Words Matter. Especially in Public Health.
2023-12-19 01:01:21
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So much of what we say is about how we say it, and sometimes we don't say it all that well. Our guest today is Jessica Mulati-Rivera, an epidemiologist and health communicator. But this week, for our last episode of 2023, we wanted to do something different to bring us some context for our discussion. Our producer, Emma, went out into the field. She shared a conversation with Craig Eidelbrook, a former anti-vaxxer.
They talked about why he resisted getting his kid vaccinated and what ultimately brought him around. My name is Craig Eidelbrook. I live in Massachusetts, near Boston, and I am an editor for a nonprofit that helps to try and improve medical health delivery. When he was younger, Craig and his then-partner were dead. Set on living as natural a lifestyle as possible. Around my senior year or after college, we became vegan and we were very strict about it.
And we started exploring other ways in which we could sort of live more naturally and do better by the environment. Craig and his partner were coming from a good place, they wanted to be the best environmental stewards they could be. But their quest eventually led to a strong suspicion of Western medicine. So that included, even like tylenol for a cold.
Actually, even regular medical care, it didn't help that they were pretty isolated from the outside world. We didn't have a heck of a lot of friends and we were in 30 acres in Maine. By ourselves, we sort of became a bit of an echo chamber with each other.
Craig's daughter was born in the early 2000s. A few years after a former British physician, Andrew Wakefield, published what was ultimately a roundly discredited paper linking vaccines to autism. The claims to whether the vaccine caused their children harm or not came from the parents, not me. I didn't have a preconceived notion about this at all. I hadn't heard of autism since medical school. The medical community immediately debunked Wakefield's claims.
But the damage was already done. Publications like Mothering Magazine, which Craig and his partner subscribed to, gave Wakefield's pseudoscience a platform, and many parents, including Craig, became concerned about vaccinating. That one piece of debunked pseudoscience gets echoed in the anti-vax community to this day. We decided not to vaccinate our child, and it was with these great intentions. Step by step, you know, similar to the road to hell. It's just that we were trying to give her the best start. And we thought that, since we were living well naturally, that this would benefit our child too.
I think there's this idea of like that people are being negligent, and that's an idea I now have in a different sense. But people are being negligent or lazy by not vaccinating their child. And in fact, I took parenting extremely seriously, and I was like, I have to try and protect my daughter at all costs.
At that time, why did protecting her against aluminum? Maybe the threat of autism, why was that more at the forefront of your mind than protecting her from measles, polio? The things that vaccines protect against, like, how did that logic work?
That logic worked in a very tortured way, because the herd immunity was so strong. You would never hear at that time, when my daughter was born, that there was an outbreak of whooping, cough or measles as you do now. And so there was this feeling of I get to choose that I can create the path to clear the way for my daughter to be the best that she can be.
I don't want to shy away from the fact that I put my daughter in danger, like I can try and rationalize. I can say, well, I was thinking this, I was thinking that. But I put my daughter in danger in several different ways throughout her early childhood. And it's only through pure luck, pure dumb luck, that she survived and stayed as healthy as she did. Craig isn't just referring to his decision not to vaccinate. He and his partner also wanted to do a home birth, but they didn't adequately prepare and ended up in the hospital.
Then there were the times their daughter had a high fever and they didn't medicate her. But worst of all, there was an accident he still feels guilty about. I slipped on some ice while I was holding her and fell on her and she hurt her head. And we didn't go to the doctor, at least not for a while.
Craig says it was hard to find the pediatrician who would see his daughter because she was unvaccinated. They did find someone eventually. She's still practicing in Maine. I believe her name is Dr.
Whitaker And she really did believe in vaccines, but she was willing to see my daughter.
And was willing to sort of try and keep the nonjudgmental lines of communication open. And so she helped lay some groundwork, and that's the thing. There was a lot of groundwork to get to that point, and there's a lot of groundwork to get back.
What were some of the things that Dr. Whitaker said that made a nonjudgmental atmosphere that kept that lifeline open?
One is just the door being open was extremely important, two was the tone, she said at the very first time we met, which was not trying to persuade, stating her beliefs, but being friendly and caring. She just kept a relationship going. And the one visit I do remember that really was impactful, had nothing to do with vaccines. Several months after I took that slip on the ice with my daughter, she was going for a well child checkup.
And again, I didn't seek out medical help for her. So during the Well child checkup, Dr. Whitaker's feeling around the head. And just calmly, she says, I don't want to freak you out. But did anything happen to her head? I immediately felt the shame and guilt, and I relayed what happened and she believed me like it wasn't. There had been no indication of any kind of actual abuse.
Like, I can tell that she trusted us and she said, Okay, I don't want to freak you out. I think she had cracked her skull and then she looked over at me and she saw me.
And she was like, I said, don't freak out, hang on, and she saw that. I was about to pass out because all the blood drained from my face when I realized how bad she had been hurt and how much could have gone wrong at that moment.
