Words Matter. Especially in Public Health. | Crooked Media
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December 19, 2023
America Dissected
Words Matter. Especially in Public Health.

In This Episode

It’s not only what you say — it’s how you say it. And that’s often where public health gets it wrong. Our producer Emma Illick-Frank talks to a recovered anti-vaxxer about what ultimately brought him around. Then Abdul talks to Jessica Malaty Rivera, an epidemiologist and health communicator, about how far humility and accessible language can go to protecting health.

 

TRANSCRIPT

 

[AD BREAK] [music break]

 

Dr. Abdul El-Sayed, narrating: The Texas State Supreme Court rules against an abortion for a non-viable pregnancy. The FDA approved a new therapy for sickle cell anemia. The first FDA approved therapy that uses CRISPR technology. The W.H.O. warns of impending public health disaster in Gaza as the death toll nears 20,000. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] So much of what we say is about how we say it. And sometimes we don’t say it all that well. Our guest today is Jessica Malaty Rivera, an epidemiologist and health communicator. But this week, for our last episode of 2023, we wanted to do something different. To bring us some context for our discussion, our producer Emma went out into the field. She shared a conversation with Craig Idlebrook, a former anti-vaxxer. They talked about why he resisted getting his kid vaccinated and what ultimately brought him around. 

 

[clip of Craig Idlebrook] My name is Craig Idlebrook. I live in Massachusetts near Boston, and I am an editor for a nonprofit that helps to try and improve medical health delivery. 

 

Emma Illick-Frank, narrating: When he was younger, Craig and his then partner were dead set on living as natural a lifestyle as possible. 

 

[clip of Craig Idlebrook] Around my senior year or after college. We became vegan and we were very strict about it, and we started exploring other ways in which we could sort of live more naturally and uh do better by the environment. 

 

Emma Illick-Frank, narrating: Craig and his partner were coming from a good place. They wanted to be the best environmental stewards they could be, but their quest eventually led to a strong suspicion of Western medicine. 

 

[clip of Craig Idlebrook] So that included even like Tylenol for a cold or actually even regular medical care. 

 

Emma Illick-Frank, narrating: It didn’t help that they were pretty isolated from the outside world. 

 

[clip of Craig Idlebrook] We didn’t have a heck of a lot of friends, and we were in 30 acres in Maine by ourselves. We became a bit of an echo chamber with each other. Craig’s daughter was born in the early 2000s, a few years after a former British physician, Andrew Wakefield, published what was ultimately a roundly discredited paper linking vaccines to autism. 

 

[clip of unspecified person] The claims to whether the vaccine caused their children harm or not came from the parents, not me. I didn’t have a preconceived notion about this at all. I hadn’t heard of autism since medical school. 

 

Emma Illick-Frank, narrating: The medical community immediately debunked Wakefield’s claims. But the damage was already done. Publications like Mothering Magazine, which Craig and his partner subscribed to, gave Wakefield’s pseudoscience a platform. And many parents, including Craig, became concerned about vaccinating. That one piece of debunked pseudoscience gets echoed in the anti-vax community to this day. 

 

Craig Idlebrook: We decided not to vaccinate our child. And it was with these great intentions step by step, you know similar to the road to health, is just that we were trying to give her the best start and we thought that since we were living well naturally, that this would benefit our child too. I think there’s this idea of like that people are being negligent and and that’s just an idea I now have in a different sense. But people are being negligent or lazy by not vaccinating their child. In fact, I took parenting extremely seriously and I was like, I have to try and protect my daughter at all costs. 

 

Emma Illick-Frank: At that time, why did protecting her against aluminum, maybe the threat of autism, why was that more at the forefront of your mind than protecting her from measles, polio, the things that vaccines protect against? Like how did that logic work? 

 

Craig Idlebrook: That logic worked in a very tortured way because the herd immunity was so strong you would never hear at that time when my daughter was born that there was an outbreak of whooping cough or the measles as you do now. And so there was this feeling of I get to choose. That I can create the path to clear the way for my daughter to be the best that she can be. [music plays] I don’t want to shy away from the fact that I put my daughter in danger. Like I can try and rationalize I can say, well, I was thinking this, I was thinking that. But I put my daughter in danger in several different ways throughout her early childhood. And it’s only through pure luck, uh pure dumb luck that I that she survived and stayed as healthy as she did. 

 

Emma Illick-Frank, narrating: Craig isn’t just referring to his decision not to vaccinate. He and his partner also wanted to do a homebirth, but they didn’t adequately prepare and ended up in the hospital. Then there were the times their daughter had a high fever and they didn’t medicate her. But worst of all, there was an accident he still feels guilty about. 

 

[clip of Craig Idlebrook] I slipped on some ice while I was holding her and fell on her and she hurt her head and we didn’t go to the doctor. 

 

Emma Illick-Frank, narrating: At least not for a while. Craig says it was hard to find a pediatrician who would see his daughter because she was unvaccinated. They did find someone eventually. 

 

Craig Idlebrook: She’s still practicing in Maine. I believe uh her name was Dr. Whitaker. Um. And she really did believe in vaccines, but she was willing to see my daughter um and was willing to sort of try and keep the nonjudgmental lines of communication open. And so she helped lay some groundwork. And that’s the thing. There was a lot of groundwork to get to that point, and there’s a lot of groundwork to give back. 

 

Emma Illick-Frank: What were some of the things that Dr. Whitaker said that made it a nonjudgmental atmosphere that you know kept that lifeline open? 

