There are two central challenges to public communication: knowing how you’re perceived and knowing who you’re not hearing back from. We don’t do either well in public health. Abdul reflects on these challenges and what they mean for public health. Then he sits down with Dr. Brian Castrucci, President and CEO of the de Beaumont Foundation to talk about the results of a Morning Consult poll they commissioned.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: DeSantis appointed Florida Surgeon General Joseph Ladapo altered vaccine study data to disinform the public. New reporting shows that the National Academies, a key adviser on national policy, took nearly $20 million dollars from the Sackler family who helped ignite the opioid epidemic. A new study finds that bilingualism may help prevent dementia. This is America  Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today we’re talking about polling public health. But to give you some context about why polling can be such a critical tool, I want to step back and reflect on my past life. I ran for governor of Michigan in 2018. I didn’t win, which is why in the tried and true tradition of losing political candidates, I get to host this lovely podcast with you. But running for office taught me a lot about public communication. There’s this thing that happens when you run for office. You spend almost all day fundraising just to get to the end of the day, to the part that you thought you were going to do, which is go out and campaign. That was my favorite part. An ice cream parlor in Ishpeming or a VFW hall in Flint or a library in Grand Rapids. I’ve spoken at all of them. I love getting out into the community and meeting folks, hearing about their challenges and talking through what the government could do to solve them. All that campaigning, you think you’re out there convincing voters, making your case about why you’d be the best candidate for the job. The problem, though, is that you really only see two kinds of people. People who already like you enough to spend their evening listening to you speak, or people who hate you and want to shut you down. The people you really need to convince though, there are the folks in the middle. There are the folks who are too busy to come to your event. They’re trying to work an extra shift or shuttle the kids to and from school or practice. They’re the people for whom politics is just background noise. If you’re an empathic communicator, you’re always trying to adjust to the feedback you hear. You try to use what the last person told you to make your point a bit better. But the problem is that you’re never really getting an objective viewpoint from the folks who you speak to. The people who already like you, after all, will tell you you’re doing great. The people who hate you, they just hate you. You’re never getting the feedback you need from the folks whose voices you don’t hear because, well, you don’t hear them. And that’s where polling comes in. Polling is about trying to get an objective viewpoint from the folks you don’t spend all day talking to. It’s about trying to reach out and understand those folks who you absolutely need to support you but won’t ever come out to that VFW hall to tell you what they want you to fix. And I’ll admit it. Polling has gotten a bad rap over the past few years, but that’s because we’re using it all wrong. We’re using it to predict the outcomes of an election. That kind of predictive polling, it’s high definition, inaccurate. The other problem is how politicians use it. Those more interested in holding power than doing anything important with it will use it to tell them what to say rather than how to say it. Frankly, folks who don’t know what they believe on issues of vital importance to the country probably shouldn’t run for office in the first place. But that’s another story for another day. You’re probably already starting to appreciate the parallels between the politicians dilemma and public healths. As a public health official. I spent a lot of my days surrounded by other people who live and breathe public health, people who already agree with what I have to say and understand the shorthand we too often speak in to say it. But when we’re surrounded by these folks, we forget that everyone else, most of the people we’re trying to communicate with don’t speak public health-ese nor care to. Then, of course, there are the people who hate us. And too often we try to soften our message to accommodate them, even though they’ll probably continue to hate us for being, quote, “unelected bureaucrats,” albeit unelected bureaucrats who spend our lives trying to save lives anyway. So how do we fix it? Well, polling. And that’s exactly what the De Beaumont Foundation, one of our sponsors here at AD are doing. They’ve been polling public health since the pandemic, giving us critical feedback not about what to say, but about how to say it. They’ve also been reaching out to understand the general mindset into which we’re communicating. What do people really think about vaccines, long COVID or whether or not COVID is over? Most recently, they polled doctors to understand how misinformation is shaping their practice. How often are they confronted with misinformation by their patients? How does it change their practice? I wanted to talk a bit more about the idea of polling public health and dig into the latest poll. So I invited De Beaumont Foundation president and CEO Brian Castrucci back on the show. Here’s our conversation. 

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

Brian Castrucci: I’m Brian Castrucci, I’m the president and CEO of the De Beaumont Foundation. 

Dr. Abdul El-Sayed: Brian. You’re basically like the resident consultant whenever we we talk about public health in the public interest. Um. This is our second time having you on. The last time we had you on it was in November, just after the 2022 midterms. And we talked a lot about the politicization of public health in the lead up to the election. The way that politicians, uh for good or for evil um were were flogging public health uh to try and win votes. And we’re, in theory, in an off year in theory. So I want to ask you, just as you sort of think about uh this moment in public health, as the dust has settled, do you feel like the attention, the focus, the vise grip uh has become any less intense on public health? Or do you feel like we’re just like politics now in sort of perpetual campaign mode? 

