to anything.
01:42And the answer is, yeah, Drew did.
01:46So we had a a marvelous experience with
01:48Drew and we weren't at all surprised
01:50that he went on to do great things.
01:52He did his residency up at the
01:54Mass general and he's been on the
01:56faculty at Cornell for some time now.
01:58And it was not long ago I was just
02:00telling Drew that I just happened to
02:01stumble across something he had written
02:02in the New York Times a few years ago.
02:04And what a great pleasure that
02:05was just to happen,
02:06to see one of your former students names
02:08on the byline at the New York Times.
02:10And Drew has done quite a bit of
02:12writing since and policy work,
02:13so to for a more formal introduction
02:15of one of the most.
02:16Impressive medical students I've had
02:18the pleasure to teach drive collar is
02:20a physician and assistant professor
02:22of health policy and economics
02:23at Weill Cornell Medical College.
02:25He's also a writer at The New Yorker,
02:27where he writes about medicine,
02:28healthcare, and politics.
02:29He currently serves as the Director of
02:31Policy dissemination at the Physician
02:34Foundation Center for Physicians
02:35Practice and Leadership and was
02:37recently a senior Research fellow at
02:39the New York City Health and Hospitals.
02:41His research focuses on value based care,
02:44health disparities, and medical innovation.
02:46And has been published in JAMA and
02:48the New England Journal of Medicine.
02:50Drive,
02:51as I mentioned,
02:51went to college and medical school
02:53here at Yale,
02:54did medical training at Massachusetts General
02:56Hospital and at Harvard Medical School.
02:58He also received a master's in public
03:00policy from the Harvard Kennedy School,
03:03where he was a fellow at the
03:04Center for Public Leadership.
03:06He's been recognized by LinkedIn as among the
03:09top ten healthcare professionals under 35,
03:12by the National Minority Quality Forum
03:14as a 40 under 40 leader in health,
03:17and by FAST for the organization
03:18I just mentioned with the 2019.
03:21Distinguished fellow award
03:22for ethical leadership.
03:23It is with great pleasure that
03:26I introduce you to Drew Kular,
03:28who's gonna speak to us for a bit
03:30about the misinformation in the
03:32medical setting and then we'll have
03:34a conversation the way this typically
03:35works and the way it's going to
03:36work tonight now because again,
03:37this is our first hybrid session.
03:39Is Drew will speak for about 45 minutes
03:42plus or minus and after that we will
03:45sit here and I'll moderate Q&amp;A session.
03:47If you have a question or a comment,
03:49please raise your hand.
03:50Karen will be walking around
03:51with a microphone.
03:52Please wait for the microphone,
03:54obviously at a courtesy to
03:54everybody else so they can hear you.
03:56But also now for the folks
03:57who are here on zoom,
03:58so they can hear you and we
04:01can have a conversation,
04:02you can ask him anything you want now.
04:05And I'll also be looking at the
04:06zoom callers for questions there.
04:08So for the folks on zoom out.
04:09Ask you to please send your questions
04:11through the Q&amp;A portion and I'll be
04:13going through those while Drew is
04:15speaking during the second portion
04:16to pick out questions for him.
04:18So introduce you now Dr Kullar.
04:48Thanks so much Mark.
04:49It's it's so good to be back at Yale.
04:52I can't tell you how much it means
04:54to to see old professors and to just
04:56get off the the Metro-North at Union
04:59Station and and you know coming back
05:01here always makes you feel kind of very
05:04viscerally what a special place Yale is.
05:06And and I think while you're here
05:07sometimes you can you can lose sight
05:09of that and when you leave you
05:11can you know you don't appreciate
05:12that as much but then coming back
05:14really really drives it home.
05:16So thank you for the opportunity to
05:18come come back and speak with you all.
05:19So I wanted to talk about misinformation
05:22and particularly misinformation in the
05:24medical setting and in public health.
05:26And it's something that obviously
05:27is on the minds of a lot of people,
05:29particularly during the COVID-19
05:31pandemic with the rise of social media.
05:34But the more I thought about it,
05:36the more it seemed that you can't really
05:38understand the story of misinformation
05:40without understanding the story of
05:42mistrust and distrust in society and
05:44what has happened over the past few decades,
05:47because it's clear that misinformation.
05:50And disinformation really thrive and
05:53flourish in settings where trust is lacking,
05:57where people don't trust institutions, where
05:59they don't trust the people around them.
06:01There becomes kind of a vacuum that is
06:04filled with poor quality information.
06:06So I want to start the talk by
06:08talking about mistrust,
06:08and then we'll kind of transition over to
06:11to to some issues around misinformation.
06:14This is an ethics seminar,
06:15so I'm going to disclose my conflicts
06:18of interest up front.
06:20So I I have grants,
06:21none of which are are related
06:24to misinformation or mistrust,
06:25and unfortunately, no commercial conflicts.
06:29OK, So what are we going to talk about today?
06:31I want to talk about three main things.
06:33The first is to describe trust and
06:36mistrust in institutions in the United
06:38States over the past few decades.
06:40The second is related, but is this idea of?
06:44Trying to understand the environment
06:46in which medical misinformation can
06:48flourish and why it's spreading,
06:49in part because, as we'll see,
06:50the massive decrement in trust in nearly
06:53every institution in the United States
06:55and 3rd is to discuss possible avenues
06:58to minimize the harm of misinformation.
07:00And I view this section as as very
07:02much a work in progress because
07:04I don't know how to do it,
07:05and I don't think anyone knows how to
07:08do it in a really effective way yet.
07:10But I think there are some ideas that
07:12are intriguing and over hopefully
07:14over the next few years.
07:15We'll we'll come up with evidence
07:18based strategies that actually
07:19minimise the harm that's caused by
07:22by poor quality health information.
07:24So we're at a medical school.
07:25I want to start with a medical mystery.
07:28This one starts in the early
07:301980s in in in Chicago.
07:34And so on September 29th,
07:361982,
07:36a 12 year old girl named Mary Kellerman,
07:38she woke up with a cold in
07:40the Chicago suburb area.
07:43Her parents gave her some Tylenol out
07:45of a out of two two capsules of Tylenol
07:49and the next morning she had died.
07:53That same day, a 27 year old man he was
07:55supposed to worker named Adam Janis,
07:58he developed discomfort in his chest.
08:01He passed away.
08:02People thought that it had been some kind
08:05of freak early heart attack and his,
08:07his family comes to his home.
08:09They're mourning, they develop,
08:11you know, headaches, they're crying.
08:13Both his brother and his sister-in-law take
08:16Tylenol from the same bottle that Adam used.
08:20And by the end of the week both
08:22of them had also. Passed away.
08:25So over the next couple of days,
08:27there are three more mysterious deaths
08:29of this nature in the Chicago area,
08:32each of them linked to someone taking
08:35a Tylenol from from a recently
08:38purchased bottle of Tylenol.
08:40So a few facts come to the forefront.
08:42The first is that Tylenol was
08:45laced with cyanide.
08:46As you can imagine,
08:48this causes widespread disarray and
08:51alarm across the United States.
08:54There are more than 100,000 stories in
08:57newspapers about the Tylenol crisis.
09:00In the coming weeks,
09:01there's hundreds of hours of
09:03television dedicated to this story.
09:04More than 90% of Americans hear about
09:07cyanide laced Tylenol that's killing people.
09:10In Chicago,
09:11and by some estimates,
09:12this story gets more coverage than
09:15any story in the United States
09:18since the JFK assassination.
09:20OK,
09:20so Johnson and Johnson has a
09:22crisis on its hands.
09:23Obviously,
09:23it's a it's a tremendous tragedy
09:25that they're dealing with,
09:27but they also have a financial
09:29calculus at play.
09:30The first thing to note is that
09:32Tylenol accounts for nearly 20% of all
09:34of Johnson and Johnson's profits in 1982.
09:37Tylenol accounts for nearly 40%
09:39of the analgesics market share
09:41in the United States.
09:42So if Tylenol were its own company,
09:45its profits would place it in the
09:47top half of Fortune 500 companies.
09:49So there's a massive amount of money.
09:51At stake in this crisis?
09:55So a few facts emerge over
09:57the next couple of days.
09:58The first is that the tampering
09:59is not occurring at the
10:01Johnson and Johnson facility.
10:02There's nothing wrong with what
10:03they're doing at the facilities.
10:05It seems like someone is
10:06sneaking in to these pharmacies,
10:08opening up the capsules,
10:10putting cyanide inside and and and
10:12that's the way that this poison is
10:14spreading throughout the Chicago
10:16area and there are no cases
10:18anywhere else in the United States.
10:20So Jim Burke,
10:21who's the chairman of Johnson and Johnson,
10:24he has a few decisions to make,
10:25and his behavior in the next few
10:28days and weeks and months is often
10:31thought of as a model for how to
10:33regain trust that has been lost.
10:36And so he actively engages the media.
10:38He's out there talking to people
10:39as much as he can.
10:41Johnson and Johnson establishes
10:42a hotline for customers and
10:44news organizations to call in
10:45to get up-to-date information.
10:47They recall every bottle of
10:48Tylenol in the entire country,
10:50not just in the Chicago area.
10:52And they introduce new tamper resistant
10:54packaging for all their products,
10:57not just for Tylenol.
11:01I don't know if this is gonna
11:02work, but I'm gonna try it.
11:07Can you guys see this on zoom?
11:10I guess they can't answer it.
11:15We can see it.
11:21That's always good advice.
11:22There we go. OK, there we go.
11:25Yeah. OK, great.
12:49Alright, so we'll we'll stop there.
12:53OK. So, so Jim Burke is out front,
12:56he's he's doing these things.
12:57And as I mentioned it,
12:59it's very successful.
13:00So it becomes a model for crisis management.
13:04Tylenol sales as you might imagine
13:06plunged the 7% of the analgesic
13:08market after the crisis and then
13:10within a year it's back to baseline.
13:12So basically they are exceeding
13:14Tylenol sales within a year.
13:16The following year Congress passes
13:17in part because of the work that
13:20that he and and Johnson Johnson
13:22had done passes the Tylenol bill.
13:23Making it a federal offense to
13:25tamper with consumer products.
13:27A few years later,
13:28FDA establishes federal guidelines for
13:31manufacturers of all products that are
13:33sold in this way to be tamper proof.
13:35So it's it's it's really a
13:37success story in this way.