 

Craig Idlebrook: One is just the door being open was extremely important. Two was the tone she set at the very first time we met, which was not trying to persuade, stating her beliefs but being friendly and caring. She just kept a relationship going. And the one visit I do remember that really was impactful had nothing to do with vaccines. Several months after I took that slip on the ice with my daughter, she was going for a well-child checkup and again I didn’t seek out medical help for her. So during the well-child checkup. Dr. Whttaker’s feeling around the head and just calmly she says, I don’t want to to freak you out, but did anything happen to her head? I immediately felt the shame and guilt and I relayed what happened and she believed me. Like it wasn’t there had been no indication of any kind of actual abuse. Like she, I could tell that she trusted us. And she said, okay, I don’t want to freak you out. I think she had cracked her skull then. And then she looked over at me and she saw me. And she was like I said, don’t freak out. Hang on. And she saw that I was right about to pass out. Because all the blood drained [sigh] from my face when I realized how badly she had been hurt and how much could have gone wrong at that moment. That moment of emotional vulnerability and overwhelming guilt could have gone such a different way if she had started really clamping down and saying, why did you do this? And having judgment. It was instead a moment where she cared deeply about my daughter and cared deeply about me at the same time, even though I had done something that had been wrong for my daughter medically. And that was a big beat for me, that helped push back the idea that the doctors are the enemy, that I can take the best care of my daughter without them and that percolated. 

 

Emma Illick-Frank, narrating: But perhaps the biggest impact on Craig’s stance came from separating from his partner. 

 

[clip of Craig Idlebrook] I was alone a lot with my daughter. Um. I had to keep her busy. So we would go out in the world more and I would interact more and sometimes you were bending rules, you were having some food that you weren’t allowed to, and you were finding that it wasn’t the end of the world. Me going out into the world sort of helped break some of that echo chamber. 

 

Emma Illick-Frank, narrating: Craig also started dating and eventually married someone who did believe in vaccination. 

 

[clip of Craig Idlebrook] There’s a lot of reasons for Kate to judge and for her family who lives nearby to judge. And again, like Dr. Whitaker, they provide this relationship first. This forum for ideas in a relatively non-judgmental fashion, didn’t push too hard. And that gave me the space to reconsider vaccination. And so by the time I was trying to enroll my daughter in kindergarten, there was just this feeling that this actually doesn’t need to be a thing anymore. My daughter um she’s fully vaccinated now. Um. So she’s you know, got vaccinated against all the regular childhood immunizations. She’s been vaccinated against HPV. Um. I think there was one other one, like one of the Heps that she wasn’t required to have but got herself caught up on. I don’t remember exactly which because to be honest, it’s her journey now. 

 

Emma Illick-Frank, narrating: When it comes to addressing health misinformation. One strategy is to keep pathways of communication open and free of judgment or impatience. This approach is slow and steady. Like Craig said, it takes a lot of groundwork to dismantle these beliefs. But what if we just made it harder for misinformation to take root in the first place? Is it possible to inoculate people against brainwashing? Cecilie Traberg thinks so. She’s a Ph.D. candidate at Cambridge who studies the psychology of misinformation. 

 

[clip of Cecilie Traberg] It originated as a communication theory by a guy named McGuire who had a theory about how we might reduce persuasion. And he was really interested in seeing whether we could use an analogy derived from biology with the mind to reduce brainwash. And so the idea was that if you want to kind of boost the mental immune system, you first have to expose them or make them aware that an attack is imminent, a more persuasive attack is imminent, just like biological vaccines do. 

 

Emma Illick-Frank, narrating: Bill McGuire’s research from the 1960s and seventies is the basis of psychological inoculation or prebunking a strategy you’ll hear more about today. And it’s pretty effective even with online misinformation. 

 

[clip of Beth Goldberg] We’re a little bit too late when we’re debunking, right? 

 

Emma Illick-Frank, narrating: This is Beth Goldberg. She leads research and development at Jigsaw, a Google unit that investigates misinformation and extremism. 

 

[clip of Beth Goldberg] Misinformation is really sticky. It sticks in our brains really well often because it’s really sensational um and also because we have this first impression bias. So if if someone’s first impression of the misinformation is the misinformation itself. Like that’s going to have an advantage. If we can get to someone first and warn them. Prebunk is is this preemptive warning that says, hey, you’re likely to encounter something that looks like this next time you’re online. This is manipulative and here’s why. So we wanted to know, can we teach people in just 30 seconds how to identify what that looks like um and and then spot it themselves when we show them examples? 

 

Emma Illick-Frank, narrating: This is from an interview Beth did last year on another Crooked podcast, Offline with Jon Favreau. 

 

[clip of Beth Goldberg] So we we did these tests first in a lab setting where we sort of paid people to sit down and answer our questions and watch our videos. 

 

[clip of ad from Google’s Jigsaw team] You might think about skipping this ad. Don’t. What happens next will make you tear up. Kidding. You just got tricked. When online, you’re likely to see content that is loaded with emotional language. Appealing to emotions like fear or outrage is a trick to get you to pay attention. And it’s key for the spread of ideas through social networks. 

 

Emma Illick-Frank, narrating: The team at Google was heartened to find that young or old across different demographics and education levels, the videos worked. People were better able to identify emotional language. They trusted it less and they were less likely to share it on social media. When Beth’s team rolled out the videos as YouTube ads. 10% of viewers were better able to identify manipulation techniques. But the inoculation needed a booster. 

 

[clip of Beth Goldberg] This is just like a a vaccine for your body, where the the resistance you gain from that, the antibodies you build, they wear off over time. Um. And so what we found from these particular videos, they last for for a solid ten days and then we’re going to start to see decay over over the course of a month. But just like a vaccine, you can give people a booster. Um. So one really cool study we have coming out and some other folks have been testing this as well is, you know, can we give you even like a ten, 15 second reminder, a little booster of of what you saw in that first video and get you all the way back up to full mental immunity. And um we found that at least in the lab setting, that that works really well. 

 

Emma Illick-Frank, narrating: These results are very exciting, but they left me wondering how sustainable of a strategy this is, particularly for anti-vaxxers who might balk at the terminology. So I asked Cecilie, the misinformation researcher. 

