Special Episode: Deborah Cohen & Bad Influence

If you have a medical question, where do you turn? How often is google or social media your first stop? As you sift through the AI overview and countless reels professing to have the answers, it becomes harder and harder to separate fact from fiction. Do these supplements actually do what they promise? Should I be wary of this commonly prescribed medication? Even if you’re not directly seeking this information, it finds you anyway, preying on health anxieties and promising an easy fix. In this week’s TPWKY book club episode, Dr. Deborah Cohen, medically-trained, award-winning journalist, broadcaster, and editor, joins me to discuss the implications of this flood of health misinformation, which she explores in her recent book Bad Influence: How the Internet Hijacked Our Health https://bookshop.org/a/3175/9780861549887. From podcast bros touting peptide injections to TikTok influencers swearing by supplements, Cohen demonstrates that the internet is a wild west in desperate need of consumer protections. But it has also been a double-edged sword, providing community and connection alongside these bad actors. How can we continue to leverage the good of the internet to democratize health information while putting guardrails on nefarious wellness influencers hawking lies for profit? Tune in to find out. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:01Speaker 00

  This is Exactly Right.

• 0:06Speaker 01

  Breathe in and reset with Lincoln Rejuvenate, an available multisensory feature in the 2027 Lincoln Navigator SUV. Experience the luxurious massage, visuals, and sense to help you relax in the driver's seat. It's your time for a reset. Visit Lincoln.com to learn more. Lincoln Rejuvenate does not operate unless the vehicle is in park. When the vehicle is off, or if any doors open, do not use the feature in a closed garage or in other enclosed areas. See owner's manual for important operating instructions. Lincoln and Navigator are trademarks of Ford or its affiliates. All rights reserved.

• 0:37Speaker 02

  CBS Thursday. There's something different about our new CBS Family Comedy, Eternally Yours.

• 0:43Speaker 03

  Are you all vampires? Is that why none of you age?

• 0:45Speaker 02

  From the mortals who brought us the hit comedy Ghosts.

• 0:48Speaker 04

  I don't want you dating a human. You are being so unfair. Well, life is tough and then you continue to not die.

• 0:54Speaker 02

  A new family comedy with bite.

• 0:55Speaker 05

  You have to formally invite me in.

• 0:57Speaker 02

  Oh, this is what you think. Don't worry, I will. Are you any garlic? That's actually a very offensive stereotype. The new comedy, Eternally Yours, new CBS Thursday, 8:30, 7:30 Central.

• 1:07Speaker 06

  This is Danielle Fishel from Pod Meets World. When my skin is feeling dry, I want a moisturizer that I can actually feel working. But I don't want to feel it sitting on my face all day. That's what I love about Clinique Moisture Surge 100 Hour Moisturizer. It's this lightweight gel cream that absorbs so quickly and my skin just feels instantly refreshed, plump, and hydrated. Never greasy or heavy. And somehow, that hydration lasts for up to 100 hours. It's oil-free, fragrance-free, allergy-tested, and safe for sensitive skin. Try Clinique Moisture Surge 100 Hour today at Clinique.com. Feels like Moisture Surge.

• 2:29Speaker 07

  Hi, I'm Erin Welsh, and this is This Podcast Will Kill You. Welcome to the latest episode of the TPWKY Book Club series, where I bring on authors of popular science and medicine books to chat about their latest work. These books span such a wide range of subjects, there's really something for everyone. Maybe you'd like to learn more about the evolution of language, or what's going on with the diagnosis crisis around the world. Maybe you're curious about how refrigeration transformed the world, or how our understanding of cancer was shaped by tragedy. You can check out the full list of books featured on this series and upcoming books by heading over to our website, thispodcastwillkillyou.com.

• 3:14Speaker 07

  Under the Extras tab, you'll find a link to our bookshop.org affiliate page, which has a bunch of TPWKY-related lists, including one for This Book Club and one for The Kids' Book Club, which is hosted by Erin Updike on our socials. Make sure you're following us there if you aren't already. We always say it, but we always mean it. We love hearing from you, whether it's episode suggestions, book recommendations, firsthand accounts, or anything else that's on your mind. The best way to get in touch with us is through the Contact Us form or the Submit Your Firsthand Account form. You can find both on our website. Two last things before we get to this week's book, and that is to please rate, review, and subscribe.

• 3:56Speaker 07

  We'd love to make this podcast as long as we can, and this really does help us out. And finally, you can find full video versions of most of our newest regular episodes on YouTube. Make sure you're subscribed to Exactly Right Media's YouTube channel so you never miss a new episode drop. These days, if you have a question about a medical issue, the internet is likely your first stop. After all, the next opening at your doctor's clinic is months away, and even if you manage to snag an earlier appointment, would you have enough time to ask all your questions and get them all answered? Probably not. Why wait when you can research at your leisure, scrolling through TikToks, asking AI, or

• 4:37Speaker 07

  listening to a podcast where the overconfident hosts swear by peptide injections and smart rings, using medical language to disguise what they're really doing, which is inventing a problem and selling you the solution? Increasingly, people are turning towards the internet to seek solutions for many of their health care and wellness needs. But even if you aren't actively searching for this type of content, it finds you anyway. The proliferation of wellness influencers and the commodification of health anxiety has had profound impacts on our relationship with medicine, expertise, and truth. In today's episode, I'm joined by Dr. Deborah Cohen, medically trained, award-winning journalist,

• 5:19Speaker 07

  broadcaster, and editor, to discuss these issues, which she explores in her recent book, Bad Influence: How the Internet Hijacked Our Health. Extensively researched and compellingly written, Bad Influence uncovers the insidious manipulation by those seeking to make a profit, and the way they prey on vulnerable individuals simply looking for help. As Dr. Cohen demonstrates, the internet is a double-edged sword, rife with this type of exploitation, but also a source of empowerment and community. Navigating this virtual landscape has never been more challenging, with marketing masquerading as medicine, and an endless supply of snake oil salesmen in their newest iteration as

• 6:02Speaker 07

  podcast bros and, one simple trick, clickbaiters. Dr. Cohen pulls back the curtain on the underbelly of the wellness industry, and in so doing, makes an urgent call for regulation to protect consumers. Until that happens, if it ever happens, she leaves readers with a crucial piece of advice. Ask yourself why you're seeing what you're seeing in your feed. Who's telling you this stuff, and why? Bad Influence is a timely and necessary guide to the Wild West of internet wellness and the nefarious health influencers spreading lies for profit. I'm very excited to bring this conversation to you all, so let's just take a quick break and get started.

