Throughout the COVID-19 pandemic, SARS-CoV-2 wasn’t the only thing going viral. In fact, mis- and disinformation ultimately framed so much of society’s response to the virus itself. In her new book, “What the Fact?,” physician and author Dr. Seema Yasmin traces the evolution of information disorder — and what we can do to protect ourselves and society. Abdul sat down with her to talk about it, and what it means for the future of health communication and beyond.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: Respiratory syncytial virus, otherwise known as RSV, as well as covid infection and flu, are surging, creating what some experts fear will be a tripledemic this fall and winter. The Biden administration announced new efforts to encourage Americans to get their COVID boosters, and new evidence suggests that the pandemic didn’t just change society. It suggests that it’s changed us. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] It should be no coincidence that the word we use for a piece of content that spreads rapidly on the Internet is viral. That virality is what every content creator aims for. But peel that back for a minute, and you have to appreciate that before 2010 or so, virality was definitively a bad thing. For most of human history. Viruses have been uniformly bad, even on the internet before social media, getting a virus meant malware on your computer. And it’s no wonder, then, that while it may be the pathway to fame and fortune for a whole generation of Internet stars, the content that often goes viral is still, well, bad. Social media has ushered in a whole new level of what our guest today calls information disorder. Mis-, dis-, and mal information that specifically, intentionally or not, turns us away from the truth. Information Disorder has interacted with health for a long time. Even before the pandemic, it fueled an anti-vaxx movement that led to the resurgence of a disease that vaccinations had held at bay for decades, measles. And so much of the wellness industry is built on myths and disinformation, telling you to take this pill or use that lotion. The pandemic was the first time that the twin meanings of virality went viral. We had a never before seen virus spreading across the world. Scientists struggled to understand the virus, often borrowing from what we thought we knew about its nearest cousin to impute on the fly policy to curb the spread. An information vacuum created a moment where myths and disinformation went viral, too. And as new information emerged that was, in fact, backed by good science, information disorder had already done its damage. And when the evidence based policies didn’t comport with their political interests, politicians, including the president of the United States himself at the time, Donald Trump, spread this false information even further. Information disorder had become a substrate of our national polarization before itself, a consequence of so much more myths and disinformation. Today, millions of Americans have yet to receive a first dose of a safe, effective vaccine that has saved millions of lives, all because they’ve been victims of the virality of information. And that leaves them exposed to become victims of the virus itself. And what all of this reminds us is that it’s not enough to know the truth. One has to be able to communicate it too. And that’s gotten a lot more complex over time, because no longer are we just communicating into a blank canvas of a public waiting to be informed. We’re communicating into a media ecosystem that has already been smudged over with mis-, dis- and mal information many times over. It forces those of us who talk about these things to be a lot smarter about the way we talk. But it also forces all of us to be a lot smarter about what and how we consume information. And that’s just what our guest’s new book is all about. Our guest today is Dr. Seema Yasmin, a physician, journalist and professor, the author of What the Fact, A Comprehensive, Easy to Read Guide to Information Disorder and How to See It, Process it, and Find the truth. She joined me to talk about why information disorder happens, how we need to talk about it, and how we move forward. Here’s my conversation with Dr. Seema Yasmin: 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Dr. Seema Yasmin: Yeah. I’m Dr. Seema Yasmin, author of What the Fact: Finding the Truth in All The Noise. 

Dr. Abdul El-Sayed: So walk me through why you decided to write this book right now, and I have some thoughts about it, but I’d love to hear it in your words. 

Dr. Seema Yasmin: Because there’s not much out there for teens and young people that offers them a helping hand as to how to navigate misinformation and disinformation. So what you see and when you talk to young people, they are bombarded with this concept of fake news, fake news, everything out there is fake. Just be skeptical, cynical. Don’t believe anything you read, see, or hear. And that’s an awful and just overwhelmingly negative message to give. And it makes people feel like the situation is hopeless. Let’s just give up. Everything goes viral. Fake news and lies abound and we can’t do anything about it. And that’s such BS. So I wanted to write this book that was really fun, really accessible to young people, but to older people and older people as well. And kind of gives you the evidence based tools that really exist out there that can make you a very savvy consumer of information. We all think we already are. We’re all very susceptible, of course though, to falling for BS so What The Fact is your how to guide for spotting the lies and for kind of immunizing yourself against believing falsehoods. 

Dr. Abdul El-Sayed: So what’s interesting to me is that I find that the uh skepticism to information because of the fear of mis- and disinformation by a different generation just looks different. Right. There’s this notion that uh young people are better consumers of information. And what I find is that the vulnerability to mis- and disinformation just comes in a different form. It’s that I don’t believe what I hear on some cable news channel or even on uh the local evening news uh or shared by you name the news outlet online. What I believe is the TikToker that I really like uh and what they have to say, because that person wouldn’t dare lie to me um even though I’m one of 1.2 million followers and they don’t know who the hell I am. Um. How how uh how much does that sort of assessment comport to what we actually understand about vulnerability to mis- and disinformation? 

