Health Misinformation: How Did We Get Here?

Ashish Jha: 00:00:00

Hey, everybody. Ashish Jha, coming at you from Providence, Rhode Island for another episode of a moment in health, a podcast where we talk about one data point, discuss one study, and then answer one question, and let's get going with the data point. So the data point I want to discuss today is $267 that's the average cost per beneficiary to set up a Medicaid work requirement. Now if you're listening to this, you know that the President just signed into law recently that one big, beautiful bill that the Republican Congress passed one of the key provisions in it is a Medicaid work requirement. Now it sounds pretty reasonable on surface us making sure people are working if they're eligible, and to ensure that that only people who really need Medicaid get it. The problem, it turns out, is, while the that sounds like a reasonable provision. It's extraordinarily expensive to set up. You have to build up a big bureaucracy to constantly be going back to Medicaid beneficiaries and saying, Hey, are you still eligible? Are you still eligible? Prove it and that extraordinarily complicated bureaucracy is expensive, and it is going to be responsible for kicking about 5 million people off the Medicaid rules, not because they're not eligible, really, but because people have a hard time keeping up with all the forms and all the things that they have to fill out. And the best data on the cost of setting up this bureaucracy comes from Arkansas, one of the five states whose work requirement was fully implemented, and for them, the cost was about $26 million which comes out to about $1,400 administering costs for every person that they disenrolled. So turned out they spent $26 million they kicked about 18,000 enrollees off the Medicaid most of those people probably were eligible, they just didn't fill out their forms in time. Weren't able to kind of keep up with all the bureaucratic requirements. And ultimately, when you look across all the places where these

Ashish Jha: 00:02:10

programs have been put in, about $267 per beneficiary is the cost of these Medicaid work requirements. Very expensive. All right, that's your data point of the week,

Ashish Jha: 00:02:26

let's talk about a study. The study I want to talk about comes from the June 30 issue of the lancet and it's entitled evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030 it's a study done by an international group of researchers, the lead from Brazil, but also a group of colleagues from Barcelona and elsewhere. And what they do is they look at data over the last really, over the last 20 years, and they look at places where USAID has had interventions, primarily around HIV, maternal causes, trying to improve maternal care, malaria, childhood vaccinations. And what they find is that higher levels of USAID funding and activity primarily directed towards low income countries, was associated with a 15% reduction in age standardized all cause mortality, and a 32% reduction, basically a third reduction by a third in under five mortality. And they estimate that USAID to date, has saved about 90 million lives over the past two decades. And finally, they estimate that if the USAID programming had continued that you would, they would save about an additional 14 million between now and 2030 obviously, if we cut the programs as we have, we're going to see a lot more deaths. I want to just take a minute here to talk about USAID. It is a complicated, large set of programs that have largely been shuttered under the Trump administration. Was it perfect? No. Could it have been improved? I'm sure it could have been. But the amount of bad information that was spread about what it did, how it did it, was extraordinary. And what this analysis does is puts into very clear terms, the number of lives that we, the American people, through USAID, have saved over the last two decades, the enormous good that we have done, the enormous amount of benefit that we have not only helped bring to people in low income countries, but the political benefit, the social benefit, the soft power benefit that it has

Ashish Jha: 00:04:40

given the United States all of that now gone with these programs now being shuttered. So that is your study of the week, evaluating the impact of two decades of USAID in the June 30 issue of the Lancet. You.

Ashish Jha: 00:05:00

All right. And now for the question of the week and for the question of the week, I have my friend and colleague, Professor Stefanie Friedhoff, who runs the information futures lab here at the Brown School of Public Health. Stefanie, welcome to the show. Hi,

Stefanie Friedhoff: 00:05:14

Ashish. Thanks for having me so Stefanie, not

Ashish Jha: 00:05:17

even sure exactly how to phrase my question, but let me tell you how I'm thinking about it, and I promise I will get to a question. Find ourselves in an incredibly odd moment in public health, in public health communication. I was watching a video earlier of somebody talking about how COVID swabs were causing nasal cancers. By the way, folks, COVID swabs don't cause nasal cancers. And just the sheer volume of bad information that pervades our lives and the susceptibility people have, and I'm not saying this as a way of saying other people have that susceptibility, and I don't, I am sure I am also susceptible to bad information as you look at this, this broad amount of like bad information floating around, and how we all seem to fall for it, what led us here? How did we get to a point where things like someone saying a nasal swab Causes Nasal cancer actually gets play and gets seen and probably believed by a lot of otherwise reasonable people. How did we get here? Stephanie,

Stefanie Friedhoff: 00:06:34

well, that's a great question. How did we get here?

