A new bill introduced in Congress calls on the U.S government to focus on combating misinformation. The “zero draft” of a proposed international pandemic treaty calls on member states to do the same. The FDA is zeroing in on misinformation. Webinars galore are focusing on fighting misinformation to build trust. Even public libraries and schools are entering the fight against fake news.
I hate politics in public health matters but if we're to be honest, it is the Fox News information ecosystem that's been the source of probably 90% of the bad info out there. Get rid of that info ecosystem and things clear up. But they are too powerful to wish away unfortunately! Tie them up in unending litigation says I.
A necessary part of achieving this goal is to learn how to effectively communicate risk.
When I am talking to patients about serious diseases and treatments with a reasonable probability of harm, I try and find language that is intelligible to them. Using percentages with four significant digits is not helpful.
Depending on the particulars of the case helpful phrases include the following:
- “Unfortunately you do not have any completely safe options“
- “A few people will be harmed by this therapy but most people will live longer with it”
- “We are all working together to help you live as long and as comfortably as possible“
- “The treatment we are discussing has quite a bit of burden and most patients your age and with this disese complete their lives within 6 months even with the treatment so we also want to discuss the option of focusing on comfort care and hospice."
Nicely done, but not surprised the WaPo, home of Leana Wen, rejected it.
Thing is, I have in-laws who believe in a flat earth, love Trump. I’ve had a friend tell me that Covid was both a Chinese bioweapon and a hoax—both. At the same time.
Honesty about what we do and do not know, without spin, is critical. Spinning information by emphasizing the positive and omitting the negative erodes trust just as much as, if not more than, an outright lie.
Having worked at FDA during the HIV crisis (1990-93) and again from 1999 to 2016, one observed the increasing LAYERS of lawyers and non-scientists who had to clear any public statement. All the Centers, even though the product had no direct relation to their work, had to clear public statements. Not just be informed but to clear. For any public health crisis there should be a SMALL crisis team with scientists as the final clearance in place in public institutions. Yes, include a lawyer and a PR person but the core of the team needs to be the scientific experts and they should have the final say.
IN response to the comment re mis-information = you are NOT informed if you only listen to the major TV news. I have challenged my scientist friends to commit to listening, during a crisis, to the following: news on 2 major channels like ABC, NBC, CBS & PBS AND then Tucker Carlson. If you are not willing to at least LISTEN to an alternative belief system then you are just as ignorant of what is happening as those who refuse to hear any other perspectives. Yes, I wish he were less snarky and wore socks but that is not the point. Closed minds do not bother to even hear what others have to say, whether you like it or not. Though I have been a life long Democrat, I now find my Democratic friends much more closed-minded, & unwilling to listen or try to understand my Republican friends' opinions. They have become self-righteous and that is dangerous. D. Murphy, MD, FAAP
A timely set of comments with which nobody should disagree! One suggestion I have been making for only three years now is that Persons In Authority must work around the clock to eliminate from the Public Health patois all uses of weasel words or weasel phrases from official spokespersons in the Gubment --- I am talking about folks who, despite MD and or MPH after their names, have serially attempted (with just lousy skills) to tip-toe around, technically "tell the truth", but all the while not totally tell the truth with a crispness befitting the nature of the COVID-19 pandemic situation. There have been hundreds of televised instances of this nonsense to date, going all the way back to the very first month of the pandemic. Oddly -- and I mean *really oddly* -- the release of noxious nattering as continued all the way into the current reign of folks like Jha, Walensky, et al. The uses of cute jingles, catchy jargon, business-world buzzwords, oily weasel phrases, hand-waving gestures while speaking, saying "you know" in every other sentence like some junior high kid hanging out in a mall, and the deployment of just truly dumbed-down metaphors ---- taken in total all of this has comprised nothing less than a very calculated dispersal of bullshit. This must stop. Seriously. Period. Not negotiable.
Are there any instances of “misinformation” during the pandemic that later were proven true?
Remember when it was misinformation to question whether natural immunity protected as well as vaccines? Or to question vaccine mandates (that have silently faded without apology or explanation)?
I think a big part of the problem with public health messaging/communication is the lack of nuance, and an unwillingness to express uncertainty. We saw this play out over and over during the Covid crisis. First, masks were definitely not needed, because, Fauci now admits, they didn't want people taking them away from first responders. Then, they were required and nearly 100% effective, which is nonsense--only N95s, worn properly, are effective--forcing people to wear cloth masks even *outside* was absurd. There was lack of nuance around so many other things: school attendance (no one was allowed to question whether kids should in fact not just go to school for educational reasons, but also because they actually benefit from exposure to viruses!); vaccines (timing, efficacy/intent); the value of testing, which types to use and when; the actual risk to different populations...