Brian Castrucci: I think we’re indelibly linked to COVID, and that’s part of the challenge is when you talk public health, you think mask mandate, you think closing schools, you think closing businesses. And people have different thoughts on that now. And so as long as that’s how we’re going to be depicted, it’s going to stay a political vise grip on the future of public health. We are weaker now than we were at the start of this pandemic, and there’s already some bat boogieing down with some pig cooking up the next virus that we’re going to have to deal with. And we are solely, wholly, absolutely underprepared for that. 

Dr. Abdul El-Sayed: Yeah. You know, one of the things that I think you’re really touching on is the fact that we have in the past as a point of pride, talked about how we operate in the background behind the scenes, keeping you safe. And we had our moment in the limelight on the stage and it didn’t go very well. And I think for a lot of people in public health, they’re like, I just wanna go back behind the scenes. But I don’t think we fully appreciate what this moment has meant for diminishing us and how much we need to re-articulate who we are. And I worry about that instinct that says, let’s just go backstage again because it was safe over there. Do you feel like public health uh and the public health leaders that you talk to have recognized that um that going back backstage is is is is sort of to the detriment of what we’re doing? Or do you feel like there’s just sort of an overwhelming need to just get off stage? 

Brian Castrucci: I think people understand they have to communicate better, but they just don’t know how. I mean, for me, Abdul, this is like public health Vietnam. I mean, these these public health people were doing their job. They were doing the things that they were told to do. They were trying to save American lives. And now returning after this pandemic, or as this pandemic winds down May 11th, pandemic over day, as you know identified by the administration, now we have this very complex relationship, post-COVID, with many sectors, both politically and socially. And we’re going to have to rebuild that. And thinking that we can do this from behind the scenes is no longer going to be okay. It wasn’t okay before and it’s really bad now. You don’t shut down your Facebook lives and your Instagram lives. You double down on them. Because what we didn’t have was was trust, you know, to shut down a school to close businesses. That takes an amazing amount of trust that we maybe didn’t have. We were doing things that we didn’t have the credibility to do, and we have to reckon with that and make sure that that’s never the case again. It’s already going to be ten times harder to enact a mask mandate going forward than it was during COVID, and we’re going to have to be trustworthy agents for all sectors of the public for us to be able to use every tool that we have to prevent worse scenarios coming with future pandemics. 

Dr. Abdul El-Sayed: So I’m hearing you talking about we recognize that we need to communicate with the public. We recognize that that’s been a deficit of ours through the pandemic. What should we be talking about? 

Brian Castrucci: We need to talk about basic public health, health literacy. And our challenge right now is we now have this in this whole group of people mobilized to spread disinformation and with real consequences. We recently did a poll that found that nearly three quarters of physicians said that misinformation has made it harder to treat patients for COVID 19. And that same percentage said it had negatively impacted patient outcomes. This is no longer a debate at three in the morning in the bar. This is people weaponizing information and physicians spreading disinformation. And so the hard part right now going forward is it’s not that people are anti-science, it’s that they have found scientists who agree with them. I mean, I don’t think we ever gave Kellyanne Conway enough credit. She in 2016, she rebranded lies. It was amazing. Like before that alternative facts were lies. That’s what alternative facts are. Right they’re lies. You know my son was saying something to me and I said, I don’t think that’s true. And he said, Dad, it’s an alternative fact. I was like, don’t you do that. That’s a lie. And in this house, it’s still a lie. But now we have to deal with this idea that everything is an opinion. And that makes it really hard to just even advance evidence based practice. And I think that’s going to be the legacy of COVID for a long time. 

Dr. Abdul El-Sayed: You know, you’re making a really important point, right? But I think the linchpin in this is attention. So we we had our moment in the limelight largely because people cared what we had to say and they cared what we had to say, either because they found what we had to say credible and wanted to follow our advice or they cared what we had to say because they saw it as some sort of uh charge against their civil liberties, that that’s, you know, the MAGA Republican talking point about public health. Is it’s uh what do they call it, medical authoritarianism. Right? And but people cared what we had to say. And the hard part now is as COVID fades in public attention, even if the pandemic and the disease are still with us. As it fades in public attention, people don’t really care what we have to say anymore, which means that we are now speaking into a space where we’re implicitly competing for other people’s attention. And the hard part is that we’re not very good at competing for attention. We’re not very interesting, we’re not very compelling. We don’t make good content. Right. Um. And and that means that we have to be a lot smarter about how we engage. Now, the thing about this moment in public communication, the nature of the Internet, is that facts as a matter of course, are boring. And so what’s become interesting is controversy, right? When you have facts and alternative facts now you get takes, right? And takes are interesting and people want to listen to takes. And the problem is that that confused a lot of how we spoke in the sense that people took our actual facts, logic and and science as just a take. And so I want to ask you, like in this in this world where facts have been rebranded as just simply different opinions or that there can be alternative facts, how do we engage, interestingly, in a way that actually competes for people’s attention and gets them to want to listen to what we have to say in a cacophony of conversation that really is just about controversy and takes. 

