# Deborah Cohen: The Wellness-Industrial Complex

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 23 Aug 2026, 59 min.

Audio: https://api.substack.com/feed/podcast/207850718/73c6385dc2c32335c0daaa76cf604d27.mp3

Deb Cohen is an award winning investigative journalist and correspondent who trained as a physician and has worked with the BBC and BMJ. She just published BAD INFLUENCE, a book which takes us deep into the wellness-industrial complex—the confluence of the supplement, testing, tech, and pharma industries, and how they sell health anxiety to healthy people. Here are some of the points we discussed: —The big market in healthy, well people. Tests, wearables, imaging, supplements, etc —Algorithms feed the health anxiety in an amplifying, vicious loop on the social media platforms. When the algorithm knows you better than you. —The special qualities of influencers, likable, relatable, vulnerable, appearance as friends, certainty, cultivating parasocial relationships. “I understand you, I see you, I hear you.” Often with financial conflicts of interest. Plus hidden financial benefits. —The inverted pyramid of evidence and displacement of trust. Anecdotes believed and accepted as best evidence instead of rigorous randomized trials. A big flip, doctors losing trust to influencers and the sponsors of influencers. —The Nocebo effect of harm through expectations —The epidemic of neurologic tics during the pandemic traced back to TikTok, a viral contagion with 5.8 billion views (Figure made with Notebook LM) —Potential for regulation of patient/consumers/prosumer influencers —Celebrity influencers and the recent NEJM paper —Many ideas for how we can mitigate this mess (Graphic by Notebook LM) —Many illuminating patient examples: Femtech, silicon breast implant illness (BII), beta blocker experiment, a bogus bioresonance of hair test in a woman with GI symptoms, full-body MRI of brain lesions (transmitted to the patient by an automated message) that were a false positive. —The term “wellness” —Concierge physicians Thank you jojofinance, Vote Against Billionaires, Gretchen Faucett, Mary Powers, Jessica Coffman, and hundreds of others for tuning into my live video with Bad Influence! Join me for my next live video in the app. Ground Truths has subscribers from every US state and 214 countries. There are over 302,000 followers of Ground Truths so nearly 90,000 folks who can easily convert to be free subscribers. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join! If you found this interesting PLEASE share it! A couple of other things to note: —Thanks to the voluntary paid subscribers who support our summer internship program for high school, college, and grad school students. On August 6th, we had a poster session with our SRTI summer interns (pictured below) which was an extraordinary event with about 100 posters! —I hit a publication milestone that I had not ever envisioned. More than 400,000 citations with an h-index of 259, as tallied by Google Scholar Thanks to all for your support of Ground Truths. Get full access to Ground Truths at erictopol.substack.com/subscribe

## Transcript

[0:01] SPEAKER_01: There's a lawsuit that was just announced today against OpenAI,
[0:07] SPEAKER_01: ChatGPT, for a man who claimed that he was hurt by their advice.
[0:13] SPEAKER_01: So that's going to be an interesting legal precedent on the AI side.
[0:20] SPEAKER_01: All right.
[0:21] SPEAKER_01: So we're getting folks on board.
[0:24] SPEAKER_01: And as soon as we get a quorum here, we'll get started.
[0:28] SPEAKER_02: Mm-hmm.
[0:29] SPEAKER_01: I do want to remind everybody,
[0:31] SPEAKER_01: I think you know,
[0:31] SPEAKER_01: that we're open to questions and just put those right into the message on the app
[0:39] SPEAKER_01: and we'll try to get to them along the way.
[0:46] SPEAKER_01: So let me introduce Debra Cohn.
[0:49] SPEAKER_01: She is a remarkable journalist,
[0:54] SPEAKER_01: correspondent, both for BBC, the British Medical Journal, for ITV.
[1:02] SPEAKER_01: So she has a lot of experience in this space of journalism.
[1:06] SPEAKER_01: Medicine, Science, Reporting.
[1:09] SPEAKER_01: And she's written a great book, a very important book.
[1:13] SPEAKER_01: It's called Bad Influence.
[1:15] SPEAKER_01: And it's subtitled How the Internet Hijacked Our Health.
[1:20] SPEAKER_01: It just came out.
[1:22] SPEAKER_01: And of course,
[1:23] SPEAKER_01: in the UK, it's getting a lot of uptake and soon it will be the same case in the US.