13:39But what I wanna focus on and what I'm,
13:41you know, curious about,
13:42is there a way to get rid of this here?
13:49You know, I think what I want to focus
13:51on is trying to understand, you know,
13:54could this have happened today,
13:55or at least how different would it be
13:58for for an organization or corporation
14:00to go through something like this
14:02and regain the trust of the public?
14:04And there's a few reasons that I think
14:06it would be far more difficult than it
14:08is far more difficult. The first is,
14:10as we'll talk about in a minute,
14:11the crisis of trust in institutions.
14:13And I should say, not just a crisis
14:15of trust on part of the public,
14:17but I think a crisis of trustworthiness.
14:19On the part of corporations
14:20and some institutions as well,
14:22Johnson Johnson itself recently
14:24reached a $5 billion settlement
14:26for its role in the opioid crisis.
14:29So this isn't just a unidirectional
14:31why don't,
14:32why doesn't the public trust these
14:35institutions or these corporations?
14:36There's something going on in
14:38terms of trustworthiness as well.
14:40The second point is around
14:42deepening political polarization.
14:43And not just polarization,
14:45but negative tribalism.
14:46Negative polarization,
14:47meaning you don't just like your
14:49team and want to root for your team.
14:50You hate the other team,
14:52and part of what you want to
14:53do is see the other team lose,
14:55not just seem at your own team win.
14:58The third factor, I think,
14:59is economic inequality and
15:00worsening economic inequality.
15:01The feeling that a lot of
15:03people are being left behind,
15:05that their wages are stagnant,
15:06that the gains in the economy
15:08are realized by a very small.
15:11Trust of society.
15:12And that understandably creates a level
15:15of resentment against people who are
15:18perceived to be gaining a lot more,
15:21and perhaps unjustly.
15:23The 4th factor I think is the
15:25splintering of the medial ecosystem.
15:26So Jim Burke back in the day
15:28would go and speak with three
15:30or four or five news anchors.
15:32And today that's completely different in the
15:35area of Twitter and Facebook and you know,
15:38thousands of new media organizations
15:41and also the cratering of old
15:44traditional legacy institutions that
15:46were based in local communities,
15:49a lot of newspapers that were
15:51kind of the heart and soul.
15:53Helping people understand what
15:55was going around on around them.
15:57They have gone out of business
15:58over the past one or two decades.
16:00Obviously,
16:01the rise of social media,
16:02we'll talk a little bit about that.
16:03All this creates an environment
16:05in which misinformation and
16:06disinformation can thrive.
16:11OK, so let's talk a little bit
16:13about trust and step back and think
16:15about why trust is so important.
16:17So the first thing to recognize,
16:19I think, is that trust has elements
16:21of both risk and vulnerability.
16:22Now, if you have nothing at risk,
16:24whether it's your reputation or your mental
16:26piece or your health or your livelihood,
16:28there's no reason to
16:30trust that trust kind of.
16:32You have to have some level,
16:33something at stake in order to trust
16:35that someone will treat you in a
16:37way that you want to be treated.
16:39Trust is also voluntary, so.
16:42If you involve, if it's involuntary,
16:44it's really just dependency.
16:45So trust has to be given in a
16:48voluntary manner and it's prospective.
16:49It's an assessment of the way that
16:51things might go in the future as
16:53opposed to satisfaction or discontent.
16:55Those are appraisals of how
16:56things went in the past.
16:57And then finally,
16:58of course trust is malleable.
17:00You know it.
17:01It doesn't take a lot to to destroy
17:03trust and it takes a lot to to to gain
17:06it back after it's been destroyed.
17:08OK, so here's a skeptical view by by
17:11Doctor Edward Deming, statistician.
17:13He says in God,
17:14we trust all others must bring data.
17:17And I think as scientists, as doctors,
17:18as clinicians, actually we, we,
17:20we tend to think a lot in this way and that,
17:23you know, we want to see the data
17:25before we we believe something.
17:26But that's not actually the way I
17:28think most of society operates.
17:29That's not even the way that
17:32we really operate.
17:33So I think it's much closer to Kenneth era,
17:36the Nobel Prize winning economist conception.
17:38Which is that virtually
17:40every commercial transaction,
17:42and I would say commercial,
17:43social, medical transaction,
17:45has within itself an element of trust.
17:48Much of the economic backwardness
17:50in the world can be explained by
17:52the lack of mutual confidence.
17:53So think about just something as
17:55simple as going to get a haircut and
17:57how much trust is embedded in that.
17:59You don't even think about the millions
18:02of little things that you are trusting in.
18:04Maybe not millions,
18:04but at least dozens, right?
18:05So you put your credit card
18:07information into the Uber app.
18:09We trust that it will be secure and private.
18:11You call the Uber, you open the door,
18:14and some complete stranger asks
18:15you to get in their car.
18:17You get in their car.
18:18You trust that they're they're,
18:19they're not going to kidnap you.
18:20You then trust that that the Department
18:22of Motor Vehicles has given them a
18:24license and they are a sensible driver,
18:26that they're not going to run red lights,
18:28they're not going to get into an accident.
18:30You get to the haircut, the hair salon.
18:32You meet the Barber.
18:34You never met this Barber before.
18:35He's going to take scissors and wheel
18:37them within millimeters of your head.
18:39He's not gonna you think.
18:40He's not gonna cut off your ear.
18:41He's not gonna harm you in any way.
18:43And then you give him some,
18:44some cotton in your pocket as some paper,
18:47and it's worthless,
18:48only that everyone believes that it's money.
18:51And every the entire kind of economic system
18:54depends on trust in the US dollar, right?
18:57So. So. So I think we just don't even
19:00think about and assume all the ways in
19:02which trust is really central to the
19:05functioning of society and why it's so
19:08devastating that trust has declined.
19:09So many different areas.
19:12OK, so, you know, I think that,
19:15you know, trust can feel mushy,
19:17it can feel complicated.
19:18But I think it really comes down
19:20to three questions and the ability
19:21to answer 3 questions for people.
19:23And I think about this in
19:25the patient care setting.
19:25I think about this more broadly
19:27in the public health world.
19:29So the first is this idea of
19:30competence you want to answer.
19:31Do you know what you're doing?
19:33And you want.
19:33It's very hard to trust someone if you
19:35don't think that they're competent,
19:36that they know what they're doing.
19:38The 2nd is a question of transparency,
19:40and it's this idea of will you tell me?
19:42What you're doing,
19:43you might know what you're doing,
19:44but if you're completely opaque about it,
19:46it's also very hard to trust someone.
19:48And the third is,
19:49are you doing it to help me,
19:50or are you doing it to help yourself?
19:51It's a question of motive.
19:52So I think competence,
19:54transparency, and motive.
19:55You know,
19:56I've I've recently done some
19:57writing about vaccine hesitancy
19:59and why people are so hesitant.
20:00And there's all sorts of reasons,
20:02of course,
20:02but one thing that came
20:04up a lot was this idea of.
20:05Pharmaceutical corporations making
20:06a lot of money and pushing out
20:09these vaccines on people and and
20:10you know that is something that is
20:12on the minds of a lot of people.
20:13And so this idea of motive I think
20:16still is really important to think
20:18about as we're communicating
20:19about science and public health.
20:24So let's talk about some very depressing
20:26slides about trust and institutions.
20:28The first one here is trust
20:30in the federal government.
20:31This is some polling from Pew.
20:33It basically asked, you know,
20:35do you have, do you trust the
20:37government to do what's right,
20:38at least most of the time?
20:40So as you can see in the
20:42Eisenhower administration,
20:43the Kennedy administration,
20:44even the Johnson administration back then,
20:46trust to for the federal government to do
20:48what's right most of the time, 70 to 80%.
20:51That has declined precipitously
20:53over the past. 50 years.
20:57There's obviously a partisan aspect to this.
20:59So as you can see,
21:00you know when your own party is in power,
21:03you're more likely to trust the government.
21:04When the other party is in power,
21:05you're less likely to trust the government.
21:07The red squiggles are higher
21:08during the Reagan administration.
21:10The blue struggles, squiggles are
21:11hired in the Obama administration.
21:13That all makes sense.
21:14But I think what's important to note,
21:16and what's particularly damaging here,
21:17is that trust in the past when the other
21:21party was in power was higher than trust.
21:24Now when your own party is in power, so.
21:26So Democrats under Eisenhower had way
21:29higher levels of trust than Democrats
21:31do under the Obama administration.
21:34Right at the lowest point of Republican
21:36trust in the Johnson administration,
21:38right.
21:38Remember Vietnam here,
21:39if you remember kind of the
21:41turmoil of that period,
21:42the lowest point of trust among Republicans
21:45in the Johnson administration will still
21:47higher than Republicans trust in the
21:49government during the Trump administration.
21:50So.
21:51So this is something that has
21:52a parse and valence to it,
21:54but but it's a it's a broad secular trend.
21:58OK, let's look at trust the media.
22:00Trust the media in 1976 was 72%.
22:03This is not a huge,
22:06a very high bar.
22:07How much trust and confidence you
22:08have in the mass media when it
22:10comes to reporting the news fully,
22:11accurately and fairly,
22:12at least a great deal or
22:15at least a fair amount.
22:17So just a fair amount is
22:18what we're looking at.
22:19Not even not a super high bar.
22:22So in 76 it was 72% that doesn't,
22:25it's not totally surprising.
22:27This was after Watergate kind of the.
22:28You know the high point I think of
22:30of of American journalism today
22:32that is down to about a third.
22:35So only about 1/3 of Americans have even
22:37a fair amount of faith that the mass
22:40media is doing fair and accurate reporting.
22:42Again,
22:43there's a huge partisan divide here.
22:46And so what's interesting to note is,
22:48you know, even 20 years ago,
22:49if you look back 1997,
22:51nineteen 99, you know,
22:5459% of Democrats said that they have a
22:56fair amount of trust in the mass media,
22:5752% of Republicans not a
22:59huge discrepancy over time.
23:01As you can see,
23:02Democrats have actually developed
23:04more trust in the mass media and the
23:06Republican support has totally cratered.
23:0811% of Republicans have trust
23:11in the mass media.
23:12And it's important to note that
23:14independents are closer to Republicans
23:15than they are to Democrats.
23:19Alright, getting closer to home, science.
23:21So science is, is it's a good story right.