• 7:07Speaker 07

  Dr. Cohen, thank you so much for joining me today.

• 7:10Speaker 08

  Thank you for having me, and thank you for being interested in the book.

• 7:13Speaker 07

  Oh, of course. I mean, I was so excited to come across your book and to read it, because it explores so many of the things that I feel like on this podcast we're constantly confronting. It's this kind of one-two punch between these active disinformation spreaders, along with worsening access to medical professionals, and it's created this perfect storm of just where do you get good information and how do you recognize the good and the bad? Was there a moment in the construction of this book and the production of this book where you said, okay, this needs to be a story that I want to tell?

• 7:51Speaker 08

  It was quite early on. The reason I wrote it, there was a few things happening at the same time. So, one of my cousin, I'm from Liverpool in England, and I was at my auntie's birthday party, and one of my cousin's friends said to me, she'd just bought an AMH test. And I was like, why have you done that? And she said, I want to know how fertile I am. And I said, is it really gonna, is it really gonna tell you that? And people in Liverpool, if your audience don't know, were very direct. There's no smooth talking, it's all very direct. I was like, why have you done that? And, and, and I said, well, what are you gonna do with the results? Say if they're low, what are you gonna do? And she went, well, I'm gonna go and see my GP or primary care physician.

• 8:35Speaker 08

  And I said, well, what are you gonna do if they're normal? And she looked at me and she said, I'm going to go and see my primary care physician. And I said, who isn't going to be able to use the results, because it isn't telling you anything about your fertility? You've just wasted 160 pounds, so $200. And that, that was sort of the start. And I said, where did you get the information from? And she said, oh, Insta, as if I was stupid. You know, why wouldn't you go to Insta for your health information? But, but doctors couldn't give her the information she needed, because she couldn't conceive, she was struggling to conceive, there was no real medical reason for it, and it was an obvious place to go. And there, it was all sorts of clinics were offering that as a solution, the ectinol test.

• 9:21Speaker 08

  And then other friends I noticed who, university-educated, smart, and again, going online for information about hormone replacement therapy, or menopause hormone therapy, whichever term you want to use, testosterone, you know, full body screening, ADHD information. And there were problems with the access to health care, whichever part of the world you're in, and it differs according to what part of the world you're in. We've got a national health service in the UK, and there's massive waiting lists. But equally, a lot of the book, I speak to a lot of US-based physicians and patients and influencers, and different challenges, but even still challenges, getting access to health care. And traditional health care services can't provide an answer.

• 10:06Speaker 08

  There's always someone online who will. And there was a, noticing an increase in growth of that. And then people were sort of having to, in my day job as a journalist, I'll sort of go, well, why are you coming to me with that information? What's your agenda? What's your, why are you telling me that? I look for the benefits, I'm looking for the harms, I'm looking for the evidence. And they were having to be almost their own mini journalists online, but without the, the background that I had, or that training that I had to critically appraise information. And perhaps that's some of that automatic skepticism. If I get a press release, I'm thinking, yeah, why do you want me to cover that story? So as a journalist, I'm naturally skeptical, and that's what we're supposed to be, but,

• 10:51Speaker 08

  but people were being bombarded with stuff and didn't really know what to make of it.

• 10:57Speaker 07

  I want to dive into the influence in your title. Who is doing the influencing, the bad influencing? Where are they influencing? And who is being influenced? Can you sketch out the major areas where this is happening?

• 11:12Speaker 08

  So I think we've talked about for many years on medical journals or in academia or in healthcare generally, there's always been commercial actors that influence our health. We know the tobacco industry sat on the harms of smoking for decades, even though they knew it was causing lung cancer. We know the drug industry asks certain questions to get certain answers. You know, you can be clever in how you do your randomized control trials. We know the alcohol industry, big food, fossil fuel companies, they influence our healthcare. They lobby politicians, they lobby decision makers to create policies that are favorable in their interests.

• 11:55Speaker 08

  And we know that they influence the evidence base. And what was really interesting to me was we've got this whole new set of commercial players now. So I was less interested in the kind of classic conspiracy theorists. I was much more interested in these industries that perhaps are shaping, scientific industry, should I say, that are shaping our healthcare. So the obvious one is big tech. And they host the platforms, they operate the algorithms that influence what we see. They decide what's going to be first in our feed. If it's an advert, you are an obvious advert from a company, you're going to drop further down the feed, but they will surface the influencers that have financial relationships

• 12:40Speaker 08

  with other companies. So that's, that's, that's the obvious one. So in my mind, I think of it as big tech meets all these little other industries, all these other little companies, if you like, influencers, online pharmacies, telehealth, a big one, your wearables, your apps, it's unfettered advertising. And so, so you've got all these different commercial incentives that are at play, that are being surfaced by, by the big tech companies, whether that's Meta or TikTok, Dancebite or, or Google, YouTube. And they're controlling in many ways what we see in our feed. And I was interested to think about, well, how are these actors shaping our health?

• 13:25Speaker 08

  And I think there's a big open question still because there's an absence of evidence. So I didn't want to be too certain because what I didn't want to do is debunk bad science by doing bad science myself. You say, that's overstated claim and I've made overstated claims. But there's clear that there's something going on. And we know healthcare and our understanding of medicine is shaped by culture, is shaped by society and is massively shaped by commercial interests. So they were the, they were the questions really for me and in what direction are we going? And there were some interesting anecdotes from US physicians, actually.

• 14:04Speaker 08

  And one OB GYN at Duke University said to me, and she deals with contraception. And she said to me, I know when my young patients come to see me, they spend four hours a day on TikTok getting their information. I've got like 20 minutes with them. And a men's health specialist at a Harvard affiliated hospital, he, he said to me, he feels he's tilting at windmills where he's got all these men's health providers that are offering testosterone as a drop of a hat. And he wants to counsel patients properly about health interventions that, that might actually change, change their health and actually help their testosterone levels to losing weight. But he's like, they want a quick fix.