Dr. Seema Yasmin: Bingo. You just hit the nail on the head, man, and everyone thinks I am not the problem. I’m super educated, I’m smart, I’m a freethinker. I can tell the difference between fact and fiction. But to your point, there are studies from 2018, from this year, um studies from Yale, Cornell, Princeton showing the vulnerability of people over the age of 65 to falling for falsehoods, showing their patterns where they’re sometimes six or seven times more likely to spread political false information because they’ve fallen for it, more likely to spread that on Facebook, for example. So we’re all vulnerable, but we are targeted in different ways and on different platforms and in different places. And this idea that it’s not me, it’s someone else’s problem, it’s another generation problem, it’s the young people, they’re on social media all the time. No it’s the older people because they’re on old school Facebook. Actually, we are all vulnerable and therefore we can all access these tools, these evidence based strategies that exist that we can employ to make sure we’re not part of that problem. 

Dr. Abdul El-Sayed: You in your book uh highlight this almost canonical, instructive lesson about a Facebook post from a gentleman named Peter from Buckinghamshire. Can you walk us through what Peter did and and what happened um and why it was such an instructive lesson about how fast uh mis- and disinformation can move? 

Dr. Seema Yasmin: So What The Fact is full of stories and full of anecdotes and I was spoiled for choice in writing this book because anytime you want examples of misinformation or disinformation or mal information, all the different types, there’s just an abundance, right? Of things that have gone viral, things that have become really catchy. So this particular example, people might even remember it. If you can think back to very early in the pandemic, like February, March 2020, and you have this guy Peter from England, uh older looking guy, very avuncular avatar on Facebook, looks nice and trustworthy and he’s not a bad person. Like, let’s just put that out there. Peter’s really freaked out about this new virus that’s spreading. He might be thinking people don’t seem concerned enough or people want some answers. And so he writes this Facebook post that purports a connection with a friend of a friend that someone who’s in the military, who works in science, blah, blah, blah. And it has this whole list of info, quote unquote “info” about this new coronavirus. Everything from you should avoid ice cold drinks to you should do this to this is how long the virus lives on paper or on a wooden table or on a doorknob, for example. So he writes this long list and it goes viral like this Facebook post from this one man translated into like a dozen languages, travels around the country. And a very interesting thing happens where people don’t just like copy and paste it word for word. They don’t just screenshot it and put that out there. They copy and paste it and tweak it. So this piece of information is going contagious, mutates just like a virus mutates. And people are adding their own typos, their own edits, their own purported connections to someone. And it just really hits a nerve. And at one point, like universities are having to speak out about this because, you know, I work at Stanford and at one point this viral Facebook post mutated to have a purported connection to scholars at Stanford University because the reach was so wide. Stanford came out and was like, uh this has nothing to do with us. Like the information in here, like it’s too early to say how long the coronavirus might live on a doorknob, for example. So it was just a very prime example, and the BBC jumped on that too, and went and interviewed him and he was like, Oh my gosh, I wasn’t like trying to do anything bad. I was trying to help people. But that’s often how misinformation originates. 

Dr. Abdul El-Sayed: Now, poor Peter, in a week full of hapless folks from the UK, um you got to put Peter and Liz Truss kind of in the same bucket here. 

Dr. Seema Yasmin: Oh, don’t get me started on British politics [laughter] because I have so much to say about that. 

Dr. Abdul El-Sayed: You know I spent I spent two years uh in the UK as a graduate student and I just found British politics fascinating um. 

Dr. Seema Yasmin: That’s a polite way of putting it. Yeah.

Dr. Abdul El-Sayed: That being said, I obviously I’m I’m uh born and raised here in the U.S. And so I look at British politics uh out of fascination and I look at our own politics in this moment with horror. So, you know, fascination is a slightly, slightly more interesting than horror. 

Dr. Seema Yasmin: Yeah. And I’m a newly, very newly minted American. So for the time being at least, I mean, I’m going to say a dual citizen, but for the time being, at least, I have two G7 votes so I can vote in the U.K. and I can vote here. And yeah, you know, a lot of my interviews about What The Fact are have been around election misinformation and disinformation. I’m like, man, I’m so I have my ballot sitting here on my kitchen table. I’m so excited to be able to vote and participate in democracy. And at the same time, I’m giving interviews about ballot meals and the stop the steal lies, so yeah. And watching the U.K. disintegrate, it feels like so, interesting times. 

Dr. Abdul El-Sayed: Welcome and uh mabruk on your first vote. 

Dr. Seema Yasmin: [indistinct]. 

Dr. Abdul El-Sayed: We got we got to get you out to uh to Michigan or to, you know, Pennsylvania, where where that vote really can have an impact. [laughing] 

Dr. Seema Yasmin: Sure. 

Dr. Abdul El-Sayed: Um so I want to ask, there is something about viral mis- and dis- and mal information um that makes it irresistible. And in your book, you talk quite a bit about the neurochemistry in the way that we think about information and what we’re wired to understand and find compelling. What role does that play in the spread of these kinds of forms of mistruth? 