23:24So look back in 75,
23:27you know do you have quite a lot
23:28of trust or a great deal of trust,
23:30confidence in science,
23:3170% of US adults say yes,
23:34now it's 64%, so not a huge decrement.
23:36This is on par with some of the most
23:38trusted institutions in the United States,
23:40small businesses and the military.
23:43This is a little bit less satisfying.
23:46So as you can see again,
23:48what has happened here is that Democrats
23:51and liberals now have more trust than
23:53they did 50 years ago, 40 years ago.
23:56Independents have declined modestly.
23:58Republicans have totally cratered a 30
24:00point decrement in their trust in science.
24:03And I think what's important
24:04to note is back in 1975,
24:05Republicans had more trust in
24:07science than the Democrats.
24:09You 72% of Republicans say
24:11they trust science, only 67.
24:13Percent of Democrats, you know,
24:16there's an interesting story
24:17to be told here in that,
24:18you know,
24:19around that time there's a distinction I
24:22think some sociologists have made between
24:24production science and impact science.
24:26So back in the post war era,
24:27there's this huge swell
24:29of production science,
24:30production scientists,
24:31things that are thought to fuel
24:34the economy that, you know,
24:36influence our military might that,
24:40you know, are able to develop
24:42new technologies that might be.
24:43Helpful and interesting.
24:46That overtime shifted somewhat.
24:47I mean,
24:48that's still happening to impact science.
24:50What are the consequences of these things,
24:52the most obvious one being
24:54something like greenhouse gases,
24:55but other things like pesticides,
24:57carcinogens,
24:57the unintended consequences of science.
24:59As that happened,
25:01it ushered in also more regulation
25:04and things that are kind of
25:07anathema to conservative ideals.
25:10And so that I think is,
25:11is part of the story here.
25:12In any case, huge partisan divide.
25:15All right. Medicine.
25:17OK.
25:17So confidence in medical leaders,
25:20this is particularly distressing.
25:21So in the 60s,
25:23about 75% of Americans had great confidence.
25:27Today, that's about 1/3 great
25:30confidence in medical leaders.
25:33How about doctors in your country?
25:34So this is an international perspective.
25:37Switzerland, 83% of the Swiss,
25:39they're very trusting,
25:40strongly agree or agree that
25:42their doctors can be trusted.
25:43Britain, you know, comparator countries,
25:4676% US was down at 2424,
25:49so only less than six in ten Americans.
25:52I think that medical professional
25:53can be trusted.
25:54I want to throw in a caveat here,
25:56which I think is is a reason for
25:58hope and potentially a way that we
26:00can kind of rebuild some of this.
26:02The US actually has very high levels
26:04of satisfaction with your own doctor.
26:06So you may trust this,
26:07trust the medical profession in general.
26:09You may distrust healthcare,
26:10but they have among the highest levels
26:13of satisfaction with your own doctor.
26:15So it's kind of like people hate Congress
26:17but they love their own congressmen.
26:18It's like a similar type of thing
26:20going on here where people do trust
26:22in the relationship they have with
26:23their own clinicians.
26:24And I think this gets back to
26:26the power of relationships.
26:27So both parties without parse
26:29and differences, very high levels
26:31of trust and healthcare workers.
26:32That they personally know.
26:35And Even so, even though doctors
26:37in the United States generally
26:38may not have as high levels of
26:40trust as some other countries,
26:41and public trust and doctors and nurses are,
26:43is still much higher than the
26:45rest of the healthcare system,
26:46and they are among the most trusted
26:48professions in the United States.
26:51So Kaiser last year did a poll,
26:53and this is a poll just of people who
26:54are on the fence about vaccination,
26:56about COVID vaccination.
26:57Where are you going to turn to figure
26:59out whether you don't want to get vaccinated?
27:01By far,
27:02your own personal doctor or your own nurse,
27:04some healthcare provider?
27:05About 8:00 and 10:00 of those people
27:07who who are have some level of
27:09vaccine hesitancy said that they
27:10would return to their own clinician.
27:12So I just want to keep this in the
27:14back of our mind as we're thinking
27:15about ways to try to rebuild trust
27:17or counteract some of the medical
27:19misinformation that's spreading.
27:20Across the country.
27:24Alright, so kind of a summary slide here,
27:26thinking about the consequences of
27:29mistrust in American institutions.
27:31Why is it so problematic?
27:32I think at heart what it does is
27:35it creates a legitimacy vacuum.
27:37There is no objective
27:38sources of truth any longer.
27:41There's a real fracturing of narratives.
27:42So because there's not a kind of
27:45centralized or several, you know,
27:47institutions that people say, OK,
27:49when I don't know what's going on,
27:50I can really trust this.
27:51There's a huge fraction of narratives,
27:53people.
27:53Select their their media sources
27:55that tell them what they want,
27:57or they simply, you know,
27:59do what the people around them are doing.
28:01And those people may be influenced
28:03by by kind of pernicious sources.
28:06And then there's lack of shared purpose.
28:07There's no coherent shared story
28:09that people can feel good about that
28:11they're part of some collective thing.
28:13We're all part of the same project,
28:14and I think all these things
28:16create an epistemic environment,
28:17an environment of knowledge,
28:19and the transmission of information in
28:21which misinformation can really thrive.
28:24There's two authors that I just
28:25want to highlight here who I
28:27have a lot of respect for.
28:29And what they're talking about here
28:30is not just that misinformation
28:32or bad information is out there,
28:34but actually the processes by
28:36which a society comes to figure out
28:38what is true and what is false.
28:41Those processes are what have been degraded.
28:43And so Jonathan hate here says
28:45in the righteous mind,
28:46if you put individuals together in the
28:48right way such that some individuals
28:50can use their reasoning power to
28:52disconfirm the claims of others,
28:53and all individuals feel some.
28:55Common bond or shared fate that
28:57allows them to interact civilly.
28:59And you can create a group that ends
29:01up producing some good producing
29:02good reasoning as an emergent
29:03property of the social system.
29:05So really talking about it's not your
29:07own powers of reasoning but really
29:10this idea of almost peer review.
29:12You know,
29:13getting the best people to point and
29:15poke holes in other people's theories
29:17and that's how we kind of move forward.
29:20Another Jonathan, this time Jonathan Rauch,
29:22who I also really like.
29:24He has this both the
29:25Constitution of knowledge.
29:25Like if you haven't read it,
29:27I would highly recommend it,
29:29he says the reality based community is
29:30a is the social network and he he talks
29:32about social networks on the online sense,
29:34but but kind of in in person social networks
29:37which adheres to classical liberal science,
29:40not not not political liberal.
29:43Rules and norms, objectivity,
29:46factuality, rationality,
29:47they live not just within
29:49individual minds and practices,
29:50but on the network.
29:51So again,
29:52getting at this idea that you know,
29:54we often think that we make
29:55decisions by ourselves,
29:56that we understand the world
29:58because we are researching things
30:00in in in in an individualistic way.
30:02But actually it is the network,
30:04the the social milieu,
30:06in which we kind of test different
30:09theories and and iterate upon
30:12what we know and what we don't know.
30:14That gets us to A to a better place.
30:16And this type of thing, he says,
30:18you know, applies not just to
30:19science but to scholarship,
30:20journalism, government, law,
30:21these are these are kind of the reality
30:23based communities that he's talking about.
30:26Alright, so that's kind of the,
30:27I think the, the baseline in terms of
30:30we're in a really bad place with the trust,
30:32trust in almost all institutions
30:34that's created over the past
30:36few decades and now we have,
30:38we have this rise of medical misinformation
30:40in part fueled by social media.
30:47OK, first thing to note is that this
30:50information, we talk about it a lot now,
30:52but it's actually a very, very old problem.
30:54There's probably been medical
30:56misinformation for as long as there's
30:58been medicine in some capacity.
30:59I came across this, this Bureau of
31:03Investigation that the AMA opened in 1906,
31:06and this Bureau was really dedicated
31:08to quote, exposing quacks,
31:10analyzing suspicious nostrums,
31:13and alerting both the medical
31:14profession and the public.
31:15To unscrupulous promoters.
31:17So the language is a little antiquated,
31:19but the general themes are things that
31:21that we want to be doing, I think.
31:22And this Bureau was in existence
31:24for six or seven decades, really.
31:25And it published articles about
31:27deceptive medical claims that
31:29responded to questions from the public,
31:31worked with federal agencies like the
31:33FDA and the Federal Trade Commission,
31:35and it's served as a resource
31:37for journalists who are writing
31:39about complex scientific issues.
31:41They could call up this Bureau
31:42and sign and get someone on the
31:44phone I was going back through.
31:46Some interesting articles
31:47that were published in Java.
31:49This one was JAMA 1919.
31:52So a few years after this Bureau opened
31:53and they published this article and
31:54just to give you a sense of what,
31:56what what types of things that
31:57they were doing at that time.
31:58So this article started the
32:00propaganda for reform.
32:01This was pre World War Two.
32:03So propaganda just meant,
32:04you know information not not kind
32:06of what it means.
32:07Now this is a mist or Murray's infallible
32:10system tonic it could they did some
32:13evaluations analysis contains mercury,
32:15licorice.
32:16And this guy got a fine for $25
32:18Doctor Bedlington 6 Prairie
32:21herbs sold in Minneapolis.
32:22Government chemists reported that
32:24the odor and taste suggested that
32:26of highly diluted and sweetened
32:28whiskey also fine of $10 here.
32:30And this is the real ivermectin of the day.
32:33So Kilmer, Swamp root,
32:35this cures Bryce disease,
32:37acute nephritis, cancer of the liver,
32:38acute and chronic gonorrhea,
32:40my favorite part etcetera.
32:42So Phil and Phil had to have the,
32:44the disease that you want to be cured here.
32:46He got a fine of $150.00.
32:48So anyway,
32:49the point is people have been dealing with
32:52this in one way or another for a very,
32:55very long time.
32:56But of course it's a different
32:58story with social media.
33:00Social media really has intensified,
33:02I think,
33:03the reach,
33:04the speed and the consequences
33:06of misinformation,
33:08the kind of rate in which it
33:11accelerates information out into
33:12the world with very little check
33:14on on it before it goes out.
33:16Into the eyes and ears of millions of
33:18people is like nothing we've seen before.
33:20So you know,
33:2170% of Americans use some form
33:24of social media.