[1:30] SPEAKER_01: So welcome, Deborah.
[1:32] SPEAKER_00: Thank you for having me.
[1:33] SPEAKER_00: It's a real pleasure to finally meet you.
[1:36] SPEAKER_01: Yeah, same here.
[1:38] SPEAKER_01: So in the book,
[1:40] SPEAKER_01: you get into this,
[1:43] SPEAKER_01: what has to be a very sound term,
[1:46] SPEAKER_01: wellness industrial complex,
[1:49] SPEAKER_01: which brings together the culprits of the tech industry,
[1:53] SPEAKER_01: pharma, the testing or diagnostic companies, and supplements.
[2:00] SPEAKER_01: How do you view this complex, the wellness industrial complex?
[2:07] SPEAKER_00: So it's a really good question.
[2:09] SPEAKER_00: And I think there's been a change.
[2:11] SPEAKER_00: There's been an idea that at one point we used to go and see the doctor
[2:15] SPEAKER_00: when we have symptoms and then we have a workup.
[2:19] SPEAKER_00: But there's a bigger market out there and that's well people.
[2:24] SPEAKER_00: And it was actually Barry Kramer who said this to me.
[2:26] SPEAKER_00: He used to be head of the National Cancer Institute.
[2:29] SPEAKER_00: He used the term, we're sick until we're proven now.
[2:34] SPEAKER_01: Yeah.
[2:35] SPEAKER_00: And well people,
[2:35] SPEAKER_00: whether you are a company that is making glucose monitors for people
[2:40] SPEAKER_00: that use insulin,
[2:41] SPEAKER_00: we'll talk about two diabetes, there's a bigger market in well people.
[2:47] SPEAKER_00: And actually the regulators,
[2:48] SPEAKER_00: the FDA in the US or the MHRA in the UK,
[2:52] SPEAKER_00: they're much more interested in medical devices for sick people than devices
[2:59] SPEAKER_00: for well people.
[3:00] SPEAKER_00: But the regulations just aren't the same.
[3:05] SPEAKER_00: Increasingly,
[3:07] SPEAKER_00: there's this idea that if we tell people that they're sick,
[3:10] SPEAKER_00: if we tell people that they're broken,
[3:12] SPEAKER_00: there might be something inside them that they're not aware of.
[3:15] SPEAKER_00: We can sell them a solution.
[3:17] SPEAKER_00: And actually,
[3:18] SPEAKER_00: George Orwell,
[3:20] SPEAKER_00: the famous novelist and journalist,
[3:23] SPEAKER_00: actually said, you know, that is how advertising works.
[3:26] SPEAKER_00: You create the problem and then you sell a solution or you sell a solution
[3:31] SPEAKER_00: and create the problem.
[3:33] SPEAKER_00: And that is effectively what we are seeing.
[3:37] SPEAKER_00: And we've talked about for ages in healthcare and in medicine how we have diagnostic creep.
[3:45] SPEAKER_00: We expand the definition of what an illness is so you can potentially market more drugs.
[3:52] SPEAKER_00: This happens.
[3:53] SPEAKER_00: We know that happens.
[3:54] SPEAKER_00: But it's not just drug companies that are involved in that.
[3:57] SPEAKER_00: And don't get me wrong, drug companies have been responsible for some incredible breakthroughs.
[4:02] SPEAKER_00: We wouldn't have the effective vaccines that we have or antibiotics
[4:05] SPEAKER_00: and all those different things.
[4:08] SPEAKER_00: But we've got this creep where we're telling well people, just be careful.
[4:13] SPEAKER_00: You might feel okay.
[4:15] SPEAKER_00: You don't really know what's going on inside you.
[4:18] SPEAKER_00: So go and do that full body MRI or Go and have that diagnostic test or wear
[4:24] SPEAKER_00: that wearable device.
[4:25] SPEAKER_00: Go and track your glucose,
[4:27] SPEAKER_00: track your sleep,
[4:28] SPEAKER_00: track your heart,
[4:29] SPEAKER_00: track your heart rate variability, whatever term that they're using.