That moment of emotional vulnerability and overwhelming guilt could have gone such a different way. If she had started really clamping down and saying, Why did you do this? And having judgment. It was instead a moment where she cared deeply about my daughter and cared deeply about me at the same time. Even though I had done something that had been wrong for my daughter medically. And that was a big beat for me. That helped push back the idea that the doctors are the enemy, that I can take the best care of my daughter without them.
And that percolated.
But perhaps the biggest impact on Craig's stance came from separating from his partner. I was alone a lot with my daughter, I had to keep her busy so we would go out in the world more and I would interact more. And sometimes you were bending rules, you were having some food that you weren't allowed to, and you were finding that it wasn't the end of the world.
And you're going out into the world to sort of help break some of that echo chamber. Craig also started dating and eventually married someone who did believe in vaccination. There was a lot of reasons for Kate to judge and for her family, who lives nearby, to judge. And again, like Dr. Whitaker, they provide this relationship first. This forum for ideas in a relatively non-judgmental fashion.
Didn't push too hard.
And that gave me the space to reconsider vaccination. And so, by the time I was trying to enroll my daughter in kindergarten, there was just this feeling that this actually doesn't need to be a thing anymore.
My daughter, she's fully vaccinated now, so she's vaccinated against all the regular childhood immunizations, she's vaccinated against HPV. I think there was one other one, like one of the HEPs, that she wasn't required to have, but got herself caught up on. I don't remember exactly which, because, to be honest, it's her journey now.
When it comes to addressing health misinformation, one strategy is to keep pathways of communication open and free of judgment or impatience. This approach is slow and steady. Like Craig said, it takes a lot of groundwork to dismantle these beliefs. But what if we just made it harder for misinformation to take root in the first place? Is it possible to inoculate people against brainwashing?
Cecilia Traeberg thinks so she's a P.h.D. candidate at Cambridge who studies the psychology of misinformation.
It originated as a communication theory by a guy named McGuire, who had a theory about how we might reduce persuasion. And he was really interested in seeing whether we could use an analogy derived from biology with the mind to reduce brainwash. And so the idea was that if you want to kind of boost the mental immune system, you first have to expose them. Or make them aware that an attack is imminent, or a persuasive attack is imminent, just like biological vaccines do.
Bill McGuire's research from the 1960s and 70s is the basis of psychological inoculation, or pre-bunking. A strategy you'll hear more about today, and it's pretty effective even with online misinformation.
We're a little bit too late when we're debunking, right?
This is Beth Goldberg. She leads research and development at Jigsaw, a Google unit that investigates misinformation and extremism.
Misinformation is really sticky, it sticks in our brains really well, often because it's really sensational, and also because we have this first impression bias. So if someone's first impression of the misinformation is the misinformation itself. Like, that's going to have an advantage if we can get to someone first and warn them pre-bunk.
Is this preemptive warning that says, Hey, you're likely to encounter something that looks like this next time you're online? This is manipulative, and here's why. So we wanted to know, can we teach people in just 30 seconds how to identify what that looks like and then spot it themselves when we show them examples?
This is from an interview Beth did last year on another crooked podcast, Offline with Jon Favreau.
So we did these tests first in a lab setting, where we paid people to sit down and answer our questions and watch our videos.
You might think about skipping this ad, don't? What happens next will make you tear up, kidding you just got tricked.
When online, you're likely to see content that is loaded with emotional language. Appealing to emotions like fear or outrage is a trick to get you to pay attention and is key for the spread of ideas through social networks. The team at Google was heartened to find that, young or old, across different demographics and education levels. The videos worked. People were better able to identify emotional language, they trusted it less, and they were less likely to share it on social media.
When Beth's team rolled out the videos as YouTube ads, 10 of viewers were better able to identify manipulation techniques. But the inoculation needed a booster.
This is just like a vaccine for your body, where the resistance you gain from that, the antibodies you build, they wear off over time. And so what we found from these particular videos? They last for a solid 10 days and then you're gonna start to see decay over the course of a month. But just like a vaccine, you can give people a booster. So one really cool study we have coming out and some other folks have been testing this as well is can we give you even like a 10, 15 second reminder? A little booster of what you saw in that first video and get you all the way back up to full mental immunity? And we found that, at least in the lab setting, that that works really well.
These results are very exciting, but they left me wondering how sustainable of a strategy this is, particularly for anti-vaxxers who might bulk at the terminology. So I asked Cecilia, the misinformation researcher.
Just the idea of psychological inoculation, that phrase, I could imagine being really triggering to people who are dead set against vaccines. You know, it's like, Oh, now you wanna vaccinate? My mind, it seems like these people's worst nightmare. So how do you present this information in a way that you know, isn't misleading? But isn't necessarily using those buzzwords that people are suspicious of? Right? I mean, so definitely to take out the vaccine word, I would replace that with training.
So just psychological training to resist misinformation. A key reason for people not trusting vaccines is the whole natural element that you don't want anything kind of unnatural to come inside of your body. With these trainings, you would essentially be helping them not get something kind of invasive into their minds. So I think the key would be to frame it as psychological training, or even cognitive training, because psychological also makes it seem like we're going to try to brainwash you or something. But cognitive training might be kind of an easier pill to swallow. To use another analogy, you know, if everybody did these exercises and was inoculated, that would be great, but how do you get the mass American public, for example, to be inoculated when they would have to do this exercise?
