WEBVTT - Special Episode: Deborah Cohen & Bad Influence 0:00:44.159 --> 0:00:47.639 Hi, I'm Aaron Welsh and this is This Podcast Will 0:00:47.680 --> 0:00:51.120 Kill You. Welcome to the latest episode of the tp 0:00:51.479 --> 0:00:54.480 w k Y book Club series, where I bring on 0:00:54.600 --> 0:00:57.560 authors of popular science and medicine books to chat about 0:00:57.560 --> 0:01:01.040 their latest work. These books span such a wide range 0:01:01.040 --> 0:01:04.959 of subjects there's really something for everyone. Maybe you'd like 0:01:05.040 --> 0:01:08.559 to learn more about the evolution of language, or what's 0:01:08.600 --> 0:01:12.319 going on with the diagnosis crisis around the world. Maybe 0:01:12.319 --> 0:01:16.840 you're curious about how refrigeration transformed the world, or how 0:01:16.880 --> 0:01:20.399 our understanding of cancer was shaped by tragedy. 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After all, the 0:02:34.160 --> 0:02:37.280 next opening at your doctor's clinic is months away, and 0:02:37.360 --> 0:02:40.640 even if you managed to snag an earlier appointment, would 0:02:40.639 --> 0:02:43.240 you have enough time to ask all your questions and 0:02:43.280 --> 0:02:47.240 get them all answered? Probably not. Why wait when you 0:02:47.280 --> 0:02:51.160 can research at your leisure, scrolling through tiktoks, asking AI, 0:02:51.600 --> 0:02:54.919 or listening to a podcast where the overconfident hosts swear 0:02:54.919 --> 0:02:58.560 by peptide injections and smart rings, using medical language to 0:02:58.600 --> 0:03:02.320 disguise what they're really doing, which is inventing a problem 0:03:02.560 --> 0:03:06.880 and selling you the solution. Increasingly, people are turning towards 0:03:06.880 --> 0:03:09.960 the Internet to seek solutions for many of their health 0:03:10.000 --> 0:03:13.359 care and wellness needs. But even if you aren't actively 0:03:13.400 --> 0:03:16.600 searching for this type of content, it finds you anyway. 0:03:17.120 --> 0:03:21.000 The proliferation of wellness influencers and the commodification of health 0:03:21.040 --> 0:03:27.200 anxiety has had profound impacts on our relationship with medicine, expertise, 0:03:27.520 --> 0:03:31.799 and truth. In today's episode, I'm joined by doctor Deborah Cohen, 0:03:32.040 --> 0:03:36.560 medically trained, award winning journalist, broadcaster, and editor, to discuss 0:03:36.600 --> 0:03:40.760 these issues, which she explores in her recent book Bad Influence, 0:03:40.920 --> 0:03:46.080 How the Internet Hijacked Our Health. Extensively researched and compellingly written, 0:03:46.280 --> 0:03:50.800 Bad Influence uncovers the insidious manipulation by those seeking to 0:03:50.840 --> 0:03:53.920 make a profit and the way they prey on vulnerable 0:03:53.920 --> 0:03:58.760 individuals simply looking for help. As doctor Cohen demonstrates, the 0:03:58.840 --> 0:04:01.800 Internet is a double edged sword, rife with this type 0:04:01.800 --> 0:04:06.040 of exploitation, but also a source of empowerment and community. 0:04:06.600 --> 0:04:10.320 Navigating this virtual landscape has never been more challenging, with 0:04:10.480 --> 0:04:14.320 marketing masquerading as medicine and an endless supply of snake 0:04:14.360 --> 0:04:17.840 oil salesmen in their newest iteration, as podcast brows and 0:04:18.080 --> 0:04:22.320 one simple trick clickbaiters. Doctor Cohen pulls back the curtain 0:04:22.360 --> 0:04:25.000 on the underbelly of the wellness industry, and in so 0:04:25.160 --> 0:04:29.320 doing makes an urgent call for regulation to protect consumers 0:04:29.880 --> 0:04:33.640 until that happens, if it ever happens. She leaves readers 0:04:33.680 --> 0:04:37.960 with a crucial piece of advice, Ask yourself, why you're 0:04:38.000 --> 0:04:41.240 seeing what you're seeing in your feed, who's telling you 0:04:41.320 --> 0:04:45.240 this stuff? And why. Bad Influence is a timely and 0:04:45.360 --> 0:04:48.760 necessary guide to the wild West of Internet wellness and 0:04:48.800 --> 0:04:53.159 the nefarious health influencers spreading lives for profit. I'm very 0:04:53.200 --> 0:04:55.679 excited to bring this conversation to you all, so let's 0:04:55.720 --> 0:05:22.880 just take a quick break and get started. Doctor Cohen, 0:05:22.920 --> 0:05:24.880 thank you so much for joining me today. 0:05:25.040 --> 0:05:26.880 Thank you for having me, and thank you for being 0:05:26.920 --> 0:05:27.920 interested in the book. 0:05:28.160 --> 0:05:31.400 Oh of course. I mean I was so excited to 0:05:31.760 --> 0:05:34.080 come across your book and to read it because it 0:05:34.160 --> 0:05:36.479 explores so many of the things that I feel like 0:05:36.520 --> 0:05:40.240 on this podcast we're constantly confronting. It's this kind of 0:05:40.279 --> 0:05:44.960 one two punch between these active disinformation spreaders along with 0:05:45.120 --> 0:05:49.160 worsening access to medical professionals, and it's created this perfect 0:05:49.200 --> 0:05:53.120 storm of just where do you get good information and 0:05:53.200 --> 0:05:56.800 how do you recognize the good and the bad. Was 0:05:56.800 --> 0:06:00.719 there a moment in the construction of this book and 0:06:00.720 --> 0:06:03.280 the production of this book where you said, Okay, this 0:06:03.320 --> 0:06:05.719 needs to be a story that I want to tell. 0:06:06.279 --> 0:06:08.880 It was quite early on the reason I read it. 0:06:08.880 --> 0:06:10.920 There was a few things happening at the same time. 0:06:11.120 --> 0:06:15.560 So one of my cousin I'm from Liverpool in England, 0:06:16.200 --> 0:06:19.640 and I was at my auntie's birthday and one of 0:06:19.640 --> 0:06:22.480 my cousin's friends said to me she just bought an 0:06:22.520 --> 0:06:24.919 AMAH test and I was like, well have you done that? 0:06:24.960 --> 0:06:26.960 And she said, I want to know how fertile I am. 0:06:27.240 --> 0:06:29.160 I said, is it really going to is it really 0:06:29.200 --> 0:06:32.080 going to tell you that? And people in Liverpool if 0:06:32.120 --> 0:06:37.159 your audience don't know, we're very direct. There's no smooth talking. 0:06:37.200 --> 0:06:40.160 It's all very direct. So why have you done that? 0:06:41.040 --> 0:06:43.120 And I said, well, what are you going to do 0:06:43.160 --> 0:06:45.279 with the results? Say? If they're though, what you're going 0:06:45.360 --> 0:06:47.039 to do? And she went, well, I going to go 0:06:47.080 --> 0:06:50.880 and see my GP or primary care physician. And I said, well, 0:06:51.160 --> 0:06:53.159 what are you going to do if the normal And 0:06:53.200 --> 0:06:55.880 she looked at me and she said, I'm going to 0:06:55.920 --> 0:06:58.240 go and see my primary care physician. And I said, 0:06:58.320 --> 0:07:00.000 who isn't going to be able to use the results 0:07:00.200 --> 0:07:03.920 because it isn't telling you anything about your fertility. You've 0:07:03.960 --> 0:07:06.520 just wasted one hundred and sixty pounds, so two hundred 0:07:06.560 --> 0:07:09.040 dollars and that that was sort of the start. And 0:07:09.080 --> 0:07:10.760 I said, where did you get the information from? And 0:07:10.840 --> 0:07:13.760 she said our insta As if I was stupid, you know, 0:07:13.800 --> 0:07:17.640 why wouldn't you going to insta your health information book? 0:07:18.040 --> 0:07:21.040 Doctors couldn't give her the information she needed because she 0:07:21.080 --> 0:07:23.640 couldn't conceive. She was struggling to conceive. There was no 0:07:23.840 --> 0:07:27.560 real medical reason for it, and it was an obvious 0:07:27.560 --> 0:07:30.600 place to go. And there it was all sorts of 0:07:30.680 --> 0:07:34.080 clinics were offering that as a solution. The egg time 0:07:34.120 --> 0:07:37.520 of test and then other friends I noticed who the 0:07:37.600 --> 0:07:41.720 university educated smart and again going online for information about 0:07:41.800 --> 0:07:45.160 hormone replacement therapy or menopause hormone therapy, whichever turned me 0:07:45.200 --> 0:07:50.400 on to use testosterone, you know, full body screening ADHD information. 