[4:34] SPEAKER_00: And so, and as one cardiologist,
[4:36] SPEAKER_00: British cardiologist put to me,
[4:38] SPEAKER_00: it was like,
[4:38] SPEAKER_00: if you wanted an intensive care at home these days,
[4:42] SPEAKER_00: you could go and source it yourself.
[4:45] SPEAKER_00: And I think it raises questions over...
[4:48] SPEAKER_00: What we want society to look like and this sort of consumerism and commodification
[4:54] SPEAKER_00: of healthcare.
[4:55] SPEAKER_00: And that's really where I think the term comes from.
[5:00] SPEAKER_01: Yeah, I think it captures it well.
[5:03] SPEAKER_01: And as you just described it,
[5:04] SPEAKER_01: basically,
[5:06] SPEAKER_01: we have this complex of selling health anxiety,
[5:10] SPEAKER_01: the word well, and even making people sick or otherwise healthy.
[5:15] SPEAKER_01: And this is echo chamber as you aptly go through in the book where
[5:20] SPEAKER_01: the algorithms just feed these people and it's a vicious cycle.
[5:24] SPEAKER_01: And they start out healthy and they're just getting sicker and sicker
[5:28] SPEAKER_01: the more things that they get in their feed.
[5:32] SPEAKER_01: And there's many qualities about the channel of the misinformation or feeding on
[5:39] SPEAKER_01: the worried well, like predatories.
[5:43] SPEAKER_01: As you really nicely captured again in the book,
[5:47] SPEAKER_01: the influencers,
[5:49] SPEAKER_01: which are key fours,
[5:51] SPEAKER_01: they are successful because they're very likable,
[5:55] SPEAKER_01: they have relatability, vulnerability.
[5:58] SPEAKER_01: There's these special qualities of these influencers that make them remarkably believable.
[6:05] SPEAKER_01: Can you go into that a bit more?
[6:08] SPEAKER_00: Yeah, so they're called parasocial relationships.
[6:12] SPEAKER_00: And in the past,
[6:13] SPEAKER_00: when you advertise something,
[6:15] SPEAKER_00: you know,
[6:15] SPEAKER_00: you might have a big sports star advertising Adidas or Nike or some products.
[6:21] SPEAKER_00: But we sort of know that they're celebrities.
[6:24] SPEAKER_00: They're not really like us.
[6:25] SPEAKER_00: We might aspire to be like them, but we're not them.
[6:29] SPEAKER_00: But this has changed on social media.
[6:32] SPEAKER_00: And increasingly,
[6:34] SPEAKER_00: there are companies that work with,
[6:36] SPEAKER_00: and not just companies, they're people that create themselves as well.
[6:42] SPEAKER_00: They talk to us like they are one of us.
[6:44] SPEAKER_00: So if you think about where you consume a lot of your media,
[6:47] SPEAKER_00: I mean, I'm talking to you now in my phone.
[6:49] SPEAKER_00: It's a very personal space.
[6:51] SPEAKER_00: I feel like I could be chatting,
[6:52] SPEAKER_00: you know,
[6:53] SPEAKER_00: to a mate at,
[6:54] SPEAKER_00: you know,
[6:54] SPEAKER_00: the end of the phone,
[6:55] SPEAKER_00: even though they were sort of, you know, the great big ponder part.
[6:59] SPEAKER_00: But we have this intimate relationship with our phone and that is where we see influences.
[7:04] SPEAKER_00: They pop up.
[7:05] SPEAKER_00: It might be where we speak to our grandkids,
[7:07] SPEAKER_00: our kids, our parents, our grandparents, our friends.
[7:10] SPEAKER_00: But then You get a snapshot into their environment.
[7:14] SPEAKER_00: So one trope is sitting behind the steering wheel of a car.
[7:19] SPEAKER_00: You feel like you're on a journey with them or in the female space putting lipstick
[7:24] SPEAKER_00: on or doing your makeup and having these very personal conversations
[7:27] SPEAKER_00: or you've got kids running around in the background.
[7:29] SPEAKER_00: You're in your messy kitchen.
[7:31] SPEAKER_00: So they give this sense of we are like you.
[7:34] SPEAKER_00: We are just like you.
[7:36] SPEAKER_00: And where people get advice from,
[7:38] SPEAKER_00: often they turn to their relatives or they turn to their friends for advice.
[7:42] SPEAKER_00: And then how they foster these relationships is they drop into the comment section.