The motivation element is kind of the key challenge. How do you get to people who don't really care about misinformation or aren't really kind of motivated to learn about it? So a key thing kind of being discussed now is who is telling people to get inoculated. Because often, the people who are more likely to be affected by misinformation are those people who have lost trust and faith in institutions and governments. You have to find key people in the right communities to kind of communicate this message.
So in a way, we're back to square one. We have a proactive protective tool, and this one doesn't even have a scary needle. But we're still searching for the right way to get the word out, the right messengers to get people on board. Craig, the former anti-vax dad, says he appreciates pre-bunking, but he believes public health folks should leave no stone unturned. Unfortunately, there's no silver bullet to avoid someone like me, who seems perfectly rational, going down a rabbit hole or two. But I think from a public health standpoint, whatever can be done. To be non-judgmental about choices, even if those choices could be a problem health-wise, I think, is much more important than any fact you can give someone.
I was given plenty of facts, I was given plenty of brochures, I was told exactly what was wrong with my decision. But I had other brochures, I had other pamphlets, I had other magazines to counter it.
So whenever there's the opportunity to create a non-judgmental space to talk about these ideas, that is, I think, vitally important. What you say may not seem like it's making an impact, but it might actually be percolating for months at a time and come back at a critical juncture, like it did with me.
That was our incredible producer, Emma, with some excellent reporting from the field, and a special thank you to Craig Eidelbrook for sharing his story with us. You'll notice a lot of the same themes about the critical work of pre-bunking and the importance of an honest, non-judgmental tone. In my conversation with Jessica after this break.
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Okay, can you introduce yourself with the tape? sure.
My name is Jessica Malati-Rivera, I'm an infectious disease epidemiologist and science communicator, and right now, I am the senior Science communication advisor at the Debeaumont Foundation. And I'm also a researcher at Johns Hopkins University and a doctoral student in the Center for Health Security.
Very cool. So walk me through how you got into health communications, like, what is it about the way we do things? And then the lived experience that you bring to this work. Where I'm rather certain you probably saw a pretty big disconnect and were like.
Yeah, you know, it's an interesting story because it was a bit accidental, I gosh, many moons ago, probably 15 years ago. I was recruited to do some research at Georgetown Medical Center in the realm of biosurveillance, essentially tracking emerging infectious disease outbreaks in plants, animals and humans. With a mostly federal audience that was looking to find kind of the next big one in any of those populations. And so I came in as an Arabic and Spanish speaker. They wanted people to be using their different languages, to look on open source media and try to find clues.
And we were looking at things like ventilator shortages and farmers getting sick and animals needing to be culled. And it was in that work of translating literally from different languages into English, and then summarizing it into pithy summaries. For a very lay audience, some specialized, but mostly lay audience. That I kind of learned a new language, and that was the language of science communication, the ability to translate things into meaningful and accessible information. So that somebody could read it and understand what it's saying and understand what it's not saying. So I got really good at that. It was before I knew of the space of science communication.
And I did that for a number of years before. I then went into kind of healthcare. PR to help big companies translate their clinical milestones into everything from social media to leave behind in a doctor's office. And it just became something I got really passionate about, the explanation of it. The emotional intelligence required the empathy that it needs. And I would say that for many, many years, as an epidemiologist, expecting a next pandemic, a big one. We were kind of silently screaming. Many of us in this space, saying, if we're not prioritizing science, communication, we're gonna get really unlucky when the next big one comes.
Yeah, I would say we probably got a little bit more than unlucky. I think we categorically missed the boat. I wanna dig into what it takes to be a good communicator because I think you mentioned a lot of those pieces. You would imagine that for a collection of scientists that make up the public health community, driven by the goal of improving the wellbeing of the public. That we would come at this from the perspective of engaging that public more. And I think at some point we kind of lost that empathy and that grounding and that focus.
And instead, I think we spend a lot more time biasing the rigor and comprehensiveness of what we share about science, rather than making sure that it's understood and implicit. Here is there's a disconnect between what we assume are priors on behalf of the population and what really are priors. And I actually think that's widening. Can you share a little bit from your perspective?
All of us started out as quote lay people, none of us were public health professionals from the jump. Why do you think we lose that so quickly? Like, when we get into science speak, like, why is it that we get almost miseducated about how to talk to everyday folk about this thing?
We spend a lot of time learning like, where does that happen?
I mean, I think you partially answered it by saying, think about our training, right? It's not miseducated, it's uneducated in our training. We're not usually thinking about the audiences beyond our peers, we're thinking about how do we write the most impactful piece of peer-reviewed content for a high-impact medical journal? For the purpose of making my publication list long and getting more credibility among my peers. Instead of thinking about the process of science being incomplete until it's communicated to more people than just your peers. That it just can sit behind these fancy institutions and these walls and laboratories, and in research centers. And instead of it, making an impact to the community. From our education, from our master's degrees, our P.h.DS, our M.DS, whatever we're getting. It's not usually thinking about a very broad audience. And I think that's probably one of the biggest shortcomings of training as a scientist. That you're not thinking about who and why and where these findings are gonna go.
