Epidemics of misinformation and why we should stop oversimplifying things

Notes from a speech to the World Congress of Science and Factual Producers in San Francisco, December 1, 2017.

I used to be a disease detective for the federal government. In fact, that’s the job that enticed me to leave my work as a hospital doctor in east London and move to America. As an officer in the Epidemic Intelligence Service, I’d be deployed to stop an outbreak of flesh-eating bacteria in the Navajo Nation one week and to investigate inmates who had suddenly become paralyzed in a maximum-security prison the next week. It was tricky work. I had to trace the path of an outbreak, hunt the virus, fungus or bacteria. At the same time, I had to navigate through communities of people who were petrified about the disease. I loved that job and I thought it was hard.

Then I became a journalist. My first job was as a staff reporter for The Dallas Morning News. I arrived in Dallas and a few weeks later, Ebola arrived in Dallas. Remember that? Autumn of 2014. Thousands of people were infected with Ebola in West Africa. Thousands of people had died from Ebola in West Africa. In my new hometown of Dallas, Texas, there was one case of Ebola. And people became hysterical.

I learned that it’s not just viruses and bacteria that you have to hunt and trace to their source, it’s fear and misinformation. Fear and misinformation are contagions. They spread — sometimes faster than a disease.

At that time when there was a case of Ebola in Dallas, a pediatrician friend told me a story about a doctor in central Texas. Here’s how it goes: a mother walks into a doctor’s office with her daughter. She says, “Can you give my child the Ebola vaccine, please?” The doctor says, “Well, there isn’t a vaccine for Ebola and even if there was, you know, we’re in central Texas, we wouldn’t need it. But it is flu season so we can give your daughter the flu vaccine.”

And the mother says, “The flu vaccine? Oh no. I don’t believe in vaccines.”

This denial of facts, this very human, very irrational assessment of risk and what can kill you (which in Texas…Ebola is not so likely to kill you, but flu, yeah, it could kill you) — that very human, very irrational risk assessment is way trickier to navigate than any outbreak I’ve had to contend with — and I’ve dealt with some crazy, weird outbreaks.

One of the first things you do when you arrive at the scene of an outbreak is to map all the people who are sick or who have died. Before you know it you have a spider’s web of connections. A network. Jim knew John who knew Elsa who knew Ali who knew Layla and they all got sick and they all worked at the same nursery and what do you know, every kid at the nursery died. That’s a bit of a grim example, but you get my point. You do this mapping exercise so that you can try and find patient zero — the first person to get sick in the outbreak.

Finding patient zero helps you find the person who started the outbreak — not to assign blame, but so you can isolate them if necessary (if they’re still alive), and so you can identify everyone they came into contact with. It gives you a handle on the messy outbreak.

Nowadays, I’m not tracking the spread of diseases so much as I’m tracking the spread of misinformation and the fear it incites. I’m a John S. Knight Fellow at Stanford University where I spend my days thinking about the ways that rumors spread during epidemics.

The reason I’m tracking misinformation about science and health is because misinformation spreads from person to person, from Twitter account to Twitter account, much like an infection. It has the potential to cause panic, affect economies and put people in danger.

I’m wondering: if you could find the source of misinformation, the patient zero of misinformation if you like, it could be a person or a bot, then what if you could vaccinate against that misinformation or develop a misinformation antidote? What if you could stop misinformation spreading in the first place?

This is where you come in.

As makers, funders and commissioners of film, you get to tell the stories that shape people’s ideas, beliefs and feelings about science and medicine (the feelings part is really important). You can make the documentary film about vaccines being a government conspiracy to poison people or the documentary about wheat being the root of all evil. You can produce the film that makes people too nervous to touch a genetically modified orange. These and many more films like them are available online — I checked last night.

The thing is, these stories are entertaining. I grew up listening to and loving conspiracy theories. I still get a laugh out of hearing them. They are the easier stories to tell. They are sensational, scary, simple and scandalous.

But the story of how many babies don’t die from diphtheria and whooping cough because we have successful vaccines, well that story isn’t sexy. Many of the success stories of public health aren’t sensational.

So I have a challenge for you — the first of two challenges. I want you to pick what seems like the less sexy story. Take that un-sexy story and make it killer. Maybe a bad choice of word, so let me say it like this: we have at our disposal tools like VR, AR, 360 video. We talk about immersive storytelling and we use lots of storytelling buzzwords.

Your challenge — and you can handle this because you are excellent storytellers — is to take the story that’s harder to tell and use your tools and your creative talents to make it a brilliant, compelling story. Your film will be based on fact and it will be entertaining. Your film will be honest and gripping.

We all have a hand in the spread of fake news and we each have a role to play in preventing its spread. When I talk at medical and public health conferences I point the finger at my audience and say that we need to own up to our place in this fake news ecosystem. As doctors and public health officials, we have to confess to our role.

Medicine has a dirty side. We don’t like to talk about it but some of the treatments we use, some of the information that’s in our textbooks, comes from unethical, inhumane experiments. Experiments on Black men. Experiments on Mexican women. Experiments on kids who were labeled “retarded.” I don’t have enough time in this session to tell you about all of those horror stories but they are part of the reason why we’re in this situation today.

Since 2014, there’s been an outbreak of tuberculosis in Alabama and public health folks and doctors have lamented: “Oh, but we’ve sent mobile clinics to the area! Oh, but we’re doing free testing and still people are coughing and not coming to get tested!”

Well, it takes thirty seconds to look on Google Maps, drop a pin on the town where the outbreak is and see that it’s a two-hour drive from Tuskegee, site of the Tuskegee Study of Untreated Syphilis in the Negro Male, a U.S. government-sponsored study between 1932 and 1972 that left Black men suffering with syphilis even when there was a cure for the infection.

That was happening in Alabama forty-five years ago. The children of those men are alive now. So how can you ask why people in Alabama aren’t running with wild enthusiasm and open arms towards doctors and government-sponsored clinics? There’s a story behind the outbreak. It’s important we remember those stories.

When people write to me and say, “You’re a journalist and a doctor, you should write about how the government is trying to kill us through chemtrails,” I have to be honest and say that based on the digging I’ve done, chemtrails are made of water crystals and fuel emissions and are probably not toxic to people.

I also have to say that the government is complicit in the death and sickness of some people, particularly poor people, Black people and people of color. Like in Flint. Like in D.C. where between 2001 and 2004 there was an outbreak of miscarriages because pregnant women were drinking tap water which was contaminated with lead and their foetuses were dying. In the nation’s capital. And again in 2006 there was a second outbreak of miscarriages in D.C. because there was lead in tap water and the government’s public health agency misinformed the public about the safety of their tap water.

I’m writing a book about medical myths and pseudoscience at the moment. It’s based on a newspaper column I used to write called Debunked where every week people would write in with medical myths and pseudoscience and I’d dissect these myths. I think people expected me as a doctor and scientist to just say, “No, chemtrails are not a government conspiracy to poison you,” and, “No, vaccines do not cause autism,” and to end the discussion there.

But to build trust, to get to the root of the spread of fake news and misinformation, we have to put our hands up and admit to the messiness of it all. These aren’t easy, tidy topics.

That brings me to my second challenge: confront the complexity. Embrace the fact these are complicated, nuanced stories. Don’t erase the nuance. Don’t be ahistorical. It’s much harder to do that than it is to present stories as two-sided creatures. Explain them, pick them to pieces, but don’t try and make them tidy when they’re not.

That’s it. Two challenges. Pick the unsexy story, use your skills to make it killer. Confront the complexities.