On April 22, 2021, Yale’s Department of Internal Medicine hosted its second event on Clubhouse, a social networking app that allows members to gather in audio chat rooms and discuss issues in a live podcast style. The event focused on the effect media coverage on COVID-19 vaccines is having on public health, how to engage in conversation about the vaccine, and what may be around the corner in this pandemic.
The following experts participated in the panel discussion:
- Mahalia Desruisseaux, MD, associate professor of medicine (infectious diseases);
- Manisha Juthani, MD, associate professor of medicine (infectious diseases) and epidemiology (microbial diseases);
- Prerak Juthani, MD, MBA student, Yale School of Medicine
This event was moderated by Perry Wilson, MD, MSCE, associate professor of medicine (nephrology); and director of the Clinical and Translational Research Accelerator (CTRA).
Below are some highlights from the event. The conversation has been edited for brevity.
Q: Medical myths are not new, but it does feel like there's something different about medical misinformation in the coronavirus era. What's going on now that has made medical misinformation such a problem?
Prerak Juthani: It’s a very interesting time because social media seems to be taking off right as a lot of big things are happening in this world, and that hasn't made misinformation easier. I think, if anything, social media has contributed to a lot of potential misinformation and created an avenue for misinformation to get out, which has then made it that much more tough, because some of the people be fighting misinformation haven't used social media before.
Manisha Juthani: I think there are a couple of unique things. We have this new deadly disease that even experts in infectious diseases were learning about on the go, and we became the resident experts, when we were learning about the disease as it was unfolding. And there was a great desire to try to do something. And so with social media, as Prerak clearly outlined, people have the capacity to take their anecdotal data or their best guess or hunch that may not be backed by science or evidence, and put it out there, and social media does allow for misinformation to take off in a way that we have not seen before. One example is the concept of bleach or other sanitizing products, even hand sanitizer. Back in March as this was all unfolding, people were trying to do what they were told— wash their hands, keep distance to try to prevent from getting this disease. And a paper was published in the New England Journal [of Medicine] in April, talking about surfaces and comparing coronavirus, SARS-CoV-2, to SARS-CoV-1, which was what caused SARS back in the early 2000s, and how much the virus was able to last on plastic, on cardboard. I think that paper really spurred the actions of so many people, who were using bleach products and wipes and other things to wipe down their groceries and surfaces. And while coronavirus is viable on surfaces, we also know a year later that that is an unlikely mechanism for infection. And then, we also had comments by leaders about ingesting bleach, and I think there's data out of the CDC that shows over the last year an increase in calls to poison control and an increase in hospitalizations and ED visits for ingestion of hand sanitizer or other products like this. It is something that public health officials have seen and tried to warn people against, that this is not a way to protect yourself from getting COVID. So I think this is an example of how a myth can overtake our media and overtake the way people end up living their lives.
Mahalia Desruisseaux: I just wanted to add to what Manisha was saying—this is such a new virus, and as our knowledge of the virus evolved, things changed. So initially, we had a shortage of masks, and we had a shortage of different items that we needed to preserve for healthcare workers, and so the CDC and the administration's advice to the public was, "Do not wear masks." But then as masks became more readily available and we realized that droplets were the way the virus was transmitted, then the CDC recommendation became, "Let's wear masks." So as things evolved and the recommendations evolved people became confused, especially due to the lack of transparency around how these decisions are made. Initially, it's one infection, a couple of people, it's not to the level of a pandemic, but then less than a month later we're calling it a pandemic, and now people don't trust the leaders anymore. They not trust the CDC, they don't trust the institutions which are supposed to give them advice on what to do with the virus. So where are they going fall to? The myths on social media.
Perry Wilson: Yes, that's a great point. There are a couple, as you're talking, of cognitive biases that come into play here that I can think of. So one that has come up a lot before in terms of what we often call complementary and alternative medicine or sometimes Eastern medicine practices, is this fact that, why do doctors keep changing their minds about stuff, as you mentioned, Mahalia. And obviously, COVID-19, there's some examples here when it comes, for example, to masking. But this happens all the time, a study comes out saying that eggs cause heart disease, and then three months later, a study comes out saying, "Oh, no, eggs are good for you, you should all be eating eggs,” and people get really frustrated. It does lead to a breach of trust.