Dr. Seema Yasmin: Our brains are wild, man. They are just absolutely fascinating. And as someone who’s studied myths and disinformation for over a decade, honestly, it was only in the course of writing this book and talking to evolutionary biologists that it started to make sense to me. Why exactly we will believe a lie and spread a lie sometimes even when we have an inkling that it is a lie. And this idea that what you believe in, you want to think you’re rational. Right? I do. We’re smart, we have degrees and whatever, we read. So you want to think you’re logical, but actually your beliefs are very often based not so much on fact, but on belonging. And you think wait that doesn’t make sense. And the biologists I spoke to said, stop thinking about it from an intellectualist point of view. You’re an epidemiologist. You like millions of data points, right? Many of us out there like that kind of big data set. But our brains weren’t necessarily evolved to analyze information in that way. They did evolve, however, to make sense of the world through stories. And so the biologist I spoke to said, put that intellectualist perspective to the side. Think about this not from an intellectualist points of view, but an interactionest one that over the course of humanity, we survived and we outlived predators, for example, because we were able to form communities and bond over shared beliefs. So that changed everything for me and that okay, I kind of get it more now. Why I might have a conversation with a parent about getting the flu shot, and they’re adamant they won’t give their kid the flu shot in Texas, but they want their kid to have an Ebola shot. Right? Like, how is it that as humans we form these kinds of beliefs? So that was a game changer for me in helping me understand that belief is about belonging and truth is very often tribal and our brains are fantastic and they are so complicated and confusing and confounding. But understanding the neuroscience of belief and understanding that we are hardwired to be susceptible to stories makes us all that more savvy and helps, you know, oh my gosh, I’m reading a tweet and hold on a second. I’m not going to retweet because I just noticed my blood pressure has gone up like I feel heat and I feel indignant because of this tweet. Stop right there. That’s a red flag for misinformation and disinformation and the very sophisticated bad actors out there who are seeding this stuff, they know exactly how to engineer messages to go viral and making them emotionally triggering is one way. 

Dr. Abdul El-Sayed: So is it fair to say that rather than thinking about all of us going about bumping along in this information soaked environment and trying to wade through it with rationality, rather, we are in this information soaked environment and we are attracted to that which is most consistent with our mythos, the mythos of our tribe, the group that we feel affiliated to. And that’s not as simple as color of skin, origin. It’s a lot more about how you define yourself today. 

Dr. Seema Yasmin: Yeah. And let me blow your mind when you turn on BBC News or you listen to a podcast or you choose which magazine you’re going to get your news from, you’re kind of doing it to get new information, but really not that much. You’re absorbing information from chosen places because you want messages that affirm your existing world view. You want a bit of new information, you’ll let that in, you’ll let it trickle in, but not so much that it disrupts your status quo too much. And communication scholars have known this for a really long time. They talk about like the ritual model of communication, the fact that watching BBC for me is akin to going to the mosque on Friday. It is a ritual. It affirms my world view. And once you understand that, once you can admit that uncomfortable truth, it can make you more open to challenging your beliefs, having your beliefs challenged. And one of the central things that I talk about in What The Fact is not just all about misinformation and disinformation and how to recognize it, it’s how do we make ourselves more resilient to falling for that stuff. One of the ways is to say straight out the bat, our beliefs probably most of the time should not be binary. You don’t have to be 100%, I believe yes, in this and I believe no in that. Maybe for some things that’s essential, but not for everything. And actually what you want to do is assign levels of credence to your beliefs. What that does is it keeps you open minded. So when someone challenges your belief, first, you’re like, oh, this is getting me heated. Why is that? Oh, I think it’s because I remember belief is about belonging. Belief is about identity. Someone challenging my belief on vaccines is actually challenging what feels to me like my identity. But I haven’t assigned a 100% belief in this thing. I have an open mind, right now I’m a seven. Abdul is saying something. Oh, actually I let in some new information. Now I’m going to shift that to an eight or a six. That’s probably a much better way to go through life than just being staunchly, staunchly in one particular corner about everything. 

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Dr. Abdul El-Sayed: What I find really interesting is that this hard wiring of our brains almost sits in parallel to, orthogonal to the parts of our brains that are taught to think rationally. It’s like we can think rationally within bounds that don’t challenge our own identities. And you see it a lot in terms of extremely educated folk who will look at a set of ideas that challenge a firmly held sense of their identity. And then they just react with the same level of of passion, when arguably right, intellectual engagement should be about dispassionate analysis of the world around you uh and an effort to change your worldview uh in accordance with what the truth says, rather than reject that truth simply because it does not conform to your worldview. And you see it across the board. And, you know, as someone who um can sometimes fall into the trap of saying, well, I’m a highly educated person and therefore I know things, uh it can be really hard to say that to other really educated people who think that because they’re so educated that they do not have a firmly held, uh almost ideological, identity driven worldview. How do you have that conversation with other folks who, you know, who, by virtue of their education, assume that what they believe is fundamentally about a rational analysis rather than a a group belonging? 

Dr. Seema Yasmin: Yeah. And I write about this in What The Fact that the studies show that the higher your level of educational attainment, the deeper your biases can be and the more difficult it can be to shift your belief, even when your belief is based on something that’s not factual. There’s a lot of hubris and ego tied up into this. Again, not saying it’s good, it’s bad, it just is what it is. And if we’re aware of that, you start noticing like, oh, okay, I see why this conversation is getting heated. And I mean, I like conversations to be a little heated. I like the drama. But when you realize that, oh, this is really triggering me because it’s not what they’re saying about the vaccine, it’s what this represents about a bigger world view. Then you kind of get to the nuts and bolts, I think, to the deeper roots of what’s really being challenged. And as a public health doc said, this is what frustrates me about how we do science communication is we’re so focused on in the context of vaccines as one example, here’s a vaccine. Take it, it’s safe. Here’s a pamphlet. It’s got that list of ten ingredients, and here’s what all the ingredients are. And they’re safe because they’re also in these other things, right? A person’s belief about a vaccine is not just about what’s inside the vial. It’s to do with their upbringing, their faith traditions, their geography, their family history, what languages they speak, their belief in government, their feelings about science institutions. But we like to ignore all of that and focus just on this singular issue. And I think that’s really why we fail so often in trying to combat polarization where there shouldn’t be such polarization. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that point. And I find that sometimes intellectual flexibility can be just as easily used to rationalize a pre held position as it can be to be rational about why a position ought to change. And I think sometimes we uh have more fealty to our rationalizations than we have to our rationality, and that can be uh a real challenge to change. I want to ask you about um the difference between mis-, dis-, and mal information, which you take great pains to define in the book. What are those differences and why do they matter? 