0:07:51.400 --> 0:07:55.120 And there are problems with the access to healthcare whichever 0:07:55.240 --> 0:07:58.200 part of the world you're in, and it differs according 0:07:58.280 --> 0:08:00.360 to what part of the world you're in. We've got 0:08:00.400 --> 0:08:03.200 a national health service in the UK and there's massive 0:08:03.240 --> 0:08:06.280 waiting lists. But equally a lot of the book, I 0:08:06.360 --> 0:08:10.080 speak to a lot of us BACE physicians and patients 0:08:10.080 --> 0:08:15.080 and influencers and different challenges, but even still challenges getting 0:08:15.120 --> 0:08:20.640 access to healthcare and traditional healthcare services can't provide an answer, 0:08:20.720 --> 0:08:24.320 there's always someone online who will. And there was a 0:08:25.120 --> 0:08:29.000 noticing an increasing growth of that, and then people were 0:08:29.040 --> 0:08:32.120 sort of having to In my day job as a journalist, 0:08:32.320 --> 0:08:34.960 I'll sort of go, well, why are you coming to 0:08:34.960 --> 0:08:38.800 me with that information? What's your agendas? Why are you 0:08:38.960 --> 0:08:40.880 telling me that I look for the benefits, I'm looking 0:08:40.920 --> 0:08:43.679 for the harms. I'm looking for the evidence. And they 0:08:43.720 --> 0:08:46.400 were having to be almost their own mini journalists online, 0:08:46.440 --> 0:08:50.120 but without the background that I had, or that training 0:08:50.160 --> 0:08:54.240 that I had to critically appraise information. And perhaps that's 0:08:54.240 --> 0:08:57.720 some of that automatic skepticism. If I get a press release, 0:08:57.840 --> 0:09:00.960 I'm thinking, yeah, why do you want me to that story? 0:09:01.640 --> 0:09:04.640 So as a journalist, I'm naturally skeptical, and that's what 0:09:04.640 --> 0:09:08.080 we're supposed to be. But people were being bombarded with 0:09:08.200 --> 0:09:10.400 stuff and didn't really know what to make of it. 0:09:11.600 --> 0:09:16.040 I want to dive into the influence In your title, 0:09:16.440 --> 0:09:20.560 who is doing the influencing, the bad influencing, Where are 0:09:20.600 --> 0:09:24.080 they influencing, and who is being influenced? Can you sketch 0:09:24.080 --> 0:09:26.120 out the major areas where this is happening. 0:09:26.960 --> 0:09:30.400 So I think we've talked about for many years on 0:09:30.840 --> 0:09:35.120 medical journals, or in academia, or in healthcare. Generally, there's 0:09:35.240 --> 0:09:39.120 always been commercial actors that influence our health. We know 0:09:39.200 --> 0:09:42.480 the tobacco industry sat on the arms of smoking for 0:09:42.640 --> 0:09:45.559 decades even though they knew it was causing lung cancer. 0:09:46.200 --> 0:09:49.960 We know the drug industry ask certain questions to get 0:09:50.040 --> 0:09:52.360 certain answers. You know you can be clever in how 0:09:52.400 --> 0:09:56.319 you do your randomized control trials. We know the alcohol industry, 0:09:56.360 --> 0:10:02.679 big food, fossil fuel companies. They influence healthcare. They lobby politicians, 0:10:03.000 --> 0:10:08.479 they lobby decision makers to create policies that are favorable 0:10:08.520 --> 0:10:11.280 in their interests. And we know that they influence the 0:10:11.720 --> 0:10:15.679 evidence space. And what was really interesting to me was 0:10:16.320 --> 0:10:19.640 We've got this whole new set of commercial players now. 0:10:19.960 --> 0:10:23.359 So I was less interested in the classic conspiracy theorists. 0:10:24.120 --> 0:10:28.439 I was much more interested in these industries that perhaps 0:10:28.440 --> 0:10:31.800 are shaping scientific industry. Should I say that are shaping 0:10:31.800 --> 0:10:34.880 our healthcare. So the obvious one is big tech, and 0:10:35.160 --> 0:10:40.160 they host the platforms, they operate the algorithms that influence 0:10:40.240 --> 0:10:43.560 what we see. They decide what's going to be first 0:10:43.559 --> 0:10:46.800 in our feed. If it's an advert, you are an 0:10:46.920 --> 0:10:49.720 obvious advert from a company, you're going to drop further 0:10:49.760 --> 0:10:52.880 down the feed. But they will surface the influencers that 0:10:52.960 --> 0:10:58.240 have financial relationships with other companies. So that's the obvious one. 0:10:58.280 --> 0:11:00.640 So in my mind, I think of it as big 0:11:00.679 --> 0:11:04.160 tech meets all these little other industries, all these other 0:11:04.200 --> 0:11:09.160 little companies if you like influencers, online pharmacies, telehealth a 0:11:09.280 --> 0:11:15.120 big one, your wearables, your apps. It's unfettered advertising, and 0:11:15.520 --> 0:11:18.760 so you've got all these different commercial incentives that are 0:11:18.760 --> 0:11:23.160 at play that are being surfaced by the big tech companies, 0:11:23.200 --> 0:11:27.880 whether that's Meta or TikTok or dance vital or Google YouTube, 0:11:28.640 --> 0:11:31.520 and they're controlling in many ways what we see in 0:11:31.559 --> 0:11:35.319 our feed. And I was interested to think about, well, 0:11:35.840 --> 0:11:40.439 how are these actors shaping our health And I think 0:11:40.440 --> 0:11:44.000 there's a big open questions still because there's an absence 0:11:44.000 --> 0:11:46.560 of evidence as so I didn't want to be too 0:11:46.600 --> 0:11:48.839 certain because what I didn't want to do is deep 0:11:48.840 --> 0:11:52.360 and bad science by doing bad science myself. You say, 0:11:52.600 --> 0:11:56.440 that's overstated claimer, and I've made over stated claims. But 0:11:56.559 --> 0:11:59.400 there's clear that there's something going on. And we know 0:11:59.600 --> 0:12:02.840 health and our understanding of medicine is shaped by culture, 0:12:03.000 --> 0:12:07.680 is shaped by society, and is massively shaped by commercial interests. 0:12:08.240 --> 0:12:12.160 So they were the questions really for me, and in 0:12:12.160 --> 0:12:15.920 what direction are we going? And there's some interesting anecdotes 0:12:15.960 --> 0:12:23.599 from US physicians. Actually. On one obgyn University said to me, 0:12:23.720 --> 0:12:27.680 and she deals with contraception, and she said to me, 0:12:27.760 --> 0:12:30.719 I know when my young patients come to see me, 0:12:30.880 --> 0:12:34.480 they spent four hours a day on TikTok getting their information. 0:12:35.440 --> 0:12:38.679 I've got like twenty minutes with them. And men's health 0:12:38.720 --> 0:12:43.480 specialists that are half a deffiliated hospital. He said to me, 0:12:43.720 --> 0:12:46.000 he feels he's tilting at windmills where he's got all 0:12:46.000 --> 0:12:50.520 these men's health providers that are offering testosterone at a 0:12:50.600 --> 0:12:53.040 drop of a hat, and he wants to counsel patients 0:12:53.080 --> 0:12:57.559 properly about health interventions that might actually change change their 0:12:57.559 --> 0:13:01.640 health and actually help their testosterone levels losing weight, but 0:13:01.720 --> 0:13:04.719 it's like they want to quick fix. So that was 0:13:04.760 --> 0:13:08.000 a very long winded way of saying, there's all these 0:13:08.000 --> 0:13:12.400 different actors that are on our platforms that are trying 0:13:12.440 --> 0:13:14.600 to grab our health, that are trying to shape our health, 0:13:15.040 --> 0:13:18.680 and influencers as well. With certain symptoms, they will change 0:13:18.679 --> 0:13:22.880 their symptom profile according to what's going viral. So if 0:13:22.920 --> 0:13:28.160 you take the example of ADHD and you are changing 0:13:28.280 --> 0:13:31.000 what your symptoms are because you know it's resonating with 0:13:31.040 --> 0:13:33.840 an audience, what's that going to do to our understanding 0:13:33.880 --> 0:13:36.160 of ADHD if you look at it through a social 0:13:36.200 --> 0:13:36.880 media prism. 0:13:38.080 --> 0:13:40.320 Let's take a quick break and when we get back, 0:13:40.360 --> 0:13:56.480 there's still so much to discuss. Welcome back everyone. I've 0:13:56.480 --> 0:13:59.960 been chatting with doctor Deborah Cohen about her book Bad Influence, 0:14:00.200 --> 0:14:04.280 how the Internet hijacked our health. Let's get back into things. 0:14:04.440 --> 0:14:08.680 It's so interesting what you mentioned about somebody spending four 0:14:08.679 --> 0:14:11.400 hours a day on social media and TikTok scrolling, and 0:14:11.400 --> 0:14:13.840 that's where they're getting the vast majority of their information 0:14:14.000 --> 0:14:19.240 versus this twenty minute time with their doctor. And there's 0:14:19.280 --> 0:14:23.200 also what they're seeing and you dive into this when 0:14:23.240 --> 0:14:25.200 you discuss the nocebo effect. 