And I wanna change that. I think it goes back to our education.
So I wanna zero in on the pandemic. I mean, we've had a lot of conversations on this podcast about misinformation during the pandemic, but it was almost a perfect storm to be a nidus for misinformation. And what's starting to emerge to me is that there is a health information environment before the pandemic and a health information environment after the pandemic. And I think for a lot of us, we wanna put the toothpaste back in the tube and obviously that's a very difficult thing to do, if not impossible. So I wanna ask you, what do you think made Covid such a nidus for misinformation? And what? In? Thinking about what happened? There can lead us to thinking about how to get to a future where a lot of the mistrust that hatched during the pandemic is healed.
So many things to unpack here, because there's nothing new about misinformation and disinformation, and vaccine hesitancy, and even the concept of infodemics, right? If you look back at the history of vaccines, when people were getting protected against smallpox using the Cowpox virus, there were conspiracies about people turning into cows. Because of misunderstandings of how the science worked, the whole process of variolation scared people, so it's not a new phenomenon. I think the fact that we haven't treated it with the kind of sobriety and seriousness as it needed is kind of how we got here.
But the thing that I think made it so much worse and so ripe for this type of level of infodemic is the digital world. I think that we are dealing with an oversaturation of information to the point where it becomes even difficult for people who are trained to understand scientific content to feel a bit overwhelmed. There were more publications on Covid on pre-print servers to actual publications than any other subject that's ever been studied in science. And that becomes an infodemic in and of itself, where there's just so much information. And I think when we consider the fact that we have people who have proximity and access to information at a speed and at a cadence, that is unprecedented. And not even like what you and I grew up in when we were kids and teenagers and young adults. It makes it very difficult to kind of get ahead of that.
Which is why I think, when we think about the concept of science communication being as important as research and development. For a new vaccine or for an antibiotic. That it needs to kind of go from the very beginning, that preclinical phase to approval and rollout. The communication machine needs to kind of be slowly burning next to it, so that it's not an afterthought, so that we don't have the head of the NIH being like. I wish we had an idea that vaccine skepticism was such a big deal, and many of us in the space were saying, we've known all along. We just needed to get ahead of it by prioritizing the R&D side of comms, and not just the R&D side of vaccines.
One of the things that I think has really full out, like, confused a lot of us in the field. And I think we haven't really adjusted to, is that notion that there's a before and after. And we've watched as a lot of pandemic era mis and disinformation. A lot of pandemic era tropes have now transmogrified from COVId-19 to almost backwards into rather settled public health interventions like kindergarten vaccines. The basic stuff all of us got that nobody really made a big to-do about in the past. Why do you think that happened? And I think it's really tough when you have to, like, retrace your steps to be like, Oh, we have to go back and fix this.
Yeah.
How do you think we do that?
Well, this is where the trust comes in, right? And I think that we have not treated trust as the currency that it is when it comes to people's adoption of public health behaviors. And when trust is broken, which is very quick and easy to happen, repairing that trust is a long and painful journey. And I think the politicization of public health, the politicization of the pandemic itself, had people reacting in this, like throwing the baby out with the bathwater of, Oh. If the COVID-19 vaccine is up for debate, then the whole pediatric vaccine schedule should be questioned. And it's that kind of mentality of I don't trust the people who are pushing that, and they're also pushing this. So get rid of it all.
It's the same kind of scorched earth response to the C.D.C, a deeply flawed government agency, but a deeply necessary and important part of our public health infrastructure. And when we look at, you know, this idea, that truth can be subjective, that facts can be alternative. You know, we're living in a bit of a post-truth society where it's less about empirical evidence. And the rigor that is required to show that this has more benefits than risks. It's now a matter of opinion, and I think we create these false equivalences. When we say, oh, somebody who's a skeptic and somebody who's an expert in the space should debate, I think that's really dangerous.
It creates a really bad precedent when it comes to how science is iterated and evolves. And I also think, though, we've kind of hurt ourselves by using language that's not very meaningful, like trust the science. It's a pretty meaningless statement, right? But it becomes very polarizing, and it becomes very binary in the way that people think. It becomes a red and blue issue, a black and white issue, a zero risk or 100 risk issue.
And binary thinking, I think, is gonna be the death of all of us sometimes.
Yeah, I mean, the funny thing about it is.
In becoming almost an equal opposite to the unserious skeptics.
We've bypassed a lot of the nuances that make science science like trust the science is an anathematic statement. Science is intended to move forward because people do not trust the science. So when you tell people to trust the science, you're actually making a very anti-science statement.
The other problem with science is it's not vibes-based, and unfortunately, there are a lot of science by vibes. And it didn't really work out all that well for us, and I worry that, rather than communicate into the void. I think what a lot of our community has done is to try and either step away or just yell what they were saying louder. Yes, and I worry that there hasn't been much of an engagement with, or a nuancing of what it is we're about.
