Dr. Megan Ranney, Incoming Dean, Yale School of Public Health, Yale University 
Moderator: Michal Lev-Ram, FORTUNE 


Brainstorm Health 2023 - Learning From Dr. Tiktok

Conferences

Research shows that more than 60% of adults look online for health information and like so many things in recent years, the pandemic boosted this trend with more people jumping online to devour information and sometimes even to self diagnose. There is no doubt that digital channels can be a powerful positive resource. For example, offering a vehicle that allows health professionals to connect directly with the public to share accurate and useful information. But oftentimes it's not credible research that people are turning to. It's random postings on social media. The problem here, social platforms are fraught with medical misinformation from amateurs, pushing unproven theories and advice. So let's talk about the effects of digital misinformation, how it can be countered and how social media can be used in a positive way for better health outcomes. Joining us now are Dr Sasha Hamdani, psychiatrist and CEO of focus Genie Jessica Mala Rivera Research program assistant at the Johns Hopkins Bloomberg School of Public Health Center for Health Security and Doctor Megan Ranney, incoming Dean of Yale School of Public Health at Yale University. Please welcome them to stage. I thanks so much for um joining us here. So I'm curious to, just to start with, um, to hearing a little bit about your own personal relationships with how you use social media and I'm gonna start with you because you're, you're an avid user and because I'm uncomfortably close to you. Yeah, I can move a little if you want. Um, yeah, so I, um, I'm a psychiatrist. I'm based out of Kansas City and I got onto social media around the same time that everybody got onto social media, which was around the pandemic. The reason that kind of got me onto social media in the first place was really that my patients were holding up their phone to the telehealth visit and they were saying I have a DH D because of this and like nine times out of 10, it was not a valid video, it's kind of dumb. And so I, I initially started creating content to put out information that was accurate and valid to create kind of a safe space on the internet for that and it snowballed from there. Ok. And I, I did see you've got like, you know, your public apology to the barista because you spoke in a British fake British accent. That was very interesting. And then, and then you've got, you know, stats on a DH D I mean, it kind of runs the gamut. Is it, was that something that came naturally to you having the entertainment factor and the, the information or did you have to sort of, I mean, maybe, I don't know, it's, it's constantly evolving. It's, it's mostly um to provide educational content, but it's kind of like hiding the broccoli in a meal, you know, you're providing, you know, you're giving educational content within a entertaining scope just to make it more digestible. Ok. Can you share, you know, similarly where it kind of happened accidentally, I had a very private, you know, per existence on social media prior to the pandemic. But a lot of people who knew my training, which is in infectious diseases and specifically in emerging infectious diseases and pandemics. Uh My, my D MS and my texts were just inundated with questions from people who knew my training and said, can you just help me understand all the headlines I took to Instagram, which was just the first app that I picked and decided to do basic informational highlights 101 contact tracing 101 virology, 101 just to kind of explain what was happening because in studying infectious diseases, so much of my work was in the science communication behind them. And so explaining both the epidemic, the emergence of the disease and the info mic that was kind of in tandem. Um it just took off from there and I realized there was an a an insatiable appetite for that kind of content on social media and had quite the captive audience really quickly. Yeah, I I would imagine that, uh, being an epidemiologist and a communicator came in very handy these last few years. So, pretty amazing, uh, skill set there. Um, so you've got a little bit of a, of a different, uh, you know, relationship probably with, with social media. I mean, I think you all are and I will ask you about both the good and the bad, right? But, but give us a sense of just what your relationship is. So I've actually been on social media, very active on Twitter since about 2010. I'm also a practicing emergency physician and so originally used it as a way to network with colleagues across the country. I created studies through partnerships on social media. I found identified patients who became partners in my research using social media. And then I'd say my use of social media started to change in the mid 2010 s actually helped create a movement called This is Our Lane in 2018 where we physicians, public health professionals, nurses took to Twitter, which was at that point, the dominant form of social media sharing ways in which firearm injury is a health problem and is very much the lane of health care professionals. We did that in the wake of an NRA tweet telling us as doctors to stay in our lane and not talk about gun violence as a public health problem. Use social media at that time really to help drive the lifting of what had been at that point in over 20 year uh absence of federal funding for firearm injury research, we got uh the CDC and N I H refunded to start doing that research in 2020 for the first time since 1996. And then it grew from there. My use of social media changed during the pandemic as it did for all of you as a, as a, you know, front line provider. I talked a lot about the need to get Us PPE actually use social media to organize a nonprofit called Get Us PPE that then delivered, donated personal protective equipment to those who needed it most across the country. And then of course, also do research on it because I am an academic and currently Deputy Dean soon to be incoming dean. This question of how can we use social media to organize, to share good information but also to combat myth and disinformation to fill these information voids that Sasha and Jessica have acknowledged. I'm sure there were all sorts of domain names like get Us P pe available before the pandemic but not, not anymore. We bought them very quickly. Yeah. Um So it's interesting, I mean, you just said, you know, putting out good information to combat misinformation. Um is that, is that enough? And there's so much we're