0:14:25.760 --> 0:14:29.560 Yeah, it's fascinating. I don't think we talk enough about 0:14:29.720 --> 0:14:34.240 mind body medicine in healthcare. I think we can often 0:14:34.280 --> 0:14:37.480 follow the biomedical model too much, and some of the 0:14:37.520 --> 0:14:42.800 more Eastern philosophies perhaps use the mind body model more. 0:14:43.480 --> 0:14:48.400 But we know that our expectations shape so many different things, 0:14:48.400 --> 0:14:52.240 and symptoms are included. How we experience stuff comes from 0:14:52.240 --> 0:14:54.480 all comes from our head, and it's not to say 0:14:54.720 --> 0:14:59.680 it's all in the mind. Symptoms are very real physical manifestations. 0:15:00.520 --> 0:15:03.160 But if we have anxiety, say for example, we were 0:15:03.200 --> 0:15:06.800 more likely to experience pain. We know how we experience 0:15:06.840 --> 0:15:11.120 stuff of us are going to shape how we experience symptoms, 0:15:11.920 --> 0:15:15.560 and that is for good and for bad. So placebo 0:15:16.520 --> 0:15:19.960 is if you believe something is going to help you, 0:15:20.360 --> 0:15:24.560 then that may help your symptoms. So placebo effect is 0:15:24.560 --> 0:15:28.240 an incredibly powerful effect. Testosterone, which we know is being 0:15:28.320 --> 0:15:34.360 promoted heavily to men and to women perimenopausal and menopausal women, 0:15:34.720 --> 0:15:38.640 we know testosterone has quite a strong placebo effect. So 0:15:38.680 --> 0:15:43.240 if you feel tired or low energy, you have some testosterone, 0:15:43.280 --> 0:15:46.080 suddenly feel better quite a lot. That is placebo, and 0:15:46.120 --> 0:15:50.440 that's a very powerful effect. Equally, there's something called the 0:15:50.480 --> 0:15:53.040 Mecibo effect, and that is the evil twin. If you 0:15:53.160 --> 0:15:56.880 like of placebo. It literally means I will harm, So 0:15:57.000 --> 0:16:00.240 you will know if you see someone throwing up feel 0:16:00.360 --> 0:16:03.920 sick yourself. It does not mean that you have that 0:16:04.040 --> 0:16:09.840 viral infection or bacterial infection, but that very graphic visual 0:16:09.880 --> 0:16:13.640 invict of someone being sick. It can make you feel nausea, 0:16:13.680 --> 0:16:17.640 and that is your mind. Those symptoms of nausea are real, 0:16:17.800 --> 0:16:21.240 but that is your mind mimicking if you like what 0:16:21.280 --> 0:16:24.480 you're seeing, if you think about little bugs crawling up 0:16:24.520 --> 0:16:28.040 your neck, you can feel a little bit twitchy. You know, 0:16:28.080 --> 0:16:31.320 you can literally feel it. And what we know is 0:16:31.920 --> 0:16:36.960 visually seeing something is more powerful than reading about an effect. 0:16:37.880 --> 0:16:41.920 And when you read the side effects of a drug, 0:16:42.400 --> 0:16:46.040 it increases your chances of having those side effects. Or 0:16:46.040 --> 0:16:48.920 we're talking things like headache and nausea and fatigue and 0:16:49.680 --> 0:16:53.400 those those kinds of symptoms. And that is something that 0:16:53.480 --> 0:16:55.800 researchers are starting to look at, which I think is 0:16:55.880 --> 0:17:00.720 fascinating about how social media shapes how we think about 0:17:00.720 --> 0:17:04.040 our symptoms or how we feel about our symptoms. And 0:17:04.080 --> 0:17:07.480 this is where I think some illness forums are a 0:17:07.480 --> 0:17:10.800 double edged sword where they can provide people with support 0:17:11.440 --> 0:17:14.920 and feeling heard and seen and a sense of camaraderie 0:17:15.520 --> 0:17:19.400 cut through loneliness. Equally, if people are constantly talking about 0:17:19.440 --> 0:17:23.720 their symptoms, what does that do to your expectations of 0:17:23.760 --> 0:17:26.359 whether you're going to have those particular symptoms connected with 0:17:26.440 --> 0:17:29.680 a certain condition. And we're sort of in the foothills 0:17:29.760 --> 0:17:34.640 of really exploring that and the contribution of social media 0:17:35.320 --> 0:17:38.720 to that no Sebo effect. The last thing you should 0:17:38.720 --> 0:17:41.760 do if people are having very real symptoms from an 0:17:41.800 --> 0:17:46.880 Acibo effect is dismiss their experience because those symptoms are real. 0:17:47.280 --> 0:17:52.080 Just the causation of it might not be physical, or 0:17:52.119 --> 0:17:54.560 it might not be pathological, there might be another reason 0:17:54.640 --> 0:17:58.840 for it, and they're very powerful. Our expectations are very 0:17:58.880 --> 0:18:01.959 powerful shapers how we experience our illnesses. 0:18:02.640 --> 0:18:05.440 You mentioned social media being this double edged sword where 0:18:05.480 --> 0:18:08.199 you have these supportive communities that can be formed and 0:18:08.240 --> 0:18:12.160 someone can finally no longer feel alone in their experiences, 0:18:12.280 --> 0:18:15.080 and so it's on the one hand very empowering, but 0:18:15.160 --> 0:18:17.440 on the other hand, it can lead to these formation 0:18:17.600 --> 0:18:22.080 of echo chambers potentially or leave people vulnerable to exploitation. 0:18:22.640 --> 0:18:24.480 Can you share more about what this means in terms 0:18:24.480 --> 0:18:29.320 of social media and the commodification of stress and anxiety, fear. 0:18:29.200 --> 0:18:33.480 Cells We know that from newspapers you know you, or 0:18:33.560 --> 0:18:38.520 headlines sensationous headlines, fear cells and stress and anxiety equally sells. 0:18:38.800 --> 0:18:41.800 Tell somebody that there might be something lurking beneath them 0:18:42.760 --> 0:18:47.280 and create that fear, but then you sell the solution. So, 0:18:47.520 --> 0:18:51.159 for example, full body MRI is I have a chapter 0:18:51.240 --> 0:18:55.880 on that, and influencers have really jumped on that because 0:18:56.520 --> 0:19:00.720 it sort of makes sense there might be something inside you. 0:19:00.720 --> 0:19:04.320 You might feel perfectly fine, symptom free, but there might 0:19:04.359 --> 0:19:07.639 be something inside you that is lurking. We have the 0:19:07.720 --> 0:19:11.679 machine that will spot that. When you give somebody a 0:19:11.720 --> 0:19:14.480 medical test when they are otherwise healthy, that is called 0:19:14.480 --> 0:19:17.520 a screening test, and there are all sorts of problems 0:19:17.560 --> 0:19:20.600 with that. There are very few screening tests that a 0:19:20.720 --> 0:19:25.200 recommend it at a population level, even by the American 0:19:25.240 --> 0:19:29.159 authorities that prevented His Services Task Force, say, for example, 0:19:29.240 --> 0:19:32.480 or even the American College of Radiology. Likewise, in the UK, 0:19:32.640 --> 0:19:35.639 we have very similar bodies and their guidelines between them 0:19:35.680 --> 0:19:38.840 are very very similar as it happens, but there are 0:19:38.920 --> 0:19:40.920 very few because of the risk of what we call 0:19:41.000 --> 0:19:45.160 false positives, and if you see something on a scan 0:19:46.080 --> 0:19:48.280 you sort of have to follow it up, you want 0:19:48.320 --> 0:19:50.960 to follow it up, and that can then lead to 0:19:51.000 --> 0:19:56.360 a cascade of care of further investigations that might expose 0:19:56.400 --> 0:19:59.399 you to all sorts of different harms or risks, plus 0:19:59.440 --> 0:20:03.600 financial But that idea of there might be something within 0:20:03.760 --> 0:20:06.800 and Andrew Houberman is guilty of doing this. Him and 0:20:06.840 --> 0:20:09.960 Peter are here guilty of quite a few of these, 0:20:09.960 --> 0:20:13.159 and a lot of the podcasters are. And you know, 0:20:13.280 --> 0:20:15.240 he talks about you might be walking around with all 0:20:15.240 --> 0:20:17.680 these spots on your brain. Don't you want to see it? Well? 0:20:19.080 --> 0:20:20.439 Do you? Do? You? 0:20:21.119 --> 0:20:23.200 And I it was also, I think was that the 0:20:23.280 --> 0:20:28.080 chapter where somebody you know went and purchased this full 0:20:28.080 --> 0:20:32.800 body MRI and then in order to like unlock the results, 0:20:33.160 --> 0:20:35.639 you had to pay again even further. And it's just 0:20:35.680 --> 0:20:40.800 sort of like this endless, just parasitic sucking people dry 0:20:40.840 --> 0:20:43.280 of money, more and more and more money grabs that 0:20:43.440 --> 0:20:46.159 just prey on this anxiety. Once you hook someone, then 0:20:46.200 --> 0:20:47.080 you've got them. 0:20:47.280 --> 0:20:47.920 You've got them. 0:20:48.280 --> 0:20:52.359 You mentioned earlier the algorithm and social media. This this 0:20:52.400 --> 0:20:56.359 really struck me to social media has become so individualized, 0:20:56.480 --> 0:20:58.800 or it is so individualized rather than social. You know, 0:20:58.840 --> 0:21:00.840 what I see on my feet is going to be 0:21:00.880 --> 0:21:03.320 profoundly different from what you see on your feed is 0:21:03.359 --> 0:21:05.159 going to be different than what you know, just like 0:21:05.560 --> 0:21:08.840 every single person's feed has been directed by these tiny 0:21:09.040 --> 0:21:11.919 decisions how long you look at a video, whether you 0:21:12.040 --> 0:21:14.239 like or you share something. It's on my mind all 0:21:14.280 --> 0:21:15.800 the time now where I'm like, if I just set 0:21:15.840 --> 0:21:18.040 my phone down with it's still open, does it think 0:21:18.080 --> 0:21:20.000 that I want to look at that video the whole time? 0:21:20.640 --> 0:21:26.040 But as you write this, this engagement, this algorithm, it 0:21:26.080 --> 0:21:30.639 can normalize misinformation, this illusion of truth bias. What is 0:21:30.680 --> 0:21:34.400 this bias? And how does the rewarding of certain engagement 0:21:34.760 --> 0:21:37.080 what sort of content is it promoting? 