Stefanie Friedhoff: 00:06:39

I think one way we got here is that for a long time, we underestimated how many people are getting their information online in a number of different ways. And for over a decade now, especially some disinformation agents have been building strong relationships with people online. And when we think about this vaccine question, and we think about, why would people believe that, you know, neurotoxins or other, you know, cancer causing substances would be in our vaccines? Why would you believe that? Then it is because we're all vulnerable when we first have children, and we want to protect our children. But also when we had questions, who was there to answer the question? Was it the doctor who only had 10 minutes for me, or was it my community online that gave me a lot to read and think about and hurt me when really, really heard what I had to say or wanted to know? So there's a big part of this is that we've underestimated in public health the importance of these information ecosystem and social relationships that have been built online and over time. What happens there we're often focused on a specific nugget of content. Is this fact true? Or why would wouldn't people understand that this particular fact is wrong when we are not as human beings really engaging in facts. We're engaging in ideas. We're engaging in laughter with our friends, and we build relationships and identities online, and then if somebody says something that doesn't quite match with maybe what we have known or not, we can discard that easily. We all do this, as you say, as human beings. I was doing an experiment recently in my class, which was, and I now take this to all the talks that I do, which is that a colleague here at Brown had posted that Elon Musk had spent $40 million on ads in the Super Bowl. And there was this went viral. And I really believed my colleague who had posted this on LinkedIn and had shared a list of things, you know, how we should actually be

Stefanie Friedhoff: 00:08:47

spending the money. And I thought, Great. This guy knows data. I'm glad he laid out all this information only then to realize that Elon Musk did not spend $40 million on the Super Bowl. But when I ask this question now to wherever or go and give a talk, you can see that around 10% of people believe it's definitely true, and around 30 to 40% of people believe that it is probably true, which shows that biased decision making exists in every you know. Doesn't matter if you're politically left, middle or right. We all fall for these types of things. And

Ashish Jha: 00:09:21

can I on that one on the Elon Musk and Super Bowl? The reason almost half your audience falls for it is because it feels true. It seems true. We have a narrative in our brain that suggests it's probably true, and the person who's asking it, and the community you're part of largely believes is probably true. So there is that, is that what's going on there? Because, like,

Stefanie Friedhoff: 00:09:47

you know, cognitive bias, like, we're exactly, we're part of communities, and it seems very likely, and it seems like something it could be doing, yeah, and, and then if we go back to that vaccine question, it, you know, it seems. Why does it seem to people that that is something that government could be doing? Yeah, and I think that is a core of the question here, because people have lost so much trust in what government is and isn't doing for them. So it doesn't seem so unlikely as it seems to somebody who has, you know, a different set of experiences.

Ashish Jha: 00:10:19

Great. I want to have to have you come back and talk about how we make all of this stuff better. But the promise was one question you answered it brilliantly. Stefanie Friedhoff, thanks so much for taking the time to come over and hang out and chat with me. Thanks. Ashish.

Ashish Jha: 00:10:40

All right. So there you have it. Another episode of a moment at health where we talked about one data point, $267 the average cost per beneficiary of subjecting people to the work requirement that is now going to be law across the country. A hugely expensive bureaucracy is going to be built in states across the country. We talked about one study evaluating the impact of two decades of USAID interventions, basically estimating that the work of the US government through USAID has saved about 90 million lives over the last two decades. And then we asked one question to my colleague and friend, Professor, Stefanie Friedhoff about how is it that we find ourselves in the information ecosystem, information moment we are in. And Stefanie, I think, did an extraordinary job of talking about information demand, how there are moments where people need information. We, in public health, are not very good at anticipating those moments. We're not very good at delivering those the right information in those moments. And so that is one huge part of it. Another important part of it is that people are less interested in facts and they're more interested in relationships, and that information coming from trusted sources means so much more, and that we in public health have not done enough of a good job on these issues that we've left the field wide open to people who have, in my view, exploited those situations to spread bad information that's been ultimately harmful. I am going to bring Stefanie back to talk at some point, sooner rather than later, about solutions, but keeping in the tradition of just one question, I thought that was a very helpful diagnosis for the moment we are in. So thanks a lot for joining us once again, and as I mentioned last week, we have new music from Katherine Beggs. So once again, thank you, Katherine for composing your wonderful music for our podcast, a moment in health. See you all next week. You.