33:25But I think that's quite a bit less
33:27relevant than the idea that social
33:29media actually has a huge influence
33:31on our media and our politics
33:33and our academic institutions.
33:34And so basically the information
33:36and the agenda setting that comes
33:38out of social media actually
33:40trickles down to everyone,
33:42whether or not you use social
33:43media in some way or another.
33:48So I I want to be clear,
33:50this is going to come off as as kind
33:52of a social media bashing lecture.
33:54But but I don't think it's all bad.
33:57I think there are things that
33:58are important and that we need
34:00to be careful about when we're
34:02trying to combat misinformation.
34:03It does democratize discourse.
34:05People who did not have a say,
34:07who weren't able to express their opinions,
34:09who couldn't get around the
34:11gatekeepers of traditional media.
34:12This is a way that all those
34:14things can happen.
34:15People can get their views
34:16out there in a way that.
34:18Never had the opportunity to before.
34:20On the other hand,
34:21I think it's important to recognize
34:23that very few accounts can often
34:26dominate an entire conversation.
34:27So there's analysis in 2021,
34:29only 12 accounts.
34:31The disinformation doesn't.
34:32We're responsible for 65% of anti
34:34vaccine information on Twitter,
34:36Facebook and Instagram that year.
34:37So if you can just imagine that we
34:40think we are democratizing discourse,
34:42and in some ways we are at the same
34:44time because of the virality of
34:46the way that information spreads.
34:48This doesn't look very democratic either.
34:50This is 12 people or 12 accounts
34:52that are able to have a huge,
34:54huge effect on an entire conversation
34:58around vaccine misinformation.
35:02So I think the hope is and I think you
35:04know I have shared this hope and I I still
35:07share this hope to some extent that social
35:09media will be the two new town square.
35:12It will be an online space or online spaces
35:15where people can connect with one another,
35:17they can share their views and they
35:19can debate issues of importance and
35:21these are all good things that we
35:23hope that that social media could be.
35:25But I think the reality is much darker
35:27and and the reality right now is that
35:30the business model of a lot of these
35:32platforms relies on advertising.
35:33And selling of your data,
35:36it rewards outrage at the expense of nuance.
35:39It increases political polarization.
35:41It increases confirmation bias.
35:42You can always find what you want
35:44and what your side is saying.
35:46There's a tremendous amount
35:47of information overload.
35:48And so even if there's a lot of good
35:50information out there and there's
35:51some bad information out there,
35:53very hard to figure out what
35:54is what for a lot of people.
35:55And there's a tremendous
35:57amount of harassment,
35:58including a physicians,
35:59as we'll see in a couple slides,
36:01for people who share unpopular
36:02opinions that could be unpopular.
36:03In any sense that you want to take it,
36:05but particularly in this case for
36:08physicians and other clinicians who
36:09share pro vaccine messaging and they
36:11have been subject to tremendous
36:13amounts of harassment online,
36:14sometimes in person as well.
36:17So I think we all kind of have
36:19a general sense but but just to
36:20kind of put a fine point on it,
36:22during the COVID pandemic
36:24misinformation has been tightly linked
36:26to the use of unproven treatments.
36:28It has been linked to non adherence to
36:30public health mitigation measures and
36:32to high levels of vaccine hesitancy.
36:34I came across a study recently
36:36which which was, you know,
36:38incredibly distressing that you know,
36:39higher immunization rates,
36:41not 100% but just higher,
36:43could have prevented between a third
36:45and half of all US COVID deaths.
36:48Over the past year and a half.
36:52Alright, So what to do about it?
36:53Here's my comprehensive list of
36:55things that I'm confident will work.
37:00But here are some things for discussion. So.
37:04The the first is algorithmic adjustment,
37:06and we'll talk about that in the next slide.
37:08The second is misinformation research
37:11and a surveillance system to try to.
37:14Respond quickly to misinformation
37:16when it's breaking out.
37:17The third is the training
37:19of medical professionals and
37:20other public health officials.
37:21And the 4th that's really
37:22engaging communities.
37:23And that gets back to this idea of trust
37:26is fundamentally relationship based,
37:28and so it's it.
37:29While it's possible to gain
37:31trust at a distance,
37:32I think we're on surest footing when
37:34we're working within our own communities
37:36and with people we know and meet.
37:40So algorithmic adjustment.
37:41So as we know in the past and and and
37:45certainly for many platforms currently,
37:47their algorithms tend to promote
37:49more extreme and sensational content.
37:52That's not surprising because that is
37:54what we subconsciously or consciously
37:56seek as people and it promotes user
37:59engagement and the goal is to get
38:01you on that platform as long as
38:04possible and get you coming back.
38:05There were some interesting work done
38:07by Zeynep Tufekci a couple years ago.
38:10She's a sociologist.
38:11Some of you may know what she would
38:13do is she would basically start going
38:15to YouTube and putting in a topic
38:17that she wanted to know more about.
38:19And what she found was when she
38:20put in a topic,
38:21the next video that YouTube served
38:23her up was always more extreme than
38:24the one that she had started with.
38:26So she starts her vegetarianism,
38:28leads her down to veganism,
38:29leads her down to the Paleo diet,
38:31leads her down all the way to
38:33some crazy diets.
38:34She starts to talk about jogging,
38:37she enters jogging,
38:38she wants to learn jogging techniques
38:39that goes down to ultra marathons.
38:41Within a few videos you put in Trump,
38:43you get to some right wing conspiracy
38:45theories, you put Sanders in,
38:46you go the other way and so,
38:48so this is what has been going
38:50on in a lot of platforms and
38:52particularly YouTube in this case.
38:54And so the the broad idea is to design
38:56algorithms that try to reduce the
38:58visibility of misinformation and to
39:00elevate high quality information.
39:02And YouTube actually recently partnered
39:04with the National Academy of Medicine
39:07to start to lay out some fundamental
39:09principles of what platform should be
39:12doing to elevate credible health sources.
39:15These aren't groundbreaking principles.
39:16You want to be science based,
39:17objective,
39:18transparent and accountable.
39:19But I think it's a step,
39:20at least at YouTube,
39:21I think has recognized that
39:22a lot of this is happening.
39:24They're working with the National
39:26Academy and trying to to move forward.
39:28I think there's a lot more work
39:29that needs to be done here,
39:30but it's in the encouraging side.
39:32So one part of this is elevating credible
39:34information and the other part of this
39:37is flagging and removing misinformation.
39:38And this often runs into a lot
39:41of arguments around free speech
39:43and if not the letter of the law.
39:46You know,
39:46these are in general private entities.
39:48They can have whatever terms of use
39:50agreements they want to enforce,
39:52but the spirit of free speech.
39:54And that's what I think a lot of
39:56people often say is that, look,
39:57people should be able to say what
39:59they wanna say.
40:00The best ideas went out.
40:01This is a marketplace of ideas.
40:02I think for a number of reasons
40:04that we can talk about that,
40:05that that doesn't totally hold water.
40:07But that's kind of the argument.
40:08In any case,
40:09I do think there needs to
40:10be a lot more thinking,
40:11a lot of discussions about
40:13the threshold at which we're
40:15going to flag a claim to be misinformation.
40:17Science changes quickly.
40:19There's often a lot less certainty
40:21around all sorts of things
40:22than we would like there to be.
40:24And so that does need to
40:26be a topic of discussion.
40:28But the easiest thing,
40:28or the most straightforward thing I think,
40:30is to start with material that is clearly
40:33pernicious and false and demonstrably so,
40:35and that even after warnings
40:37people refuse to take it down.
40:40So I think that's that's a place to start.
40:42But again, these are the this
40:43type of thing I think is is,
40:45is still in its early days.
40:48The second topic is misinformation,
40:50research and surveillance.
40:51And so I think, you know,
40:53we hear a lot about misinformation
40:54that has fueled by social media.
40:56But this is an incredibly new phenomenon,
40:58you know, probably in the last five years,
41:00certainly not more than the last 10 years,
41:02it's really taken off.
41:03And so, you know,
41:05it's often the academic thing to say is that,
41:06you know, we need more research.
41:07That's always the,
41:08the last line in your paper.
41:10But I think in this case,
41:11you actually do need more research
41:12and we need to figure out exactly
41:15how misinformation spreads.
41:17We need to figure out what the health.
41:18Social consequences are,
41:19but importantly we need to figure out how
41:22they vary by things like the platform,
41:24the country and the demographic group.
41:27You know,
41:28they do not have one set of you know,
41:32effects for people with very high versus
41:34very low education levels or people
41:37in one country versus another or the
41:39effect of Twitter versus Facebook.
41:42And so these types of things I
41:43think we we still need to tease out.
41:45You know,
41:46there are some things that people have shown.
41:48Can be effective.
41:49I think these aren't, you know,
41:52widely used things but in
41:54studies exposing people to cross
41:56attitudinal news outlets,
41:57meaning you know if you're, you know,
42:00liberal seeing more of the conservative
42:02side of things and and vice versa
42:04that in other recent in other,
42:05you know,
42:06prior research has not been as effective.
42:08But at least some studies around social media
42:10have shown that this this may be the case.
42:13And then prompting users
42:14simply to think about accuracy,
42:17it seems to decrease their
42:18intention to share things.
42:20Either without reading it or things
42:21that they think might be kind of on the
42:24fence about whether it's true or not.
42:25I do want to highlight this
42:27that this organization,
42:27the social Science Research Council,
42:29they recently, recently.
42:31Launched this project called the
42:33Mercury Project last year and the whole
42:35idea is to fund a global consortium
42:37of researchers to really examine the
42:39causal effects of of misinformation
42:41and potential intervention.
42:42So I, you know, the hope is that,
42:44you know,
42:44in a few years we have a much
42:46stronger evidence base to figure
42:48out what to deploy to,
42:49to minimize the consequences
42:50and the harm of misinformation
42:52in the medical setting.
42:56You know, one of my colleagues,
42:58David Scales at Cornell,
42:59he's done a lot of work and
43:01misinformation and thought a lot about
43:04a misinformation surveillance system.
43:06And this is really modeled off a surveillance
43:08system for emerging infectious diseases.
43:11And so the idea would be that you
43:13would observe in real time deviations
43:15from routine levels of misinformation,
43:17just like we do for infectious diseases.
43:19You would be able to characterize
43:21and describe how the disease,
43:23in this case misinformation,
43:24is spreading through networks.