Brian Castrucci: I think we know we can do it. I mean, my my kids watch on YouTube, other people watching other people play video games. [laughter] And so if if that person can figure out how to make that content creative, then we should be able to figure out how to make public health creative. But we need to really think through it’s not just our science. We can’t just lead with our facts. We need to be creative and interesting and really make it about, you know, what, how it impacts you. One of our staff said, you know, if you think about if there are fewer police, my house is less safe. If there are fewer teachers my kids don’t get educated. If there are fewer public health practitioners dot dot dot you know what what is our what is our thing? And I put that out on Twitter. And you had folks saying, well, that then if there are no public health practitioners, then my neighbor will starve to death from malnutrition. And I thought, well, my neighbors won’t. They just won’t. I live in a community that’s constructed to to exist without the health department. And so that kind of, you know, if this then that we have to really work on that with public health so that people understand if there is no public health, then this will happen. And it can’t be just simply communitarian values of the greater good. It has to be some individual. This is what it will mean to me. It might mean my employees aren’t as healthy or, you know, our kids at school aren’t going to graduate on time or something has to be there. But we’ve not done a real good job at marketing public health. And we need to do that. But also, I mean, you know, Abdul, you know this like you have young kids now and I’m sure they have the little Melissa and Doug doctors dress up kit. So we started we started culturating people around medicine from the minute they’re born, right? Doc McStuffins on Disney, um you know, nurses and doctors, you play dress up for those roles. No one plays, you know, epidemiologist as a kid, you don’t even know what that is. You don’t even understand that there is a you know direct correlation between your community health and your individual health. When do you get that? College, maybe? 

Dr. Abdul El-Sayed: Yeah. 

Brian Castrucci: I mean, I asked my kids, what how do you think tobacco ads influence how you think about smoking? And in my community, they gave me the right answer. Dad, what’s a tobacco ad? Right? Because my community is constructed not to have tobacco ads, so they never influence my kids. But that’s not true for everybody. And we have to think about how we can pass the right policy so that everybody can achieve their optimal health. But while we’re trying to figure out for what decades? How to communicate public health, medical, what is it medical individualism is is already well defined now. 

Dr. Abdul El-Sayed: Yeah. I mean, the thing about and I think that the thing we’re circling on is we’ve got to be better storytellers. But the story for public health is hard to tell. The story for medicine is easy. I felt sick. I saw a doctor. Doctor treated me. I felt good. Therefore doctor is good, honorable, noble and someone I need in my life versus um I was feeling fine and I kept on feeling fine. I don’t know why I kept on feeling fine, but I think it was somebody working in the background there, making me feel fine, which is a much harder story to tell. And we’ve got to be just that much better at telling it. And one of the reasons that I want to start with the conversation about about narrative is because we kind of have to understand how we’re perceived as we move forward. Um. You know, everybody uh who listens to the pod knows that I ran for office once, and I think if there’s a cardinal skill in politics, it’s knowing how you’re perceived. And I think we would do well to do that. And you all have taken up the effort to do exactly that. And you’ve been polling on public health. I want to ask you, you know, this isn’t a normal thing to poll on, but what led to the idea to sponsor and put polls out in the field to understand um baseline perspectives on things? What was that one spark moment where you’re like, no, we should do this? 

Brian Castrucci: Well, I think, you know, as a former politician, you all poll on everything. Like that’s how decisions are made. You have to know how people perceive you. And we didn’t have those data. And you know, what the polling has showed has shown me is that it is really a small group of people with giant megaphones who are really trying to undermine public health. Most people appreciate what public health are doing, even if they can’t necessarily define what it is. But we need active, consistent polling. Health Affairs just published an article on trust, you know, polling around trust in the public health infrastructure. I think it’s important to know these things, track them and see how we’re doing, because these are the real issues that we have to attend to. Yes, we have to attend to our science and we need to attend to our programs. But just how public health is perceived is critically important. And, you know, you are such a great storyteller when you talk about, you know, people you met during your campaign. We have to understand that public health is a science job, but it is a political job now, maybe not a partisan job, hopefully not a partisan job, but definitely a political job. And if I see health commissioners in health departments, they’re in the wrong place. They need to be at the Rotary Club. They need to be at the school opening, they need to be everywhere meeting people so that when even if you think, you know, I don’t know what public health is, but I know this person and they care about me and my health and that’s important. I think that’s a huge step forward. 