And one of the aphorisms of political communication is, say what you're for, rather than what you're against. We spend a lot of time saying what we're against. And in that case, we're literally debating features that center the misinformation that we're trying to debate. Rather than just going out there and saying, here's what we're about, like, here's what matters, here's what you should pay attention to.
If you want to f those guys, but pay attention to what I'm saying to you now, right? And f those guys in the nicest, most thoughtful way possible.
Kindly f those guys. But we don't say as much of what we're for. Why do you think that's our instinct? And personally, I think part of that is like all of us who go into these fields. These, like very academic fields have like a fundamental imposter syndrome where we are particularly insecure to anyone coming for our credentials. And so when people come for our credentials, we end up having to defend our credentials. Which means explaining why others are wrong, rather than having the confidence of our own credentialing to say why we're right.
But I'd love to hear what your thoughts are on that.
I mean, part of this is the consequence of a very digital world. It creates a reactive response to whatever you're facing. And I have been very discouraged to see even some folks kind of entering the science communication space and trivializing it to like witty debunks. Because, really, it's giving more life to things that don't need more life, more oxygen into a fire that we hope will just kind of, like, drown out on the side. There is discernment and a science to science communication. Knowing which things to spend your time debunking if they're incredibly harmful, if they have certain dynamics of kind of how prolific they are. But so much of what we're supposed to do is like, what you said, inoculating people with good information, being forward with truth.
Even The Truth Sandwich is a perfect example. You start with truth, you fix the kind of mess in the middle, but you finish with truth. You say what it is, you say what is true.
But again, even the concept of truth, I think people have, and this maybe comes from, like, religious upbringings, and from the way that our political climate has made people so tribal. That you're looking at things as if there is no nuance that it has to be absolute, and science is not even absolute, right? There's no zero risk in anything, even in the most miraculous things that we've seen in innovation to keep people healthy and reduce harm. And I think that that's where we've kind of failed. Folks in the 101 of some of these public health things, right? I often say, like, where did we go wrong in health?
And like, why is it so okay for people to say breakthrough infection, like, that's such a ridiculous term to me? Because vaccines, since the history of vaccines, have been intended to prevent serious illness and death, to keep people alive. So a breakthrough infection is not a failure of a vaccine. But it just when you think about the shock of I did this thing and it was supposed to absolutely protect me from this, and I got it anyway. It feels like a betrayal, it feels like you were lied to, It feels like this is a sham.
And these sentiments around us and them profit ugly, big, pharma, big, whatever it is, kind of furthers that bias against whatever team you're not on.
You talk a bit about in your work, about pre-bunking, what is that and how does it work?
I love pre-bunking. It's a very evidence-based approach to science communication. There's a lot of data to show that. It works on essentially information inoculation, on creating a resilient population, a population that understands kind of what is to come. Whether in the data that is good or the bad takes about that data. So that people, when they see headlines, when they see announcements coming in from the C.D.C, when they hear their doctor talking about something, they have a familiarity with it. So it's getting ahead of the noise and conditioning folks to be prepared for what could be a really difficult to navigate infodemic around them.
And it's fascinating because it's been studied a lot in climate science. And climate science is probably a perfect example of where politics and message massaging kind of ruins a lot of the momentum around it. And it's not all bad, right? We can't just be thinking about ways to pre-bunk about doom, you can pre-bunk about good things, emerging, things that are gonna be beneficial to society.
It's one of the many tactics that is effective in helping people understand science. It's not can't be done alone. Because I think a lot of what's missing on the emotional side of pre-bunking or truth sandwiches is humility. You know, I think scientists struggle saying things like we don't know or we don't know yet. Part of that can be part of pre-bunking, right? Part of that can be saying, like, hey, masks, for instance, we are still learning about the effectiveness of masks. Instead of don't wear masks, always wear masks.
Like, that created so much confusion. But instead, like, getting ahead of it in a humble way, with kind of that emotional intelligence in mind. Can prevent a mess that you're gonna have to clean up later.
I wanna ask you, because part of the challenges with pre-bunking, you have to kind of know where the fallacy is headed.
Yeah.
And we don't always. And so what happens is it kind of ends up being almost the takedown of a whole set of people. Cause you're like, I don't know what the fallacy they're gonna come up with is, but I know who's gonna come up with it. And it does end up almost becoming an U.S. them situation, and I know, you know, as scientists, it's not really about them.
It really is about the folks that we're trying to convince. So as you think about pre-bunking, and as you think about, you know these mega misinformers that are out there, how do you pre-bunk? Without specifically targeting those folks? Or like the misinformers who tend to drive all the misinformation. And then also like, how important is it? As folks who are interested in where the conversation is going to actually pay attention to the misinformers and the evolution of their speech?
Yeah, it's a great question because I think about this a lot. And there's a degree of like unoriginality to a lot of the claims that circulate. There is a playbook, and a lot of the claims are regurgitated from that playbook. So a pre-bunk about fertility is something that could easily be on all of our radar. Because in every new innovation, whether it's a vaccine, whether it's a treatment, fertility. And fears about infertility and sterilization and impairment almost inevitably come up. So you kind of know, like the themes, that it's going to land in genetic modification, fertility, reduced immunity, susceptibility to other illnesses.