43:26You would identify as super
43:28spreaders and super spreading events
43:30and ideally then employ evidence
43:32based methods for neutralizing
43:34those missing misleading messages.
43:36So I want to walk through kind of
43:39one example of how this might work.
43:41You know,
43:42it certainly hasn't been deployed yet,
43:43but this this would be kind of the the idea.
43:47So here's the situation.
43:49The CDC comes out with a
43:51report in September of 2020.
43:53It's a report of 314 people who were
43:56infected or part of the study in July 2020.
44:00154 of them had COVID-19,
44:02160 of them were controls and
44:04they're trying to figure out what
44:05were the what were the things that
44:07made some people more likely to get
44:08COVID and other people's people not.
44:10They come up with these, these,
44:12these, these two things which are
44:15not incredibly groundbreaking.
44:16Having close contact with
44:18someone with COVID-19,
44:20you're more likely to get it and
44:21going to bars and restaurants,
44:22indoor settings where you can't
44:24wear your mask as much and and
44:26there may not be great ventilation.
44:27As part of the study,
44:28they also ask people how how much of
44:30the time are you wearing your masks?
44:32Are you ask where are you not a mask
44:34wearer what the people who got infected said,
44:36you know, 70% of them said, look,
44:38we almost always wear our mask,
44:4015% say we mostly wear our mask.
44:42So together 85% say we we
44:44mostly wear our mask.
44:45Obviously,
44:46close contact with someone in your home,
44:48you're not wearing your mask at that time,
44:50obviously when you're eating a restaurant,
44:51not wearing a mask.
44:52So, so, so that's kind of the deal here.
44:55OK, so the federalist is an
44:58online conservative magazine.
44:59It's not incredibly widely read,
45:01but it is cited a lot by right of
45:04center radio hosts and cable hosts.
45:06They interpret this study as saying mass
45:09and face coverings are not effective
45:11in preventing the spread of COVID-19.
45:13This was on October 12th, 2000.
45:15Twenty 85% of people who got
45:17infected wear their masks.
45:18Therefore Wawa masks are not effective.
45:23The next day, Tucker Carlson on his show,
45:25which reaches 4,000,000 viewers every night.
45:27Almost everyone,
45:2885% who got the coronavirus in July was
45:31wearing a mask and they were infected anyway.
45:33So clearly this doesn't work
45:35the way they tell us it works.
45:37Two days later, Donald Trump picks it up.
45:40Did you see the CDC,
45:42that 85% of people wearing
45:43the masks catch it?
45:45OK,
45:45I always have trouble imitating
45:47his sentence structure,
45:48but that's that's that's what he says at
45:50this town hall reaches 13 million people.
45:52OK,
45:52so we go.
45:53In this tiny federalist magazine
45:55online to 20 million people in the
45:58matter of three days because of
46:00because of the way this was picked up.
46:03So the idea here,
46:03and this is this is David's
46:05work that I'm presenting here,
46:06is to come up with an epidemiologic
46:09model to counter misinformation.
46:12So he says, OK, how would this work?
46:13So various sources would provide data feeds.
46:16These sources would be things like Google,
46:18Facebook,
46:18other platform based monitoring tools.
46:21They would provide data feeds,
46:23info demonologists.
46:24This is his version of Epidemiologists.
46:26Not the most catchy term,
46:27but info demonologists,
46:29they integrate this information,
46:31they have their own on the ground kind of.
46:34People that they're talking
46:35to what they're hearing.
46:36This is modeled off a program that exists,
46:39the program for monitoring infectious
46:40diseases members of which the
46:42clinicians share information
46:43through the Sentinel network.
46:45You would spot something like the
46:47mischaracterization and the federalist
46:49this this paper here and you would
46:51see that and you and you would
46:53see that it's starting to spread.
46:54Use preemptive messaging,
46:55basically get the studies authors out
46:57there reiterating their findings,
46:59dismissing this type of misreading
47:01of the information and you.
47:03Disseminate that information
47:04to community based info,
47:05demonologists and fact checkers.
47:06This would all ideally happen before
47:08the President of the United States,
47:10you know says that on national
47:12television to 20 million people.
47:13That's that's kind of the idea you know,
47:15whether or not something like this
47:17works I think depends a lot on whether
47:19you have evidence based strategies to
47:21actually counteract that type of thing.
47:23But at least knowing about it early on,
47:24having a surveillance system I think is an
47:27interesting idea and potentially promising.
47:30OK.
47:31So let's talk about training
47:32medical professionals.
47:33As I mentioned before,
47:34physicians and nurses are
47:36still among the most trusted
47:38professions in the United States.
47:39We obviously received very little
47:42information about techniques
47:43on how to address false claims
47:46either online or in person.
47:48That is starting to change
47:50at Duke University,
47:51I think has one of the
47:52most interesting programs.
47:52They have a program specifically
47:54dedicated to training clinicians
47:56on how to address misinformation,
47:58how to engage with patients.
48:00You have beliefs that are informed
48:02by poor quality information and so I
48:04think this is a type of model that
48:06I think could be could be scaled
48:08to other institutions as well.
48:12One thing I want to note is that it's
48:14also important to think about how to
48:17support clinicians who who speak out.
48:19I was, I was shocked when I saw
48:20some of these numbers.
48:21But, you know,
48:22one in four physicians,
48:23according to some surveys,
48:24have been attacked on social media.
48:26The most common reason is vaccine advocacy.
48:29One in six female physicians have been
48:31sexually harassed on social media.
48:33And 2/3 of physicians who are
48:35interviewed in media outlets about
48:37COVID-19 report being attacked online.
48:39Even if you say, you know,
48:41these are high numbers.
48:41We take half of that.
48:43That's still incredibly alarming.
48:44And so there are now these groups that
48:47are forming that are basically groups
48:49of clinicians who can come to your
48:52aid if you're being attacked online
48:53and and they kind of descend and they're,
48:56they're supposed to try to
48:57support you on online and kind of
48:59develop a little bit of cocoon.
49:00That is something that is happening as well.
49:04And the last point here is
49:06around engaging communities.
49:06And I think this is, you know,
49:08a really fundamental point
49:10for all of healthcare,
49:11but also for misinformation
49:13in particular and and,
49:15you know,
49:15really engaging with community leaders.
49:17And that's particularly true of
49:20communities that have been systemically
49:23targeted by misinformation.
49:25You know, in New York and Rockland County,
49:27New York has a large Jewish community,
49:29Orthodox Jewish community.
49:31It has been targeted by
49:33vaccine misinformation.
49:34For years now we had our first case of polio,
49:37paralytic polio in the United States and in,
49:40in, in, in years.
49:42And so this is an example that you
49:45can see over the past decade what,
49:48what, what type of Flyers,
49:49what type of information has been going into
49:51this Community and the end result being,
49:53you know the first case of
49:54paralytic polio in in a long time.
49:56And so working with community
49:58leaders who have respect,
50:00who have relationships within
50:01those communities I think
50:02is is is a really important.
50:04Part of countering misinformation.
50:05It doesn't have this kind of national scale
50:08that we always want with with everything.
50:10But I think it,
50:11it has a more more promise than
50:14than some of those things as well.
50:16You know,
50:16I want to,
50:17I want to note one thing here
50:19around health systems and their
50:21role in engaging communities.
50:23Where I train at MGH during the pandemic,
50:25they started virtual town halls where
50:27they were just answering questions about
50:29basic things that community members,
50:31patients were interested in,
50:33wanted more information.
50:34Out and they've continued those overtime
50:37and some of them are now hybrid town halls.
50:40But that type of thing I think lets
50:42you develop the type of relationship
50:44with the local community that when
50:47someone hears something online but
50:48they know a doctor or a nurse or
50:51a clinician at a health system or
50:52they've been going to these town
50:53halls for some time and it's totally
50:55different from what they're saying.
50:57I think it provides an opportunity
50:58to to engage them,
50:59but also provides an opportunity
51:01to gain the trust that you need
51:03to pre bunk claims, you know.
51:05Debunked by pre bunk.
51:06Before even people are exposed
51:08to certain things,
51:09tell them about the techniques
51:11that people who are, you know,
51:13misinterpreting studies.
51:14For example,
51:14tell them about the techniques that
51:16are used to try to misrepresent
51:18data that's out there.
51:22OK. So we covered a lot of ground, I think.
51:24But I just wanted to kind of
51:26summarize by saying trust has fallen
51:28precipitously in the past few decades.
51:30That has created an information
51:32environment and ecosystem that
51:33is ripe for misinformation,
51:35which has been supercharged
51:37by by social media,
51:38has all sorts of harmful social,
51:40economic and health consequences.
51:42And there's a few strategies that I think
51:45we should start thinking about to try
51:48to combat some of that misinformation.
51:49Again, I want to thank you for.
51:51Allowing me to come back.
51:52And it's always a real pleasure
51:53to be here at Yale.
52:06Thank you so much.
52:07Truth that was terrific.
52:08Now just to let you folks
52:10know what we're going to do,
52:11we're going to keep going
52:12until 1:00 o'clock.
52:13So if you've been watching and I
52:15think that's been like that since
52:17since 2003 years, but anyway,
52:20while I was here
52:21it was still like that.
52:22Yeah. So time stands still
52:24here at the Alliance center.
52:26What we're gonna do now is we
52:27will drive and I'll have a seat
52:29and I ask you to raise your hand.
52:31I'll moderate a conversation.
52:32And for the folks who are
52:33watching on zoom, if you can,
52:35please send in questions so that you
52:36have might have or comments on the
52:38QA portion and I'll look at that and
52:40I'll read some of those to drove as well.
52:44So we're going to let me get
52:45hooked up with the mic here.
52:46Ohh, just to let you know.
52:47By the way,
52:49before I forget, we
52:50have plenty of extra sandwiches, so please.
52:53Take one home for your loved one or for
52:56your lunch tomorrow or something like that.
52:59And for those of you who are zooming
53:00in and join us in two weeks when you
53:02can get a free sandwich on top of
53:03everything else and all this fellowship,
53:05have a seat through.
53:06We're going to get started.
53:21All right, am I? Am I working?
53:25Yep. Terrific. Ben. Karen,
53:27if you've got the mic ready, Ben,
53:30I think has something he wants to ask.
53:38What's that?
53:41So, so thank you for a really
53:43chilling and and great talk.