all constantly reading and talking about this and you know, it's the social media companies and their responsibility. There's the government there's, you know, what's going maybe will happen on the federal level, starting to happen on the state level for better or worse. Right. Um But is what's the role of putting good information out there and how much can it really do to combat the misinformation that is very clearly going to be a part of social media networks for the foreseeable future. So I think it is absolutely essential. I see no way for social media companies to fully un route misinformation and information. There are some safeguards that they can put in place and that they need to put in place. For example, we've seen a huge rise in anti vaccine messaging on Twitter since Elon Musk took over and allowed many of the dirty dozen back on Twitter. So there are things that we can do to root out those worst purveyors of disinformation. But the better thing is to elevate the voices of credible social media purveyors. I actually worked with the World Health Organization, the National Academy of Medicine and youtube to help define what a credible messenger looks like on social media. So health care providers, nonprofits for profits, health care organizations can now get a check on social, on youtube to say that they are a trusted information source and then have that message elevated. I think that's the most important thing that we can do is to flood the airwaves with real trusted information is Elon Musk paying for them to get the check. So Sasha, can you talk a little bit about? I mean that you kind of fell into this, you know, because of, of your patients, right? Um There is a lot of good information out there, not just you other professionals are, are are posting, there's also a lot of value obviously, especially in the mental health space to having that community, right? And that support system online, but self diagnosis just to name one, you know what's the risk there and how do you try to mitigate it? So, I mean, I think it boils down to responsible consumption, right? And we we know that this algorithm is very interest based. So if you're interested in something and if you have questions about it and if you are engaging more with certain content, it's going to feed you more of that content. So if you get pigeon holed and if you continue to go down that pathway, you can get very entrenched in diagnosis. Um and that becomes problematic at times when people are trying to use that to self treat. Now, in terms of self diagnosis, I think that the initial steps to self diagnosis of people learning more about their internal condition, finding the words to explain what's happening, finding relatable content. That's all there's a lot of positive in that they are using that information theoretically and hopefully right, to go to a credible source, to go to their physician, to go to their therapist to go to someone who can help them and guide them through this journey. Um So I think there's positives with that. I think it can get dicey when they're trying to self manage it though. Ok. Um Jessica, what are your thought? You actually? And speaking of positive outcomes, I know you've managed to convince some people to get vaccinated, including some famous people. So what works there? What was, what was effective? So my 9 to 5 is data all day, every day. It's a very evidence based. And I use that even in my science communication because there is a science to it and there's evidence behind certain methods in that process. One in particular is information inoculation or pre bunking. So essentially anticipating the logical fallacies, the conspiracies before they happen, as you kind of see the news cycles, you know, spin things and equipping folks to be prepared for those opportunities to make bad choices or good choices, health. And I think that a lot of times science is a missing component in the scientific process and the scientific method. And when we're not training providers or even educators in these institutions to take science beyond the laboratory, beyond the peer reviewed journals that are only being read by nerds like us, you know, it's not really helping society. And I mean, I can I look at it as fluent in another language and instead of dumbing it down, it's really trying to elevate people's literacy in that so that they can feel empowered to make those choices. And it went a really long way. It was not shame based, it was not fear based. It was using a lot of inclusive language leaning into my identity as a woman of color, as a mom, making choices for my Children and all of those things kind of kind of added to the currency of trust in my messaging. Um I'd love to get your questions in. Please raise your hand. We'll bring a microphone to you if you'd like to question or come and we've got one over here. Hi, thanks for speaking to. I run a small newsletter called Stats of one. I'm a bio statistician by day. Um So some public um so because I run this newsletter, I also use social media. I put out uh you know, tweets and all that stuff. We have a podcast now. Um Is there like a gotcha in each of your respective experiences that comes to mind like, oh, this is something you should watch out for, you know, this is going out to the world. What is there something like that that it's like, oh, ok. You know, look out for that, like things to look out for. Exactly. I would say there's a lot of themes that kind of are common in the traps that people fall into when it comes to consuming medical misinformation. And a lot of times it's the very obvious things like the appeal to nature fallacy, you know, that kind of consistently becomes an issue of what are these ingredients or I can't pronounce them. Therefore, it must be bad or this sounds scary because it sounds like this and reminding folks, you know, kind of, of the role of science and the fact that it's not done in order to control or to all those scary words, those verbs that people kind of assume when they don't understand something has really kind of dissolved. A lot of the fear. I mean, I would argue nothing is as destabilizing or as fear inducing as a pandemic. Anybody who is alive is at risk. It's very different from a localized conflict. So, um you know, when you kind of normalize that and say, you know, we're all equal, we're all human, we're all at risk, but here are ways to not fall into these traps. Um You can kind of see it from a distance like, oh, that's gonna turn into this type of messaging or that's gonna turn into this type of opportunity to sell a