 

Emma Illick-Frank: Just the idea of psychological inoculation, that phrase I could imagine being really triggering to people who are dead set against vaccines. You know, it’s like, oh now you want to vaccinate my mind. It seems like these people’s worst nightmare. So how do you present this information in a way that you know isn’t misleading but isn’t necessarily using those buzzwords that people are suspicious of? 

 

Cecilie Traberg: Right. I mean, so definitely should take out the vaccine word. I would replace that with training. So just psychological training to resist misinformation. A key reason for people not trusting vaccines is the whole natural element that you don’t want anything kind of unnatural to come inside of your body. And with these trainings, you would essentially be helping them not get something kind of invasive into their minds. So I think the key would be to frame it as psychological training or even cognitive training, because psychological also makes it seem like we’re going to try to like, brainwash you or something. But cognitive training might be kind of an easier pill to swallow, to use another analogy. 

 

Emma Illick-Frank: You know, if everybody did these exercises and and was inoculated, that would be great. But how do you get the mass American public, for example, to be inoculated when they would have to do this exercise? 

 

Cecilie Traberg: The motivation element is is kind of the key challenge. How do you get to people who don’t really care about misinformation or aren’t really kind of motivated to learn about it? So a key thing kind of being discussed now is who is telling people to get inoculated. Because often the people who are more likely to be affected by misinformation are those people who have lost trust and faith in institutions and governments. You have to find key people in the in the right communities to kind of communicate this message. 

 

Emma Illick-Frank, narrating: So in a way, we’re back to square one. We have a proactive protective tool, and this one doesn’t even have a scary needle. But we’re still searching for the right way to get the word out, the right messengers to get people on board. Craig, the former Anti-vaxx dad, says he appreciates prebunking, but he believes public health folks should leave no stone unturned. 

 

[clip of Craig Idlebrook] Unfortunately, there’s no silver bullet to avoid someone like me who seems perfectly rational going down a rabbit hole or two. But I think from a public health standpoint, whatever can be done to be nonjudgmental about choices, even if those choices could be a problem health wise, I think is much more important than any fact you can give someone. I was given plenty of facts. I was given plenty of brochures. I was told exactly what was wrong with my decision. But I had other brochures, I had other pamphlets, I had other magazines to counter it. So whenever is there is the opportunity to create a non-judgmental space to talk about these ideas that is I think vitally important. What you say may not seem like it’s making an impact, but it might actually be percolating for months at a time and come back at a critical juncture like it did with me. 

 

Dr. Abdul El-Sayed, narrating: That was our incredible producer, Emma, with some excellent reporting from the field. And a special thank you to Craig Idlebrook for sharing your story with us. You’ll notice a lot of the same themes about the critical work of prebunking and the importance of an honest, non-judgmental tone in my conversation with Jessica. After this break. [music break]

 

[AD BREAK] [music break]

 

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

 

Jessica Malaty Rivera: Sure. My name is Jessica Malaty Rivera. I’m an infectious disease epidemiologist and science communicator. And right now, I am the senior science communication advisor at the de Beaumont Foundation. And I’m also a researcher at Johns Hopkins University and a doctoral student at the Center for Health Security. 

 

Dr. Abdul El-Sayed: Very cool. So walk me through uh how you got into health communications. Like, what is it about the way we do things and then the lived experience that you bring to this work where I’m rather certain you probably saw a pretty big disconnect and were like, you know what? I can solve that. 

 

Jessica Malaty Rivera: Yeah, you know, it’s an interesting story because it was a bit accidental. I mmm, gosh, many moons ago, probably 15 years ago, I was recruited to do some research at Georgetown Medical Center um in the realm of bio surveillance, essentially tracking emerging infectious disease outbreaks in plants, animals and humans with a mostly federal audience that was looking to find kind of the next big one in any of those, uh you know, populations. And so I came in as an Arabic and Spanish speaker. They wanted people to be using their different languages to look on open source media and try to find clues. And we were looking at things like ventilator shortages and farmers getting sick and animals needing to be culled. And it was in that work of translating literally from different languages into English, then summarizing it into pithy summaries for a very lay audience, some specialized but mostly lay audience that I kind of learned a new language. And that was the language of science communication, the ability to translate things into meaningful and accessible information so that somebody could read it and understand what it’s saying and understand what it’s not saying. So I got really good at that. Um. It was before I knew of the space of science communication, and I did that for a number of years before I then went into kind of health care PR to help big companies translate their clinical milestones into everything from social media to a leave behind in a doctor’s office. Um. And it just became something I got really passionate about um the explanation of it, the the emotional intelligence required, the empathy that it needs. And I would say that for many, many years as an epidemiologist, expecting a next pandemic, a big one, um we were kind of silently screaming, many of us in the space saying, if we’re not prioritizing science communication, we’re going to get really unlucky when the next big one comes. 

 

Dr. Abdul El-Sayed: Yeah, I would say we probably got a little bit more than unlucky. I think we, you know, categorically uh missed the boat. I want to I want to dig in to what it takes to be a good communicator, because I think you mentioned a lot of those pieces. You know, you would imagine that for a collection of scientists that make up the public health community. Driven by the goal of improving the well-being of the public, that we would come at this from the perspective of engaging that public more. And I think at some point we we kind of lost that empathy and that grounding and that focus. And instead, I think we spend a lot more time biasing the the rigor and comprehensiveness of what we share about science rather than making sure that it’s understood. 

 

Jessica Malaty Rivera: Mm hmm. 

 

Dr. Abdul El-Sayed: And implicit here is there’s a disconnect between what what we assume are priors on behalf of the population and what really are priors. And I actually think that’s widening. Can you can you share a little bit from your perspective? You know, all of us started out as, quote, “laypeople.” None of us were public health professionals from the jump. Why do you think we lose that so quickly, like when we get into science speak? Like, why is it that we get almost miseducated about how to talk to the everyday folk about this thing we spend a lot of time learning? Like, where does that happen? 