Dr. Abdul El-Sayed: Yeah. And one of the things that, you know, as someone who’s commissioned polling in the past, one of the things that polling ought to allow you to do is to see past the people who want to be seen by you. What do I mean by that? Is that when you’re out in the community, you usually see people who like you or you see people who hate you, but you don’t see anyone in the middle. And it’s those folks in the middle who matter most to understand where, you know, especially in the campaign, where you’re headed. But if you think about what we do in public health, our constituency aren’t necessarily the people who are privileged enough to understand what public health is doing and support it. Or not privileged enough not to live outside the bounds of what we do. You know, those are our constituency as well. But if we want to continue to thrive, if we want to continue to be able to support those folks who need us most. We really have to win over those folks who sit in the ether between those two groups and understanding what they’re thinking, what value they see us as adding or not, what dangers they see around the corner. I think getting their perspective on it is critical, such that we can continue to provide services that we fundamentally need to provide. And the hard part about it is that it does require people to agree and believe that there ought to be an institution that services people who are not like them. I mean, that’s the hard part about public health. The people who benefit the most from us uh tend to be folks um who uh are not in positions of power to really influence um the directions and the choices that society uh is headed into. I want to ask you about your most recent poll, because it’s an interesting one. And Brian, I know you pretty well and I know that um, you know, you came up in this conversation, you’re not a fan of doctors, right? And it’s not that you’re not a fan of doctors. Doctors saved your life. They’ve saved mine. It’s that you’re not a fan of the the implicit narrative built around doctors in health. Right. And um and it’s always interesting to me or is curious to me that you polled both doctors and polled people about doctors. So walk me through um the reasoning behind that. 

Brian Castrucci: My concern with with physicians in public health is that far too many jurisdictions require an M.D. to be a health commissioner. And I don’t I don’t think MDs are bad health commissioners, but I think there are a lot of people who could be health commissioners who don’t have that training. And if we could open it up, I think we’d be better off as a as a public health you know system. And so with this, we really, you know, having worked with physicians throughout COVID and worked with them around messaging and hearing the real impact of misinformation at the bedside, I thought it was really important to hear that this isn’t just something someone wrote on Twitter. This isn’t like debating whether the Patriots should trade Mac Jones. That’s that’s just a mindless debate that you have with your friends, especially if you’re a Patriots fan like I am. This has real impact. This is people weaponizing ivermectin, making huge money. What did you see that article in Medscape about the physician in Texas who wrote 800,000 hydroxychloroquine prescriptions? 

Dr. Abdul El-Sayed: Wow. 

Brian Castrucci: In a year? That’s that’s a lot of prescriptions. So this is this is something we needed to understand that there’s real damage being done to the American public. And I think it also expands beyond COVID. I am a type two diabetic, and it’s always interesting when I look at my own Facebook feed how many physicians are peddling cures for diabetes. I didn’t think there was a cure for diabetes. I thought we had to medically manage it. So but I’m going to go next week to someone who’s going to tell me I can get off on my medication because they’re going to balance my hormones or give me a a multivitamin. And I’m smart enough to know that difference. But this is harming the American public. And that’s what we really wanted to see with the poll. Um. Physicians were more concerned about losing trust than the American public had said, we don’t trust our physicians anymore. So, you know, the American public still trust physicians. It is an amazing profession and that you have amazing trust from people. And so it’s it is so important for medical boards to be the real keepers of that trust and act against these physicians who are doing things in the interest of monetary enhancement instead of medical expertise. 

Dr. Abdul El-Sayed, narrating: We’ll be back with more after this break. 

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Brian Castrucci. 

Dr. Abdul El-Sayed: So walk me through some of the key findings here. I know you asked a question about the impact of mis and disinformation at the bedside. What did you find? 

Brian Castrucci: Yeah, we had nearly three quarters of physicians saying that COVID misinformation has made it harder to treat patients and that it has negatively impacted patient outcomes. We had 44% of physicians that said more than half of the COVID information that they see, read or hear from patients is misinformation. So those who are spreading misinformation are doing a great job. They’re doing a much better job than we are. And I don’t like their outcomes, but they are achieving their outcomes. They are seeding doubt. Right. And and what we know is that physicians agree that COVID vaccines are safe. 92% of physicians in our poll said the vaccines are safe, 91% said they’re effective. So that I had heard one of the big disinformation doctors saying we know the vaccine is harming people. We know it’s causing myocarditis. And physicians are coming around to this. No, that’s not true. That’s a lie. And I have the data to call it out. And that’s what’s important right now, is we’ve got to call out these fabrications with real data, because that’s the hard part on our side Abdul. It’s we’re limited by like facts and science and truth. So I can’t just make stuff up. And honestly, and this is one you know to really think about if you ask you or I can you guarantee me that in ten years the vaccine won’t turn you into a zombie? Our answer really has to be, I can’t guarantee you that. The data would suggest that we’ll always have ongoing trials. It is unlikely. But then the folks on the other side. Come on. There are chips in the vaccine that will allow us to track you? That you know this is a way that we’re going to do mass mind control. They can make up anything. And it starts to sound really compelling. 