Dr. Seema Yasmin: Yeah, they matter to me because I use this analogy of information contagion, right? These pieces of information go viral. They are as contagious as infectious diseases. And I learned about over a decade ago when I first came to the U.S. to be an officer in the Epidemic Intelligence Service. And everywhere I got sent for an outbreak investigation. It was never just a virus that was spreading. It was these anti-science, anti-public health, anti-government messages that were also spreading. And I take this medical approach that as a physician, I can’t help a patient unless I figured out what’s wrong with them. I have to make that diagnosis first. I need words to describe what’s going on before I can conjure up a treatment plan. And so when we think about this concept of fake news, it’s not a very accurate diagnosis. It’s really broad. It’s what I think of as like a dust bin term. You can just shove everything into it. Plus, this time, fake news has really been weaponized and lobbed like a word grenade, especially at people like journalists and investigative journalists who are speaking truth to power. You know, we’ve seen presidents and people in power just shout fake news to drown out accountability reporting, for example. So instead of fake news, I say let’s talk about misinformation, let’s talk about disinformation. And the difference between those two, it’s really simple. Misinformation and disinformation, they’re both lies. They’re both false. But misinformation is like Peter’s Facebook post. He probably didn’t fully realize that all of what he was sharing was not accurate. And according to him, he wasn’t trying to hurt anybody. He really felt like there’s not much information out there. Everyone’s panicking. Let me share things that I think will help you. So misinformation is like that friend, you know, who’s saying, oh, there’s this new virus out there. I heard if you gargle with salt water, you won’t get it. Not true. They’re prob– hopefully not trying to hurt you, but it’s false and it can still go viral. Disinformation is false, but it’s false information that’s spread knowingly by people, by bad actors, usually who know it’s false. And with this very deliberate intention of seeding chaos and harm and all the examples, anyone who read the New York Times piece about Linda Sarsour and the Women’s March will see uh a really good piece of reporting about the mechanics of disinformation, how those messages are engineered, how they’re made to go viral. And speaking of diagnosis, when you want to see the disinformation like that, whether it’s against Black Lives Matter movement, whether it’s against feminists, whether it’s against Muslims, and I use an Islamophobic example in What The Fact, you first actually as the bad actor, make a diagnosis of what’s already broken in that society. Where are the fissures already and how can we deepen those? So they do a really good history and examination, a really good analysis of where to go. Um. And that’s the difference between misinformation, disinformation. Mal information is an interesting one, and that is accurate information that’s spread with bad intent and it’s accurate information that probably should have been kept private and should never have been put out into the public domain. Might be somebody’s personal information, for example. And these three categories go under the umbrella of information disorder, which is the term we give for this viral, vicious, harmful spread of all kinds of false information that have the potential to collapse economies and dismantle democracies. 

Dr. Abdul El-Sayed: As we think about this, you know, we’re having this conversation somewhat a new because of the degree to which this information disorder that you talk about can be accelerated by social media. And in some respects, the question of misinformation versus disinformation and mal information is the question of intention, which is in some respects also the question of power. Usually you don’t have misinformation spread by folks with a lot of power. It’s usually you know picked up because there’s a there’s a vacuum in the information environment and it it gets pushed out. But with mal information and disinformation, there’s often a power analysis involved in that. And it’s both the power analysis implicit in algorithmic amplification by social media, which exists to move as much alarming information as possible to keep your eyes glued to the medium. And it’s also the power of bad actors who can build uh infrastructure inside these platforms to move it. What are some of the ways um when it comes to health in particular, that we’ve seen that power of both social media firms and bad actors act to move disinformation, whether it’s on purpose or just by failure to act to do something about it? 

Dr. Seema Yasmin: Oh my gosh, we need another podcast episode. There’s so many examples, and one of the things I study is the patterns and trends in these, because they just cycle through and with every outbreak, every crisis, every new public health threat. So even just go back a few years to the Ebola outbreak of 2014 to 2016. Remember that? Um biggest Ebola outbreak in history um all these people dying thousands of miles away from the U.S. in West Africa. And there was um a Kremlin linked Russian agency, in fact, called the agency, um the Internet agency, which hacked Yahoo! News accounts, Twitter– 

Dr. Abdul El-Sayed: Mmm. 

Dr. Seema Yasmin: And posted that there was an Ebola outbreak in Atlanta. And we think the same organization created a CNN.com landing page that looked very legit, very believable, and had this disinformation about people infected with Ebola in Atlanta. I mean, that’s just one example where you can see how quite easily you can see panic and chaos and you have enough people turn up at urgent care and ERs and suddenly you can’t care for those who are genuinely sick. Right? Um. So there’s that example. But I mean, like the book also lists so many others, not just health and science one ones, but that’s one. Another thing that I find really interesting in the context of the whole vaccine debate is that where we’ve seen Russian bots and trolls play into the vaccine discourse, interestingly, it’s not always been the kind of vaccines are toxic they cause autism kind of disinformation. It’s been more stoking debate and asking questions to incite the debate where there isn’t really debate because we have evidence that shows vaccines are safe and effective and lead to long life. So different tactics. But one of the things I also talk about in What The Fact is, the kind of KGB disinformation playbook that dates back a long time but uses these strategies of taking, you know, disinformation you want to spread, but wrap it in a kernel of truth. They’re just using the same strategies over and over again, whether it’s to discredit feminist activists or whether it’s to discredit um anti-Black racism, activists or whether it’s to massively unravel gains we’ve made in public health because of vaccines. 