 

Jessica Malaty Rivera: I mean, I think you partially answered it by saying, you know, think about our training, right? It’s not miseducated. It’s uneducated. In our training we’re not usually thinking about the audiences beyond our peers. We’re thinking about how do we write the most impactful piece of, you know, peer reviewed content for a high impact medical journal for the purpose of making my publication list long and getting more credibility among my peers, instead of thinking about the process of science being incomplete until it’s communicated to more people than just your peers. That it just can sit behind these fancy institutions and these walls in laboratories and in research uh centers, and instead of it making an impact to the community from a from our education, from our master’s degrees, our PhDs our MDs, whatever we’re getting, it’s not usually thinking about a very broad audience. And I think that’s probably one of the biggest shortcomings of training as a scientist, that you’re not thinking about who and why and where these findings are going to go. And I want to change that. I think it goes back to our education. 

 

Dr. Abdul El-Sayed: So I want to zero in on the pandemic. And we’ve had a lot of conversations on this podcast about uh mis and misinformation during the pandemic. But it was almost a perfect storm to be a nidus for misinformation. And what’s what’s starting to emerge to me is that there is a health information environment before the pandemic and a health information environment after the pandemic. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: And I think for a lot of us, we want to put the toothpaste back in the tube. And obviously that’s a very difficult thing to do, if not impossible. So I want to ask you, what do you think made COVID such a nidus for misinformation and what in thinking about what happened there can lead us to thinking about how to get to a future where um a lot of the mistrust that hatched during the pandemic is healed?

 

Jessica Malaty Rivera: Yeah. So many things to unpack here because there’s nothing new about misinformation and disinformation and vaccine hesitancy and even the concept of infodemics. Right? If you look back at the history of vaccines, you know, when when people were getting protected against smallpox using the cowpox virus, there were conspiracies about people turning into cows uh because of misunderstandings of how the science worked. The whole process of variolation scared people. So it’s it’s not a new phenomenon. I think the fact that we haven’t treated it with the kind of sobriety and and seriousness as it needed is kind of how we got here. But the thing that I think made it so much worse and so ripe for this type of level of infodemic infodemic is the digital world. Um. I think that we are dealing with an oversaturation of information to the point where it becomes even difficult for people who are trained to understand scientific content, to feel a bit overwhelmed. Uh. There were more publications on COVID on, you know, preprint servers to actual publications than any other subject that’s ever been studied in science. And that becomes an infodemic in and of itself. Where’s there’s just so much information. And I think when we consider the fact that we have people who have proximity and access to information at a at a speed and at a cadence that is unprecedented and not even like what you and I grew up grew up in when we were kids and teenagers and young adults. Um. It makes it very difficult to kind of get ahead of that. Which is why I think when we think about the concept of science communication being as important as research and development for a new vaccine or for an antibiotic, that it needs to kind of go from the very beginning, that pre-clinical phase to approval and rollout the communication machine needs to kind of be slowly burning next to it so that it’s not an afterthought so that we don’t have the head of the NIH being like, I wish we had had an idea that vaccine skepticism was such a big deal. And many of us in the space were saying, we’ve known all along we just needed to get ahead of it by prioritizing the R&D side of comms and not just the R&D side of vaccines. 

 

Dr. Abdul El-Sayed: One of the things that I think has really [laugh] full out like confused a lot of us in the field and I think we haven’t really adjusted to is that notion that there’s a before and after and we’ve watched as a lot of pandemic era mis and disinformation, a lot of pandemic era tropes have now transmogrified from COVID 19 to almost backwards into rather settled public health interventions like, you know, kindergarten vaccines, the the basic stuff all of us got that nobody really made a big to do about in the past. Why do you think that happened? And um I think it’s really tough when you have to, like, retrace your steps to be like– 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Oh, we have to go back and fix this. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: How do you think we do that? 

 

Jessica Malaty Rivera: Well, this is where the trust comes in, right? And I think that we have not treated trust as the currency that it is when it comes to people’s adoption of public health behaviors. And when trust is broken, which is very quick and easy to happen. Repairing that trust is a long and painful journey. And I think the politicization of public health, the politicization of the pandemic itself had people reacting in this like throwing the baby out with the bathwater of, oh, if the COVID 19 vaccine is up for debate, then the whole pediatric vaccine schedule should be questioned. And it’s it’s that kind of mentality of I don’t trust the people who are pushing that and they’re also pushing this, so get rid of it all. It’s the same kind of scorched earth response to the CDC, a deeply flawed government agency, but a deeply necessary and important part of our public health infrastructure. And when we look at, you know, this idea that truth can be subjective, that facts can be alternative, you know. We’re living in a bit of a post-truth society where it’s less about empirical evidence and the rigor that is required to show that this has more benefits than risks. It’s now a matter of opinion. And I think we create these false equivalencies when we say, oh, somebody who is a skeptic and somebody who’s an expert in the space should debate. I think that’s really dangerous. Um. That creates a really bad precedent when it comes to how science is is iterated and and evolves. And and I also think though, we’ve kind of hurt ourselves by using language that’s not very meaningful, like trust the science. It’s a pretty meaningless statement, right? But it it becomes very polarizing and it becomes very binary in the way that people think. It becomes a red and blue issue, a black and white issue, a zero risk or a 100% risk issue. And binary thinking, I think, is going to be the death of all of us sometimes. 

 

Dr. Abdul El-Sayed: Yeah. I mean it’s, the funny thing about it is in becoming almost an equal opposite to the unserious skeptics. We’ve bypassed a lot of the nuances that make science science. Like trust the science is an anthematic statement. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Science is is is intended to move forward because people do not trust the science. 

 

Jessica Malaty Rivera: Yup. 

 

Dr. Abdul El-Sayed: So when you tell tell people to trust the science, you’re actually making a very anti science statement. The other problem with science is it’s not vibes based. [laugh] And unfortunately– 

 

Jessica Malaty Rivera: Right. 

 

Dr. Abdul El-Sayed: Like there are a lot of like science by vibes and um. 