0:21:38.080 --> 0:21:41.200 So a little of truth biases. The more you see something, 0:21:41.520 --> 0:21:45.960 the more true it feels. Now, not everybody is susceptible 0:21:45.960 --> 0:21:49.720 to all sorts of all biases. And again, what's still 0:21:49.760 --> 0:21:54.720 trying to understand how this information affects behavior? And as 0:21:54.760 --> 0:21:57.479 you said, then it's very hard to study from an 0:21:57.480 --> 0:22:01.679 academic perspective because everybody's fee are different and you need 0:22:01.720 --> 0:22:05.600 to follow it up longitudeinly, and you don't always know 0:22:05.800 --> 0:22:08.600 what is that little bit of information that you have 0:22:08.720 --> 0:22:12.359 that tips over a certain behavior change. Because we're bombarded 0:22:12.400 --> 0:22:15.560 with information all the time, but people are spending on 0:22:15.600 --> 0:22:17.880 a lot of time on their phones. And the thing 0:22:17.920 --> 0:22:20.400 with the phone and social media is it's so personal. 0:22:20.560 --> 0:22:23.320 It's in your pocket, it's in your phone. It's the 0:22:23.359 --> 0:22:25.919 place where you might speak to your grandmother on FaceTime, 0:22:26.040 --> 0:22:28.680 or your or your family, or you connect with people, 0:22:29.119 --> 0:22:31.840 and you've got these influences in your phone. You're looking 0:22:31.880 --> 0:22:34.840 at them bills like eye to eye. But then one 0:22:34.880 --> 0:22:37.520 of the issues is it's the more sensationless stuff that 0:22:37.600 --> 0:22:40.640 gets surfaced. It's the stuff that grabs attention. I think 0:22:40.640 --> 0:22:42.800 of the book in the sense this is what happens 0:22:43.520 --> 0:22:46.240 when you put health on platforms that are geared for 0:22:46.520 --> 0:22:50.800 entertainment and for commerce. It's not the dry statistics or 0:22:50.840 --> 0:22:54.040 evidence based information that's going to be surfaced in your feet. 0:22:54.960 --> 0:23:00.439 It is the grabby the sensation list the stories, and 0:23:00.600 --> 0:23:03.960 we are we're geared to listen to stories. We're humans, 0:23:04.240 --> 0:23:07.080 and it's all those that will surface in your feed. 0:23:07.119 --> 0:23:09.560 And there's one anecdote that I have in there. It's 0:23:09.600 --> 0:23:13.040 from some Harvard academics who talk about a young girl 0:23:13.520 --> 0:23:17.040 who was terrified that young people her age were getting 0:23:17.040 --> 0:23:20.240 stage four cancer because she'd lingered on the video. Her 0:23:20.280 --> 0:23:23.440 feed filled with more and more videos of young people 0:23:23.440 --> 0:23:25.920 with stage full cancer. Even though it was incredibly rare 0:23:25.960 --> 0:23:29.240 for people her age, she felt that everybody was being 0:23:29.240 --> 0:23:30.639 diagnosed with stage full cancer. 0:23:31.560 --> 0:23:33.840 Let's take a quick break here, We'll be back before 0:23:33.880 --> 0:23:52.479 you know it. Welcome back, everyone, I'm here chatting with 0:23:52.520 --> 0:23:55.960 the wonderful doctor Deborah Cohen about her book Bad Influence. 0:23:56.160 --> 0:24:00.720 Let's get into some more questions. These algorithms reward these 0:24:00.800 --> 0:24:05.080 extreme stories, these personal anecdotes, these things that are shocking 0:24:05.280 --> 0:24:09.040 or more shareable. But the two things that the algorithm 0:24:09.119 --> 0:24:13.200 does not reward are nuance and uncertainty, both of which 0:24:13.200 --> 0:24:16.600 are foundational to science and medicine. How does this play 0:24:16.640 --> 0:24:21.240 out in the media representation of scientific research and is 0:24:21.280 --> 0:24:24.760 there anything that we can do to make uncertainty a nuance, 0:24:25.119 --> 0:24:27.600 more clickable, more and more engaging. 0:24:29.320 --> 0:24:32.119 It's a really good question, and I si slightly I'd 0:24:32.119 --> 0:24:34.679 love to know the answer to that. In many ways, 0:24:34.880 --> 0:24:36.960 I think there's I think we have to get better 0:24:37.000 --> 0:24:39.800 at communicating, and there are people online that do it 0:24:39.920 --> 0:24:42.679 very very well. For me, one of the risks if 0:24:42.960 --> 0:24:46.280 people are too robust with pointing out this information and individuals. 0:24:46.320 --> 0:24:49.320 Obviously there are bad actors. I worry that that drives 0:24:49.320 --> 0:24:54.040 people away. So one example, young women side effects of 0:24:54.080 --> 0:24:58.360 them or hormonal contraceptive pill believe they are having particular 0:24:58.480 --> 0:25:01.160 side effects from the pill, like weight gain that isn't 0:25:01.200 --> 0:25:05.160 necessarily backed by randomized control trial evidence. It might be 0:25:05.160 --> 0:25:07.280 because the time they're going on the pill, they're going out. 0:25:07.359 --> 0:25:09.040 You know, they've got new partner, they might be going 0:25:09.040 --> 0:25:10.800 off for dinners more, they might have just gone to college. 0:25:10.800 --> 0:25:13.280 It might be all sorts of reasons why they're gaining 0:25:13.280 --> 0:25:16.240 weights at that particular time. But they're people as well 0:25:16.280 --> 0:25:18.560 that they are turning to social media because they feel 0:25:18.560 --> 0:25:21.200 that the health profession doesn't listen to them. But by 0:25:21.240 --> 0:25:24.800 pointing out and saying you're spreading misinformation doesn't make them think, oh, 0:25:24.840 --> 0:25:27.080 I'm going to come back to the health system if 0:25:27.119 --> 0:25:29.560 they're already feeling alienated. So I think we have to 0:25:29.560 --> 0:25:34.399 do that carefully. There are some very good physicians online, 0:25:34.880 --> 0:25:36.840 but then there are some that are nefarious as well. 0:25:36.880 --> 0:25:41.000 As you're engaging in nefarious activity selling products, selling dumpty 0:25:41.119 --> 0:25:44.840 services and everything else, it's it's a real minefield for people. 0:25:44.880 --> 0:25:47.159 My view is someone that trained to be adoptor is 0:25:47.240 --> 0:25:50.280 that health profession needs together, get their act together as well, 0:25:50.320 --> 0:25:53.760 get their own house in order. But I do think 0:25:54.040 --> 0:25:58.280 we need better health literacy and coming from the UK, 0:25:58.440 --> 0:26:02.120 what's really interesting for me is how we are adopting 0:26:02.280 --> 0:26:06.080 US style health system by the back door, because our 0:26:06.520 --> 0:26:10.240 national health service is really struggling. We've got this massive 0:26:10.359 --> 0:26:14.800 rise of private clinics of consumer health that is only 0:26:14.920 --> 0:26:18.480 really in the last sort of five years that is 0:26:18.560 --> 0:26:23.680 really taking hold, where people have private general practitioners or 0:26:23.760 --> 0:26:27.280 private primary physicians on the part of the hand, that's 0:26:27.320 --> 0:26:31.960 all relatively new. So we're we in Europe and the 0:26:31.960 --> 0:26:33.880 rest of Europe as well, because what we've got from 0:26:33.880 --> 0:26:37.119 the US is director consumer advertising and prescription drugs that 0:26:37.320 --> 0:26:41.240 is banned across Europe, but it's bordered US. A story 0:26:41.280 --> 0:26:43.159 I'm doing for the BMJ at the moment, actually it 0:26:43.200 --> 0:26:45.040 should come out the next couple of weeks is how 0:26:45.080 --> 0:26:48.199 we've adopted director consumer advertising. What's the impact of that 0:26:48.960 --> 0:26:51.680 because the systems are bordered US and we're not used 0:26:51.720 --> 0:26:55.320 to navigating it in the UK and Europe, so it's 0:26:55.359 --> 0:26:56.919 all a bit of a it's sort of a bit 0:26:56.920 --> 0:26:58.719 of a shock to the system. 