• 14:49Speaker 08

  So, and that was a very long-winded way of saying, there's all these different actors that are on our platforms, that are trying to grab our health, that are trying to shape our health. And influencers as well, with certain symptoms, they will change their symptom profile according to what's going viral. So if you take the example of ADHD and you are changing what your symptoms are because you know it's resonating with an audience, what's that going to do to our understanding of ADHD? If you look at it through a social media prism?

• 15:23Speaker 07

  Let's take a quick break. And when we get back, there's still so much to discuss.

• 15:28Speaker 09

  When intimate itch strikes, waiting it out isn't always an option. That's why there's Vagisil Maximum Strength Anti-Ich Cream. It provides fast relief from intense external feminine itching and burning. And 92% of women said Vagisil provided long-lasting itch relief. Intimate itch can have more than 60 causes, from everyday things like shaving, pads, tight clothing, to yeast infection-related irritation. Vagisil helps protect delicate skin from further irritation. Trusted by generations, clinically and gynecologists tested. Don't let discomfort get in the way. Visit vagisil.com to find the relief that's right for you.

• 16:00Speaker 07

  Fall is a great season for looking like you tried harder than you did. Put on a good sweater, throw on some nice jeans, and suddenly you're an upstanding member of society. For clothes that do some of the work for you, there's Quince. Quince specializes in effortless, high-quality essentials like ultra-soft organic cotton and premium Mongolian cashmere sweaters. They're beautifully tailored, built to last, and transition seamlessly from morning meetings to dinner. And as the weather gets colder, Quince has everything you need to round out your wardrobe, from warm, responsibly sourced down jackets and cozy cashmere scarves and gloves, to beautiful 14-karat gold jewelry that adds the perfect finishing touch. Everything at Quince is priced 50 to 80% less than similar brands.

• 16:42Speaker 07

  They work directly with ethical factories and cut out the middlemen, so you're paying for quality, not brand markup. My fall wardrobe has basically become my Quince Bella Stretch Wide Leg Jeans with my 100% organic cotton cropped polo sweater, comfy and flattering, it's the best. Find the fall pieces you'll reach for most at Quince. Download the Quince app for app-exclusive offers or go to quince.com. Get free shipping on your order and 365-day returns, now available in Canada and the UK too. And when Quince asks where you heard about them, let them know it was this podcast will kill you. It's the best way to support the show.

• 17:18Speaker 10

  Lisa, we should tell them about our new show.

• 17:22Speaker 03

  Oh my God, Lexi, we have a new podcast. It's called Don't Lie To Me.

• 17:26Speaker 10

  I'm Lexi Iwanu. We're two best friends, 22 years apart, but so close at heart.

• 17:31Speaker 03

  And I'm Lisa DiGiulio, the old one, which means we have wildly different references, occasionally different opinions, and at this point in my 50s, I've lived it all.

• 17:40Speaker 11

  I'm not going to get into where you're fighting. That is wild. I learned that about you today.

• 17:47Speaker 10

  Now in my 30s, being the founder of new shoes, good taste is my business and I've always got something to say. If men were just honest about this, there would be so much more peace in the world.

• 17:58Speaker 03

  We're going to talk about dating, relationships, beauty, getting older. And a little wiser. We're best friends, but we don't always agree.

• 18:06Speaker 12

  Because you told us how accommodating you are. Obviously, I would do what I think I could do to, to fight the fight, but there's only so much fight I can fight.

• 18:14Speaker 03

  Don't lie to me.

• 18:15Speaker 10

  Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Liar. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I don't really care.

• 18:40Speaker 07

  Welcome back, everyone. I've been chatting with Dr. Deborah Cohen about her book, Bad Influence: How the Internet Hijacked Our Health. Let's get back into things. It's so interesting what you, what you mentioned about somebody spending four hours a day on social media, on TikTok scrolling, and that's where they're getting the vast majority of their information versus this 20-minute time with their doctor. And there's also what they're seeing. And you, you dive into this when you discuss the placebo effect.

• 19:11Speaker 08

  Yeah, it's fascinating. I don't think we talk enough about mind-body medicine in healthcare. I think we can, we can often follow the biomedical model too much. And some of the more eastern philosophies perhaps use the mind-body model more. But we know that our expectations shape so many different things and symptoms are included. How we experience stuff comes from, comes from our head. And it's not to say it's all in the mind. Symptoms are very real, physical manifestations. But if we have anxiety, say, for example, we're more likely to experience pain. We know how we experience stuff.

• 19:53Speaker 08

  Our views are going to shape how we experience symptoms. And that is for good and for bad. So placebo is if you believe something is going to help you, then that may help your symptoms. So placebo effect is an incredibly powerful effect. So you take testosterone, which we know is being promoted heavily to men and to women, perimenopausal and menopausal women. We know testosterone has quite a strong placebo effect. So if you feel tired or low energy, you have some testosterone, suddenly you feel better. Quite a lot of that is placebo. And that's a very powerful effect. Equally, there's something called the placebo effect, and that is the evil twin, if you

• 20:38Speaker 08

  like, of placebo. It literally means I will harm. So you will know if you see someone throwing up, you feel sick yourself. It does not mean that you have that viral infection or bacterial infection, but that very graphic visual image of someone being sick.