 

Jessica Malaty Rivera: [laugh] Yeah. 

 

Dr. Abdul El-Sayed: It didn’t really work out all that well for us. 

 

Jessica Malaty Rivera: No. 

 

Dr. Abdul El-Sayed: And I, I worry um that, you know, rather than communicate into the void, I think what a lot of our community has done is to try and either step away or just yell what they were saying louder. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: And I worry that there hasn’t been much of an engagement with or a nuancing of what it is we’re about. And you know, one of the one of the aphorisms of political communication is say what you’re for rather than what you’re against. We spend a lot of time saying what we’re against. And in that case, we’re literally debating features that center the misinformation that we’re trying to debate. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Rather than just going out there and saying, here’s what we’re about, like here’s what matters, here’s what you should pay attention to. Um. You know, if you want to like F those guys, but pay attention to what I’m saying to you now. Right. And you know, F those guys in the in the nicest, most um–

 

Jessica Malaty Rivera: Polite yeah. 

 

Dr. Abdul El-Sayed: –possible way possible. 

 

Jessica Malaty Rivera: Yeah. [laugh]

 

Dr. Abdul El-Sayed: Uh. [laugh] Kindly F those guys. [laughter] Uh. But but we don’t say as much of what of what we’re for. Why do you think that’s our instinct? And that, you know, personally, I think part of that is, like all of us who go into these fields, these, like very academic fields have like a fundamental imposter syndrome where we are particularly insecure to anyone coming for our credentials. And so when people come for our credentials, we end up having to defend our credentials, which means– 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: –explaining why others are wrong. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Rather than having the confidence of our own credentialing to say why we’re right. 

 

Jessica Malaty Rivera: Mm hmm. 

 

Dr. Abdul El-Sayed: But I’d love to hear what your your thoughts are on that. 

 

Jessica Malaty Rivera: I mean, part of this is the consequence of a very digital world. It creates a reactive response to whatever you’re facing. And I have been very discouraged to see even some folks kind of entering the science communication space and trivializing it to like witty debunks um because really it’s it’s it’s giving more life to things that don’t need more life, more oxygen into a fire that we hope will just kind of like drown out on the side. You know, there is discernment and a science to science communication, knowing which things to spend your time debunking if they are incredibly harmful, if they have certain dynamics of kind of how prolific they are. But so much of what we’re supposed to do is like what you said. Inoculating people with good information, being forward with truth, even the truth sandwich is a perfect example. You start with truth. You fix the kind of mess in the middle, but you finish finish with truth. You say what it is, you say what is true. Um. But again, even the concept of truth, I think people have and this maybe comes from like religious upbringings and from the way that our political climate has made people so tribal that you’re you’re looking at things as if there is no nuance, that it has to be absolute. And science is not even absolute. Right. There’s no zero risk in anything, even in the most, you know, miraculous things that we’ve seen in innovation to keep people healthy and reduce harm. And I think that that’s where we’ve kind of failed folks in the 101 of some of these public health things. Right. I often say like, where did we go wrong? And heal– and like, why is it so okay for people to say breakthrough infection? Like that that’s such a ridiculous term to me because vaccines since the history of vaccines have been intended to prevent serious illness and death to keep people alive. So a breakthrough infection is not a failure of a vaccine, but it just it when you think about the shock of I did this thing and it was supposed to absolutely protect me from this and I got it anyway, It feels like a betrayal. It feels like you were lied to. It feels like this is a sham. And these sentiments around us and them. Profit, ugly big Pharma, big whatever it is, kind of furthers that bias against whatever team you’re not on. 

 

Dr. Abdul El-Sayed: You talk a bit about in your work about prebunking? Um. What is that um and how how does it work? 

 

Jessica Malaty Rivera: I love prebunking. It’s a it’s a very evidence based approach to science communication. There’s a lot of data to show that it works on essentially information inoculation on on creating a resilient population, a population that understands kind of what is to come, whether in the data that is good or the bad takes about that data so that people, when they see headlines, when they see um announcements coming in from the CDC, when they hear their doctor talking about something, they have a familiarity with it. So it’s getting ahead of of the noise and and conditioning folks to be prepared for what could be a really difficult to navigate infodemic around them. Um. And it’s it’s fascinating because it’s been studied a lot in climate science. And climate science is probably a perfect example of where politics and message massaging uh kind of ruins a lot of the momentum around it. And it’s not all bad, right? We can’t just be thinking about ways to prebunk about doom. You can prebunk about good things, emerging things that are going to be beneficial to society. Um. It’s one of the many tactics that is effective in helping people understand science. Uh. It’s not can’t be done alone because I think a lot of what’s missing on the emotional side of prebunking or truth sandwiches is humility. You know, I think scientists struggle saying things like we don’t know or we don’t know yet. Part of that can be part of prebunking. Right? Part of that can be saying like, hey, masks for instance, we are still learning about the effectiveness of masks. Instead of don’t wear masks, always wear masks. Like that created so much confusion, but instead like getting ahead of it in a humble way. Kind of that emotional intelligence in mind can prevent a mess that you’re going to have to clean up later. 

 

Dr. Abdul El-Sayed: I want to ask you, because part of the challenges with prebunking, you have to kind of know where the fallacy is headed. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: And we don’t always. And so what happens is it kind of ends up being almost a takedown of a of a whole set of people because you’re like, I don’t know what the fallacy they’re going to come up with is. But I know, I know who’s going to come up with it. Right? 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Um. And it does end up almost becoming an us them situation. And I know, you know, as scientists, it’s not really about them. It really is about the folks that we’re trying to convince. So as you would think about pre bunking and as you think about, you know, these um mega misinformers that are that are out there, how do you prebunk without specifically targeting those folks? 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Who are like the misinformers who tend to drive all the misinformation. Um. And then also like how important is it as folks who are interested in where the conversation’s going to actually pay attention to the misinformers and the evolution of their speech? 