0:26:58.960 --> 0:27:03.399 Social media in influencers can of course be very predatory nefarious. 0:27:03.400 --> 0:27:06.160 We have these bad actors, but science and medicine also 0:27:06.200 --> 0:27:09.080 of course have roles to play. There's this long history 0:27:09.160 --> 0:27:13.960 of medicine being dismissive or paternalistic towards patients. There are 0:27:14.000 --> 0:27:18.440 these horrifically unethical scientific or medical experiments, and there's kind 0:27:18.480 --> 0:27:22.000 of a general gatekeeping of like, how dare you question 0:27:22.119 --> 0:27:26.360 me or trust me, I'm the expert here attitude, And 0:27:26.760 --> 0:27:31.320 it seems like these are also contributing to people seeking 0:27:31.560 --> 0:27:35.200 answers elsewhere. Can you tell me more about that? 0:27:36.000 --> 0:27:40.040 Yeah? And I think certainly. Again, and this comes up 0:27:40.200 --> 0:27:43.640 a lot in women's health, where women's health has been 0:27:43.720 --> 0:27:46.520 largely underfunded. I think it was nineteen ninety three that 0:27:46.600 --> 0:27:50.080 the NIH sort of said that women could be part 0:27:50.080 --> 0:27:53.000 of clinical trials that they founded in nineteen ninety three. 0:27:53.200 --> 0:27:55.680 That's what Interactic Park came out. You know, we had 0:27:55.720 --> 0:28:00.320 all this great sub computerized films. Only then where we 0:28:00.400 --> 0:28:04.240 go in clinical trance and so there's been there's a 0:28:04.320 --> 0:28:08.760 sense of not feeling seen, not feeling heard, and it 0:28:08.880 --> 0:28:12.000 becomes really again, it becomes a double edged soul because 0:28:12.320 --> 0:28:15.720 the doctors that i've spoken to, and you know I 0:28:15.880 --> 0:28:19.240 speak to a lot day to day. Is they're battling 0:28:19.240 --> 0:28:22.960 with information that comes up in people's feed when they 0:28:23.000 --> 0:28:26.880 come into the consultation, and then they're left with even 0:28:26.960 --> 0:28:30.320 less time to deal with the kind of the issues 0:28:30.359 --> 0:28:33.159 at hand. And what I'm really interested in going forward, 0:28:33.160 --> 0:28:35.480 and this is what I'm hoping to actually formally study, 0:28:36.119 --> 0:28:41.280 is how social media and large language models are shaping 0:28:41.360 --> 0:28:45.680 doctor patient relationships and our relationship with the healthcare, particularly 0:28:45.760 --> 0:28:48.400 when we know the lllms people rate them has been 0:28:48.400 --> 0:28:52.000 more empathic than doctors. It's wasn't saying I think it's 0:28:52.000 --> 0:28:56.840 about the medical profession. I have to say it really is. 0:28:57.040 --> 0:28:58.800 We need to get our own house and order again 0:29:00.040 --> 0:29:04.120 and say that sense of feeling heard, but then that's exploited. 0:29:04.280 --> 0:29:07.360 And that's the challenge again with social media is with influencers. 0:29:07.440 --> 0:29:12.120 I hear you, I see you, Now buy my support, 0:29:11.800 --> 0:29:14.280 you buy my DONT test or come to see me 0:29:14.400 --> 0:29:17.600 my private clinic, and I'll give you that un necessary scam. 0:29:17.920 --> 0:29:22.040 So it's fascinating, really, I mean it does feel quite dystopian. 0:29:22.120 --> 0:29:25.720 But I do wonder going forward, what our expectations will 0:29:25.760 --> 0:29:29.720 be of healthcare and what the role of the doctor 0:29:29.800 --> 0:29:33.000 obviously not just doctors, but you know, health professionals generally 0:29:33.520 --> 0:29:35.720 will be in that sort of dynamic in the new 0:29:35.760 --> 0:29:38.120 information ecosystem. I'm going to put Panned in the jar 0:29:38.240 --> 0:29:40.480 a dollar in the jarst. I hate the term ecosystem, 0:29:40.760 --> 0:29:44.040 but I've just used it. Bit's awful. I feel like 0:29:44.080 --> 0:29:51.160 a chat box saying it a little yeah, dead box. 0:29:53.920 --> 0:29:57.800 And these doctors, these physicians are also on social media, 0:29:57.840 --> 0:30:00.000 and they're also being exposed to They have their own 0:30:00.080 --> 0:30:05.400 algorithm which might or might not be filled with bad influencers, right, 0:30:05.520 --> 0:30:09.240 these various actors, but even still, there are many of 0:30:09.280 --> 0:30:12.520 them that I'm sure are not exposed to the information 0:30:12.920 --> 0:30:15.800 that their patients are exposed to, and so that creates 0:30:15.840 --> 0:30:18.320 more of this gap in saying, okay, well, what is 0:30:18.360 --> 0:30:20.680 the information I know? What is the information that you know? 0:30:20.760 --> 0:30:23.640 And how do we communicate and get on the same 0:30:23.840 --> 0:30:26.720 level in this twenty minute appointment. 0:30:27.720 --> 0:30:31.200 It's really hard. And one conversation I had recently with 0:30:31.240 --> 0:30:34.440 the PETERA Tricia here he says when his patients come 0:30:34.480 --> 0:30:36.000 in the first thing he does is say, come on, 0:30:36.040 --> 0:30:39.040 let's chat about what you've looked at tap GPT today 0:30:39.160 --> 0:30:42.440 or co Pilots or Claude or whatever. Let's have a conversation. 0:30:42.480 --> 0:30:43.960 Let's just get that out on the table so we 0:30:44.000 --> 0:30:48.760 can talk about it. And one ADHD physician in the 0:30:48.840 --> 0:30:53.320 UK she uses what her patients see about ADHD on 0:30:53.360 --> 0:30:57.240 social media as a way to talk to them. So, 0:30:57.280 --> 0:30:58.840 how do you feel about seeing that? What have you 0:30:58.920 --> 0:31:02.480 seen on social media today? How shall we talk about that? 0:31:02.640 --> 0:31:08.080 So get them to open up, because it's almost got 0:31:08.120 --> 0:31:10.920 to be part of the conversation. And in one paper 0:31:10.960 --> 0:31:12.760 that I read, and it was in one of the 0:31:12.800 --> 0:31:16.080 pediatric journals, a sort of throwaway line at the end 0:31:16.280 --> 0:31:18.920 was doctors now and they just start asking their patients 0:31:18.920 --> 0:31:21.480 about what they're seeing on social media, And it was 0:31:21.520 --> 0:31:24.360 sort of a throwaway line, and I thought, Wow. 0:31:24.560 --> 0:31:28.280 You mentioned the commercial and digital determinants of health, which 0:31:28.800 --> 0:31:30.800 I feel like that's going to be a big thing 0:31:30.960 --> 0:31:33.960 moving forward. How would we even begin to measure or 0:31:34.000 --> 0:31:38.560 incorporate that into understanding people's health and how it is 0:31:38.640 --> 0:31:43.080 influenced by their social media experiences. 0:31:43.120 --> 0:31:45.600 It's really going to be a really hard area to study. 0:31:45.680 --> 0:31:48.280 First of all, there's no transparency from the tech company 0:31:48.080 --> 0:31:51.520 so getting data and I know there are ways of 0:31:51.640 --> 0:31:56.320 potentially sharing data. But as it stands as an example 0:31:56.360 --> 0:31:59.440 in the book, one academic I spoke to said, if 0:31:59.440 --> 0:32:01.960 he wants to do study, let's say on TikTok, they 0:32:01.960 --> 0:32:04.160 will want to see the protocol. They will want to 0:32:04.200 --> 0:32:08.520 see everything before they release any data, and then on 0:32:08.600 --> 0:32:10.480 top of that, they will want to see the final 0:32:10.520 --> 0:32:15.040 publication before it goes anywhere. Now we've learned over years, 0:32:15.120 --> 0:32:18.800 let's say with the drug industry, that if they subsidize 0:32:18.840 --> 0:32:21.760 research or fund research, then you have to have sort 0:32:21.800 --> 0:32:25.920 of walls in place and protocols in place so that 0:32:26.080 --> 0:32:29.520 research isn't there for influence before it goes to publication. 0:32:29.760 --> 0:32:32.680 There has to be an element of that. And I 0:32:32.760 --> 0:32:35.840 feel that again we're very much there's a bit of 0:32:35.880 --> 0:32:40.040 tech exceptionalism at times that we can race ahead and 0:32:40.080 --> 0:32:43.120 do things. And again, if you think about what science is, 0:32:43.200 --> 0:32:46.440 we have the null hypothesis. We assume something doesn't work 0:32:47.000 --> 0:32:50.960 unless shown otherwise. Tech feels to me like, let's just 0:32:51.000 --> 0:32:53.880 get it out. We'll assume it works until it doesn't. 0:32:54.200 --> 0:32:57.440 It flips scientific thinking on its head. But we sort 0:32:57.480 --> 0:33:01.480 of have just come to accept that is what happens. 