Dr. Abdul El-Sayed: Because it’s it’s so much more interesting content, right? Like the imagination, right? Like when you talk about chips or mind control or zombies, that’s like interesting stuff I want to listen to that. It’s the problem is I’m probably going to and if it’s like you boring womp womp uh teacher from uh the Peanuts and this person talking about zombies and chips. I’m going to listen to that other one. And the thing about it is that when you’re unbounded by facts, right unfortunately, facts tend not to be all that interesting because what has happened is likely what’s going to happen. And so when you become unbounded by fact, you can make a lot more fantastically interesting content. Um. That’s what fiction is, right? And fiction is interesting. There’s a reason we don’t just all read nonfiction. There’s a reason that we read fiction is because it you know, it it it is strange. It’s it’s fantastical. Our imaginations enjoy listening to it. And the thing that that kills me is when, and you know and you talk about this in your poll, is that the purveyors of fiction are credible. So can you talk to us about what you found about the harms of misinformers in white coats we’ll call them. Doctors of disinformation. 

Brian Castrucci: Yeah, I think we’re seeing it with people believing that ivermectin and hydrochloroquine work. We’re seeing it just in that whole idea that people are now at the bedside with people who are leading with misinformation. So you have to undo that misinformation. You have to deprogram to start. And I think, you know, you had, I think Gray’s Anatomy and several other uh television programs kind of taking that on early in the pandemic. But this has now kind of waned a bit. I mean, it’s it was interesting. My you know, my son, my 13 year old, um he came to me and said, you know, after Damar Hamlin, the Buffalo Bills player uh who had Commotio Cordis, it so many people were talking about that as a vaccine injury. And he said, Dad, did you know that no one’s actually seen a clear picture of Damar Hamlin since he had that injury? And I was like, what no, they’ve seen him. And he’s like, no, no, it’s a body double. And I was like, that’s insane. Um. And I you know, I had a heart attack last year. And I said to him, I said, well, you know, Evan. Now that you’ve figured this out, your dad passed away from a heart attack. I’m a clone. And he’s like, fine, I get your point. I’m like, thank God, you get my point. But I think you’re right. I mean, this is why documentaries don’t do as well as the at the box office as Marvel movies, right? And so it’s it’s always that little bit of truth, right? There’s always one little vein of truth there, like people using the VAERS system to kind of say, look at all these deaths. Um. But it’s it is something that we need to get really good at and really fast. About how we work with our communities to get the right information out there and honestly, how we stop people just purveying lies. And they’re not lies for the sake of lies, their lies for the sake of monetary gain. 

Dr. Abdul El-Sayed: Yeah. And that’s that’s the, that’s the thing about it is that there’s always a hook on the other end of the disinformation and particularly when it’s physicians who who are providing it. One of the questions you asked about is support for medical boards governing uh disinformers in the ranks. What did you find on that front? 

Brian Castrucci: We found that there was extraordinary support for progressive discipline up through having someone’s license revoked for continued spreading of misinformation. And so it was I think we had four levels of discipline and had a good 80, 90% of the you know physicians saying we should be disciplined. If people are spreading misinformation. And and you know then always the retort is, well, then I want to become the minister of misinformation. I’ve always wanted to be the minister of magic, but never minister of misinformation. And it’s just it’s about the scientific process. Like you know, if someone was talking about science, it’s science isn’t a thing. It’s a process. And we agree on that process. We agree to the rules. And so then the outcome is what we value. But now we can’t even agree on those rules anymore. Right? You have you know the sitting health commissioner in the state of Florida producing studies and and writing policy based on those studies. When those studies follow none of the guidelines of what is science. Wasn’t peer reviewed or no authors, they were ignoring their own limitations. And this is happening more and more. This is the problem with preprints that come out and then aren’t ever really validated. And so we are, you know, systemically pumping out more and more disinformation. And it’s really hard for people to even understand what that disinformation is. I was putting out my own medication today and noticed that my pills switched color. Switched shape and I was like, okay, let me think about this. And I went and Googled it and found oh there was a change in how they’re manufacturing the medication. And I just thought, you know, if I was a person who didn’t have any health background, would I still take those meds? Would I be concerned? Right. I mean, there’s so much information right now, and we have to realize that information overload isn’t just bad information. It’s all the information that you have to sort through. So we need consistent messaging that everyone is sharing in public health. That’s when we’ll start to break through this. And we also need the help of the federal government to not create situations where platforms are allowed to just spread whatever they want, whenever they want. Right. That used to be something we didn’t do. And now it’s freewheeling. 

Dr. Abdul El-Sayed: And in your poll, uh I know you thought through where people versus doctors got their information. And how did that differ? The general public, where are they going for their information? Where are doctors are going for their information? 

Brian Castrucci: Well, I mean, doctors are still using, you know, legitimate places. But the Internet is a source of information for everybody. And I think the skill gap comes in being able to differentiate what is a legitimate source versus what is a non legitimate source. I mean have you looked at some websites that really look totally legitimate? I mean, how close have you gotten to kind of realizing that that email you got maybe it wasn’t spam and you almost acted on it? I got an email recently from a journal and the link that I clicked then started the whole, you know, your computer is under assault and it looked totally legitimate. It was like, call this 1-800 number at Microsoft. And it looked legitamate [?]– 

Dr. Abdul El-Sayed: You got spammed by a journal? 