[7:47] SPEAKER_00: So you post a comment under a reel on Instagram,
[7:50] SPEAKER_00: say, for example, and they will pick up on that comment.
[7:53] SPEAKER_00: Or the big currency now is something I've heard only recently,
[7:56] SPEAKER_00: and it was from an academic at the University of Colorado,
[8:01] SPEAKER_00: is that trans-parasocial relationships.
[8:03] SPEAKER_00: So you develop that relationship in direct messaging,
[8:07] SPEAKER_00: which if you are a regulator, it's very hard to regulate those conversations.
[8:12] SPEAKER_00: So you continue those conversations.
[8:15] SPEAKER_00: So that's how these relationships are built up.
[8:18] SPEAKER_00: And increasingly as well,
[8:21] SPEAKER_00: the drug industry are using patient influencers to market directly to patients.
[8:28] SPEAKER_00: And unlike you've got the Sunshine Act in the United States
[8:31] SPEAKER_00: where you register those relationships,
[8:34] SPEAKER_00: those relationships with drug companies, and we've got something similar in the UK.
[8:39] SPEAKER_00: You guys were the first on to it.
[8:40] SPEAKER_00: We always say America sneezes, the UK catches a cold.
[8:44] SPEAKER_00: And that was one of those instances.
[8:47] SPEAKER_00: But you don't have that sort of transparency where you know
[8:52] SPEAKER_00: which patients are working with companies and it's very, very hard to study.
[8:56] SPEAKER_00: So you've got all this big market.
[8:57] SPEAKER_00: I sort of think of social media in some ways as Big platform that is geared
[9:04] SPEAKER_00: towards shopping and entertainment at the same time.
[9:09] SPEAKER_00: And it's one thing if you want to buy a pair of sneakers or you want to buy
[9:12] SPEAKER_00: a handbag, but it's quite something different when you're talking about your house.
[9:17] SPEAKER_01: Yeah, no, this is really important when you brought out.
[9:20] SPEAKER_01: And the Sunshine Act really applies to, in the U.S., the physicians that have ties to pharma.
[9:28] SPEAKER_01: But these influencers, they're not physicians.
[9:30] SPEAKER_01: They're, you know, anybody out there, and they don't necessarily have any disclosures.
[9:36] SPEAKER_01: There's a profit motive here that's,
[9:39] SPEAKER_01: and even if they disclose that they're getting paid to help promote something,
[9:44] SPEAKER_01: that doesn't mean that it's That negates the concern of conflict.
[9:50] SPEAKER_01: And this is a mega industry.
[9:52] SPEAKER_01: I think you point out over 30 some billion dollars a year in the US.
[9:57] SPEAKER_01: Now, you really bring up a critical point that I think may be intuitive,
[10:04] SPEAKER_01: but let's really get into that.
[10:07] SPEAKER_01: And that is this inverted pyramid of evidence and the complete displacement of trust.
[10:15] SPEAKER_01: In the past,
[10:17] SPEAKER_01: we would believe randomized trials and meta-analyses of the randomized trials
[10:23] SPEAKER_01: the top of the chain pyramid for data and evidence,
[10:28] SPEAKER_01: and the anecdotes By influencers as the absolute bottom, below the pyramid.
[10:34] SPEAKER_01: And then now that's flipped because the public is now more apt to believe these anecdotes.
[10:39] SPEAKER_01: And as evidence for that, you bring up in the book that an anecdote could have 20 million views.
[10:46] SPEAKER_01: But the results of a new,
[10:48] SPEAKER_01: important,
[10:49] SPEAKER_01: randomized,
[10:50] SPEAKER_01: controlled trial of most rigorous evidence,
[10:52] SPEAKER_01: that might not get any views or, you know, get 100.
[10:56] SPEAKER_01: So we have a whole flip.
[10:58] SPEAKER_01: And this really is, as you wrote, reconstructing the perception of authority.
[11:04] SPEAKER_01: That is,
[11:05] SPEAKER_01: doctors losing trust,
[11:07] SPEAKER_01: the medical community losing trust,
[11:10] SPEAKER_01: and it's being pushed over to Influencers,
[11:15] SPEAKER_01: and of course, those who sponsor the influencers.
[11:17] SPEAKER_01: So this is a really sad truth.