 

Jessica Malaty Rivera: Yeah. It’s a great question because I think about this a lot, and there’s a degree of like unoriginality to a lot of the claims that circulate. There is a playbook and a lot of the claims are regurgitated from that playbook. So a prebunk about fertility is something that could easily be on all of our radar because in every new innovation, whether it’s a vaccine, whether it’s a treatment, fertility and fears about infertility and sterilize sterilization and impairment almost inevitably come up. So you kind of know like the themes that it’s going to land in, genetic modification, fertility, you know, uh reduced immunity susceptibility to other illnesses. Those are kind of spaces that you kind of see people usually, you know, the bad actors will gravitate to. Um. That and you can explain the concept of logical fallacy and and the tools that are enacted by those bad actors. Right. And I think this is kind of a fun part of science communication of kind of demystifying these terms. Appeal to nature fallacy, for instance. What does that mean? We’ve seen the appeal to nature fallacy absolutely hijacked. Everything from food to cosmetics to baby toys where natural, organic, clean, chemical free are these words that become just so useless and and truly meaningless. But have a white knuckle grip on parents and nutritionists and bloggers and the like, and so getting ahead of that and saying, hey, these are things to look for. If you’re seeing somebody demonize chemicals, water’s a chemical, everything is a chemical. There are ways to kind of soften that message that the everything from the chemophobia to the kind of like disordered eating that the stuff causes um can be less impairing to to the people who are getting this message. 

 

Dr. Abdul El-Sayed: My favorite one is when you hear folks like, well, our forefathers didn’t do it this way. [laugh] You’re like yeah, you’re right. You know, our forefathers died of infectious diseases that we don’t even have to pay attention to. 

 

Jessica Malaty Rivera: At like forty years old.

 

Dr. Abdul El-Sayed: You know, it wasn’t always the good old days. Yeah. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Right. Like this wasn’t a great time. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Or, um you know, most of human history when we did not know how to protect ourselves from, like, you know, people shitting in water and then us drinking it and getting really, really sick, like so– 

 

Jessica Malaty Rivera: Exactly. 

 

Dr. Abdul El-Sayed: Let’s you know–

 

Jessica Malaty Rivera: They had no teeth. 

 

Dr. Abdul El-Sayed: Let’s be careful. 

 

Jessica Malaty Rivera: And they died of dysentery. [laugh]

 

Dr. Abdul El-Sayed: Right. Like everybody. Like, I mean, anybody. I’m a child of the the late eighties, and so I grew up playing Oregon trail. 

 

Jessica Malaty Rivera: Of course. 

 

Dr. Abdul El-Sayed: And I could tell you before I ever became an epidemiologist or a physician that, like half your family always died of dysentery. 

 

Jessica Malaty Rivera: Exactly. [laughing]

 

Dr. Abdul El-Sayed: Right. Because that’s how it used to be. Come on y’all. 

 

Jessica Malaty Rivera: Exactly. Exactly. 

 

Dr. Abdul El-Sayed: Um. I want to you know, I want to ask you because, like, inevitably for me, this conversation always comes back to one thing, which is like, we need to pay science teachers a whole lot more. 

 

Jessica Malaty Rivera: Yeah, we do. 

 

Dr. Abdul El-Sayed: Like if we really wanted to fix this problem, we would just go all the way back and just and just pay science teachers. Right. A whole lot more, attract like some really, really great scientists into the field. And not to say all the science teachers I’ve ever met are some really, really great scientists who recognized early on that they need to educate the young folks. But like, if we paid this profession more, so much of the inoculation, the prebunking, would would be happening in K through 12. Right? 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Is that–

 

Jessica Malaty Rivera: Absolutely. 

 

Dr. Abdul El-Sayed: You end up with like an educated uh populace that sort of sees the lies coming and can can reason and think scientifically enough to be able to tell fact from fiction uh more clearly. And I– 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: I wonder, you know, as science communicators, those of us who are you know actively working in this space, what would it take for us to really like, kind of reach back, right? And really get to to young folks early on so that the next generation of consumers of Internet uh B.S. um are are more inoculated to it? 

 

Jessica Malaty Rivera: Yeah. I think that’s a brilliant idea, and I wish that that could happen at every level. I also think, too, though, that there’s going to be the folks like you and me, the super nerds that are going to lean in in science class and math class and really love it and pursue it hard. There’s going to be the people who are like, this is just not for me, even if it’s easy to understand, it’s not for me. Which is why I think science communication needs to kind of be as mainstay as public health. Like the two just have to exist together at all times because I don’t want people to feel shame that they don’t remember A.P. Bio. I don’t want them to feel like science was not my forte, even if it was easy for me to understand. And I just feels like I like I can’t understand this so much of like, what I want to do from like the education side K through 12 even, is to allow people to feel comfortable asking questions, to feel comfortable pursuing information about this because they know that they can get it in a way that makes sense, that they’re not going to feel overwhelmed by it. So it’s elevating their science literacy, their data comprehension skills, because the fact is, the people who are working against our cause are getting more and more sophisticated at looking like science. And so it’s kind of like training a mind to be like, how do you understand charts really well? For for one example, so that somebody is not manipulating X and Y access to make you think a certain way. And it’s it’s less about like, here’s how you know, these complex cellular functions work and more about how can you be a really smart consumer of information. Science, information, data information, information about even politics honestly, because the what we’re dealing with is so many people who are trying to get a message across. Sometimes under the guise of it looking like something else, you know, you’re seeing very, very fancy charts meant to mislead people. Documentaries that evoke a lot of emotional responses. And so it’s it’s almost like a how to be alive in this hyper digital world, how to be a wise and discerning mind so that you’re not led astray into either a logical fallacy trap or a full blown conspiracy. 