Dr. Abdul El-Sayed: Yeah. One of the saddest aspects of this is that we are seeing, like you said, falling vaccination numbers across the board, not just for COVID vaccines, which, by the way, the proportion of Americans that have had this latest booster is less than 5%. And that’s crazy. But it’s not just COVID vaccines. It’s everything from MMR to polio, things that were were settled. Um. And in fact, if you were to analyze this before the pandemic, you had higher rates of vaccination in traditionally red counties. And so you see the power of ideology wrapped around disinformation to fundamentally change uh what has been settled. At the same time, on the other side of the conversation of mis- and disinformation is the failure of true information. And one of the uh, I think, most profound failures of this pandemic on the part of the public health community is the failure to adapt to a changing information ecosystem and our inability to recognize that authority is not a platform unto itself. And so we assumed that, you know, as if this was the sixties and seventies and you had three channels, that if there was somebody with an M.D. or a Ph.D. who looked professional like and spoke in a really monotone voice, that if they got out there and said things, then people would listen to them and do what they said. And that just has not been further from the truth. And I want to ask you, why do you think that uh folks whose job it is to communicate to the public about their own health risks have fallen so flat in this moment. What are we getting wrong? 

Dr. Seema Yasmin: We’re getting so many essential, basic, foundational things wrong about how to communicate science to lay audiences. So for a very long time, all we’ve been taught is this communications model that’s called whether we knew that it was called this or not. It’s called the knowledge deficit model. And it says, you know a thing that this audience in front of you doesn’t know. Bridge that gap by translating that information in a way that they understand. Bingo. Now they’ll go get vaccinated. Wrong. Going back to that point about a choice about vaccines or a choice about voting or choice about clean air, whatever it might be. It has to do with so much more than the casting of the vote, the what’s inside the vial. And so we have these very singular, pointed conversations, neglecting to address all the other stuff, all the rest of the stuff in the information ecosystem. One example of this is the horrific measles outbreak that happened in Minnesota a few years ago with the Somali community. And this was a community that had some of the highest of vaccination rates for their kids for MMR. But what happened about ten years earlier was some Somali parents were really worried, like, hey, I think we have high rates of autism among Somali kids in Minnesota. And they took this concern to the public health department. The public health department, you know, said what good scientists say, which is we’re going to do an analysis. You know, if you’re worried about this, we’re going to study. Do Somali kids really have higher rates of developmental disorders than their white friends? So the public health department goes away to do this research. Right. In the meantime, oh, gosh, this pains me to say it because the anti-vaccine groups come in and they do a spectacular job of connecting and communicating and filling an information gap. And did they fill it with lies? Yes. But did they fill it effectively? Yes. And what they did is they said to the Somali community, we’ve heard your concerns about high rates of autism among your kids. And guess what? You’re right. And let’s show you why. Here’s a chart that shows that your MMR vaccination rates are so high compared to everyone else. That’s why your kids are autistic. They had closed door, town hall meetings with armed guards where doctors couldn’t go in, reporters couldn’t go in, public health workers couldn’t go in. Andrew Wakefield himself the discredited English doctor who did those fraudulent studies that faked a connection between autism and the combined MMR vaccine. He turned up. These other groups turned up. And I say to people, it’s horrific because what happened was vaccination rates plummeted after that. Meanwhile, the public health department comes back and it’s like years later, we’ve done the analysis. And guess what? Autism rates are not higher. It can appear that way. But we have the data that proves Somali kids in Minnesota are not developing, you know, any kind of these disorders at higher rates than their white friends. In the meantime, the vaccination rates have gone down and the Somali kids are in hospital in the ICU with measles because that’s how deadly measles is. Right. And so when I teach public health workers about communications, I’m like we need to take some of the lessons from the playbook of these people, because what they’re sharing is lies. But their strategies are phenomenal. They’re connecting their understanding what the concerns are. They’re responding in real time. They’re communicating actually in a very human, compelling, emotional, memorable way in ways that we as science communicators and public health docs, for example, just are not. 

Dr. Abdul El-Sayed: Certainly not you and I, Seema. [laughter] Well, you know, the interesting point um in that story that I really want to draw out is that we have to be thinking of ourselves as content creators, because people who don’t have the truth on their side understand that the only thing that they actually have is emotion. And so they play to their emotion. They play to creating a sense of confidence. That’s what a con man is. It’s a confidence man. And confidence is about emotion. And so they’re really good at leveraging emotion, surety, when the language of science and that is the correct language of science is about unsurety. Scientists are always interested in what we don’t know. That’s why people become scientists, because they want to understand what we don’t know. And so we’re really good at highlighting the things we don’t know rather than the things that we do know and speaking confidently about those things, because there’s going to be somebody else who’s going to fill the void of confidence with lies. And in some respects, it’s interesting where as I I make content for a living like this is what I what I do. This is a piece of content. Um. And to make good content, I recognize that people could pick from one of 2 million podcasts. And if I want them to listen to my podcast every week, I damn well better be interesting, informative, and and also be speaking truth. Right, now we do as much as we can to make sure we are speaking truth here, but it has to be interesting uh in the way and compelling in the way that it’s delivered. How do we teach folks who didn’t really get into the line of work, of content creation, to start thinking of themselves as content creators, to recognize that they are engaged in a market of ideas that is increasingly being judged on how compellingly it is delivered rather than how true it is. 