0:33:01.840 --> 0:33:06.200 But is that good science? I would can to probably. 0:33:05.720 --> 0:33:10.400 Not We've touched on a few times ADHD throughout this 0:33:10.480 --> 0:33:13.320 conversation so far, and this is a condition that has 0:33:13.440 --> 0:33:16.760 received a lot of attention on social media and that's 0:33:16.800 --> 0:33:19.880 been very positive for some people who have found community 0:33:19.920 --> 0:33:23.560 and a greater understanding of their own experiences. People who 0:33:23.600 --> 0:33:26.440 are getting diagnosed or going to their physician and saying 0:33:26.480 --> 0:33:28.680 is this is this what I've been experiencing? How can 0:33:28.720 --> 0:33:32.400 I manage this? But it is more complicated than that. 0:33:32.560 --> 0:33:37.000 Of course, their diagnoses are increasing, but there might does 0:33:37.040 --> 0:33:40.320 that also mean that it might be overdiagnosed in situations 0:33:40.360 --> 0:33:42.640 like how do we know where to draw the line 0:33:42.760 --> 0:33:46.120 between help and harm in this context? 0:33:46.600 --> 0:33:49.320 It's really difficult, And I think you can have two 0:33:49.400 --> 0:33:51.520 things together at the same time. So you can have 0:33:51.560 --> 0:33:54.160 people being missed, so you can have them to diagnosis. 0:33:54.600 --> 0:33:58.320 And we know they're largely in certain ethnic groups, so 0:33:58.360 --> 0:34:03.600 African Americans, Spanic people. There's a massive social gradient there 0:34:03.640 --> 0:34:08.359 as well, and that's mirrored in the UK. So if 0:34:08.400 --> 0:34:11.359 people have lower socioeconomic groups are less likely to get 0:34:11.360 --> 0:34:16.200 the diagnosis that they need to access treatment and help. Meanwhile, 0:34:16.239 --> 0:34:20.399 you have people that perhaps have more access health care 0:34:20.480 --> 0:34:25.800 well wealth that are getting diagnoses that may not be robust, 0:34:25.960 --> 0:34:31.160 so there we might have misdiagnosis. But also we've got 0:34:30.800 --> 0:34:37.239 this idea of perhaps over diagnosis. So the expanding definition 0:34:37.320 --> 0:34:42.440 of what cancers ADHD, and that is always subject to 0:34:42.520 --> 0:34:45.439 debate in healthcare. And I don't come down either way, 0:34:45.560 --> 0:34:49.440 but what I do think is that, and I hear 0:34:49.480 --> 0:34:52.759 it amongst my friendship groups that people's way of describing 0:34:52.800 --> 0:34:56.080 their ADHD has taken on a social media element. People 0:34:56.080 --> 0:35:02.080 talk about rejection sensitivity dysphoria like it is a certain symptom, 0:35:02.680 --> 0:35:06.960 a well described symptom of ADHD. As it stands, experts 0:35:07.000 --> 0:35:12.640 are still debating it. Is it part of ADHD or 0:35:12.680 --> 0:35:15.520 isn't it? We don't know because there isn't the evidence there. 0:35:15.719 --> 0:35:18.560 But that has come down into clinical notes, and that's 0:35:18.719 --> 0:35:21.600 sort of been born out of conversations on social media. 0:35:22.000 --> 0:35:26.760 Other medical or psychological terms have been co opted by influence. 0:35:26.800 --> 0:35:30.279 They object permanence, which is a Jean Pierge stage of 0:35:30.320 --> 0:35:34.680 development where a child realizes that if a parent isn't 0:35:34.680 --> 0:35:36.479 in the room or something isn't the room, they still 0:35:36.520 --> 0:35:39.280 exist just because they can't see it, that person still exists, 0:35:39.320 --> 0:35:41.680 And that's been co opted by influences to me, I 0:35:41.680 --> 0:35:45.960 don't miss things, and those terms go viral and again 0:35:46.239 --> 0:35:49.319 people talk about it like it is a definite part 0:35:49.320 --> 0:35:52.920 of ADHD and so and I hear that in conversations 0:35:52.960 --> 0:35:55.560 just day to day. I've got rejection sensitivity, dysform it, 0:35:55.880 --> 0:35:59.160 or I've got object in permanence because I don't miss people. 0:35:59.600 --> 0:36:02.120 And if you think about how we do field studies 0:36:02.200 --> 0:36:06.560 or we validate our questionnaires when it comes to ADHD diagnoses, 0:36:07.280 --> 0:36:10.359 if people are kept saying, well, this isn't how I 0:36:10.440 --> 0:36:14.040 see ADHD. We haven't got all these different conditions that 0:36:14.080 --> 0:36:18.319 I'm seeing. What does that then do further down the 0:36:18.360 --> 0:36:21.680 line to how we see ADHD? And I don't know. 0:36:21.760 --> 0:36:22.720 It's an open question. 0:36:23.520 --> 0:36:28.000 Yeah, how does social media shape diagnoses in a medical context? 0:36:28.080 --> 0:36:31.600 I mean it's not a one way relationship. This is 0:36:31.640 --> 0:36:34.520 all kind of intersecting and feeding into each other. 0:36:35.400 --> 0:36:42.080 Absolutely, And health is defined socially and culturally. There's a 0:36:42.080 --> 0:36:45.799 lot of healthcare that is defined. And I think what 0:36:45.960 --> 0:36:50.680 often surprises people, even diagnoses changed what the threshold, the 0:36:50.680 --> 0:36:54.359 cutoff threshold is. Sometimes it's so many standard deviations away 0:36:54.360 --> 0:36:57.839 from the mean is what you consider abnormal. That's often 0:36:57.840 --> 0:37:00.680 a surprise to people. It is not fixed in stone 0:37:01.480 --> 0:37:03.759 and over the years we've seen the idea of pre 0:37:03.920 --> 0:37:07.399 diabetes come about as we move the goalposts of what 0:37:07.480 --> 0:37:13.360 needs who needs treatment. Healthcare is constantly iterating, and it's 0:37:13.400 --> 0:37:16.239 not all pure hard science. It's real where arts and 0:37:16.320 --> 0:37:20.520 culture and society meets hard science. It's that strange interface. 0:37:21.320 --> 0:37:25.920 And health optimization, I feel like, is a key part 0:37:25.960 --> 0:37:29.080 of this too. It's doing whatever you are told is 0:37:29.080 --> 0:37:31.960 the best thing to do to optimize your health. And 0:37:32.080 --> 0:37:35.560 there's a huge market for this. I got sucked into 0:37:35.560 --> 0:37:37.279 it with a smart watch, and then I realized that 0:37:37.360 --> 0:37:40.200 I hated it. It made me miserable, so I stopped 0:37:40.280 --> 0:37:44.680 using it. Can you discuss the optimization trap, which is 0:37:44.719 --> 0:37:46.799 what you call it in your book, and how this 0:37:46.960 --> 0:37:50.040 market both over promises and underdelivers. 0:37:50.920 --> 0:37:52.680 So if you think about it, it's obvious if you 0:37:52.680 --> 0:37:55.000 if you've got a market, if you're a company, where's 0:37:55.040 --> 0:37:57.160 the bigger market a sick person or a well person. 0:37:58.000 --> 0:38:01.600 So if you take if you take continuous glucose monitors, 0:38:01.920 --> 0:38:05.839 and there's been a big trend for them. They were designed. 0:38:06.960 --> 0:38:09.279 So advert is one of the big companies that makes 0:38:09.280 --> 0:38:12.080 it a US company that makes them. They were designed 0:38:12.120 --> 0:38:15.279 principally to help people type one and type two diabetes 0:38:15.320 --> 0:38:18.520 who use insulin to monitor their blood sugar levels, so 0:38:18.560 --> 0:38:23.560 they could adapt their insulin to get optimal dosing, because 0:38:23.560 --> 0:38:26.840 we know in the short term, if you've got the 0:38:26.880 --> 0:38:29.400 right level of insulin, you're less likely to have hypos 0:38:29.400 --> 0:38:33.840 and hyperglycemic attacks, and in the longer term it reduces 0:38:33.880 --> 0:38:37.560 the risk of long term health complications. But there was 0:38:37.560 --> 0:38:41.200 a pivot. That's only a small market. There's a much 0:38:41.200 --> 0:38:44.080 bigger market in well people and if you can encourage 0:38:44.120 --> 0:38:47.960 them that they need to constantly monitor their glucose in 0:38:48.040 --> 0:38:50.400 the absence of evidence, and the NIH have done some 0:38:50.400 --> 0:38:53.120 brilliant studies and there's some brilliant clinical trials in this 0:38:53.400 --> 0:38:56.920 Kevin Hall, who is no longer at the NIH, but 0:38:57.080 --> 0:39:02.839 he's in some fascinating trials showing that you get different readings. 