 

Dr. Abdul El-Sayed: One of the things I get really frustrated by as a science communicator and I want to I want to compare notes with you is when I’m clearly trying to explain something that’s really quite complex. The folks who don’t have a lot of the baseline knowledge. I tend to use a lot of metaphor and anybody who listens to this show knows I love metaphors. Now what’ll happen is you’ll get other scientists who will then critique and say, well, that’s not exactly correct. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: This is the language you have to use. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Because this is this is the language that’s written and you’re like, you’re not you’re not explaining this fully. And part of me is like, you idiot. You fool.

 

Jessica Malaty Rivera: Yeah. Yeah.

 

Dr. Abdul El-Sayed: Like, get out of your own way. Like, this is this is why everyone hates us. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Because you are pedantic about a set of details that actually are not operational in the lived experience of most people’s lives. And and the problem though, is increasingly now with social media, because all of our conversation is public. People won’t just like text you and be like, hey, uh you explained this this way. Why why wouldn’t you explain it that way? 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: You could DM me, you can whatever, no but instead you’re going to subtweet me or you’re going to blow me up on whatever and be like, this is this is not exactly accurate. 

 

Jessica Malaty Rivera: I know. 

 

Dr. Abdul El-Sayed: Right? 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Um. And what happens is it actually dissuades a lot of people from engaging with this because what they’re coming for is they’re saying you’re basically not serious. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Now, in my case, like, I’m not an academic. I am a public health official in my day to day. And most of the time people give me enough, enough berth because I’m like, yo, I spend time in the public all day just trust me on this. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Um. But I remember being an academic and being engaged in this work. And when some somebody calls you unserious, that’s a pretty serious allegation, right? I want to [?] what will it take almost to prebunk our own community? 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: Right. So that a lot of these folks who are holier than thou or smarter than thou. Right. Get out of their own way. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: And let folks who do this work, do this work or learn how to do it themselves, but recognize that the way we communicate amongst each other, where we use jargon that has an understand, understood definition between us, that that won’t work when people don’t know the definitions of those words. 

 

Jessica Malaty Rivera: Yes. 

 

Dr. Abdul El-Sayed: And um so so I’d love to hear your thoughts on this, because I honestly think it’s one of the biggest problems that we’re facing right now. 

 

Jessica Malaty Rivera: Yeah. It’s a huge problem, and I think we have to go there now in this conversation and say that it’s a lot of times because the message curators are often white men who have positions of power, who don’t look like you and me, who think things have to be done a certain way and can’t understand the cultural competence required to code switch. That we do not speak to a monolith in any of our worlds, that none of the communities can understand vaccines as they work in our bodies the same way. I can say it, even the same words with different tone, with my hands, gesturing with an anecdote about me and my kid that’s going to land differently among women of color who are also moms versus my peers at Hopkins. That lack of understanding that it’s not one size fits all is why we’re here, because we treat our audiences as if they don’t have diversity, as if they don’t have history that informs their biases and their fears. We treat them as if they should all just understand this because one plus one equals two. And until we break that cycle of treating our audiences like a monolith and as though they should all understand this message as it is and this metaphor as it is, we’re not going to get anywhere. I have I think we have to get comfortable with the fact that repetition is our friend, but also code switching in that repetition. Doing it for a select audience is going to make it go further. And it’s not going to just be this is the metaphor that we’re all aligned with because it checks out in every single way. Um. I mean, that drives me crazy. I think that we are hurting ourselves by continuing to make science capital S science, this elitist, very white, dominant space. And I very much lean into my identity as as not that so that I can break through to certain communities so that they can see that I’m leading by example, that they can trust me because of my personal experience and because of my you know, um transparency and vulnerability. Um. So that’s why I think we need to make space for a lot more people like us to do this because it’s not going to be done the old way. That’s for sure. 

 

Dr. Abdul El-Sayed: Yeah, I really appreciate that. And I think the the big point you’re calling out here is condescension. And I think–

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: Unfortunately, a big reason people don’t trust uh forget the science, scientists is because in a lot of ways we condescend to people. It’s the words that we use. It’s the assumed paternalism that people should just listen to us because–

 

Jessica Malaty Rivera: Yep. 

 

Dr. Abdul El-Sayed: We’ve got a bunch of letters behind our name and spent a long time sitting in a classroom. And unfortunately we have leveraged that against people in actually some really, really dangerous and terrible ways. But even when it’s just a small interaction about what someone ought to do, I think that that that comes out and people can read why you’re there. And if you’re there is about some implicit ego play about being the smartest one in the room. 

 

Jessica Malaty Rivera: Yep. 

 

Dr. Abdul El-Sayed: Most of the time folks don’t have time for you. And you know one of the things I found to be super effective is when I’m talking to a group of folks in the community, I’ll introduce myself as I’m Dr. Abdul El-Sayed but I’m here today as Abdul, and I’m here today as a dad. And I’m here today to tell you about how I’m trying to protect my kids– 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: –from this disease. And here’s the thing–

 

Jessica Malaty Rivera: Absolutely. 

 

Dr. Abdul El-Sayed: –that that they’re doing. Now I could explain to you like why I’m doing this, but I want to ask you what your questions are. Like how how are you seeing this and what are you worried about? And I think when you come to somebody around a set of human identities that you may share with them that are not, I spent a long time in a lot of schools that you’ve been locked out of implicitly or explicitly. There’s a lot more attention to okay I I relate to you. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: And we had a show earlier um uh about public health swag and, you know, the sort of rizz gap that we have with uh [laughter] in the world. And the general like point that came out is like we tend to be unrelatable. 

 

Jessica Malaty Rivera: Yeah. 

 

Dr. Abdul El-Sayed: And it’s a choice that we make about how we present ourselves and how we show up in uh these communities that we say we’re serving. So I just really appreciate that point.

 

Jessica Malaty Rivera: Well and also think about like the where we’re putting the work right, we’re putting the burden on the communities to just be more trusting, to just do that work and trust us instead of us doing the work of being worthy of that trust, of saying, what can I do to make me worthy of this very special, valuable currency? Like I mentioned earlier, that you should give to me. Why do I deserve that? How can I be more winsome and trustworthy so that you listen to me, right? Instead of being like, hey, you people who are not trusting, just start trusting and ignore the reasons that are very valid for you to not. 