53:45You know at the beginning you pointed
53:48to a constellation of potential
53:50causes and I mean you know there
53:52I can see many of them are very
53:54plausible during your talk you
53:56really drilled in on social media.
54:00I'm curious, do you think that is
54:02the the primary cause of this?
54:04The levels of mistrust?
54:05It seems like you know.
54:07It precedes the development of
54:10social media and I guess I'm
54:12I'm left wondering if it's if
54:14that's a marginal contributor.
54:16And we don't address the like the
54:19fundamental underlying causes.
54:23Playing with social media may be just
54:25sort of making marginal differences
54:27and in the like fundamental
54:29problem, yeah, I mean I
54:30think it's a great point. So.
54:32So I'm not or I'm not trying to argue
54:35that that social media has contributed to,
54:37to mistrust necessarily.
54:39I think all those that are saying
54:40all those trends preceded social
54:42media by by decades in some cases.
54:44I do think it's the case that a
54:47lot of the misinformation and the
54:48speed at which misinformation can
54:50spread is fueled by social media.
54:53And so I think the environment
54:55that we have
54:56because of these forces
54:58whether it's political polarization,
54:59economic instability,
55:02you know secular distrust in,
55:05in, in institutions that I think
55:08creates an environment in which
55:10people don't know what to think,
55:13they don't know who to trust
55:14and they turn to
55:16alternative sources for information,
55:19information. And you could imagine a world
55:21without social media in which you would just.
55:24Newspapers and magazines,
55:25and maybe even newspapers and magazines
55:28that peddled miss misinformation
55:30and disinformation and you could
55:32still go to your own outlet.
55:34I think that would have the virality
55:37of spread that social media allows.
55:41I think still someone
55:43would need to go to this.
55:46You know this particular outlet
55:48to get that information,
55:49whereas I think social media kind
55:51of supercharges that and not only,
55:53even if you don't see it on social media,
55:55you know Tucker Carlson seeing
55:57it on social media or Trump or
55:59someone else who then is able to.
56:03You know, use it to their
56:05political benefit or whatever it might be.
56:07But I do take your point in that social
56:09media is certainly not everything.
56:10I mean this talk was focused on social media,
56:12but you know, even in this example, right?
56:15I mean it was, it was Fox News,
56:17a very mainstream organization that
56:19ultimately took it from what it was to
56:21to to to millions and millions of people.
56:24So I think it's part of the story.
56:27I think we would be in a much better
56:29place if we could reduce the level
56:30of misinformation on social media.
56:32But I think you're right.
56:33I mean the.
56:33Issues around mistrust and distrust and.
56:38And other forms of misinformation
56:39I think would would still persist.
56:43Jack, please. I drew that was great a
56:47number of people have have attributed at
56:51least part of this increase in mistrust
56:54and and distaste with the other team to
56:57the to the differences in socioeconomic
57:00status and they the widening gap
57:02between the the upper levels and the
57:06and the bottom 50% and that has that's.
57:12It's plausible as as a contributor if people
57:16are are annoyed with with the liberal
57:21elite who also make a whole lot more money.
57:25And then on the other side,
57:26people have noted the well,
57:28one study has noted that the last
57:31acceptable prejudice on the part of
57:34the upper class is for those who are.
57:37Uneducated or less educated,
57:39and that that prejudice is.
57:43Noticeable and even.
57:47And certainly detected by the folks
57:50on the lower end of the social scale.
57:53So I don't know what do you find that
57:56that that resonates as you do you think
57:58that I think that's absolutely
58:00true. I mean I I think.
58:02There I mean if
58:04you look at you know just economic
58:05data all the wage gains over the past
58:07couple of decades and the and the
58:09wealth gains have gone to not just
58:11the you know top 50% but really the
58:13top 1% or five percent 10% certainly.
58:17And so that creates an environment
58:20in which you are already living
58:22in kind of different worlds with
58:24different lives and different access
58:27to opportunity including education and
58:30I think it's a very understandable.
58:32A set of concerns that that
58:35people have against.
58:39Certain types of elites who then try to
58:42impose their views and values on others,
58:44and I think in some cases I agree
58:46with those and those are mine.
58:48But, but at the same time,
58:49I don't think there's a whole lot of
58:53empathy for the way in which we talk about.
59:00Talk about exactly what you're saying
59:01and I and I think it's, it's true even.
59:04And again I think, you know,
59:06I think it's something like, you know,
59:08I made I guess an ivermectin joke.
59:10And you know, even when you know a
59:14shisha or other people in positions
59:16of power call it a horsky warmer and,
59:19you know, kind of dismiss it as
59:22basically trying to call the people who.
59:26Whose friends may have experimented with it?
59:29Or. Who who feel like maybe
59:33there's something here.
59:34I feel like we talk about things in
59:37a way that alienates a lot of people.
59:39And part of the empathy that we
59:42need to show is not just for people
59:45who who are on our team, obviously,
59:46but really there's like radical empathy,
59:49which is very hard to muster for people
59:52who who are both different from us
59:54but also see us as kind of the enemy.
59:59OK. Karen, could you give us the gentleman
01:00:01there in the white shirt and while
01:00:02while I'm waiting for that I'm gonna
01:00:04go ahead and read one of the questions
01:00:05from the from the zoom audience.
01:00:08It seems that there is a cycle of mistrust
01:00:10between the lay public and governmental
01:00:12and or public health authorities,
01:00:14both mistrust and the other with
01:00:16respect to public health leaders and
01:00:17unwillingness to speak about matters
01:00:19with nuance because of the concern that
01:00:21it may be mishandled by the public.
01:00:23Leading to a feedback loop of
01:00:26spiraling mistrust.
01:00:27Do we underappreciate the degree to
01:00:30which our leaders and public figures
01:00:32are contributors and not just simply
01:00:34victims of the culture of mistrust?
01:00:36I think absolutely. I mean,
01:00:38I I don't think, as I said, it's not.
01:00:40I don't think it's unidirectional.
01:00:41I think a lot of the mistrust that's
01:00:43out there is earned, and it has been.
01:00:48There have been a number of failures
01:00:49both in the public health community
01:00:51but also more more generally over
01:00:53the past however many years,
01:00:54and that has contributed to earned mistrust.
01:00:57It's not just that I don't think
01:00:59people in positions of power or
01:01:01institutions in positions of
01:01:03power are the victims necessarily.
01:01:05I think they have done also their part in
01:01:08squandering that that mistrust and you know,
01:01:1111 obvious example of that is,
01:01:14you know early in the pandemic,
01:01:16the Surgeon general of the United States.
01:01:17Whatever his motivation was,
01:01:19maybe it was to preserve
01:01:20masks for medical workers,
01:01:22tweets out in all caps,
01:01:23that masks don't work and he doesn't
01:01:25want the general public to to use them.
01:01:27And that seems to be an example
01:01:30of obviously that's going to show
01:01:32some level of discord and distrust,
01:01:34but also not giving it to the
01:01:36public straight, right?
01:01:37That's an issue of transparency.
01:01:39It seems like probably the
01:01:40motivation there was look,
01:01:41we have a limited number of masks we want
01:01:44healthcare workers to to have access to them.
01:01:46But the but that.
01:01:47That wasn't the message
01:01:48that was communicated,
01:01:49it was masks don't work,
01:01:50don't don't use them.
01:01:52And so that is one example
01:01:55of of many that I think.
01:01:57Where there's an instance of earned
01:02:00mistrust on the part of people in power.
01:02:02So to following that along you
01:02:04mentioned this the Surgeon General.
01:02:06So it it makes me think and it makes
01:02:08me think of the teaching that we've
01:02:09the conversation that we've had over
01:02:11the years about institutions and the
01:02:13importance of institutions within the
01:02:15spectrum of when we discussed the mid 20th
01:02:17century breakdown in Europe, the Institute.
01:02:20Actions themselves coming apart and
01:02:23specifically I think that you know,
01:02:26where trust has been placed with
01:02:29regard to information was,
01:02:30you know, with the.
01:02:32The anchors from the leading networks,
01:02:34for example, Uncle Walter,
01:02:36Walter Cronkite was the guy that most
01:02:38Americans trusted back in the day,
01:02:39so we're told.
01:02:41But also more bringing up more
01:02:44closely to home the institutions
01:02:46such as Yale School of Medicine
01:02:48or Cornell School of Medicine,
01:02:50right that that these are institutions
01:02:52that at one time this meant something in
01:02:54terms of the that it could be trusted.
01:02:56But have have the institutions
01:02:59including the medical schools
01:03:00lost credibility do you think?
01:03:02And is there something specific that that,
01:03:05if so, is there something specific that we,
01:03:07the medical schools,
01:03:08the medical institutions can do to
01:03:11improve our own credibility or the
01:03:12level of trust that that we're afforded?
01:03:15Yeah, it's, it's a good question.
01:03:16I mean I I don't, I don't you know,
01:03:19pretend, pretend to have the answer.
01:03:20I mean I think that good place to
01:03:22start is community engagement and
01:03:24understanding what the the community
01:03:27around you needs and part of that is.
01:03:29I think happening, listening sessions,
01:03:32talking to local community leaders,
01:03:34understanding how you can serve the
01:03:36needs of the people around you.
01:03:37And I think, you know,
01:03:39I highlighted something that MGH is doing.
01:03:42There's other medical schools that kind of,
01:03:44I think some of the newer medical
01:03:46schools I've heard like Dell and Kaiser,
01:03:48they have a really huge component of
01:03:51community engagement which I think
01:03:53probably generates some level of goodwill.
01:03:55So you know,
01:03:56I think that's that's a place to to start,
01:03:58you know, I don't think.
01:03:59So I don't think it's just
01:04:01a communication issue.
01:04:02I think a lot of people who
01:04:05are in positions of power.
01:04:08Feel like you
01:04:08know, if if we only communicated
01:04:09our our our values better to people.
01:04:12If we only found a way to you know
01:04:15frame this in a better way than
01:04:17people would believe us or trust us.
01:04:19I think in most cases it's it's a, it's a.
01:04:22Underlying value issue,
01:04:23you know it's it's where
01:04:24are you spending your time,
01:04:25where are you spending your budget?
01:04:26Are you allowing access to the
01:04:28people in your communities?
01:04:30Are you are you serving the
01:04:33community in a in a robust way?
01:04:35Are the people in your school
01:04:36who are being recruited are they,
01:04:39are they people who have had you
01:04:43know opportunities through various
01:04:44mechanisms to to participate if
01:04:46if they you know for whatever
01:04:48reason weren't able to so.