Brian Castrucci: Yeah, [laughter] I got spammed by a journal. It’s like, someone should call them and say something may be going wrong with this link they’re sending out. But this this is what we have to really think about is that the Internet for its speed, you know, I mean, a journal article is always like a year away. Right. And that’s the time of science. And when we’re in something like a pandemic, we want speed, but speed comes at a cost. And how we differentiate between truth and fiction on Internet websites that look totally legitimate. They look like a journal, they act like a journal, um but they really aren’t a journal or the studies aren’t, you know, correct. And there’s always a methodological flaw that the average person will never be able to discern. And even really good epidemiologists can’t always discern those methodological flaws. If even the author chooses to say, you know, to share them you know in a in a legitimate way. We have like science on the table. And what’s scary is we already don’t trust the media. So we’ve effectively you know eroded media and trust in media. We’ve effectively eroded trust in government. We’ve had an ongoing conversation as to whether the 2020 election was stolen. That sounds like a bad movie plot, not something I’d hear on the nightly news. And now if we can erode science, then we’ll fall for anything. That’s the third pillar. That’s the hat trick. 

Dr. Abdul El-Sayed: To your point in your polling, you find that it’s not just COVID misinformation. It’s like COVID opened Pandora’s Box for a lot more medical disinformation. It’s not that it wasn’t there to begin with. Don’t get me wrong. It’s been there all along, but that the grifters have realized that it’s an effective grift with COVID and that it’s opened the door to misinformation across the board in a much more profound way. Can you talk a little bit about what you found and how you interpret it? 

Brian Castrucci: Yeah, this was this was really important to me. I have struggled with uh obesity my whole life, and I am a diabetic now, and so I’m often the target audience for weight loss cures or for diabetes cures. And I just have always wondered, you know, what what do we think about all of this misinformation? And we found that more than two thirds of physicians said information and misinformation is a problem for weight loss, dietary supplements, mental health and other vaccines. I mean, let’s let’s be honest with each other. There is a whole misinformation movement with dietary supplements. I mean I what supplements do you take, what don’t you take? What’s it going to do? I mean, how many things do we see on our Instagram feeds of if you take this, you’re going to get rid of this fat. It’s going to remove fat from your belly faster than anything else, and you buy these things. But those are almost legitimized because as long as they say that these are not FDA approved claims, it’s okay. Here’s the bottom line. There has always been snake oil salesman in our culture, right? It’s they’ve always been there in little carts going town to town. The difference is today with one click, they reach millions of people. So it’s a whole different game and there are people profiting off of it, whether it’s people who are selling cures for cancer or mental health cures or, you know, sign up for my newsletter for this much money. And these people have no training in mental health, but a lot wear that white coat and that white coat has a huge impact in our culture, right? We’re taught to respect it from you know day one. And there’s a huge responsibility there. And that’s what that’s what’s on the line right now. Is our legitimacy of medicine and science. And it’s being warped and it’s being warped by legitimate people. The health commissioner of Florida is a Harvard trained physician. Why would a Harvard trained physician not be telling us scientific fact? That’s a that’s a question we have to wrestle with. 

Dr. Abdul El-Sayed: As we think about what we’re learning and where we’re headed and what it teaches us about the challenge of doing legitimate, evidence driven, science based public health in the future. What worries you most about the way that this mis and disinformation reverberates back? Is it the charlatans with the right markers of credibility? Is it that we give up trying to message into the ether? Or is it that the institutional requirements for maintaining a public health infrastructure because of lack of trust fall away? Or is it something different? 

Brian Castrucci: I worry that those who are seeking to spread misinformation are far better funded and far better organized then those trying to undo that misinformation and that ultimately we are headed into a post fact era, an era where it would be near impossible to get people to pass some of the smoking ordinances that we were able to in the past because there would be much more organized resistance to you know whether smoking caused lung cancer or whether smoking was bad for you. I mean, thank God we had the smoking gun of the the documents from the industry. No industry will ever do that again. They’ve learned from tobacco. Right. Think about if HIV emerged today. Right. We know that there’s always been that small group who said HIV does not cause AIDS right they’re there. But today they would find a whole different platform. And that could catch fire in an entirely different way. And that’s what worries me, just the ability to continue the evolution of our nation when we are gambling with our safety, our security and our economic prosperity. 

Dr. Abdul El-Sayed, narrating: We’ll be back with more after this break. [music break]

[AD BREAK] 

Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Brian Castrucci. 