Those are kind of spaces that you kind of see people. Usually. The bad actors will gravitate to that, and you can explain the concept of logical fallacy and the tools that are enacted by those bad actors, right? And I think this is kind of a fun part of science communication, of kind of demystifying these terms appeal to nature fallacy, for instance. What does that mean?
We've seen the appeal to nature fallacy absolutely hijacked that. Everything from food to cosmetics to baby toys, where natural, organic, clean, chemical free are these words that become just so useless and truly meaningless. But have a white knuckle grip on parents and nutritionists and bloggers and the like. And so getting ahead of that and saying, Hey, these are things to look for. If you're seeing somebody demonize chemicals, water is a chemical, everything is a chemical. There are ways to kind of soften that message. That everything from the chemophobia to the kind of like disordered eating that this stuff causes, can be less impairing to the people who are getting this message.
My favorite one is when you hear folks like, Well, our forefathers didn't do it this way, they're like, Yeah, you're right. Our forefathers died of infectious diseases that we don't even have to pay attention to.
At like 40 years old.
It wasn't always the good old days, yeah, right, like this wasn't a great time for most of human history. When we did not know how to protect ourselves from, like, you know, people shitting in water and then us drinking it and getting really, really sick.
Like, so exactly. They had no teeth and they died of dysentery.
Right, like everybody, like, I mean, anybody. I'm a child of the late eighties and so I grew up playing Oregon Trail. And I can tell you, before I ever became an epidemiologist or a physician, that, like half your family, always died of dysentery, right? Because that's how it used to be.
Come on y'all exactly.
I wanna, you know, I wanna ask you. Because, like, inevitably for me, this conversation always comes back to one thing, which is like, we need to pay science teachers a whole lot more.
Yeah, we do.
Like, if we really wanted to fix this problem, we would just go all the way back and just pay science teachers, right? A whole lot more attract, like, some really, really great scientists into the field. And not to say all the science teachers I've ever met are some really, really great scientists. Who recognized early on that they need to educate the young folks. But like, if we paid this profession more so, much of the inoculation, the pre-bunking would be happening in K through 12, right? Is that you end up with, like, an educated populace that sort of sees the lies coming and can reason and think scientifically enough to be able to tell fact from fiction more clearly.
And I wonder, you know, as science communicators, those of us who are, you know, actively working in this space? What would it take for us to really, like, kind of reach back right and really get to young folks early on? So that the next generation of consumers of internet Bs are more inoculated to it.
Yeah, I think that's a brilliant idea and I wish that that could happen at every level. I also think, too, though, that there's gonna be the folks like you and me. The super nerds that are gonna lean in in science class and math class. And really love it and pursue it hard. There's gonna be the people who are like, This is just not for me, even if it's easy to understand, it's not for me.
Which is why I think science communication needs to kind of be as mainstay as public health. Like, the two just have to exist together at all times. Because I don't want people to feel shame that they don't remember AP Bio. I don't want them to feel like. Science was not my forte, even if it was easy for me to understand. And this just feels like I can't understand this so much of. What I wanna do from the education side, K through 12 even is to allow people to feel comfortable asking questions, to feel comfortable pursuing information about this. Because they know that they can get it in a way that makes sense, that they're not gonna feel overwhelmed by it.
So it's elevating their science literacy, their data comprehension skills. Because the fact is, the people who are working against our cause are getting more and more sophisticated at looking like science. And so it's kind of like training a mind to be like, how do you understand charts really well? For one example, so that somebody is not manipulating an X and Y axis to make you think a certain way. And it's less about like, here's how these complex cellular functions work. And more about how can you be a really smart consumer of information, science, information, data, information, information about even politics, honestly.
Because what we're dealing with is.
So many people who are trying to get a message across, sometimes under the guise of it looking like something else. You're seeing very, very fancy charts meant to mislead people. Documentaries that evoke a lot of emotional responses. And so it's almost like how to be alive in this hyper-digital world, how to be a wise and discerning mind. So that you're not led astray into either a logical fallacy trap or a full-blown conspiracy.
One of the things I get really frustrated by as a science communicator, and I'm gonna compare notes with you, is when I'm clearly trying to explain something. That's really quite complex to folks who don't have a lot of the baseline knowledge. I tend to use a lot of metaphor, and anybody who listens to the show knows I love metaphors. Now, what'll happen is.
You'll get other scientists who will then critique and say, Well, that's not exactly correct. This is the language you have to use, because this is the language that's written and you're not explaining this fully. And part of me is like, You idiot, you fool, get out of your own way.
This is why everyone hates us, because you are pedantic about a set of details that actually are not operational in the lived experience of most people's lives. And the problem, though, is increasingly now with social media, because all of our conversation is public. People won't just text you and be like, Hey, you explain this this way, why wouldn't you explain it that way? You can DM me, you can, whatever.
No, but instead you're gonna subtweet me or you're gonna blow me up on whatever and be like, this is not exactly accurate.