Dr. Seema Yasmin: I think the term content creator can make some people cringe in the same way that brand, like being on brand or having a personal brand, can make people cringe and feel really uncomfortable, especially if you’re from certain generations and not from others. So I just ask people to try and remember why they got into caring um professions in the first place and reminding people of connecting with humanity, using humanity. And then sometimes, like I said, like taking a leaf out of the playbook of some of these anti-vaccine groups who are so effective at doing what they do, in fact, so effective that they instigated the largest outbreak of measles in Minnesota in 30 years. And my beef at that time was there was also measles outbreaks happening in Eastern Europe. And I remember W.H.O. had tweeted something like worst outbreak of measles in Romania in decades. Don’t worry like, we’re disseminating pamphlets. And I was like, what the heck is wrong with you? Like, the measles is spreading because what’s spreading at the same time is these viral YouTube videos of a mother who’s crying and hoisting up her toddler and saying like, he could string together a sentence and now he can’t because of the vaccine. What do you think is more memorable, even if at first it doesn’t seem more believable? It’s the mother who’s crying. It’s these parents who have very real concerns and in some instances feel like they’ve been neglected or raised or just dismissed by the medical profession. So there’s a lot of layers to this. And I think initially there’s a lot of dirty laundry that has to get washed in that, okay, we’re asking you to be content creators, whatever else you want to call it. But first, let’s have a conversation about who we are, what profession we are in. As an officer in the Academic Intelligence Service, I would get sent to investigate outbreaks on American Indian reservations. You know, I’m Brown myself. I have a funny accent. I’m obviously not American, but I’ve represented the U.S. government. And so sometimes stepping onto a reservation, even in the midst of a truly deadly outbreak, I was met with crossed arms and disdain because of who I represented, and I had to get past that first. And in often my mind would be like, oh, it’s because of a genocidal history. Right? And it often wasn’t just that. It was like very recent indignities enacted by the U.S. government against American Indian people living on reservations. And it may not be that deep. It may just be that people don’t trust their physicians and don’t trust the government because of Tuskegee or because of modern day medical racism, but sometimes we’re trying to do this work and have conversations about the urgent vaccine, the urgent pandemic. You know, it’s a little difficult to have that if you’re going to be ahistorical and not understand why somebody is so hesitant to get vaccinated in the first place. So I think that’s even just like a base level thing that needs to happen. And that also shifts us to thinking, are we the trusted messengers that we need in an acute crisis? Because if we’re not, then let’s not try to be that. But let’s empower those community workers, those people on the ground who live in a community, who speak the same dialect, who look the same as their neighbors, who already are doing grassroots work on HIV or mental health. And I feel like we’ve underused and underrespected those people. 

[AD BREAK]

Dr. Abdul El-Sayed: The other thing that I find extremely blameworthy, uh just talking about our own tribe here for a second, is that there is a certain um responsibility to have done this from the jump. Right?Anyone who’s ever spent any moment in a clinic understands that no matter uh how good you are technically at diagnosing and treating disease, if you can’t build a rapport with the person that you are treating, then you are not being a good clinician. And so this is essential to what we do, rather than we want to call ourselves content creators or have a brand, whatever that is, having empathy and appreciating where someone’s coming from, being able to connect with them emotionally and tell them while you’re talking about care, that you actually care is fundamental to the work. And then the second part of this is that there is a real and deep and I hate to say it, but a biting disdain for people who don’t just agree. Right. And so you can tell when you’re being talked down to you can tell when you’re being talked to by somebody who thinks that they’re smarter than you or better than you, uh who thinks that they um they they know better and are talking downward and you’re not likely to listen. And so the notion that uh we assume that our knowledge or some letters that we put behind our name are an implicit platform and that we should just have to come out and talk without actually communicating emotionally is itself a failure to do the work that we train to do, whether or not um you train to communicate in a 21st century media environment or you didn’t? 

Dr. Seema Yasmin: Definitely. And it’s why What The Fact is written with the tone and the voice that it’s written with, you know, it’s for people ages 12 to 99, I don’t know why my publisher, cut off at 99. [laughter] But 12 year olds are really smart man. And I knew that writing this book, it’s just like I’m teaching you and informing you and shining a light on some things for you that you may not know about yet, but you’re going to grasp them so quickly. And as I’m on book tour for What The Fact, it’s my first time doing a book tour that involves trips to middle schools and the conversations I’m having are profound and nuanced. And they have questions about Dr. Fauci’s recommendation that we don’t wear a mask and then quick turn to say that we should wear and they get why it’s complicated and they get why that led to distrust. But there’s so much hubris and so much neglect of understanding hierarchies when we’re having conversations. And so often what I see is a very paternalistic approach to communication, which is I am the expert. I am coming in with stuff you don’t know. Therefore you should listen to me and I just say good luck with that approach. Uh, maybe it worked at some point. I’m not convinced it did, but it’s going to backfire on you now. 