[11:22] SPEAKER_01: This is the Ground Truths podcast of the flip of what is information and facts
[11:30] SPEAKER_01: and evidence and what is the misinformation and that is highly conflicted
[11:36] SPEAKER_01: and bogus stuff.
[11:38] SPEAKER_01: So let's get your comments about that.
[11:41] SPEAKER_00: So there's lots of different levels.
[11:42] SPEAKER_00: We know storytelling is important and we know stories resonate.
[11:46] SPEAKER_00: Humans, we like a story.
[11:49] SPEAKER_00: And as a TV reporter,
[11:51] SPEAKER_00: particularly when I was at ITV News,
[11:53] SPEAKER_00: actually when I was at the BBC as well,
[11:55] SPEAKER_00: when I was a reporter for the BMJ doing their investigative journalism,
[11:59] SPEAKER_00: I didn't have to worry about case studies so much.
[12:01] SPEAKER_00: I could just hit doctors and academics hard with the evidence and the information.
[12:06] SPEAKER_00: It's totally different when you work in mainstream media.
[12:11] SPEAKER_00: One of the great challenges for me was always finding that case study
[12:15] SPEAKER_00: that represented the evidence, that could best represent the evidence.
[12:18] SPEAKER_00: And obviously, that often is very, very hard to do.
[12:21] SPEAKER_00: But people respond to storytelling.
[12:26] SPEAKER_00: And I think that's possibly a lesson that we need to learn perhaps.
[12:30] SPEAKER_00: In a previous, I studied medicine, so I trained to be a doctor originally.
[12:34] SPEAKER_00: But we need to think about how people consume information and what information they respond to.
[12:41] SPEAKER_00: If you're consuming your information from Instagram and TikTok,
[12:45] SPEAKER_00: where you've got all these stories,
[12:47] SPEAKER_00: then all of a sudden you're hit hard with this dense text,
[12:50] SPEAKER_00: let's say in the UK on the NHS website,
[12:53] SPEAKER_00: you can see perhaps why engagement might drop.
[12:57] SPEAKER_00: But it has flicked on its head and that the power of the story is really hard
[13:02] SPEAKER_00: to talk uncertainty.
[13:04] SPEAKER_00: And, you know,
[13:05] SPEAKER_00: we know medicine is inherently uncertain,
[13:08] SPEAKER_00: where on Instagram and TikTok, it's all about certainty.
[13:14] SPEAKER_00: It's almost where uncertainty goes to die.
[13:19] SPEAKER_00: And it's quite hard sometimes to talk in terms of risk and statistics in a very,
[13:25] SPEAKER_00: very short video clip.
[13:28] SPEAKER_00: And that's where the power of the story grabs.
[13:31] SPEAKER_00: And then it's the polarization as well.
[13:33] SPEAKER_00: So the algorithms obviously prioritize drama.
[13:37] SPEAKER_00: And we know medicine's grey and messy and uncertain and two doctors might disagree
[13:42] SPEAKER_00: about or have differing views on a certain procedure and
[13:46] SPEAKER_00: then you take patient preferences on top.
[13:49] SPEAKER_00: One of the things I think is really interesting with all of this is
[13:53] SPEAKER_00: when doctors see patients,
[13:56] SPEAKER_00: you think about what their ideas, concerns, expectations, ice.
[14:00] SPEAKER_00: And inevitably that is shaped by the environment and the culture and the society around you.
[14:06] SPEAKER_00: And that powerful storytelling on social media plays into that.
[14:11] SPEAKER_00: So, for example,
[14:12] SPEAKER_00: menopause hormone therapy,
[14:14] SPEAKER_00: it's a lifesaver or menopause hormone therapy,
[14:17] SPEAKER_00: it's an absolute disaster where the truth often is,
[14:21] SPEAKER_00: is somewhere in that murky middle.
[14:23] SPEAKER_00: And I think the challenges for medicine is what you've got
[14:27] SPEAKER_00: on social media is absolute certainty that Given to you that,
[14:32] SPEAKER_00: you know,
[14:32] SPEAKER_00: I understand you,
[14:33] SPEAKER_00: I hear you,
[14:34] SPEAKER_00: I see you,
[14:35] SPEAKER_00: I believe you,
[14:36] SPEAKER_00: which there are concerns that mainstream media, sorry,
[14:39] SPEAKER_00: mainstream media,
[14:41] SPEAKER_00: mainstream medicine, traditional medicine, should I say, doesn't always offer that.