supplement or sell some sort of snake oil, maybe, maybe in a, some kind of A I system in the future can try to, yeah, there's keywords for sure that can be identified early on and, and you know, used to target that and combat misinformation and also going off of what Jessica said earlier, I think that we have a responsibility as science communicators to be proactive. So an example was we all knew that the vaccine was, the COVID vaccine was gonna be approved for Children under 12. And yet so many people were sitting on their hands and waited until the approval started to start messaging. Meanwhile, you'd better believe the anti vaccine had been developing their anti child vaccine messaging for not just months but literally for decades, right? This dates way back to the Mmr vaccine. We lost our period of time to prep the public and to pre bunk those ideas that we knew were going to come forward the other. Gotcha or kind of caution. A much more personal one is to always take a breath before you post something that is potentially inflammatory and particularly around those kind of back and forth arguments. The trolls are real sometimes people that criticize you are not trolls, but I have taught myself over the years. I'm not always perfect, but to always take a breath before I respond or engage because nothing can truly be deleted from social media. So it goes like it's out there and it's just not worth it. When you start going down that rabbit hole of engaging with the trolls, it it doesn't end up well for anybody. It just makes you look bad. So, so, so that kind of taking a breath caution I think is a really important one for all of us and one of the things that could potentially be helpful in what Megan was saying with, with people coming at you for information that they understand or don't understand those crediting your source. I think that's really important in terms of, um, you know, because as soon as you don't do that or as soon as you forget to do that, then all of a sudden this is not even a credible source of information. Where is this coming from? Usually it's, you know, if you have this, OK, this was cited in this journal, this is where you can find it that that already takes a lot of steam and the bad actors are getting more sophisticated. So it's also showing people how to become better consumers of even things like data visualization, which has a stickiness to it. You assume somebody's smart and really gifted at Tableau or Excel created it, but the bad information looks really science. Y so it's kind of training eyes to interpret the X and Y and the meaning behind the data, all you need is a pie chart and exactly you're good misinformation. We have another question back there. Thank you. Uh Harvey Carp from Happiest Baby. Um um One of the things and, and Megan to your point about the anti-vaxxers, you know, they're out there 10, 10 months ahead of you with their, with their um with the materials already and beautiful graphics as well and it really seems like this is an opportunity for organized uh medicine to be organized and to um and to be able to have centers of excellence that prepare these materials. So they can be disseminated. The academy of pediatrics, for example, has what they call T pediatricians. Uh where once a month we get a list of, you know, topics, uh suggestions and so we can all sing to the same uh the same hymnal. Um And uh and on, on Happy as baby, we've got about two million visitors a month who are coming for long form, not just for tweets, but they want information. I think that there are other platforms as well where we not only can give the message of the day but really kind of expand upon it so good to be organized. Yeah, so that I think that is actually the key, none of us can do this individually. I don't know how much time the of you spend on social media, but I spend a lot, it's a lot of work to gather the data to present it and doing less these days as I transition into my new role. But those sorts of collaborations with trusted messengers who are already out there is so critical, preparing the data in ways that is consumable. Stay tuned for what I'll be doing at Yale would love to collaborate on that. But, but I will also say that there is um you know, that that element of training and policing our own is critical. The public good project just released a report saying that about a third of the worst purveyors of disinformation on social media are physicians and nurses. We need to kind of watch out for our own. You know, one of them is the surgeon general of the state who actively manipulated some data that got published and created concerns about COVID vaccine in young men. Um And it's now been shown the degree to which the the study was kind of manipulated. How do we police that? It's a question that every Board of Medicine, nursing boards and schools of public health need to really take on anything to add. Have you been a part of any kind of growing more coordinated effort to get those tableau out there or, or just to collaborate in some ways on the communication piece? I mean, Megan and I worked together on that W H O partnership and that was really impactful to kind of see the the value of how do you differentiate a, you know, one source from the other? I will say it's become deeply concerning to see platforms like Instagram and Twitter now kind of throw it all away and, and have a way of identifying who is notable. And I would say some of those thresholds may needed to be, you know, audited because they could have been just, just based on popularity or celebrity. But the fact that we're not seeing that across the board to help people be better at discerning who is reliable and who is not does make this, you know, this info that we're in um even more difficult to navigate Sasha anything bad. I I I'd also like to add that. I think that this is an area of growing interest. Um just kind of across the board recently, I was part of a health care leaders on social media round table at the White House. And uh they would send out information about things that were coming down the pipeline and using us to kind of like review the information and find ways to make it digestible for the public. So I think that this is something that as, as social media continues to grow and expand and evolve, it's important to start incorporating those changes and how we behave on social media and how we look towards social media to getting information respectively. Ok. Well, if you don't follow these three on social media, please do. Um Thank you so much for coming and sharing with us again. Thank you.