0:39:03.360 --> 0:39:06.280 The same device can give different readings, or different devices 0:39:06.280 --> 0:39:10.760 give different readings, and your blood sugar level will change 0:39:10.760 --> 0:39:12.839 according to what else you've eaten, what else you've done 0:39:12.880 --> 0:39:16.320 at the same time, and so they're not really reliable 0:39:16.320 --> 0:39:20.960 because our bodies and healthy people have homeostatic mechanisms, Our 0:39:20.960 --> 0:39:24.719 blood sugar goes out, We release insulin and it comes 0:39:24.760 --> 0:39:27.960 back down again. It goes too low. We release glucagne 0:39:27.960 --> 0:39:29.719 and the blood sugar goes back up again. We're in 0:39:29.719 --> 0:39:34.960 this constant state of homeostasis. We don't know what abnormal 0:39:35.000 --> 0:39:38.239 looks like in a normal person, because you know does 0:39:38.320 --> 0:39:40.680 if you're out of range, your blood sugar goes up 0:39:40.960 --> 0:39:42.640 and people say, oh, I've got a spike. Got spike. 0:39:42.680 --> 0:39:45.640 You're like, yeah, just eaten banana. Of course you've got 0:39:45.680 --> 0:39:48.239 a spike. If it comes back down, that's what you're 0:39:48.280 --> 0:39:50.880 interested in. And guess what it comes back down, and 0:39:50.920 --> 0:39:54.800 then what happens is that then potentially creates more harm. 0:39:55.280 --> 0:39:59.840 So we don't know spikes have any issue in the 0:40:00.320 --> 0:40:01.960 certainly in the short term and certainly not in the 0:40:02.000 --> 0:40:06.360 long term. But then people change the diet accordingly. So right, 0:40:06.400 --> 0:40:07.960 I'm not going to eat banana, but I'm going to 0:40:07.960 --> 0:40:11.560 eat a burger because burger doesn't spike my glucose levels. 0:40:12.320 --> 0:40:15.320 So people then become wedded to this metric. And the 0:40:15.520 --> 0:40:17.400 thing when you look at one metric is you're not 0:40:17.400 --> 0:40:19.560 looking at all the other things that you might be ingesting. 0:40:19.560 --> 0:40:20.919 So if you have a burger, you might be eating 0:40:20.960 --> 0:40:23.680 words of cholesterol or fat or salt and all those 0:40:23.719 --> 0:40:27.279 other things, but you're so sort of wedded to this 0:40:27.320 --> 0:40:29.840 one metric in this case is glucose. You might be 0:40:30.160 --> 0:40:33.200 watching one very well monitored tree and missing the wood 0:40:33.239 --> 0:40:37.600 around it. And that's the problem is if you can 0:40:37.640 --> 0:40:39.799 measure it, you fixate on it. And in some way 0:40:39.840 --> 0:40:42.240 we saw this in the pandemic a little bit without 0:40:42.280 --> 0:40:45.520 getting too sort of controversial, is we really certainly in 0:40:45.520 --> 0:40:47.960 the UK, we focus very much on COVID desk because 0:40:48.000 --> 0:40:50.600 we can measure them. We could see it, but everything 0:40:50.640 --> 0:40:53.640 else around it was far more complicated to measure, you know, 0:40:53.680 --> 0:40:57.080 the impact on education, the impact on psychology and all 0:40:57.080 --> 0:41:00.319 those other things. They're just harder. So it's it's very 0:41:00.360 --> 0:41:04.440 easy to focus on that more metric if you can 0:41:04.480 --> 0:41:06.200 see it and it's easy to measure. And this a 0:41:06.280 --> 0:41:08.879 tendency I think in medicine to think the more parameters 0:41:08.920 --> 0:41:12.040 we measure, the better our health, and that just isn't true. 0:41:12.600 --> 0:41:18.200 There are so many science and medical or wellness influencers 0:41:18.239 --> 0:41:21.640 out there, like the health podcast Grows that you mentioned 0:41:21.680 --> 0:41:24.279 throughout your book, and they come with not only these 0:41:24.320 --> 0:41:29.160 impressive credentials but also these substantial ties to health industries 0:41:29.239 --> 0:41:33.080 or supplement industries or the wellness industry. How can a 0:41:33.120 --> 0:41:37.240 consumer know when to trust a source or can they 0:41:37.280 --> 0:41:42.160 Can educational entertainment be trustworthy or be something that is viable. 0:41:43.440 --> 0:41:46.600 It's really hard balancing at because we know people don't 0:41:46.600 --> 0:41:48.359 want to pay for stuff. People don't want to pay 0:41:48.400 --> 0:41:52.160 for their media content, and it needs to be funded. 0:41:52.960 --> 0:41:55.600 And who's going to have the biggest interest in funding 0:41:55.640 --> 0:41:58.000 a health podcast is the people that are going to 0:41:58.040 --> 0:42:00.919 benefit from it. There's a phrase I heard a lot 0:42:01.000 --> 0:42:03.840 is I only work with the companies that I believe 0:42:03.880 --> 0:42:06.359 in or I use personally. Well, what happens if there's 0:42:06.360 --> 0:42:11.240 evidence that suggests that that company, that product isn't very good, 0:42:11.480 --> 0:42:15.120 but you've become financially dependent on it, do you suddenly 0:42:15.160 --> 0:42:17.920 drop it? So for me, it's a nonsense term. It's 0:42:17.920 --> 0:42:22.800 a nonsense expression. And we have seen certain podcast pros pivot. 0:42:22.960 --> 0:42:25.479 You know, I don't like glucose monitors. Oh look, I've 0:42:25.520 --> 0:42:27.839 just spoken to somebody that works for one and they're 0:42:27.880 --> 0:42:31.040 sponsoring my podcast, and now I recommend them. Oh I 0:42:31.080 --> 0:42:33.560 don't like this Ora ring go Look then I'm going 0:42:33.640 --> 0:42:35.480 to I'm going to stop backing it. And putting it 0:42:35.520 --> 0:42:37.360 on my podcast, and guess what, I'm going to be 0:42:37.400 --> 0:42:40.160 a paid advocate, and I'm going to try and get 0:42:40.160 --> 0:42:42.839 it into medical journals and I'm going to advocate for 0:42:42.880 --> 0:42:46.440 it in academic studies. It's that that was blown open 0:42:46.560 --> 0:42:50.440 in a court case between Aura and Peter Attia is 0:42:50.480 --> 0:42:54.200 his relationship with the company, and it sheds the light 0:42:54.239 --> 0:42:59.080 on these commercial relationships that podcasters have with companies. And 0:42:59.160 --> 0:43:02.359 I think it comes more problematic in many ways when 0:43:02.360 --> 0:43:06.600 it's a medical professional that does it, because it sort 0:43:06.600 --> 0:43:11.080 of gives it more of an endorsement. And there's one 0:43:11.320 --> 0:43:14.799 UK podcaster, doctor angan Chaategy and I took him out 0:43:14.800 --> 0:43:17.080 the book and I'm kicking yourself for taking him out 0:43:17.120 --> 0:43:20.359 the book, but he's sponsored by ag One and our 0:43:20.480 --> 0:43:25.240 regulator Offcom they don't regulate podcasts, but they did highlight 0:43:25.280 --> 0:43:28.680 this as an example is when it's a health professional 0:43:28.760 --> 0:43:32.759 that is working with a company, even if they say 0:43:32.800 --> 0:43:36.040 they declare it, it looks like an endorsement. And in 0:43:36.080 --> 0:43:38.759 many ways, I think health professionals have to have an 0:43:38.760 --> 0:43:42.239 even well, they should do have a higher standard. You know, 0:43:42.680 --> 0:43:45.279 we're a regulated profession you know you've got your state 0:43:45.320 --> 0:43:48.799 licensing boards we have the General Medical Council in the 0:43:48.920 --> 0:43:53.960 UK and it's really difficult balancing how do you get 0:43:53.960 --> 0:43:57.480 the funding and remain independent at the same time. It's tricky. 0:43:57.920 --> 0:44:02.000 Does accurate scientific inform me have a place on social 0:44:02.040 --> 0:44:03.840 media and what does that place look like? 0:44:04.480 --> 0:44:06.600 I think it has to because that's where people are going. 0:44:07.000 --> 0:44:09.359 I think we need to be more skeptical. I think 0:44:09.400 --> 0:44:14.719 we need to be have better health literacy. But even then, 0:44:14.960 --> 0:44:17.440 is somebody going to be able to interpret a systematic 0:44:17.440 --> 0:44:20.440 reviewer a better analysis or around vice control trap. That's 0:44:20.480 --> 0:44:25.040 a difficult task. I think health professionals have to do 0:44:25.120 --> 0:44:28.319 better or have to sort of meet people where they're at, 0:44:29.040 --> 0:44:30.880 and there are some people that do it very well. 0:44:31.080 --> 0:44:33.960 It's not all bad, and I'm obviously doom and glue 0:44:33.880 --> 0:44:36.400 the book titles them and glue for me is but 0:44:36.640 --> 0:44:39.440 let's think critically about where our information is coming from 0:44:39.840 --> 0:44:42.880 and what is shaping our healthcare, and what incentives and 0:44:43.360 --> 0:44:46.239 what are the interest shaping our health care and our 0:44:46.280 --> 0:44:50.400 health information system. And then the next challenge obviously is 0:44:50.400 --> 0:44:53.120 going to be the large language models and how the 0:44:53.160 --> 0:44:56.600 information on them are being shared. And we know companies 0:44:56.640 --> 0:45:02.920 are already trying to make their information prioritized by the lms. 0:45:03.200 --> 0:45:05.279 You know, it used to be search engine optimized. Now 0:45:05.280 --> 0:45:08.680 it's geo engine optimized or some I can't remember the 0:45:08.680 --> 0:45:11.759 exact term, but there is there's a whole cadre of 0:45:11.800 --> 0:45:14.480 people that are working on information to make sure the 0:45:14.520 --> 0:45:17.680 bots pick up on their content. And that is going 0:45:17.719 --> 0:45:19.560 to be the people with the deep pockets that are 0:45:19.600 --> 0:45:22.279 able to shape their content accordingly. And who knows what 0:45:22.400 --> 0:45:25.440 deals going on behind the background. I wouldn't want to say, 0:45:25.840 --> 0:45:29.279 and that would be pure speculation on my behalf. But 0:45:29.400 --> 0:45:33.000 already we know that if you do a Google search, 0:45:33.239 --> 0:45:35.719 it's the sponsored content that comes up to the top 0:45:35.760 --> 0:45:38.959 of your feed, but it's going to be less transparent. 