• 20:57Speaker 08

  It can make you feel nausea and that is your mind. Those symptoms of nausea are real, but that is your mind mimicking, if you like, what you were seeing. If you did think about little bugs crawling up your neck, you can feel a little bit twitchy. You know, you can literally feel it. And what we know is visually seeing something is more powerful than reading about an effect. And when you read the side effects of a drug, it increases your chances of having those side effects. And we're talking things like headache and nausea and fatigue and, and those, those kinds of symptoms. And that is something that researchers are starting to look at, which I think is fascinating,

• 21:43Speaker 08

  about how social media shapes how we think about our symptoms or how we feel about our symptoms. And this is where I think some illness forums are a double edged sword, where they can provide people with some support and feeling heard and seen and a sense of camaraderie, cut through loneliness. Equally, if people are constantly talking about their symptoms, what does that do to your expectations of whether you're going to have those particular symptoms connected with a certain condition? And we're sort of in the foothills of really exploring that and the contribution of social media to that nocebo effect. The last thing you should do, if people are having very real symptoms from, from a nocebo

• 22:27Speaker 08

  effect, is dismiss their experience because those symptoms are real. Just the causation of it might not be physical, or it might not be pathological. There might be another reason for it. And they're very powerful. Our, our expectations are very powerful, shape us of how we experience our illnesses.

• 22:48Speaker 07

  You mentioned social media being this double edged sword where you have these supportive communities that can be formed and someone can finally no longer feel alone in their experiences. And so it's, it's on the one hand, very empowering, but on the other hand, it can lead to these formation of echo chambers potentially, or leave people vulnerable to exploitation. Can you share more about what this means in terms of social media and the commodification of stress and anxiety?

• 23:14Speaker 08

  Fear sells. And we know that from newspapers, you know, you or headlines, sensational headlines, fear sells and stress and anxiety equally sells. Tell somebody that there might be something lurking beneath them and create that fear, but then you sell the solution. So for example, full body MRI is, is, I have a chapter on that. And, and influencers have really jumped on that because it sort of makes sense. There might be something inside you. You might feel perfectly fine, symptom free, but there might be something inside you that is lurking. We have the machine that will spot that.

• 23:56Speaker 08

  When you give somebody a medical test, when they are otherwise healthy, that is called a screening test. And there are all sorts of problems with that. There are very few screening tests that are recommended at a population level, even by the, by the American authorities, the preventative services, task force, say, for example, even the American College of Radiology. Likewise, in the UK, we have very similar bodies and their, their guidelines between them are very, very similar, as it happens. But there are very few because of the risk of what we call false positives. And if you see something on a scan, you sort of have to follow it up. You want to follow it up. And that can then lead to a cascade of, pair of further investigations of, that might

• 24:41Speaker 08

  expose you to all sorts of different harms or risks, plus financial harm. But that idea of there might be something within, and Andrew Huberman is guilty of doing this. Him and Peter Attier are, are guilty of quite a few of these and, and a lot of the podcasters are. And, you know, he talks about, you might be walking around with all these spots on your brain. Don't you want to see it? Well, do you?

• 25:05Speaker 07

  Do you? And I, it was also, I think, was that the chapter where somebody, you know, went and purchased this full body MRI? And then in order to like unlock the results, you had to pay again even further. And it's just sort of like this endless, just parasitic sucking people dry of money, more and more and more money grabs that just prey on this anxiety. Once you hook someone, then you've got them.

• 25:33Speaker 08

  You've got them.

• 25:33Speaker 07

  You mentioned earlier, the algorithm and social media, this, this really struck me too. Social media has become so individualized, or it is so individualized, rather than social. You know, what I see on my feed is going to be profoundly different from what you see on your feed is going to be different than what, you know, just like every single person's feed has been directed by these tiny decisions, how long you look at a video, whether you like or you share something, it's, it's on my mind all the time now, where I'm like, if I just set my phone down with it still open, does it think that I want to look at that video the whole time? But as you write, this, this engagement, this algorithm, it can normalize misinformation, this illusion of truth bias. What is this bias?

• 26:17Speaker 07

  And how does the rewarding of certain engagement, what, what sort of content is it promoting?

• 26:23Speaker 08

  So illusion of truth bias is the more you see something, the more true it feels. Now, not everybody is susceptible to all sorts of bi, all biases. And, and again, we're still trying to understand how this information affects behavior. And it, and as you said then, it's very hard to study from an academic perspective because everybody's feeds are different and you need to follow it up longitudinally. And you don't always know what is that little bit of information that you have that tips over a certain behavior change? Because we're bombarded with information all the time. But people are spending a lot of time on their phones. And the thing with the phone and social media is it's so personal. It's in your pocket, it's in your phone.

• 27:08Speaker 08

  It's, it's the place where you might speak to your grandmother on a FaceTime or your, or your family, or you connect with people. And you've got these influencers in your phone, you're looking at them, feels like eye to eye. But then one of the issues is it's, it's the more sensationalist stuff that gets surfaced. It's the stuff that grabs attention. I think of the book in the sense of this is what happens when you put health on platforms that are geared for entertainment and for commerce. It's not the dry statistics or evidence based information that's going to be surfaced in your feed. It is the grabby, the sensationalist, the, the stories. And we are, we're, we're geared to listen to stories, we're humans. And it's all those that, that will surface in your feed.

• 27:52Speaker 08

  And there's one anecdote that, that I have in there and it's from some Harvard academics who talk about a young girl who was terrified that young people her age were getting stage four cancer because she'd lingered on a video. Her feed filled with more and more videos of young people with stage four cancer, even though it's incredibly rare for people her age. She felt that everybody was being diagnosed with stage four cancer.

• 28:17Speaker 07

  Let's take a quick break here. We'll be back before you know it.

• 28:20Speaker 09

  When intimate itch strikes, waiting it out isn't always an option. That's why there's Vagisil Maximum Strength Anti-Ich Cream. It provides fast relief from intense external feminine itching and burning. And 92% of women said Vagisil provided long lasting itch relief. Intimate itch can have more than 60 causes, from everyday things like shaving, pads, tight clothing, to yeast infection related irritation. Vagisil helps protect delicate skin from further irritation. Trusted by generations, clinically and gynecologist tested. Don't let discomfort get in the way. Visit vagisil.com to find the relief that's right for you.

• 28:52Speaker 10

  Lisa, we should tell them about our new show. Oh my God, Lexi, we have a new podcast. It's called Don't Lie To Me. I'm Lexi Iwanu. We're two best friends, 22 years apart, but so close at heart.

• 29:05Speaker 03

  And I'm Lisi DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my 50s, I've lived it all.

• 29:14Speaker 11

  I'm not going to get anywhere fighting. That is wild. I learned that about you today.