Right?
And what happens is it actually dissuades a lot of people from engaging with this. Because what they're coming for is they're saying, you're basically not serious now. In my case, I'm not an academic, I am a public health official. In my day to day, and most of the time, people give me enough birth. Because I'm like, Yo, I spend time in the public all day, just trust me on this.
Yeah.
But I remember being an academic and being engaged in this work. And when somebody calls you unserious, that's a pretty serious allegation, right? I wanna? I mean, what will it take almost to pre-bunk our own community? Yes, right?
So that a lot of these folks who are holier than thou or smarter than thou, right, get out of their own way. And let folks who do this work do this work, or learn how to do it themselves. But recognize that the way we communicate amongst each other, where we use jargon that has an understood definition between us. That won't work when people don't know the definitions of those words. And so I'd love to hear your thoughts on this, because I honestly think it's one of the biggest problems that we're facing right now.
It's a huge problem and I think we have to go there now in this conversation and say that. It's a lot of times because the message curators are often white men who have positions of power. Who don't look like you and me, who think things have to be done a certain way and can't understand the cultural competence required to code switch. That we do not speak to a monolith in any of our worlds, that none of the communities can understand vaccines as they work in our bodies. The same way I can say it, even the same words, with different tone, with my hands gesturing, with an anecdote about me and my kid.
That's gonna land differently among women of color, who are also moms, versus my peers at Hopkins. That lack of understanding that it's not one size fits all is why we're here. Because we treat our audiences as if they don't have diversity, as if they don't have history that informs their biases and their fears. We treat them as if they should all just understand this, because one plus one equals two. And until we break that cycle of treating our audiences like a monolith, and as though they should all understand this message as it is, and this metaphor as it is, we're not gonna get anywhere.
I think we have to get comfortable with the fact that repetition is our friend, but also code switching in that repetition. Doing it for a select audience is going to make it go further, and it's not going to just be. This is the metaphor that we're all aligned with because it checks out in every single way. I mean, that drives me crazy. I think that we are hurting ourselves by continuing to make science capital s.
This elitist, very white, dominant space, and I very much lean into my identities as not that, so that I can break through to certain communities. So that they can see that I'm leading by example, that they can trust me because of my personal experience and because of my transparency and vulnerability. So that's why I think we need to make space for a lot more people like us to do this. Because it's not going to be done the old way, that's for sure.
Yeah, I really appreciate that. And I think that the big point you're calling out here is condescension. And I think unfortunately, a big reason people don't trust, forget the science, scientists, is because, in a lot of ways, we condescend to people. It's the words that we use, it's the assumed paternalism that people should just listen to us because we've got a bunch of letters behind our name.
It's been a long time sitting in a classroom and unfortunately, we have leveraged that against people in actually some really, really dangerous and terrible ways. But even when it's just a small interaction about what someone ought to do, I think that that comes out. And people can read why you're there, and if you're there, is about some implicit ego play, about being the smartest one in the room. Most of the time, folks don't have time for you.
And so one of the things I've found to be super effective is when I'm talking to a group of folks in the community. I'll introduce myself as I'm Dr. Abdul El-Sayed, but I'm here today as Abdul, and I'm here today as a dad. And I'm here today to tell you about how I'm trying to protect my kids from this disease. And here's the thing that they're doing now. I could explain to you, like, why I'm doing this, but I wanna ask you what your questions are.
How are you seeing this and what are you worried about? And I think when you come to somebody around, a set of human identities that you may share with them that are not. I spend a long time in a lot of schools that you've been locked out of, implicitly or explicitly. There's a lot more attention to, Okay, I relate to you. And we did a show earlier about public health swag and the sort of risk gap that we have in the world. And the general point that came out is that we tend to be unrelatable.
And it's a choice that we make about how we present ourselves and how we show up in these communities that we say we're serving. So I just really appreciate that point.
Well, and also think about like, where we're putting the work right? We're putting the burden on the communities to just be more trusting, to just do that work and trust us. Instead of us doing the work of being worthy of that trust, of saying, What can I do to make me worthy of this very special, valuable currency? Like I mentioned earlier, that you should give to me, why do I deserve that? How can I be more winsome and trustworthy so that you listen to me right? Instead of being like, Hey, you people who are not trusting, just start trusting and ignore the reasons that are very valid for you to not.
So for folks who wanna learn a little bit more about your work, Jessica, where can they find you?
In a few places, I would say that my most captive audience is probably on Instagram. You can find me at at Jessica Malati Rivera. But I am doing a lot of work with the Debeaumont Foundation and the Public Health Communications Collaborative. So you can find me moderating panels with them and creating content and speaking at events there too.
Awesome, Well, we really, really appreciate you and your leadership. Our guest today was Jessica Malati Rivera. She's an infectious disease epidemiologist and science communicator at the Debeaumont Foundation, who is, of course, one of our sponsors. And at Johns Hopkins University, we really appreciate you taking the time today.
Thanks so much for having me.