At the same time, the reason this is happening, as you point out, is that this is how science works. We are always learning more and making incremental progress, and because of that, we often learn that things we did before were wrong. If you draw a contrast between that approach to finding truth, this slow, gradual bending towards truth to certain practices, take something like acupuncture or homeopathy, where oftentimes the marketing around these practices is based on the fact that they have not changed, that this has been going on for a thousand years, and people view that inherently as a marker of trustworthiness. This is called the argument from antiquity.
But of course, if you take a little step back and ask, "Why aren't we improving acupuncture? Why aren't there ongoing studies trying to figure out what the best place to put the needles are? Why don't we apply the scientific method to those things?" And in some sense, we have to be comfortable telling people that we are getting it wrong sometimes, but as we go forward, we are getting better and better and better. And of course, if you compare medicine now and what we can do now to medicine 50 years ago or 100 years ago, it blows your mind at the progress that this process has made. But it comes with this nasty little side effect, that sometimes we realize that the thing we were doing 10 years ago that everyone thought was the right thing to do was wrong. And actually, that's a feature, not a bug.
I want to circle back to social media for a minute, because the other bias that I think has really affected people is something called the illusory truth effect, a phenomenon where if you hear the same fact, even if it's incorrect, again and again, your brain starts to believe it's true more often. So someone tells you, "Well, the average person eats 30 spiders a year in their sleep," you hear that once and you think, "Oh, that's creepy." And then you hear from another person and you hear from another person, and all of a sudden you think, "Gosh, maybe I'm eating 30 spiders in my sleep." You're not, by the way, that is a myth. It seems to me like social media plunges us into the illusory truth effect, because of the way the algorithms work, you can fall down these rabbit holes where it does seem like lots of people are repeating the same fact, but it's not because the fact is true, it's because the algorithm is linking you to people with the same beliefs. So is this a problem? Is the algorithm making us believe lies?
P. Juthani: I can chime in. I'm taking a healthcare narrative class right now with Dr. James Hamblin. He showed us this graph. The Y axis was the probability of going viral on the internet and the X axis was the intelligence of the post. So the things closer to the origin were really stupid, and then as you get further and further along, something that's super intelligent. And it was essentially a U-shaped curve, saying that things that are very stupid that a lot of people relate to have a pretty high chance of going viral on the internet just because people are like this is awesome, let's talk about how stupid this is. But then believe it or not, then there's this big gap of things that we talk about day to day which if we don't make it accessible, we don't make it relatable, don't have a chance of going viral because people will see it and just say, "Okay, I don't understand this, maybe I don't relate."
And then the things on the very, very right are things like Dr. Hamblin does pretty well, which is communicate really important information in a way that's relatable but also doesn't delineate or discriminate against anyone, and so it actually allows spreading of that information. So I think part of it is the algorithm, but part of it is also when people see something that they can relate to, they're more likely to be like, "Oh cool, maybe I'll retweet this or maybe I'll share it." But when people feel like they don't understand it or that maybe they don't agree with something that's said, that's when it doesn't get shared.
Q: How can we leverage the algorithm to spread truth? Is there a strategy here or is the nuance that we all feel compelled to put in our posts antiviral? No pun intended.
M. Juthani: I think that's a great point what you both are bringing up. I'm not an expert at this. But what I do think is important is that people who are academics, who are educated, who have knowledge, do have a presence in these places so that those voices are out there just as much as some of those stupid and funny voices are out there, because as we've seen with elected officials and other scientists who are very good at getting their points out, by being in this space there's a greater chance that in that U-shaped curve that Prerak was talking about, we get stuff on the far right that is easily relatable but also what as scientists, to the best of our knowledge, is the truth in today's moment and now. Because I think the other thing we have do is have humility to know that and say that we're doing the best we can, we have the information that is most readily available to us and state-of-the-art science, but that may change as more science comes out. And having that humility, I think also allows people to trust us and know at the end of the day that we're all human and that we're just doing the best we can, but that we may say something different, some years, sometimes even months later. Like Mahalia mentioned something like masking where Dr. Fauci will say, "Well, I said people didn't need to wear masks in the beginning, but then we learned more and we knew that they were more available and we changed what we needed to recommend." And so, I think those are two important points is just to have that humility but also have the voices out there.