0:45:39.760 --> 0:45:42.440 So that's another question that I had, is that if 0:45:42.440 --> 0:45:48.400 we can make educational content reliable, accessible interesting to people, 0:45:48.600 --> 0:45:52.080 there's still the issue of this flood of misinformation or 0:45:52.600 --> 0:45:55.960 information that is in the gray area or that isn't 0:45:56.000 --> 0:46:00.279 backed by these robust studies and people who have financial eyes. 0:46:00.920 --> 0:46:06.200 How can we incorporate regulations or just health literacy training 0:46:06.280 --> 0:46:09.600 to get people to recognize when what they're seeing is 0:46:10.400 --> 0:46:13.080 being promoted by these bad influencers. 0:46:14.719 --> 0:46:17.920 There just has to be a lot more skepticism. So 0:46:18.000 --> 0:46:19.840 one of the things I would say to people is, 0:46:19.960 --> 0:46:23.600 don't dismiss someone's story, but ask why they're telling you. 0:46:23.600 --> 0:46:26.120 Ask why they're stepping onto a platform in the first 0:46:26.120 --> 0:46:28.600 place to tell you about their condition or to tell 0:46:28.600 --> 0:46:30.960 you about this product or treatment. That's the first thing 0:46:31.000 --> 0:46:33.360 you should ask, why is this person telling me this? 0:46:33.719 --> 0:46:36.040 Why should I believe you? And equally, why should people 0:46:36.040 --> 0:46:38.200 listen to me or believe me? I got asked that 0:46:38.280 --> 0:46:40.680 the other day at the Edinburgh Science Festival. The first 0:46:40.719 --> 0:46:44.200 question I was asked by a pediatric radiologist why should 0:46:44.239 --> 0:46:46.799 I believe you? And I said, well, I sort of 0:46:46.840 --> 0:46:49.480 have to be accountable, but equally you can dismiss me. 0:46:49.600 --> 0:46:52.920 You know, if I'm on the BBC, I'm regulated by offcom, 0:46:53.080 --> 0:46:56.120 you know, regulator. Or if I write something in the BMJ, 0:46:56.880 --> 0:47:00.440 I have responses that, oh, you can literally come down 0:47:00.480 --> 0:47:03.439 on my door and hammer down the door. But there's 0:47:03.480 --> 0:47:07.600 no accountability here, or very little accountability, if any at all. 0:47:08.320 --> 0:47:10.760 And if someone's only telling you the benefits are something, 0:47:11.400 --> 0:47:14.520 why aren't they telling you about the harms? Because because 0:47:14.560 --> 0:47:17.120 every treatment has benefit and every treatment has a heart, 0:47:17.400 --> 0:47:19.480 we don't necessarily know whether you're going to be the 0:47:19.480 --> 0:47:22.000 person that benefits or gets the harm. You know, we're 0:47:22.280 --> 0:47:28.320 medicine again is quite slow moving and that precision. If 0:47:28.360 --> 0:47:31.960 I give you a statin and to prevent a heart attack, 0:47:32.120 --> 0:47:35.319 as a doctor, I cannot tell you whether you will 0:47:35.320 --> 0:47:38.359 be that person that benefits from that statin. It's all 0:47:38.400 --> 0:47:41.800 statistics and that's that's the problem. If someone's over certain, 0:47:42.360 --> 0:47:46.560 then they're you know, they're probably not right. So it's 0:47:46.680 --> 0:47:50.600 just those little cues. You know, if you're thinking about 0:47:50.640 --> 0:47:52.960 a treatment, what's the benefits are doing, what's the risks, 0:47:53.360 --> 0:47:57.560 what the alternatives? And what if I do nothing? They're 0:47:57.560 --> 0:48:02.120 the decisions that go in the stuff and who's behind 0:48:02.160 --> 0:48:07.839 this information really, so it's just being a bit skeptical 0:48:08.239 --> 0:48:12.520 and in terms of provision of information, whether you're the 0:48:12.560 --> 0:48:15.480 Preventative Terms Task Force in the United States or the 0:48:15.600 --> 0:48:19.200 NHS in the United Kingdom, or the Institute of Medicine 0:48:19.280 --> 0:48:22.719 or whoever you are, perhaps you need to think about 0:48:22.760 --> 0:48:27.640 presenting your information in different ways. It's really tricky because 0:48:27.880 --> 0:48:32.399 again you're held to a different standard of accountability if 0:48:32.400 --> 0:48:36.400 you are those institutions, and let's say you mess up rightfully, 0:48:36.400 --> 0:48:38.160 you're going to be held to account, and I think 0:48:38.160 --> 0:48:42.359 it's very difficult for people to I feel in the 0:48:42.480 --> 0:48:45.120 UK that we've got something called the Royal Colleges, so 0:48:45.239 --> 0:48:47.840 they're Royal College of Surgeons or color Physicians or College 0:48:47.840 --> 0:48:51.000 of Obstetrics and Gynecology. I feel that they need to 0:48:51.000 --> 0:48:55.040 do some kind of campaign about, you know, consumerization of 0:48:55.080 --> 0:48:57.840 health and all these tests and treatments that you see. 0:48:58.000 --> 0:49:01.919 Be careful before you buy because it's a pretty unregulated 0:49:02.000 --> 0:49:05.160 market in the UK. I think the United States possibly 0:49:05.320 --> 0:49:08.120 more so than the United Kingdom, but equally we're going 0:49:08.160 --> 0:49:12.319 that way. What should change here? If people are being 0:49:12.360 --> 0:49:16.680 offered egg freezing that it is an indicated or statistics 0:49:16.719 --> 0:49:21.879 that are wrong, where's the regulation going on here? It's 0:49:21.920 --> 0:49:25.640 who's protecting consumers? Really? What we're talking about in I 0:49:25.640 --> 0:49:29.239 think in this particular instance, is who's protecting consumers and 0:49:29.280 --> 0:49:32.200 there isn't a huge amount of consumer protection going on. 0:49:32.719 --> 0:49:35.680 It's the new snake oil, That's what it is. It's 0:49:35.719 --> 0:49:36.160 the new. 0:49:36.000 --> 0:49:41.120 Snakel Absolutely, doctor Cohen. I really appreciate you chatting with 0:49:41.160 --> 0:49:44.560 me today. This has been such an eye opening conversation 0:49:44.760 --> 0:49:46.719 and your book has so much food for a thought. 0:49:46.800 --> 0:49:48.319 It was fantastic thank you. 0:49:48.920 --> 0:49:50.440 Thank you so much for fighting me on. 0:50:08.560 --> 0:50:10.960 A big thank you again to doctor Deborah Cohen for 0:50:11.000 --> 0:50:13.320 taking the time to chat with me. If you enjoyed 0:50:13.320 --> 0:50:15.839 today's episode and would like to learn more, check out 0:50:15.840 --> 0:50:18.480 our website this podcast will kill You dot com. We're 0:50:18.480 --> 0:50:20.680 I'll post a link to where you can find bad 0:50:20.760 --> 0:50:24.080 Influence How the Internet Hijacked our health, as well as 0:50:24.120 --> 0:50:26.399 a link to doctor Cohen's website where you can find 0:50:26.400 --> 0:50:29.000 her other work. And don't forget you can check out 0:50:29.000 --> 0:50:32.280 our website for all sorts of other cool things, including 0:50:32.320 --> 0:50:36.520 but not limited to, transcripts, quarantine recipes, show notes and 0:50:36.560 --> 0:50:39.680 references for all of our episodes, links to merch our 0:50:39.680 --> 0:50:42.799 bookshop dot org affiliate page, our Goodreads list, a first 0:50:42.800 --> 0:50:47.080 hand account form, and music by Bloodmobile. Speaking of which, 0:50:47.120 --> 0:50:49.480 thank you to Bloodmobile for providing the music for this 0:50:49.640 --> 0:50:52.840 episode and all of our episodes. Thank you to Leana 0:50:52.880 --> 0:50:56.400 Squalatchi and Tom Bryfogel for our audio mixing, And thanks 0:50:56.400 --> 0:50:59.160 to you listeners for listening. 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