As usual, here's what I'm watching right now, after several visits to the emergency room with pain and cramping. Early in her pregnancy, Kay Cox, a 31-year-old Texas woman and mother of two, learned that her fetus had Trisomy, 18, a rare but universally fatal genetic disorder. Her doctors told her that because of her two previous C-sections, she was at higher risk of uterine rupture. And that she needed a medically necessary abortion for a non-viable fetus. But her doctors then told her they couldn't perform it. Texas's draconian abortion ban had tied their hands.
So Kay Cox sued the state. And on December 7th, a lower court judge ruled that the abortion could be pursued. Only to have the ruling quickly paused by the Texas State Supreme Court. You'll never believe the argument that swung them. Cox just didn't face enough risk. So basically, instead of getting the abortion at 20 weeks, they'd rather her wait until she could literally lose her life and then get the abortion.
When, of course, bad faith conservatives would have said that it was a late-term abortion. Rather than wait for all that to play out, Cox made the decision to leave the state to get her abortion. The case offers a critical test of just how far the opponents of abortion rights will go. And it turns out that they'll go as far as they need to to put their ideology above the wellbeing of the people they ostensibly serve. Nevermind all the nods, to quote the life of the mother.
That clearly doesn't matter. They'll gladly force you to carry a non-viable pregnancy that could threaten your life. Instead of allowing you the right to a medically necessary abortion, talk about quote, the right to life. It doesn't stop there. As we discussed last week, lower court has already tried to abrogate the whole F.DA to ban the abortion medication Mifepristone.
This week, the Supreme Court announced that they'd hear the case, with a ruling set for June. And all of this should remind us how critical this fight is, that it really is about the basic right to bodily autonomy, the right to life. We'll keep you posted. Last week, the F.D.A. approved two new treatments for sickle cell anemia, both of which use gene editing technologies, and one of which presents the first approved therapeutic use of CRISPR. Sickle cell is a genetic disease caused by a single mutation. That causes hemoglobin, the molecule responsible for carrying oxygen in our red blood cells, to fold in a way that leads to sickle-shaped red blood cells.
That leads to terrible pain crises, higher risk of strokes and heart attacks, and early death. People with sickle cell die on average 20 years earlier. It follows then that if you were to edit out that single disease-causing mutation in the bone marrow stem cells that produce red blood cells, you could cure the disease. Which is exactly what these therapies do. Problem, though, is that these treatments are several million dollars. A pop and sickle cell predominates among Black folk, who structural racism too often robs of quality, accessible healthcare. That means that the vast majority of people who need these drugs simply won't get them.
And that should remind us that it's not enough to invest in critical scientific research that unlocks what would otherwise have seen miraculous cures for terrible diseases. They're amazing, but if they don't get to the people who need them, it adds insult to injury. It's one thing to die of a disease for which there is no cure, it's another to die of a disease that is curable, but you simply can't get it.
Also, in catastrophic policy choices, the WHO and U.N. warn of impending public health disaster in Gaza as the death toll creeps up to 20,000. For more than two months now, residents have been pummeled by an Israeli airstrike and then ground invasion. That has turned the 146 square mile strip, home to 2.3 million people, into a war zone, the likes of which we haven't seen in this century. They've spared nothing, not schools, not mosques or churches, not hospitals. Before I talk about the rest of the iceberg, let's reflect on the tip that nearly 20,000 people who were killed in just two months, that's 10,000 a month.
That's 333 a day, the equivalent of a Jumbo jet crash every single day. Proportionally, that'd be like losing 3 million Americans in two months. I remember talking about stats just like these during the worst of the Covid pandemic, but this is preventable, and that's just the tip of the iceberg. The sine qua non of public health is the notion that it's the structural pieces that no one pays attention to. That kill yet more people that we have to solve.
And the 20,000 murdered would be enough, but we're on the cusp of far worse those who haven't died, respiratory and GI illnesses are ravaging. It's December, and as the weather has turned seasonal, infectious diseases have spiked. And as thousands of homes have been destroyed, large families have been forced to seek shelter in overcrowded circumstances, maximizing the spread. Or still as the water supply, as homes have been destroyed, and Gaza's freshwater lines have been, too. The lack of clean running water and workable sanitation is creating the perfect storm for GI illness to spread, including the risk of serious and deadly cholera outbreaks.
All of this is exacerbated by the complete collapse of the healthcare system. Only 11 of Gaza's 36 hospitals are functional, as Israel has deliberately attacked hospitals in contravention to international law. Remember, regardless what anyone tells you, war is a choice that humans make, it's not inevitable, it's not unavoidable.
And our tax dollars have underwritten this. It absolutely must end. We need a ceasefire now. That's it for today. We'll be observing a holiday break for the next two weeks, and we'll see you on January 9th.
From all of us here at America, dissected and crooked media, happy holidays.
America dissected is a product of crooked media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma McFrank. Charlotte Landis mixes and masters the show. Production support from Ari Swartz.
Our theme song is by Takai Sazawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar and me. Dr. Abdul El-Sayed, your host. thanks for listening.
This show is for general information and entertainment purposes only. It's not intended to provide specific healthcare or medical advice and should not be construed as providing healthcare or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.
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