Dr. Abdul El-Sayed: You know that this was not a conversation about A.I., but I’ve been thinking quite a bit about it as I play around with chatGPT and some of these new language models. These models are trained on content. They’re not necessarily pruned for what content is truth versus falsehood. And so folks get real confused about why they get things wrong and they get things wrong because the Internet gets things wrong. And that’s the training data for these models. And I worry that there’s this recursive effect where garbage in, garbage out. We know this from, you know, anyone who’s ever done statistical modeling knows garbage in, garbage out. But, you know, AI modeling makes garbage in, garbage out so much more compelling because the models, they don’t require interpretation. They tell you, they talk to you. And I worry that in this era of mis and disinformation, where our ability to verify is so limited, when you start then creating more and more AI based content that other AI feeds off of. All you do is you’re sort of feeding all this mis and disinformation into the machines that seem to be the ones that are going to be dictating the future. And so it just becomes that much more of a scary scenario where the ability to differentiate fact from fiction when the same machine is telling you, you know, the quote “answers” um that that gets a lot harder a lot more quickly. I want to end on a positive note, if there is one here. And that to me is that even though you hear a lot more about the mis and disinformers, you know, nine out of ten doctors agree that that used to be you know a punch line for a commercial. Um. And the median sort of sees this for what it is. So what does it mean for us to give those folks the microphone? Right. What does it mean for us uh to elevate those voices and those perspectives? And I think you’re doing a lot of that by doing this polling. Um. But how do we design around, you know, that problem, the sort of I hate to use this word, but the, quote, “silent majority” problem? 

Brian Castrucci: I think it is the silent majority problem. I mean, I’ve had kids in school for the better part of you know eight years um and I like my school system. And so I have never been to a PTA meeting. I’ve never been to a school board meeting because I think everything’s going great. You know, my kids are happy. I think they get a good education. But there are people, a small minority of people who are at every school board meeting telling the school board everything they’ve done wrong. We have to get engaged with the same kind of fervor for the good. You’re saying these things are going well. This is what we believe this is okay. Right. And as long as we’re allowing specific politicians or specific media people to set a national narrative and we just kind of, you know, I think we were all just waiting for it to go away. And so we weren’t paying attention. We can’t do that anymore. Right. The stakes are too high. At this point we have to engage like we’ve never engaged before. And I love when I see more doctors on Twitter saying, no, wait, that’s not true. No, wait, that’s not true. Now they get attacked and there’s a high price that many of us are paying in this kind of ongoing debate. But it needs to be conversations that we don’t just have on Twitter, but we have with our friends, we have at our at our churches and synagogues and other places of worship. We have to have a constant conversation in this nation. But I think you brought up a really good point, how AI and the Internet is allowing misinformation and disinformation to spread in a way that we never thought possible. This is what our challenge is going forward. It’s a generational challenge and I’m an eighties kids, so I’ve always been concerned about A.I. and Skynet and the Terminator. That’s what [laughter] I was raised on as a kid. So–

Dr. Abdul El-Sayed: You and me both. 

Brian Castrucci: –none of this kind of fear is new. [laugh] Because Arnold Schwarzenegger put that in me you know decades ago. But we have to really be the the force that fights it and says, hey, listen, even though that person’s really loud, there aren’t a lot of people who agree with them. Right. And just like I think Nancy Mace in her you know, in the Twitter files, congressional hearings, it was asking this Twitter person, you know, who are you? Are you a physician? Why do you get to silence doctors? Because just because you wear that white coat doesn’t mean you’re right. Doesn’t mean you’re ethical. Doesn’t mean that you’re saying the right things. Science is a process. We have to follow it. And if we don’t, then who knows what we’ll believe. Because if we don’t stand for something, we’ll fall for anything. And when your health’s on the line, that’s super dangerous. 

Dr. Abdul El-Sayed: I think sometimes um those of us who believe in fact facts and uh truth truth, [laugh] we hesitate to speak up when we think that what we’re saying should be obvious. And the problem right now is that too few people speak for the truth or for what is obvious. And it goes without saying, right? We say that all the time. It goes without saying. But actually, in today’s day and age, you have to say what goes without saying, because there are enough people saying the exact opposite, that they are swaying public opinion because most of us are staying silent on the thing that goes without saying. And we appreciate you always being the one who’s willing to say it um and to surface uh the broader public belief and uh and to come on the show and share some of what you found with us. Our guest today uh was Brian Castrucci. He is the president and CEO of the De Beaumont foundation who is a sponsor of this podcast uh because they generally want people talking about public health. So, Brian, we really appreciate you coming and joining us today, sharing a bit more about your polling and hopefully as you get more results in the future, we’d love to check in on them. 