Part of the reason for this is political, absolutely. But much of it is a sense that people are just not that smart, and if you tell them, say, that N95 masks will help prevent spread but please don't use them right now because we need them for our docs and nurses, they'll all run out and hoard the PPE. Or, if you say that most kids can and should attend school, but that if yours are at risk of infection or of infecting an at-risk adult, they should do school online, most people will freak out. Etc.
Not sure how to handle that problem, but it's HUGE. Public health messaging is designed for the lowest-common denominator mind, with the intent of directing behavior, and often is intentionally false as a result.
Dr Nirav Shaw, head of the Maine CDC, is a tremendous communicator. He exemplifies all the skills you mentioned. Mainers all across the State looked forward to his radio appearances that happened up to three times per week during the pandemic. He took questions from the press after each report and was patient and approachable. He began each report with condolences to families who had lost a person to COVID. He explained the science in a way that was easy to understand. I think he has now left Maine and is at the National CDC .
Thank you both so much for this brilliant clarion call, which is in itself a paragon of clear communications. To me, this is the money quote (though there are many contenders in this post): “The proper goal of communication is to tell people honestly and clearly what the situation is, what risks they face, and what they should do to keep themselves and their families safe. Missteps can be avoided by properly acknowledging uncertainty: What do we know? What do we not know? And how are we trying to find answers?”
This seems like the sort of editorial which The Hill might find interesting. Although it is not known widely by the general public, The Hill is known and read by a number of important people in DC and is widely quoted by other news sources. It also tends to appreciate material from people who are expert in those fields. I will be exceedingly disappointed in them if you submitted this and they did not carry it. Frankly, I am very disappointed in any publication which did not honor such common sense.
The most successful vaccine communication I had was when I reminded folks that "The Human Genome Project" started when I was in medical school, and took almost 10 years and millions of dollars to produce the code for one person. Since Crisper (which they have heard of) anyone can get most of their genome in a week for only a few dollars. Science has advanced dramatically in the last 15 years. Since almost everyone has heard or 23 and me or Ancestry.com, it makes sense.
We then review that DNA is code for making something like protein, antibodies, or cell structures. Proteins don't create DNA, its the other way around. mRNA is "just the messenger" Don't kill (or discredit) the messenger, just doing its job. If DNA is the cookbook, mRNA is a snippet instruction from one part of one recipe. The mRNA then leaves the cell nucleus to find a ribosome (cook?) to get the protein actually assembled.
I then remind them that their DNA is absolutely unique to them, no one ever has or ever will have their sequence. However, their ribosomes are identical to mine, to my dog's, and identical to every vertebrate on this planet. Ribosomes see an appropriate mRNA, and they get to work. It's what they do.
So, scientists studying and using CRISPER, and studying errors in DNA (cancer), have been preparing for pandemics for decades. The plan was ready, just waiting for the fateful virus code. It was awesome to watch the international cooperation in getting this new type of vaccine out in record speed. mRNA has the potential to be used in more than just vaccines, and I tell them to be prepared to see it used in many other fields of medicine.
I also expressed frustration over the ridiculous lack of science education offered by the government, treating all of us as if we were too dumb to understand. There is nothing political about DNA translation, and now there are fantastic youtube illustrations to help explain things. Most people love learning these things, because it matters.
At least the folks who still declined the vaccine after my efforts are now aware that ribosomes are amazing, dependable, and underappreciated.
Sorry this was so long! Your postings have been a tonic these long, dark years!
Thanks for taking this on! I agree with all you say, and also think that we need to take a long term approach to this problem. It is great to ask those in positions of authority to focus on clear, truthful communication, but we also need to include communication training as a mandatory part of all graduate training in the sciences! This does not mean that all graduate students need to be trained to speak to the public. It does mean that all graduate students should be able to speak clearly and intelligibly to a scientist outside of their specialty. This is the bread and butter of scientific communication. There is no excuse for why most scientists are so poor at it. If we can get scientists talking clearly to each other we will have taken a big step in solving the problem of communication to the public.
Bazinga! Thank you, Dr. Rivers! I think you and Dr. Jetelina are doing great with this newsletter. This line says it all: "...we must focus instead on getting our own house in order by improving core communications." I live in greater Kansas City, and we had a pandemic team from KU Med Center that has a 2-4 minute segment on the local news, that go over the local COVID stats, treatments, and other breaking news about the virus. I don't think they're doing it anymore, but, it was the 'familiar faces we know and trust' that you wrote about.
Honestly, the CDC has promoted misinformation themselves by not taking clearer stances on masking, aerosol transmission, and long covid prevention. This isn't just about how public health communicates, but WHAT they are communicating and why. Whose interests are they protecting? How do they decide whose lives are important? Immune-compromised people are being actively harmed by public health policies right now, such as ending masking requirements in healthcare all over the country--which tells many people that covid is over now, even though it's not. It's hard to look at public health as a whole and see their communication as their biggest failure in fighting misinformtation. They are actively contributing to some of the misinformation out there.