• 29:21Speaker 10

  Now in my 30s, being the founder of new shoes, good taste is my business and I've always got something to say. If men were just honest about this, there would be so much more peace in the world. We're going to talk about dating, relationships, beauty, getting older. And a little wiser. We're best friends, but we don't always agree.

• 29:40Speaker 12

  Because you told us how accommodating you are. Obviously I would do what I think I could do to, to fight the fight, but there's only so much fight I can fight.

• 29:48Speaker 10

  Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Liar. Listen on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I don't really care.

• 30:02Speaker 00

  Welcome aboard season six of The Girlfriends Flight or Fight, which takes place 30,000 feet in the sky. There's great food, comfortable chairs and attentive stewardesses. The stewardesses were so beautiful. But in reality, the stewardess job is far less glamorous than it appears. It was the most sexist job I think you could have. In this era, the airlines told these stewardesses, they have to be single. They had no good excuse for why they wouldn't let women be married. They have to be skinny.

• 30:43Speaker 11

  We were starving ourselves.

• 30:46Speaker 00

  And they have to be young. You would retire at age 32. But one day, a group of stewardesses said. This has got to stop. They risked it all, turning a fight for fairness into a revolution. Listen to The Girlfriends Flight or Fight on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 31:26Speaker 07

  Welcome back, everyone. I'm here chatting with the wonderful Dr. Deborah Cohen about her book Bad Influence. Let's get into some more questions. These algorithms reward these extreme stories, these personal anecdotes, these things that are shocking or more shareable. But the two things that the algorithm does not reward are nuance and uncertainty, both of which are foundational to science and medicine. How does this play out in the media representation of scientific research? And is there anything that we can do to make uncertainty and nuance more clickable, more engaging?

• 32:05Speaker 08

  It's a really good question, and I slightly, I'd love to know the answer to that in many ways. I think there's, I think we have to get better at communicating. And there are people online that do it very, very well. For me, one of the risks, if people are too robust with pointing out misinformation and individuals, obviously, there are bad actors. I worry that that drives people away. So one example, young women, side effects of the oral hormonal contraceptive pill, believe they are having particular side effects from the pill, like weight gain, that isn't necessarily backed by randomized controlled trial evidence. It might be because the time they're going on the pill, they're going out, you know, they've got a new partner, they might be going out for dinners more, they might have just gone to college. It might be all sorts of reasons why they're gaining weight at

• 32:50Speaker 08

  that particular time. But there are people as well that are turning to social media because they feel that the health profession doesn't listen to them. But by pointing out and saying you're spreading misinformation, it doesn't make them think, oh, I'm going to come back to the health system, if they're already feeling alienated. So I think we have to do that carefully. There are some very good physicians online, but then there are some that are nefarious as well, engaging in nefarious activities, selling products, selling dodgy services and everything else. So it's a real minefield for people. My view, as someone that trained to be a doctor, is that health profession needs to get their act together as well, get their own house in order. But I do think we need better

• 33:32Speaker 08

  health literacy. And from, coming from the UK, what's really interesting for me is how we are adopting US-style health system by the back door. Because our National Health Service is really struggling. We've got this massive rise of private clinics of consumer health that is only really in the last sort of five years that is really taking, taking hold, where people have private general practitioners or private primary physicians on the palm of their hand. That's all relatively new. So we in Europe, and the rest of Europe as well, because what we've got from the US is direct-to-consumer advertising and

• 34:12Speaker 08

  prescription drugs, that is banned across Europe, but it's borderless. A story I'm doing for the BMJ at the moment, actually, it should come out the next couple of weeks, is how we've adopted direct-to-consumer advertising, what's the impact of that? Because the systems are borderless. And we're not used to navigating it in the UK and Europe. So it's all a bit of a, it's sort of a bit of a shock to the system.

• 34:35Speaker 07

  Social media and influencers can of course be very predatory, nefarious. We have these bad actors. But science and medicine also, of course, have roles to play. There's this long history of medicine being dismissive or paternalistic towards patients. There are these horrifically unethical scientific or medical experiments. And there's kind of a general gatekeeping of like, how dare you question me, or trust me, I'm the expert here, attitude. And it seems like these are also contributing to people seeking answers elsewhere. Can you tell me more about that?

• 35:12Speaker 08

  Yeah, and I think certainly, again, and this comes up a lot in women's health, where women's health has been largely underfunded. I think it was 1993 that the NIH sort of said that women could be part of clinical trials that they funded. In 1993, that's when Jurassic Park came out, you know, we had all this, this great sort of computerized films. Only then can women go in clinical trials. And so there's been, there's a sense of not feeling seen, not feeling heard. And it becomes really, again, it becomes a double edged sword, because the doctors that I've spoken to, and I speak to a lot day to day,

• 35:54Speaker 08

  is they're battling with information that comes up in people's feed when they come into the consultation. And then they're left with even less time to deal with the kind of, the issues at hand. And what I'm really interested in going forward, and this is what I'm hoping to actually formally study, is how social media and large language models are shaping doctor-patient relationships, and our relationship with the healthcare, particularly when we know the LLMs, people rate them as being more empathic than doctors. So it's just saying, I think it's about what the medical profession have to say.

• 36:31Speaker 07

  That's rough, yeah.

• 36:32Speaker 08

  It really is. We need to get our own house in order again. And so that, that sense of feeling heard, but then that's exploited. And that's the challenge, again, with social media, is with influencers, I hear you, I see you, now buy my supplant, or buy my dodgy test, or come to see me in my private clinic, and I'll give you that unnecessary scan. So it's fascinating, really. I mean, it does feel quite dystopian, but I do wonder going forward, what our expectations will be of healthcare, and what the role of the doctor, obviously not just doctors, but you know, health professionals generally, will be in that sort of dynamic in the new information ecosystem. I'm going to put pound in the jar

• 37:14Speaker 08

  or dollar in the jar, because I hate the term ecosystem, but I've just used it. It's awful. I felt like a chatbot saying it.

• 37:23Speaker 07

  Just put a little dash in there, too.

• 37:25Speaker 08

  Yeah, exactly, dead bot.