Brian Castrucci: Thank you so much, Abdul, and thanks for having me. [music break]

Dr. Abdul El-Sayed, narrating: As usual here’s what I’m watching right now. Most states don’t have surgeon general’s because, well, most states don’t have generals, period. Which is why it’s so curious that Ron DeSantis appointed one in the first place. And given that this is Ron DeSantis, we’re talking about, you know, a guy who literally doesn’t step into a bathroom without asking if it can benefit his political career. He appointed one Joseph Ladapo as his. Now, you all know a few things get me as hot and bothered as folks who sell out their credentials for a little bit of money, fame, or power. But that’s exactly what Joseph Ladapo has chosen to do. At every single turn he’s been a yes man to Ron DeSantis’s absurd demagoguery around COVID. At the center of this was an astounding claim he made that COVID vaccines were associated with, quote, “an abnormally high risk of cardiac related deaths in young men” based on flimsy analysis by the Florida Department of Public Health. And then he called on young men in this age group to avoid getting the vaccine. This week, the Tampa Bay Times released findings from a public records request that found that Dr. Ladapo himself had edited this into the report. Five previous drafts had all indicated, quote, “No increased risk for cardiac mortality following mRNA vaccinations.” Only in the sixth, the first with Dr. Ladapo’s edits, was this sweeping edit made. How’s that for flimsy evidence? Between the six versions of the study, you see the evolution of an effort to twist the results, fuddling with time categories and playing fast and loose with the analysis and interpretation. They also completely eliminated a key sensitivity analysis that casts a lot of doubt on the association between mRNA vaccinations and cardiac events in young men. Exactly that association which Dr. Ladapo decided to frame an entire press release around. What’s a sensitivity analysis, you might ask? Well, epidemiologists use them to stress test their findings against possibly spurious results that could result from limited data. And by removing that stress test, Ladapo made the cardiac finding seem a lot more serious than the data actually suggest. It’s hard not to see this stunning scientific malpractice as anything other than motivated entirely by Ladapo’s need to brown nose his boss, who, by the way, has taken a dark turn against public health, trying to cast himself as the real bearer of the MAGA creed. It’s also a reminder of something we touched on in our conversation with Brian. Not all that glitters is gold. We live in a moment where academic bonafides do not good science make. It just takes enough Joseph Ladapos out there willing to sell out their MDs for some power, fame, or money to drive mis and disinformation into the world. After all, who needs a fig leaf when you’ve got a white coat? And that’s why this next story is so concerning. The National Academies of Medicine, the sciences and engineering are some mix between honor society and think tank. They induct leading thinkers as members every year. Being inducted in the National Academy of Medicine, for example, is among the highest honors a medical scientist can receive. Then members of the National Academies publish well-respected reports on key issues in science that everyone from the president to Congress to state and local governments pay a lot of attention to. But it turns out that they’re not immune to outside influence either. New reporting from The New York Times found that the National Academies took nearly $20 million dollars from the Sacklers. As you remember, they’re the family behind Purdue Pharma, the manufacturers of OxyContin, the opioid widely responsible for kicking off the opioid epidemic. Worse, they’ve authored two major reports on the opioid epidemic. One of them claimed that upwards of 40% of Americans suffer chronic pain. That’s a vastly inflated number, considering that the CDC revised those numbers down to between seven and 21%. That report, well, it helped push the FDA to offer at least one problematic opioid and was cited to push doctors to prescribe them. It’s not clear whether the Sackler donations were directly tied to either report, but let’s just say it’s shady as hell. It raises a series of important questions. For example, why do the National Academies take outside money to begin with? They were founded by Abraham Lincoln in 1863 as an independent advisory organization for the government, and they get 70% of their funding from the government in the first place. Why sully their reputation with corporate contributions, including from pharma and fossil fuel companies? All of this highlights just how thick the web of corporate influence can be. Finally, a new study on the risk of dementia found that bilingualism may prevent it. This study of 746 people between the ages of 59 and 76, roughly 40% of whom had no memory issues, looked at the risk of these issues for people who spoke two languages every day, either between the ages of 13 and 30 or between 30 and 65, and they found that those who did had higher scores on various memory tests, including the ability to recall three objects or spell words backwards. Even among folks with memory challenges, those who spoke two languages regularly developed symptoms later in life. The study adds to a growing body of work, both looking at the brain benefits of bilingualism and the role of cognitive stress on dementia risk. These findings support a general thrust that shows that bilingual people may develop a certain cognitive fluidity that helps them toggle between various tasks and even manage their emotions better. As for dementia, though, we know precious little about what actually drives it. The bulk of our present research shows that, like our bodies, regular exercise is probably good for the brain too. Notice that the study isn’t just about knowing multiple languages, but about speaking multiple languages every day, which is of course really hard to do. English was not my first language. I only learned it when I started school, but today I’d be hard pressed to talk about much more than my activities of daily living in Arabic. Similarly though I learned French in school. I certainly don’t use it very often, but all of that has me thinking maybe I need to start using them more often. If not because it’s really cool and enlightening to speak to people in other languages, then maybe because it’ll help stave off the risk of cognitive decline as I age. [speaking in French] [speaking in Arabic] That’s it for today. On your way out. Don’t forget to rate and review it goes a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. [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. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, 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. 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 Veterans Services.