Dr. Abdul El-Sayed: And it has. And here we are. I uh, I get endlessly frustrated, you know, when you’re having conversations about the pandemic in the public health community. And it’s always, well, these people. And I’m like, well, listen, you know, we are the people who decided that we wanted the responsibility of dealing with this. And the fact that it was not dealt with um is not a function of what others did. It’s a function of of many of the choices we made. Don’t get me wrong, we were in so many ways trying to battle this pandemic with one arm tied behind our back. But, you know, we had the full use of our mouths and um sometimes we didn’t do a great job with them. Most of the folks listening uh today are going to be folks who generally agree they’re they’re on team public health and or team public health, adjacent or curious. But many of them are regularly interacting with folks who may not agree, who who don’t abide by uh evidence driven recommendations around everything from vaccines for COVID or vaccines for the flu. Um. And what is your guidance to folks who are out in the world, whether professionally or personally, having conversations uh with people who don’t agree with them about how to get this right and about how uh to persuade somebody uh to do this thing that’s in their best interest? 

Dr. Seema Yasmin: Yeah, great question. And there are scripts in the book like literal scripts that show you a conversation between two people who vehemently disagree on gun control to show you that there are evidence based ways people study this. And I condense their learnings in this book, evidence based ways to effectively debunk and to have productive conflict like we shouldn’t be conflict avoidant. It’s actually very necessary to being human. But you need to know how to have what we call good or productive conflict and not what we call high conflict, which is the one that goes nowhere. There’s a lot of tips on this. Like one overarching one is to go into those conversations with respect for the other person and compassion. I will say I start that whole chapter off by saying, there are times when someone’s point of view isn’t just annoying or just, you know, non factual, but it might be in opposition to your right to exist as a muslim person, a queer person, a disabled person. You need to have that for that conversation about your safety, uh about the feasibility of that kind of conversation. But once you’ve addressed that. And I always want to put that out there first, because sometimes that is the discourse we’re dealing with. Um. But once you put that to one side and you have decided you’re going to engage to go into that with compassion and respect, and that’s really hard. I get it because I have these conversations all the time. But one of the ways that compassion and empathy become your superpowers is it lets you do that thing where instead of just chucking facts at the conversation, facts that the other person’s probably already hurt, to be honest, and already dismissed. The compassion and empathy arms you with the superpower to listen, to ask questions, gather intel that will then make you think, Oh, I see how they got here. Now I know how to have this conversation with them as opposed to just going in. And you know, the typical example is you talk to six people who choose not to get the COVID vaccine, and they might have six really different reasons for not getting the COVID vaccine. One of them might never get any vaccines. One of them might get every single vaccine out there, but be scared of the Covid shot for example, are you going to have the same conversation with all six of them? I hope not, because it’s probably not going to land with five of them. Right. So that’s one thing. And there’s a lot more detail in the book, of course. One other thing I want to mention very quickly that’s helpful is scientists out there have been studying the best way to have these conversations. One of the ways is, yes, you can get deep into the topic at hand climate change, the election, COVID vaccines. That’s called a topic based approach where you go through the facts one by one. Works sometimes, doesn’t always work, and it can make the conversation just already heated. Back to that point about beliefs or about belonging and identity, which is why someone disagreeing with your belief can feel like they’re just disagreeing with you as a person. The other approach is a logic based approach where you say, Let’s put climate change and carbon dioxide to the side. How did you hear about this story and like what have you heard about it? And then what you do is you start recognizing is they tell you the answer, that there are five key strategies that are used to spread nearly all disinformation out there. More detail in the book, but includes things like fake experts, logical fallacies, cherry picking data, and the use of conspiracy theories. So what you can then do is again, leaving climate change, vaccines, whatever at the side you can say, oh, I’m noticing. Look, they used a fake expert. They used these strategies that big tobacco used, that big oil uses, that big sugar uses that’s been used for all these other campaigns over time. And that logic based approach not only takes the heat out of the very intense conversation, it gives people an aha moment about why they fell for what they fell for. But it also gives them this umbrella level of immunity and that now you’ve shown the red flags that might be used to spread lies about Shisha being safe, even though it’s fricking tobacco or about some other lie or myth. So that’s another approach that I get into in the book. But I think it’s people have found really helpful. 

Dr. Abdul El-Sayed: Yeah, that is uh that is really, really helpful. Um. One last point. Mis- and disinformation have shaped our public discourse in pretty profound ways over the past decade in particular. Obviously, they’ve been here with us for a very long time. But because of the nature of social media, just a far bigger accelerance of some of our discord as a society, what kind of public policy do you think we need to take on mis- and dis- and mal information seriously? 