• 37:30Speaker 07

  And, and these, these doctors, these physicians are also on social media, and they're also being exposed to, they have their own algorithm, which might or might not be filled with bad influencers, right? These nefarious actors. And, but, but even still, there are many of them that I'm sure are not exposed to the information that their patients are exposed to. And so that creates more of this gap in saying, okay, well, what is the information I know? What is the information that you know? And how do we communicate and get on the same level in this 20-minute appointment?

• 38:04Speaker 08

  It's really hard. And one conversation I had recently with a pediatrician, he says when his patients come in, the first thing he does is say, come on, let's chat about what you've looked up, ChatGPT today, or Copilot, or Claude, or whatever. Let's have a conversation, let's just get that on the table so we can talk about it. And one ADHD physician in the UK, she uses what her patients see about ADHD on social media as a way to talk to them. So how do you feel about seeing that? What have you seen on social media today? How should we talk about that? So, so get them to open up, because it's almost got to be part of the conversation. And in one paper that I read, and it was in one

• 38:49Speaker 08

  of the pediatric journals, a sort of throwaway line at the end was, doctors now need to start asking their patients about what they're seeing on social media. And it was sort of a throwaway line. And I thought, wow.

• 39:00Speaker 07

  You mentioned the commercial and digital determinants of health, which I feel like that's going to be a big thing moving forward. How would we even begin to measure or incorporate that into understanding people's health and how it is influenced by their social media experiences?

• 39:19Speaker 08

  It's, it's really going to be a really hard area to study. First of all, there's no transparency from the tech companies. So, so getting data, and I know there are ways of potentially sharing data, but as it stands, there's, as an example in the book, one academic I spoke to said, if he wants to do a study, let's say on TikTok, they will want to see the protocol, they will want to see everything before they release any data. And then on top of that, they will want to see the final publication before it goes anywhere. Now, we've learned over years, let's say with the drug industry, that if they subsidize research or fund research, then you have to have sort of walls in place and protocols in place. So that research isn't therefore influenced before it goes

• 40:04Speaker 08

  to publication. There has to be an element of that. And I feel that, well, again, we're very much, there's a bit of tech exceptionalism at times, that we can race ahead and do things. And again, if you think about what science is, we have the null hypothesis. We assume something doesn't work unless shown otherwise. Tech feels to me like, let's just get it out. We'll assume it works until it doesn't. And it flips scientific thinking on its head, but we sort of have just come to accept that is what happens. But is that good science? I would counter, probably not.

• 40:43Speaker 07

  We've touched on a few times ADHD throughout this conversation so far. And this is a condition that has received a lot of attention on social media. And that's been very positive for some people who have found community and a greater understanding of their own experiences, people who are getting diagnosed or going to their physician and saying, is this, is this what I've been experiencing? How can I manage this? But it is more complicated than that, of course. Their diagnoses are increasing, but there might, does that also mean that it might be overdiagnosed in situations? Like, how do we know where to draw the line between help and harm in this context?

• 41:23Speaker 08

  It's really difficult and I I think you can have two things together at the same time. So you can have people being missed, so you can have under diagnosis. And we know they're largely in certain ethnic groups, so African Americans, Hispanic people. There's a massive social gradient there as well and and that's mirrored in the UK. So if people of lower socioeconomic groups are less likely to get the diagnosis that they need to access treatment and help. Meanwhile, you have people that perhaps have more access to healthcare, more wealth, that are getting diagnoses that may not be robust. So there we might have missed diagnosis.

• 42:05Speaker 08

  But also, we've got this this idea of perhaps over diagnosis. So the expanding definition of what counts as ADHD, and that is always um subject to debate in healthcare. And I don't come down either way, but but what I do think is that, and I hear it amongst my friendship groups, that people's way of describing their ADHD has taken on a social media element. People talk about rejection sensitivity dysphoria like it is a certain symptom, a well-described symptom of ADHD. As it stands, experts are still debating it. Is it part of ADHD? Or isn't it?

• 42:49Speaker 08

  We don't know because there isn't the evidence there. But that has come down into clinical notes and that's sort of been born out of conversations on social media. Other medical or psychological terms have been co-opted by influencers, like object permanence, which is a Jean Piaget stage of development where a child realizes that if a parent isn't in the room or something isn't in the room, they still exist, just because they can't see it, that person still exists. And that's been co-opted by influencers to be, I don't miss things. And those terms go viral. And again, people talk about it like it is a definite part of ADHD. And so, and I hear that in conversations just day to day. I've got rejection sensitivity dysphoria or I I've got object impermanence because

• 43:34Speaker 08

  I don't miss people. And then if you think about how we do field studies or we validate our questionnaires um when it comes to ADHD diagnoses, if people are saying, well, this isn't how I see ADHD, we we haven't got all these different conditions I'm seeing. What does that then do further down the line to how we see ADHD? And I don't know, it's an open question.

• 43:59Speaker 07

  Yeah, how how does social media shape diagnoses in a medical context? I mean, it's not it's not a one-way relationship. This is all kind of intersecting and feeding into each other.

• 44:11Speaker 08

  Absolutely, and and health is is such is defined socially and culturally. There's a lot of healthcare that is defined. And and I think what often surprises people, even diagnoses change, what the threshold, the cutoff threshold is. Sometimes it's only standard deviations away from the mean is what you consider abnormal. That's often a surprise to people. It is not fixed in stone. And over the years, we've seen the idea of pre-diabetes come about as we move the goalposts of what needs, who needs treatment. Healthcare is constantly iterating and it's not, it's not all pure hard science. It's real where arts and culture and society meets hard science.

• 44:55Speaker 08

  It's that that strange interface.

• 44:57Speaker 07

  And health optimization, I feel like is a key part of this too. It's doing whatever you are told is the best thing to do to to optimize your health. And there's a huge market for this. I I got sucked into it with a smartwatch and then I realized that I hated it. It made me miserable, so I stopped using it. Can you discuss the optimization trap, which is what you call it in your book, and how this market both over promises and under delivers?