Wilson: So yes, one of the places where this comes up is with the vaccines. Vaccine hesitancy is a thing, it's real. I have previously said and I still believe that the limitation in vaccination we're seeing is not entirely attributable to hesitancy. There are lots of people that still have access issues. But talking about hesitancy, as a physician, I get really nervous when I'm asked about vaccines because I am so aware that everything that we say can sometimes be spun in an anti-vaccine way. So for example, if we're thinking about rare adverse effects associated with some of the vaccines. So think of the blood clots, for example, for the Johnson and Johnson vaccine, this is a rare complication about one in a million people who received the vaccine.
Nevertheless, it's true. We want to be open and honest about this, but it's so difficult because you know that by being transparent you might be convincing people that were on the fence not to take the vaccine, when deep down you feel the risk-benefit really is in favor of benefits.
Q: What are our strategies in the vaccine space? Do we just say, "Here’s the data, you really should get the vaccine but you're your own person," or are we obligated to market it?
Desruisseaux: I think the best way to promote vaccination is to be transparent. Part of the issue is different people have different reasons for being hesitant about taking the vaccine, but part of the issue is trust. We all know vaccines take a long time to develop, to go from the bench to the bedside. It takes over a year, most of the time. And this was developed in less than a year, less than nine months. We had all these companies that came together, and the rush to get the FDA approval. And people don't trust that all the steps with regard to safety were adhered to when there's this rush. So, if I withhold information and there's already a lack of trust, it's going to worsen that lack of trust, right? So, I think that the best way to combat this is to be completely transparent.
There are things we don't know about the vaccine, there are things that we do know about the vaccine, and these are some of the adverse effects that we see in people, but we know its efficacy, we know that in this patient population, it prevents severe illness in a certain age group. So, all the data on the vaccine, the 95% efficacy and prevention into severe disease, we give all the information and people are then allowed to make the decision on their own. I can't make someone take the vaccine, but I can give you all the facts that I know about the vaccine based on the published data, and I can answer all your questions about the vaccine, make myself available. If I'm explaining it to my family member, that's the same way that I would explain it to anybody else. I'm here to listen to your fears and your concerns about the vaccine, and as much as I can, try to allay those fears in my communication with you.
And for the most part, people appreciate that, people appreciate honesty, people appreciate transparency. And I've done several town halls where we've spoken about the vaccine, and I use exactly this approach, alongside Dr. [Onyema] Ogbuagu, who was involved with the Pfizer vaccine trial at Yale. And at the end, several people would reach out to us and thank us and say they changed their minds. And it wasn't anything that we forced on them, it was just giving them the facts and being transparent about what we know and what we don't know.
I do want to come back to that question about social media and why certain posts go viral. I think that as medical professionals, we tend to stay within our circles, and I will disclose that I've never had a single viral post on any social media. [laughter] And that's because my circle is very tight. The only people that are on my contacts list are people that are either at Yale or people that are medical professionals in other institutions. So it's very hard to go viral for me, and I don't have thousands of followers, but some people who do it well... I don't know if you guys are familiar, this one account, Glaucomflecken, he's an ophthalmologist. And he uses humor, and includes educational material in it, it's not just "I'm being funny to be funny," it’s, in terms of that U-shaped curve that you talked about, "I'm being funny, but I'm also teaching you what the facts are." So, he uses TikTok, he uses other formats to get his message across. Whatever he needs to do to get his message across, he does, and he does it very well.
Yale’s Department of Internal Medicine is hosting many events on a variety of topics on Clubhouse. Check out the Internal Medicine room to learn more.
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