I hate politics in public health matters but if we're to be honest, it is the Fox News information ecosystem that's been the source of probably 90% of the bad info out there. Get rid of that info ecosystem and things clear up. But they are too powerful to wish away unfortunately! Tie them up in unending litigation says I.
A necessary part of achieving this goal is to learn how to effectively communicate risk.
When I am talking to patients about serious diseases and treatments with a reasonable probability of harm, I try and find language that is intelligible to them. Using percentages with four significant digits is not helpful.
Depending on the particulars of the case helpful phrases include the following:
- “Unfortunately you do not have any completely safe options“
- “A few people will be harmed by this therapy but most people will live longer with it”
- “We are all working together to help you live as long and as comfortably as possible“
- “The treatment we are discussing has quite a bit of burden and most patients your age and with this disese complete their lives within 6 months even with the treatment so we also want to discuss the option of focusing on comfort care and hospice."
- "What are your goals?"
Nicely done, but not surprised the WaPo, home of Leana Wen, rejected it.
Thing is, I have in-laws who believe in a flat earth, love Trump. I’ve had a friend tell me that Covid was both a Chinese bioweapon and a hoax—both. At the same time.
Not sure what you do with that.
Honesty about what we do and do not know, without spin, is critical. Spinning information by emphasizing the positive and omitting the negative erodes trust just as much as, if not more than, an outright lie.
Having worked at FDA during the HIV crisis (1990-93) and again from 1999 to 2016, one observed the increasing LAYERS of lawyers and non-scientists who had to clear any public statement. All the Centers, even though the product had no direct relation to their work, had to clear public statements. Not just be informed but to clear. For any public health crisis there should be a SMALL crisis team with scientists as the final clearance in place in public institutions. Yes, include a lawyer and a PR person but the core of the team needs to be the scientific experts and they should have the final say.
IN response to the comment re mis-information = you are NOT informed if you only listen to the major TV news. I have challenged my scientist friends to commit to listening, during a crisis, to the following: news on 2 major channels like ABC, NBC, CBS & PBS AND then Tucker Carlson. If you are not willing to at least LISTEN to an alternative belief system then you are just as ignorant of what is happening as those who refuse to hear any other perspectives. Yes, I wish he were less snarky and wore socks but that is not the point. Closed minds do not bother to even hear what others have to say, whether you like it or not. Though I have been a life long Democrat, I now find my Democratic friends much more closed-minded, & unwilling to listen or try to understand my Republican friends' opinions. They have become self-righteous and that is dangerous. D. Murphy, MD, FAAP
A timely set of comments with which nobody should disagree! One suggestion I have been making for only three years now is that Persons In Authority must work around the clock to eliminate from the Public Health patois all uses of weasel words or weasel phrases from official spokespersons in the Gubment --- I am talking about folks who, despite MD and or MPH after their names, have serially attempted (with just lousy skills) to tip-toe around, technically "tell the truth", but all the while not totally tell the truth with a crispness befitting the nature of the COVID-19 pandemic situation. There have been hundreds of televised instances of this nonsense to date, going all the way back to the very first month of the pandemic. Oddly -- and I mean *really oddly* -- the release of noxious nattering as continued all the way into the current reign of folks like Jha, Walensky, et al. The uses of cute jingles, catchy jargon, business-world buzzwords, oily weasel phrases, hand-waving gestures while speaking, saying "you know" in every other sentence like some junior high kid hanging out in a mall, and the deployment of just truly dumbed-down metaphors ---- taken in total all of this has comprised nothing less than a very calculated dispersal of bullshit. This must stop. Seriously. Period. Not negotiable.
Are there any instances of “misinformation” during the pandemic that later were proven true?
Remember when it was misinformation to question whether natural immunity protected as well as vaccines? Or to question vaccine mandates (that have silently faded without apology or explanation)?
I think a big part of the problem with public health messaging/communication is the lack of nuance, and an unwillingness to express uncertainty. We saw this play out over and over during the Covid crisis. First, masks were definitely not needed, because, Fauci now admits, they didn't want people taking them away from first responders. Then, they were required and nearly 100% effective, which is nonsense--only N95s, worn properly, are effective--forcing people to wear cloth masks even *outside* was absurd. There was lack of nuance around so many other things: school attendance (no one was allowed to question whether kids should in fact not just go to school for educational reasons, but also because they actually benefit from exposure to viruses!); vaccines (timing, efficacy/intent); the value of testing, which types to use and when; the actual risk to different populations...
Part of the reason for this is political, absolutely. But much of it is a sense that people are just not that smart, and if you tell them, say, that N95 masks will help prevent spread but please don't use them right now because we need them for our docs and nurses, they'll all run out and hoard the PPE. Or, if you say that most kids can and should attend school, but that if yours are at risk of infection or of infecting an at-risk adult, they should do school online, most people will freak out. Etc.