• 45:27Speaker 08

  So if you think about it, it's obvious. If you've got a market, if you're a company, where's the bigger market, a sick person or a well person? So if you take, if you take continuous glucose monitors, and there's been a big trend for them, they were designed, um so Abbott is one of the big companies that makes it, US company that makes them. They were designed principally to help people type one and type two diabetes who use insulin to monitor their blood sugar levels so they could adapt their insulin to get optimal dosing. Because we know um in the short term, if you've got the right level of insulin, you're less likely to have hypos and hyperglycemic attacks.

• 46:08Speaker 08

  And in the longer term, it reduces the risk of long-term health complications. But there was a pivot. That's only a small market. There's a much bigger market in well people. And if you can encourage them that they need to constantly monitor their glucose in the absence of evidence, and the NIH have done some brilliant studies and there's some brilliant clinical trials in this, Kevin Hall, um who is no longer at the NIH. But he um he's done some fascinating trials showing that you get different readings. And the same device can give different readings or different devices give different readings. And your blood sugar level will change according to what else you've eaten, what else you've done at the same time.

• 46:51Speaker 08

  And so they're not really reliable because our our bodies and healthy people have homeostatic mechanisms. Our blood sugar goes up, we release insulin and it comes back down again. Oh, it goes too low, we release glucagon and the blood sugar goes back up again. We're in this constant state of homeostasis. We don't know what abnormal looks like in a normal person because, you know, does, if you're out of range, your blood sugar goes up and people say, oh, I've got a spike, I've got a spike. You're like, yeah, just eaten banana. Of course you've got a spike. If it comes back down, that's what you're interested in. And guess what? It comes back down. And then what what happens is that then potentially creates more harm.

• 47:31Speaker 08

  So we don't know spikes have any issue in the long, certainly in the short term and certainly not in the long term. But then people change their diet accordingly. So, right, I'm not going to eat banana, but I'm going to eat a burger because burger doesn't spike my my glucose levels. So people then become wedded to this metric. And then the thing when you look at one metric is you're not looking at all the other things that you might be ingesting. So if you have a burger, you might be eating loads of cholesterol or fat or salt and all those other things. But you're so sort of wedded to this one metric, in this case is glucose, you might be watching one very well-monitored tree and missing the wood around it. Um and and that's the problem is if you can measure it, you fixate on it.

• 48:15Speaker 08

  And in some way, we saw this in the pandemic a little bit, without getting too sort of controversial, is we really, certainly in the UK, we focus very much on COVID desk because we can measure them, we could see it. But everything else around it was far more complicated to measure, you know, the impact on education, the impact on psychology and all those other things. They're just harder. So it's very easy to focus on that one metric if you can see it and it's easy to measure. And and there's a tendency, I think, in medicine to think the more parameters we measure, the better our health. And that just isn't true.

• 48:48Speaker 07

  There are so many science and medical or wellness influencers out there, like the health podcast bros that you mentioned throughout your book. They and they come with not only these impressive credentials, but also these substantial ties to health industries or supplement industries or the wellness industry. How can a consumer know when to trust a source? Or can they? Can educational entertainment be trustworthy or be something that is viable?

• 49:19Speaker 08

  It's really hard balancing that because we know people don't want to pay for stuff. People don't want to pay for their media content. Um and it needs to be funded. And who's going to have the biggest interest in funding? A health podcast is the people that are going to benefit from it. There's a phrase that I heard a lot is, I only work with the companies that I believe in or I use personally. Well, what happens if there's evidence that suggests that that company, that product isn't very good, but you've become financially dependent on it? Do you suddenly drop it? So for me, it's a nonsense term, it's a nonsense expression. And we have seen certain podcast bros pivot, you know, I don't like glucose monitors.

• 50:01Speaker 08

  Oh, look, I've just spoken to somebody that works for one and they're sponsoring my podcast and now I recommend them. Oh, I don't like this, Aura Ring, oh, look, then I'm gonna, I'm gonna stop backing it and putting it on my podcast. And guess what? I'm going to be a paid advocate and I'm going to try and get it into medical journals and I'm going to advocate for it in academic studies. It's that that was blown open in a in a court case between Aura and Peter Attia is his relationship with the company. And it sheds a light on these commercial relationships that that podcasters have with companies. And I think it becomes more problematic in many ways when it's a medical professional that does it because it sort of gives it more of an endorsement.

• 50:46Speaker 08

  And there's one UK podcaster, Dr. Angan Chatterjee, and I took him out the book and I'm kicking myself for taking him out the book, but he's sponsored by AG1. And our regulator, Ofcom, well, they don't regulate podcasts, but they did highlight this as an example, is when it's a health professional that is working with a company, even if they say they declare it, it looks like an endorsement. And in many ways, I think health professionals have to have an even, well, they should do, have a higher standard, you know, we're a regulated profession, you know, you've got your state licensing boards, we have the General Medical Council in the UK. And and it's it's really difficult balancing that.

• 51:29Speaker 08

  How do you get the funding and remain independent at the same time? It's tricky.

• 51:34Speaker 07

  Does accurate scientific information have a place on social media and what does that place look like?

• 51:40Speaker 08

  I think it has to because that's where people are going. I think we need to be more skeptical. I think we need to be, have better health literacy. Um but even then, is somebody going to be able to interpret a systematic review or meta-analysis or underminded control trap? That that's a difficult task. I think health professionals have to do better or or have to sort of meet people where they're at. And there are some people that do it very well. It's not all bad and I'm I'm obviously doom and gloom. The book title's doom and gloom. It for me is about, let's think critically about where our information's coming from and what is shaping our healthcare and and what incentives and and what are the interests shaping our healthcare and our our our health information system.

• 52:24Speaker 08

  And and then the next challenge, obviously, is going to be the large language models and how the information on them are being shaped. And we know companies are already trying to make their information.

• 52:37Speaker 08

  Prioritised by the LLMs, you know, it used to be search engine optimised, now it's geo-engine optimised or some, I can't remember the exact term, but, but there is, there's a whole cadre of people that are working on information to make sure the bots pick up on their content. And that is going to be the people with the deep pockets that are able to shape their content accordingly. And who knows what deals going on behind the background, I wouldn't want to say, and, and that would be pure speculation on my behalf. But already, we know that if you do a Google search, it's the sponsored content that comes up to the top of your feed. But it's going to be less transparent.