 

Dr. Abdul El-Sayed: So um for folks who want to learn a little bit more about your work, Jessica, where where can they find you? 

 

Jessica Malaty Rivera: In a few places. I would say that my most captive audience is probably on Instagram. You can find me at @JessicaMalatyRivera, but I am doing a lot of work with the de Beaumont Foundation and the Public Health Communications Collaborative, so you can find me moderating panels with them and creating content um and speaking at events their too. 

 

Dr. Abdul El-Sayed: Awesome. Well, we really, really appreciate you and your leadership. Our guest today was Jessica Malaty Rivera. She’s an infectious disease epidemiologist and science communicator at the de Beaumont Foundation, who is, of course, one of our sponsors and uh at Johns Hopkins University. We really appreciate you taking the time today. 

 

Jessica Malaty Rivera: Thanks so much for having me. 

 

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. After several visits to the emergency room with pain and cramping early in her pregnancy, Kate Cox, a 31 year old Texas woman and mother of two, learned that her fetus had Trisomy 18, a rare but universally fatal genetic disorder. Her doctors told her that because of her two previous C-sections, she was at higher risk of uterine rupture and that she needed a medically necessary abortion for a non-viable fetus. But her doctors then told her they couldn’t perform it. Texas’s draconian abortion ban had tied their hands. So Kate Cox sued the state. And on December 7th, a lower court judge ruled that the abortion could be pursued only to have the ruling quickly paused by the Texas State Supreme Court. You’ll never believe the argument that swung them. Cox just didn’t face enough risk. So basically, instead of getting the abortion at 20 weeks, they’d rather her wait until she could literally lose her life and then get the abortion. When of course, bad faith conservatives would have said that it was a late term abortion. Rather than wait for all that to play out, Cox made the decision to leave the state to get her abortion. The case offers a critical test of just how far the opponents of abortion rights will go, and it turns out that they’ll go as far as they need to to put their ideology above the well-being of the people they ostensibly serve. Nevermind all the nods to quote, “the life of the mother,” that clearly doesn’t matter. They’ll gladly force you to carry a non-viable pregnancy that could threaten your life instead of allowing you the right to a medically necessary abortion. Talk about, quote, “the right to life.” Doesn’t stop there. As we discussed last week, a lower court has already tried to abrogate the whole F.D.A. to ban the abortion medication Mifepristone. This week, the Supreme Court announced that they’d hear the case with a ruling set for June. And all of this should remind us how critical this fight is, that it really is about the basic right to bodily autonomy, the right to life. We’ll keep you posted. Last week, the FDA approved two new treatments for sickle cell anemia, both of which use gene editing technologies and one of which presents the first approved therapeutic use of CRISPR. Sickle cell is a genetic disease caused by a single mutation that causes hemoglobin, the molecule responsible for carrying oxygen in our red blood cells to fold in a way that leads to sickle shaped red blood cells. That leads to terrible pain crises, higher risk of strokes and heart attacks and early death. People with sickle cell die on average 20 years earlier. It follows then that if you were to edit out that single disease causing mutation in the bone marrow stem cells that produce red blood cells, you could cure the disease, which is exactly what these therapies do. Problem, though, is that these treatments are several million dollars a pop and sickle cell predominates among Black folk, who structural racism too often robs of quality, accessible health care. That means that the vast majority of people who need these drugs simply won’t get them. And that should remind us that it’s not enough to invest in critical scientific research that unlocked what would otherwise have seen miraculous cures for terrible diseases. They’re amazing, but if they don’t get to the people who need them, it adds insult to injury. It’s one thing to die of a disease for which there is no cure. It’s another to die of a disease that is curable but you simply can’t get it. Also in catastrophic policy choices, the W.H.O. and U.N. warn of impending public health disaster in Gaza as the death toll creeps up to 20,000. For more than two months now, dozens have been pummeled by an Israeli air strike and then ground invasion that has turned the 146 square mile strip, home to 2.3 million people into a war zone, the likes of which we haven’t seen in this century. They’ve spared nothing. Not schools, not mosques or churches. Not hospitals. Before I talk about the rest of the iceberg, let’s reflect on the tip. The nearly 20,000 people who were killed in just two months. That’s 10,000 a month. That’s 333 a day, the equivalent of a jumbo jet crash every single day. Proportionately, that’d be like losing three million Americans in two months. I remember talking about stats just like these during the worst of the COVID pandemic. But this is preventable. And that’s just the tip of the iceberg. The sine qua non of public health is the notion that it’s the structural pieces that no one pays attention to that kill yet more people that we have to solve. And the 20,000 murdered would be enough. But we’re on the cusp of far worse. Those who haven’t died, respiratory and GI illnesses are ravaging. It’s December, and as the weather has turned, seasonal infectious diseases have spiked and as thousands of homes have been destroyed, large families have been forced to seek shelter in overcrowded circumstances, maximizing the spread. We’re still as the water supply, as homes have been destroyed and Gaza’s fresh water lines have been too, the lack of clean running water and workable sanitation is creating the perfect storm for GI illness to spread, including the risk of serious and deadly cholera outbreaks. All of this is exacerbated by the complete collapse of the health care system. Only 11 of Gaza’s 36 hospitals are functional. As Israel has deliberately attacked hospitals in contravention to international law. Remember, regardless of what anyone tells you, war is a choice that humans make. It’s not inevitable. It’s not unavoidable. And our tax dollars have underwritten this. It absolutely must end. We need a cease fire now. That’s it for today. We’ll be observing a holiday break for the next two weeks and we’ll see you on January 9th. From all of us here at America Dissected and Crooked Media. Happy holidays. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are our Tara Terpstra and Emma Illick-Frank. Charlotte Landes 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 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 hosts and guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.