Not sure how to handle that problem, but it's HUGE. Public health messaging is designed for the lowest-common denominator mind, with the intent of directing behavior, and often is intentionally false as a result.
Dr Nirav Shaw, head of the Maine CDC, is a tremendous communicator. He exemplifies all the skills you mentioned. Mainers all across the State looked forward to his radio appearances that happened up to three times per week during the pandemic. He took questions from the press after each report and was patient and approachable. He began each report with condolences to families who had lost a person to COVID. He explained the science in a way that was easy to understand. I think he has now left Maine and is at the National CDC .
Thank you both so much for this brilliant clarion call, which is in itself a paragon of clear communications. To me, this is the money quote (though there are many contenders in this post): “The proper goal of communication is to tell people honestly and clearly what the situation is, what risks they face, and what they should do to keep themselves and their families safe. Missteps can be avoided by properly acknowledging uncertainty: What do we know? What do we not know? And how are we trying to find answers?”
This seems like the sort of editorial which The Hill might find interesting. Although it is not known widely by the general public, The Hill is known and read by a number of important people in DC and is widely quoted by other news sources. It also tends to appreciate material from people who are expert in those fields. I will be exceedingly disappointed in them if you submitted this and they did not carry it. Frankly, I am very disappointed in any publication which did not honor such common sense.
The most successful vaccine communication I had was when I reminded folks that "The Human Genome Project" started when I was in medical school, and took almost 10 years and millions of dollars to produce the code for one person. Since Crisper (which they have heard of) anyone can get most of their genome in a week for only a few dollars. Science has advanced dramatically in the last 15 years. Since almost everyone has heard or 23 and me or Ancestry.com, it makes sense.
We then review that DNA is code for making something like protein, antibodies, or cell structures. Proteins don't create DNA, its the other way around. mRNA is "just the messenger" Don't kill (or discredit) the messenger, just doing its job. If DNA is the cookbook, mRNA is a snippet instruction from one part of one recipe. The mRNA then leaves the cell nucleus to find a ribosome (cook?) to get the protein actually assembled.
I then remind them that their DNA is absolutely unique to them, no one ever has or ever will have their sequence. However, their ribosomes are identical to mine, to my dog's, and identical to every vertebrate on this planet. Ribosomes see an appropriate mRNA, and they get to work. It's what they do.
So, scientists studying and using CRISPER, and studying errors in DNA (cancer), have been preparing for pandemics for decades. The plan was ready, just waiting for the fateful virus code. It was awesome to watch the international cooperation in getting this new type of vaccine out in record speed. mRNA has the potential to be used in more than just vaccines, and I tell them to be prepared to see it used in many other fields of medicine.
I also expressed frustration over the ridiculous lack of science education offered by the government, treating all of us as if we were too dumb to understand. There is nothing political about DNA translation, and now there are fantastic youtube illustrations to help explain things. Most people love learning these things, because it matters.
At least the folks who still declined the vaccine after my efforts are now aware that ribosomes are amazing, dependable, and underappreciated.
Sorry this was so long! Your postings have been a tonic these long, dark years!
Thank you to both of you for all you are doing.
Thanks for taking this on! I agree with all you say, and also think that we need to take a long term approach to this problem. It is great to ask those in positions of authority to focus on clear, truthful communication, but we also need to include communication training as a mandatory part of all graduate training in the sciences! This does not mean that all graduate students need to be trained to speak to the public. It does mean that all graduate students should be able to speak clearly and intelligibly to a scientist outside of their specialty. This is the bread and butter of scientific communication. There is no excuse for why most scientists are so poor at it. If we can get scientists talking clearly to each other we will have taken a big step in solving the problem of communication to the public.
Bazinga! Thank you, Dr. Rivers! I think you and Dr. Jetelina are doing great with this newsletter. This line says it all: "...we must focus instead on getting our own house in order by improving core communications." I live in greater Kansas City, and we had a pandemic team from KU Med Center that has a 2-4 minute segment on the local news, that go over the local COVID stats, treatments, and other breaking news about the virus. I don't think they're doing it anymore, but, it was the 'familiar faces we know and trust' that you wrote about.
Honestly, the CDC has promoted misinformation themselves by not taking clearer stances on masking, aerosol transmission, and long covid prevention. This isn't just about how public health communicates, but WHAT they are communicating and why. Whose interests are they protecting? How do they decide whose lives are important? Immune-compromised people are being actively harmed by public health policies right now, such as ending masking requirements in healthcare all over the country--which tells many people that covid is over now, even though it's not. It's hard to look at public health as a whole and see their communication as their biggest failure in fighting misinformtation. They are actively contributing to some of the misinformation out there.