• 53:16Speaker 07

  So that's, that's another question that I had, is that if we can make educational content reliable, accessible, interesting to people, there's still the issue of this flood of misinformation, or information that is in the grey area, or that isn't backed by these robust studies and, and people who have financial ties. How can we incorporate regulations or just health literacy training to get people to recognise when what they're seeing is being promoted by these bad influencers?

• 53:51Speaker 08

  There just has to be a, a lot more scepticism. So one of the things I would say to people is don't dismiss someone's story, but ask why they're telling you it. Ask why they're stepping onto a platform in the first place to tell you about their condition, or to tell you about this product or treatment. That's the first thing you should ask. Why is this person telling me this? Why should I believe you? And equally, why should people listen to me or believe me? I got asked that the other day at the Edinburgh Science Festival, the first question I was asked by a paediatric radiologist. Why should I believe you? And I said, well, I sort of have to be accountable, but equally, you can dismiss me. You know, if I'm on the BBC, I'm regulated by Ofcom, you know, regulator, or if I write something

• 54:31Speaker 08

  in the BMJ, I have responses that, that, or you can literally come down on my door and hammer down the door. But, but there's no accountability here, or very little accountability, if, if any at all. And, and if someone's only telling you the benefits of something, why aren't they telling you about the harms? Because, because every treatment has benefit and every treatment has a harm. We don't necessarily know whether you're going to be the person that benefits or gets the harm. You know, what, what, medicine, again, is quite slow, slow moving. And that, that precision, if I give you a statin and to prevent a heart attack, as a doctor, I cannot tell you whether you will be that person that benefits

• 55:13Speaker 08

  from that statin. It's all statistics. And that's, that's the problem. If someone's over certain, then they're, you know, they're probably not right. So it's just those little cues. You know, if, if you're thinking about a treatment, what's the benefits of doing? What's the risks? What the alternatives? And what if I do nothing? They're the decisions that, that go into stuff. And who's behind this information, really? So it's just being a bit sceptical. And in terms of provision of information, whether you're, you know, the Preventative Service Task Force in the United States, or the NHS in the United Kingdom,

• 55:53Speaker 08

  or the Institute of Medicine, or whoever you are, perhaps you need to think about presenting your information in different ways. It's really tricky, because again, you're held to a different standard of accountability if you are those institutions. And let's say you mess up, rightfully, you're going to be held to account. And, and I think it's very difficult for people to, to, I, I feel in, in the UK, that we've got something called the Royal Colleges. So they're Royal College of Surgeons, Royal College of Physicians, Royal College of Obstetrics and Gynaecology. I feel that they need to do some kind of campaign about, you know, consumerisation of health and all these tests and treatments that you see, be careful before you buy. Because it's, it's a pretty unregulated market

• 56:38Speaker 08

  in the UK. I think the United States possibly even more so than the United Kingdom. But equally, we're going that way. What, what should change here? If people are being offered egg freezing that isn't indicated, or statistics that, that are wrong, where's the regulation going on here? It's who's protecting consumers? What we're talking about in, in, I think in this particular instance, is who's protecting consumers? And there isn't a huge amount of consumer protection going on. It's the new snake oil. That's, that's what it is. It's the new snake oil.

• 57:13Speaker 07

  Absolutely. Dr Cohen, I really appreciate you chatting with me today. This has been such an eye-opening conversation, and your book has so much food for thought. It was fantastic. Thank you.

• 57:25Speaker 08

  Thank you so much for inviting me on.

• 57:45Speaker 07

  A big thank you again to Dr Deborah Cohen for taking the time to chat with me. If you enjoyed today's episode and would like to learn more, check out our website, thispodcastwillkillyou.com, where I'll post a link to where you can find Bad Influence: How the Internet Hijacked Our Health, as well as a link to Dr Cohen's website, where you can find her other work. And don't forget, you can check out our website for all sorts of other cool things, including, but not limited to, transcripts, Quarantini recipes, show notes and references for all of our episodes, links to merch, our bookshop.org affiliate page, our Goodreads list, a first-hand account form, and music by Bloodmobile. Speaking of which, thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you to Liana Scolacci and

• 58:30Speaker 07

  Tom Bryfogle for our audio mixing. And thanks to you listeners for listening. I hope you liked this episode and are loving being part of the TPWKY Book Club. A special thank you, as always, to our fantastic patrons. We appreciate your support so very much. Well, until next time, keep washing those hands.

• 59:18Speaker 01

  Get ready for an unforgettable night of comedy. Jamie Foxx is back with a brand-new, hilarious stand-up special, Jamie Foxx Take Care of Yourself. One of comedy's most beloved storytellers brings his signature humour, unforgettable impressions, personal reflections, and sharp observations to the stage for what might be his most honest special yet. Don't miss Jamie Foxx Take Care of Yourself, now streaming only on Hulu. Terms apply.

• 59:42Speaker 05

  This is Ashley Conetti from the Ben and Ashley Eye, almost famous podcast. You know that feeling when your skin just needs a tall drink of water? That's what Clinique Moisture Surge 100 Hour Moisturiser is for. Moisture Surge 100 Hour Moisturiser absorbs instantly and hydrates for 100 hours for plump, glowing skin. That's right, 100 hours. It's a lightweight, oil-free gel cream, safe for sensitive skin. It's allergy-tested and fragrance-free. So try Clinique Moisture Surge 100 Hour today at clinique.com. Feels like Moisture Surge.

• 1:00:19Speaker 10

  Lisa, tell them about our new show.

• 1:00:22Speaker 03

  We have a new podcast. It's called Don't Lie To Me.

• 1:00:25Speaker 10

  I'm Lexi Iwanu. We're two best friends, 22 years apart, but so close at heart.

• 1:00:30Speaker 03

  And I'm Lisi DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my 50s, I've lived it all.

• 1:00:38Speaker 10

  Now in my 30s, being the founder of new shoes, good taste is my business.

• 1:00:44Speaker 03

  Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.