01:04:50So I think it's it's looking
01:04:51at those types of things.
01:04:52As opposed to just putting the varnish
01:04:55on on communication and in some way.
01:04:58Thank you. Yes, Sir.
01:04:59Thank you so much. First of all,
01:05:01Professor Howard Foreman speaks
01:05:03very highly of you and says hi,
01:05:05I had a couple, two quick questions.
01:05:07The first is that it feels like it's
01:05:09important to address misinformation
01:05:10if it comes from a tweet on Twitter,
01:05:13not in like a long form piece
01:05:15necessarily because the audience is
01:05:16different. But it's really hard to
01:05:18say a true statement in 280 characters
01:05:21versus a lie in 280 characters. And
01:05:23it's hard to capture all the nuance
01:05:25I wanted to get your thoughts on,
01:05:26like how to create and spread truth
01:05:29in in a short amount of space at a
01:05:31time when people's attention spans
01:05:33are a lot lower than than before.
01:05:35And the 2nd is that it feels like a
01:05:37part of the spread of misinformation
01:05:39has to do with an emotional response,
01:05:41like fear mongering
01:05:42or anger. And it's harder to create
01:05:45or elicit that emotional response
01:05:46for something that's dry and factual.
01:05:48So I wanted to hear your thoughts
01:05:50about that as well. Thank you.
01:05:52Yeah. Thank you.
01:05:53You know, truth is is certainly,
01:05:55I think, at a disadvantage.
01:05:57You know, as you said it's
01:05:58it's much more appealing when
01:06:00something is new or interesting or
01:06:02sounds like it couldn't be true,
01:06:04probably because it isn't true.
01:06:05That's something that that tends to spread.
01:06:07I think there is good research to
01:06:08suggest that actually incorrect
01:06:10or inaccurate statements spread
01:06:12faster on social media than
01:06:14do then do factual statements.
01:06:16You know, I don't know if I
01:06:18have a solution to that.
01:06:20I mean 111 part of it certainly is
01:06:23maybe there are some things around
01:06:25algorithms that that that you can do
01:06:28to try to once you see something taking
01:06:31off down weight that in some in some way.
01:06:35You know, I think we would just be
01:06:37in a much healthier place if we used
01:06:40social media half as much as we do,
01:06:42or 80% less.
01:06:43And if everyone just did that,
01:06:45you know, you know,
01:06:46that's not a not a real policy prescription.
01:06:48But you can see over time how people's use of
01:06:51different types of social media does change,
01:06:53right?
01:06:53So younger people don't use Facebook as much,
01:06:56right, as some people now use
01:06:59Twitter much less than they used to.
01:07:02Whatever it might be,
01:07:04we know that.
01:07:05Instagram has substantial mental health
01:07:08effects for particularly teenagers.
01:07:10So.
01:07:12No,
01:07:12I think we often tend as people who
01:07:14are interested in public policy
01:07:16to have a policy oriented tool.
01:07:18And maybe there are some of that,
01:07:20but I think we sometimes underweight
01:07:23cultural forces and the power of cultural
01:07:26norms spreading such that maybe,
01:07:28you know,
01:07:29in five years and 10 years actually
01:07:31people are less on certain types
01:07:33of social media and more on
01:07:35other types of social media.
01:07:37You know, there are good spaces online too,
01:07:39you know. I think my favorite example is.
01:07:42You know, that's an amazing and absurd place.
01:07:45Like how could this happen?
01:07:46You know,
01:07:47how could people spend so
01:07:49much time curating this,
01:07:50this wonderful knowledge filled thing?
01:07:54But it happens.
01:07:55And you know,
01:07:56I don't spend a lot of time on Reddit,
01:07:57but from what I understand is on Reddit,
01:08:00it's not just things that are like the most,
01:08:03it's actually the delta between
01:08:04the likes and the dislikes.
01:08:05And so, you know,
01:08:07if if something is outrageous in some way,
01:08:09it's not just one group of people
01:08:11that can send it to the top.
01:08:12It's it's the delta between the two.
01:08:14So if if you're, you know,
01:08:15hated by half the thing and
01:08:17loved by half of it, you don't,
01:08:18you don't get very far.
01:08:19So maybe there are things like that,
01:08:22but I don't know. I I use.
01:08:24Social media at 80% last night
01:08:26that I did two years ago and
01:08:28it's been nice for me.
01:08:30So I I recommend that for other people too.
01:08:33Yes,
01:08:34if you could give it to the.
01:08:36So there's a woman here.
01:08:37Please, Karen, while we're
01:08:38waiting for that passage out,
01:08:40I like this question very much coming
01:08:41in from zoom because it reminds me of
01:08:43a of a quote I heard in high school.
01:08:44I think it was Thomas Carlyle,
01:08:46somebody who said, well, you know,
01:08:48in terms of fixing the world,
01:08:49he said make an honest man of
01:08:51yourself and you can be sure there's
01:08:53one less Rascal in the world.
01:08:54So this is the question,
01:08:56which is how do we ourselves
01:08:59avoid promulgating misinformation,
01:09:00as many did with the Purdue Pharma and HRT,
01:09:04for example? So how do we?
01:09:06The folks in this room and on this zoom call,
01:09:08how do we keep from being part
01:09:09of the problem?
01:09:10Yeah.
01:09:12Well, it's a good question.
01:09:13I mean you know, I don't know if you,
01:09:17I don't know if I would call like HRT.
01:09:21Misinformation, right.
01:09:22I mean misinformation is you know
01:09:24at the time you have to understand
01:09:26the evidence base at the time and
01:09:28and figure out you know what is how
01:09:30strong is that evidence based and if
01:09:32the evidence points in one way and
01:09:34you support that claim maybe you you
01:09:35should do your best to caveat it and and
01:09:37you know hint at the uncertainty with it.
01:09:39But but I don't view that necessarily
01:09:42as misinformation you know I I don't
01:09:45know I mean I think a lot of what I
01:09:48tried to do at least is is to try to.
01:09:51Foreground my uncertainty with things and
01:09:53that can be unsatisfying because and it's
01:09:56not very good social media either, right?
01:09:59I mean, social media is fast and
01:10:02snarky and and sarcastic and and
01:10:04and and powerful and so there is
01:10:07this challenge of how do you both?
01:10:10You know,
01:10:11present the nuances of an issue but also
01:10:13get something to go go kind of spread.
01:10:15And
01:10:15I mentioned that Shirley,
01:10:16I think he, he actually does
01:10:18a fantastic job of this and he
01:10:19was able to do a fantastic job
01:10:22educating people through, you know,
01:10:23not just 280 characters but have
01:10:25these long threads in which you know,
01:10:28he would really pick apart an
01:10:30issue and then kind of get
01:10:31into the nuances of it good.
01:10:33So. So two thoughts on
01:10:34that real quick through.
01:10:35So one is that you mentioned that,
01:10:38so we've got to be able to.
01:10:40Really assess how good the evidence
01:10:41is before we say that treatment X is
01:10:44actually the best approach to disease Y,
01:10:46that we should be able to evaluate the data.
01:10:48But if we're being honest with ourselves,
01:10:49I think we don't really dive
01:10:51that deeply into the data for
01:10:53everything we treat because of that.
01:10:55There's there's a time factor there.
01:10:56So we rely, we trust others.
01:10:58So you know I'm a pediatrician
01:11:01when a statement comes out from the
01:11:04American Academy of Pediatrics.
01:11:06Not going that comes out with it,
01:11:07here's a three page guideline or
01:11:09three page consensus statement and
01:11:12it's followed by a 30 or 40 page
01:11:14report technical report and I'm sure
01:11:16somebody's reading them technical
01:11:17reports but you know it's a long
01:11:19day and so you read the guidelines
01:11:20and maybe you get to the technical
01:11:22report if that's a specific subject
01:11:24you're interested in,
01:11:24but nobody's reading all of them
01:11:26for everything that they do.
01:11:27And so we are all at to some extent
01:11:30having to trust other sources as
01:11:32as we go through this stuff I think
01:11:34that we need to be really careful.
01:11:37Which sources we trust?
01:11:38I think that's right and that
01:11:39raises the question of like
01:11:40do you need to tweet it out?
01:11:42Like do do you have to share that if
01:11:44you haven't if you haven't read it
01:11:45thoroughly and understood the issue.
01:11:46And I think the impulse is yeah of
01:11:48course I I need to like everyone
01:11:49needs to hear my thoughts. But
01:11:52but that's not
01:11:52true right. I mean I think
01:11:54there there's one version of this is,
01:11:55is kind of getting to the bottom
01:11:56of the issue for yourself and your
01:11:58colleagues and having that discussion.
01:11:59And the other part of this is,
01:12:01is, you know, do you or do you
01:12:03not need to share it before you
01:12:05truly understand an issue but.
01:12:07But yeah, I I take your point.
01:12:08I think it's
01:12:09thank you. Yes, yes, please.
01:12:11Thanks so much through for the
01:12:13talk is really interesting.
01:12:14I have a question about more about like
01:12:17uncertainty and specifically about mistrust
01:12:20and misinformation kind of burgeoning
01:12:23during times of deep uncertainty,
01:12:25especially with COVID-19.
01:12:26We obviously have no a lot more,
01:12:28but there's still a lot of uncertainty
01:12:30and there's gradations of misinformation
01:12:32around various products or even how
01:12:34you know treatment and prevention
01:12:35and things like that and so.
01:12:37One of the things is, you know,
01:12:39we saw like TV outlets and
01:12:41companies hiring doctors, you know,
01:12:44to be that voice that trusted
01:12:46messenger to the public in trying
01:12:48to dispel misinformation.
01:12:50But a lot of the messages have come
01:12:51across as very black and white,
01:12:53like, yes, you know, certainty about,
01:12:55you know, certain things, you know,
01:12:56know about certain things but
01:12:58not about like the Gray areas.
01:12:59And there doesn't seem to be a lot of,
01:13:01at least in social media from doctors in
01:13:04very high positions or other clinicians,
01:13:06kind of a.
01:13:07A like a phrase of like I don't know
01:13:09or like we just don't know yet.
01:13:11And it seems to be a lot of, you know,
01:13:13reliance on confidence as a message.