Dr. Seema Yasmin: Media literacy and digital literacy in middle school, at least. These kids are smart, they get it, they’re immersed in it. They often feel overwhelmed by the deluge of information that’s just washing over them constantly. And we’re doing them a disservice by not giving them the tools to sift through this stuff as I’ve written What The Fact, as I’m doing these tours of middle schools and high schools and universities, I’m learning that so few states mandate anything about this on the curriculum. And Illinois just introduced something, but it’s like one module in high school and that’s it, like information warfare and propaganda and misinformation and disinformation to me feel like some of the most pressing concerns of our time, because they link back to climate change denialism, because they connect back to voter apathy or crumbling democracy. Right. But we’re not arming young people or anyone, I don’t think, effectively with those tools. So that’s one thing. I mean, the other is social media platforms being held accountable right now. Their decisions are made based on what will hook our attention, which is this most valuable of commodities, what will keep our eyeballs on the screen and our thumbs scrolling with absolutely no care about and, you know, sorry to sound like so deep or profound, but they don’t give a crap about world peace. They don’t give a crap about your own peace, your mental health. The book goes into some really like you can’t make this stuff up, but like really sordid details that have come out from inside of TikTok and from inside of Meta that just show they don’t give a damn. And throughout the course of the pandemic, we’ve had amazing organizations like the Center for Countering Digital Hate produce these reports that show evidence. There’s a disinformation dozen that exists. These 12 people who tweet and tweet and Facebook post more than half of all the COVID lies that went viral came from this disinformation dozen. Did they lose the ability to post on Facebook, Twitter, Instagram, TikTok, Rumble, [?]  No because the social media platforms don’t care. So that’s the other piece of this public policy part. But, you know, until that gets addressed, I really want people to think about how they can arm themselves with the tools to effectively disagree, effectively debunk and themselves become very, very savvy consumers of information. 

Dr. Abdul El-Sayed: Well, thank you so much, Dr. Yasmin, for walking us through the nature of mis-, dis- and mal information in today’s information ecosystem, the implications it has for public health. Our guest today was Dr. Seema Yasmin. She is an Emmy Award winning journalist, medical doctor, professor and author and the director of Stanford’s Health Communication Initiative and author of her most recent book, What the Fact. And I hope that you all check it out. Thank you so much. 

Dr. Seema Yasmin: Thank you. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. Respiratory syncytial virus, better known as RSV, is sending record numbers of kids around the country to the hospital. 

[clip of unspecified news reporter] 74% of pediatric hospital beds nationwide are occupied. 89% in Missouri. 91% in Texas. 99% in Rhode Island. 

Dr. Abdul El-Sayed: RSV is a common virus that infects children, particularly toddlers. It commonly surges around the fall and winter and every year some children do get it bad enough that they require hospital care. But this year’s surge is setting records. To understand why you have to understand something about how the immune system works. Our immune system is rarely permanent. Rather, it builds responses to things that we see regularly. It’s why we have to keep getting boosters for COVID. And it’s why RSV is so bad this year. Remember, earlier in the pandemic, so many more people were social distancing, wearing masks and being really careful about congregating together in big groups. These prevented COVID. Yeah, but they also prevented so many other kinds of infectious diseases from spreading, including RSV. And because we weren’t exposed to RSV as often during that time, our immune system never got an update and so our immunity waned. Meanwhile, RSV, like other viruses, took the opportunity to change a bit, make sure that it conveyed what immunity we had left. And so immunity waned. And now you have another fall, but this time way less masking or social distancing. And our immunity is lagging. Which means we’re having a far worse RSV season. And you can take that same logic and extend it to the flu, too, which is also surging this fall and well so might Covid. The European equivalent of the CDC announced that Omicron subvariant BQ.1 is likely to fuel a surge in COVID in the next several months. In the U.S., COVID deaths are up over the past two weeks, and the number of cases and hospitalizations appears to be bottoming out too. All of this has led to fears of a tripledemic, that we’d experience three different surges of three different diseases at the same time. How to protect yourselves and your family? COVID and flu vaccines, of course. And then as cases jump, N95 masks are a great way to protect yourself. On that note, the Biden administration is trying to get more people to get their booster. 

[clip of President Joe Biden] This fall, get your COVID shot and get your flu shot. It’s simple. It’s easy. And now I’ll show you uh just how easy it is to get that shot. What am I doing, my left arm? 

[clip of unspecified person] Yes sir. 

[clip of President Joe Biden] Alright. 

Dr. Abdul El-Sayed: Less than 10% of eligible people have gotten their most recent booster. Less than 10%. That is absurd. Part of that is people, [clearing throat] including the president, declaring the pandemic over. It’s not. Cases have been dropping for some time, which has lulled us into a false sense of security. The administration is rolling out a comprehensive ad campaign targeting rural communities and Black and Latino communities, as well as a series of pop up clinics around the country. Meanwhile, we’re still in the process of understanding the full impact of the pandemic on our society. And it turns out that goes pretty deep to who we actually are. A recent study from a team of psychologists at Florida State University found that since the pandemic, traits such as agreeableness and creativity have dropped and that neuroticism or stress sensitivity have increased. And that’s particularly true among young adults whom the researchers concluded had their maturation, quote, “disrupted.” It makes sense. COVID all of a sudden took away so many of the milestones we have to look forward to. It created a sense of a world where our hopes and plans can be dashed. And when that happens early in life, well, they can change you and the agreeableness thing, that’s certainly true in the interactions I’ve had out in society. My hope is that some of these changes will start to fade as the pandemic does. My fear is that so many of us who live through this will carry the scars with us. But we also know we have a choice in the matter. I found that the amount of effort I have to put into being social has gone way up since the pandemic started. When I do put in the effort, though, I do enjoy it. I have to practice being social in ways that were so much more natural in the past. But that practice is always worth it. That’s it for today. If you’re going to be at the American Public Health Association annual meeting in Boston, I hope you’ll come to our live show on Sunday evening at 6:30. I’ll be sitting down with New York Times columnist and host of the podcast, The Argument, Jane Coaston, to talk about what public health gets right and wrong about racial inequity and the public discourse. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health.