01:13:15And so I'm curious about that and
01:13:17how that fosters misinformation or
01:13:18that the research is around how to
01:13:21actually message medical uncertainty,
01:13:23not just in times of like COVID-19,
01:13:24but even beyond that when we just
01:13:27you're still learning things.
01:13:28You
01:13:28know, I think a lot about this idea
01:13:32of information vacuums and when
01:13:35when there's an information vacuum.
01:13:39Something's gonna fill it.
01:13:40And so, you know,
01:13:42I think it's important to to you know.
01:13:45Some advice that I've gotten
01:13:47is it's important to get out
01:13:49into that space if you want to.
01:13:50If you want to be someone who's
01:13:52communicating to the public,
01:13:53but also lead with your uncertainty and
01:13:55be comfortable with uncertainty in the
01:13:57sense of you may not have everything right.
01:14:00You may not know exactly,
01:14:03you know what the are not
01:14:04of this new variant is,
01:14:05or you know what people should be doing.
01:14:08But you know, I I'm sometimes torn
01:14:12about it because part of me thinks,
01:14:14you know we should be doing.
01:14:15Less of trying to do public
01:14:19health through tweet and not not
01:14:21and that's not entirely helpful.
01:14:23On the other hand,
01:14:24you know,
01:14:25if if public health leaders and
01:14:28medical leaders aren't totally
01:14:30abdicate that that domain,
01:14:32other things are going to fill it
01:14:34and presumably that's going to be
01:14:35less less effective and less high
01:14:37quality information, you know?
01:14:39I I do think that there's a
01:14:41market for people, obviously.
01:14:44Obviously it seems like everyone's
01:14:46on social media and Twitter is
01:14:49is kind of where the game is at.
01:14:51But actually a very small percentage
01:14:53of the US population is on
01:14:54Twitter or actively on Twitter.
01:14:56And so there is also this market of
01:14:59local news, long form journalism,
01:15:02other sources of information.
01:15:04And so, you know, I think we should just be,
01:15:07you know, as you mentioned,
01:15:08Ben, I think we should be.
01:15:10Thoughtful about all the different
01:15:11ways in which we can contribute
01:15:13to the conversation.
01:15:14And it doesn't just have to be
01:15:16via tweet or via social media.
01:15:19Thank you. Yes, Sir.
01:15:21Thanks for the talk. It's really great.
01:15:24I I wanted to ask you about.
01:15:28Whether different categories of information
01:15:30like if the category of information affects.
01:15:35Is related to, like how much
01:15:39someone is likely to mistrust you.
01:15:43You know, a statement about.
01:15:44So, like, you know, it's pretty obvious
01:15:47that there are a lot of people who will
01:15:50believe that a vaccine is bad for you,
01:15:52when we know that for the vast
01:15:54majority of people, it's helpful.
01:15:55Um, and so I'm a I'm an oncology fellow.
01:15:59So like.
01:16:00I am like, amazed sometimes that, like,
01:16:03we'll prescribe chemotherapy or something
01:16:05that's like potentially very toxic,
01:16:07and the patient will trust us to give them
01:16:09that, but they won't get the vaccine.
01:16:12And so like that,
01:16:13that kind of makes me wonder,
01:16:15is there something about specific
01:16:16types of information that are
01:16:18easier to mistrust than others?
01:16:21Yeah, I mean I think types of
01:16:23information is part of it.
01:16:25My, my my thought is that the the stronger
01:16:29influences is a social one and and with
01:16:32the social norms are and what your
01:16:34community believes and thinks about it.
01:16:37Very few people, a lot of people want to
01:16:39do their own homework and some people do.
01:16:42But the vast majority of our
01:16:44opinions on issues of importance are
01:16:46actually shaped by our communities,
01:16:48our families, the people around us.
01:16:50And so in the case of.
01:16:51Chemotherapy.
01:16:51You know it's it's obviously can be
01:16:55incredibly toxic and challenging to
01:16:57go through but it is widely accepted
01:16:59there's not a polarizing divide
01:17:02among Democrats and Republicans
01:17:05are conservatives and liberals.
01:17:08It's something that is obviously
01:17:09given after you have cancer as
01:17:11opposed to a preventative measure.
01:17:13Why should I put something in my body if
01:17:14I don't know I'm going to get COVID right?
01:17:16And so I I do think there are are are
01:17:19certainly differences there but but.
01:17:21Yeah,
01:17:21I I think part the type of topic or
01:17:24information is important but but I
01:17:26think more important is just what are
01:17:28the people around you think and believe.
01:17:31And that's why it's so pernicious
01:17:33that we now have basically wholly
01:17:36separate information ecosystems where
01:17:38certain groups of people believe X
01:17:40and certain believe Y and and and
01:17:43they may not be having despised.
01:17:47Thanks. So we're gonna have.
01:17:50Still not 1:00 o'clock.
01:17:51So we'll keep going,
01:17:51but actually we will we we
01:17:53will we will stop at 6:30.
01:17:55And I appreciate you folks saying
01:17:56it's gonna be two more questions.
01:17:58The gentleman right there.
01:17:59And the last question,
01:17:59Karen will be right up here in
01:18:01the I'm going to go with Peach.
01:18:03There we go.
01:18:04I got to crueler. Thanks.
01:18:06Thanks so much for talking.
01:18:07And I know you were a Zuckerman
01:18:08fellow at Harvard and I was too.
01:18:10So you know, just shout out to that.
01:18:12First off, two-part question.
01:18:15First, you talked about Twitter and
01:18:17social media being a town square but.
01:18:20Usually town squares are public and
01:18:22they're privately held companies,
01:18:24and so I'm I'm curious as
01:18:26to what you think about.
01:18:27Regulating private company activity and
01:18:29and the the social media they're in.
01:18:32And then two I want to ask about
01:18:34let's say regulation is successful.
01:18:37What happens if a,
01:18:39you know a different administration comes
01:18:41in and isn't so bound to rationality
01:18:44and starts policing those elements that
01:18:46would never happen.
01:18:52I don't know. I think I'm
01:18:53skeptical that regulation will solve
01:18:56this problem, in part because I think
01:18:59it's very hard to regulate your way.
01:19:02Around information and misinformation
01:19:04and I don't know that the.
01:19:08You know, the senators know that much about,
01:19:12you know, what, like how to go about.
01:19:14They didn't even know what Twitter is.
01:19:15One of them, you know, it's like,
01:19:17and so maybe there's a role for it.
01:19:19Maybe there's, you know,
01:19:21ways like guardrails that they want to wreck.
01:19:24Maybe there's changes to, for instance,
01:19:27you know, a lot of these platforms,
01:19:28they are not publishers.
01:19:30And in the traditional sense,
01:19:32you know, they cannot be sued for
01:19:33anything that's on the platform,
01:19:34unlike the New York Times or The New Yorker
01:19:36or something like that. And so maybe.
01:19:39But, but but I I don't know if.
01:19:43I don't know how much regulation will help.
01:19:45My sense is that there'll be a lot.
01:19:48The avenues to to to better,
01:19:51healthier social media environment
01:19:53are in part cultural and part
01:19:55social and part pressure on these
01:19:58companies to do things differently.
01:20:00Obviously, I think Elon Musk is
01:20:01going to buy Twitter soon.
01:20:02So I think things are who knows
01:20:04what's going to happen there.
01:20:06But you know, I'd be curious to
01:20:08hear other people's thoughts about,
01:20:10you know are there targeted
01:20:13regulatory policies that would be,
01:20:16you know,
01:20:16very beneficial to the social media.
01:20:18This is my I I I'm skeptical of it,
01:20:20but maybe it's possible.
01:20:22So we have, we have time for one
01:20:24more question and then I'll just
01:20:26wrap it up very quickly please.
01:20:28So I thank you
01:20:29for speaking. I think you had an
01:20:30article in The New Yorker in January
01:20:32where you described the pandemic
01:20:34as sort of like a liminal period
01:20:35or like a transitionary period.
01:20:36And how we've become a lot more aware,
01:20:39at least the conversation about mistrust
01:20:40and misinformation is growing during
01:20:42the pandemic and how we may be entering
01:20:44a post liminal period at some point
01:20:46when we kind of exit the pandemic.
01:20:48And you see that as a
01:20:49time for change, I think like a
01:20:51the monkey pox conversation that
01:20:52came a few months after that and
01:20:55that we saw the mistrust and
01:20:56misinformation surrounding that topic.
01:20:58Do you still believe
01:20:59like a time of uncertainty,
01:21:00a time where there's like a
01:21:02pandemic or even an epidemic?
01:21:03Is the right time to start a foster
01:21:05trust, or do you see that as a
01:21:06time for more of damage control
01:21:07on the behalf of medical professionals?
01:21:10That's a good question.
01:21:11I mean I think times of uncertainty,
01:21:12you know, limbo periods, liminal states,
01:21:15I think it's a it's a time in which a
01:21:17lot of progress can and should be made.
01:21:19And you know, when there is
01:21:21uncertainty and chaos in a society,
01:21:24as there has been,
01:21:25that's the time to push things in in the
01:21:28direction that that you want to see them go.
01:21:31You know, I think there's a lot more we
01:21:33should be doing right now around pandemic
01:21:35preparedness and and it seems like we're,
01:21:37you know, turning you know, our.
01:21:40Our view away from it for some reason
01:21:42and and it should be massive amounts
01:21:44of investment of next generation
01:21:45vaccines and investing public health
01:21:48departments and improving ventilation
01:21:50says all the things that we know work.
01:21:52And you know,
01:21:53it happened after 1918 and it
01:21:54seems like it's happening now.
01:21:56People want to forget about what happened,
01:21:59but that would be a mistake.
01:22:01You know,
01:22:01I think each of the last three decades
01:22:04there's been a coronavirus that's mutated
01:22:06into a epidemic type of virus and we
01:22:09were lucky her the first two times.
01:22:11There's no reason to think that in 10
01:22:12years or 20 years it won't happen again.
01:22:14And so I do think while these
01:22:17things are fresh in people's minds,
01:22:19while the pieces are shifting and we're
01:22:21trying to figure out what comes next,
01:22:24is exactly the time to try to
01:22:27capitalize on on this kind of feeling
01:22:29that we need to do something to
01:22:31prevent it from happening again.
01:22:34Doctor Drew Bullard, thank you so much
01:22:36for this evening. This is terrific.
01:22:37We really appreciate it. Thank you.
01:22:43Close.