[14:45] SPEAKER_00: And you hear repeatedly about women's concerns not being validated
[14:49] SPEAKER_00: and women's health not being invested in.
[14:52] SPEAKER_00: And I think the NIH didn't have women in clinical trials until 1993
[14:56] SPEAKER_00: or something like that, the same year as Jurassic Park came out.
[15:00] SPEAKER_00: So you hear that,
[15:01] SPEAKER_00: and then what social media offers you is that validation and that certainty,
[15:06] SPEAKER_00: but then flattens it into simple solutions,
[15:10] SPEAKER_00: where on the other hand,
[15:11] SPEAKER_00: medicine offers you perhaps complexity And not an obvious solution.
[15:19] SPEAKER_00: And sometimes really short appointments where you can't get everything out
[15:22] SPEAKER_00: and you lack some of that holistic care.
[15:24] SPEAKER_00: So you've got these two things that are diametrically opposed.
[15:28] SPEAKER_00: And it's a difficult environment.
[15:30] SPEAKER_00: And you can perhaps see where there the mistrust in doctors...
[15:36] SPEAKER_00: And trust in doctors comes from when,
[15:39] SPEAKER_00: and then I think one of the challenges becomes,
[15:41] SPEAKER_00: and repeatedly I heard this as well from physicians in the United States as well as
[15:46] SPEAKER_00: in the UK,
[15:48] SPEAKER_00: is if you end up having to spend the first half of your consultation unpicking,
[15:52] SPEAKER_00: unpacking what people have seen on social media,
[15:55] SPEAKER_00: it then compresses the time that you have to Yeah,
[15:59] SPEAKER_00: and you've summed it up very well, and it is indeed messy, uber-messy.
[16:19] SPEAKER_01: Everyone knows placebo,
[16:20] SPEAKER_01: how that expectations could lead to healing,
[16:24] SPEAKER_01: even though it's inert what you're taking.
[16:27] SPEAKER_01: But one of the big things,
[16:28] SPEAKER_01: and this is where I want to start getting into some examples that are so vivid in
[16:33] SPEAKER_01: the book to bring these points home,
[16:35] SPEAKER_01: the nocebo were actually harmed through exploitation.
[16:39] SPEAKER_01: So it's not enough that people are wasting money and they're getting duped by lack
[16:45] SPEAKER_01: of evidence and they're also...
[16:48] SPEAKER_01: So what happened during the pandemic?
[17:15] SPEAKER_00: And obviously the pandemic was a particularly unusual situation.
[17:19] SPEAKER_00: What was interesting about the pandemic as well is that was when we really saw
[17:23] SPEAKER_00: the rise,
[17:23] SPEAKER_00: particularly of TikTok, where,
[17:26] SPEAKER_00: you know,
[17:26] SPEAKER_00: in countries particularly that had lockdowns,
[17:29] SPEAKER_00: so the UK had quite stringent lockdowns,
[17:32] SPEAKER_00: people looked to other places to fill their time and social media was one of them.
[17:37] SPEAKER_00: And repeatedly I heard that from sort of influencers and content creators I spoke to.
[17:43] SPEAKER_00: But what happened was doctors around the world,
[17:45] SPEAKER_00: particularly in Anglophone countries,
[17:47] SPEAKER_00: so there was something separate in Germany as well,
[17:51] SPEAKER_00: had young people come and see them that had sort of young women in particular
[17:56] SPEAKER_00: with quite explosive tics and repeated words that they said like beans.
[18:02] SPEAKER_00: And really unusual presentation because there were Tourette's-like tics,
[18:08] SPEAKER_00: But they weren't the typical patient population that you'd see with tics.
[18:12] SPEAKER_00: So that's typically younger boys and they don't necessarily present with really explosive tics.
[18:18] SPEAKER_00: And I couldn't figure out what was happening.
[18:22] SPEAKER_00: And pediatricians in the UK started speaking to each other saying, what's going on?
[18:27] SPEAKER_00: And then they went on forums with pediatric neurologists and,
[18:30] SPEAKER_00: oh, look, it's happening in Canada.
[18:34] SPEAKER_00: Oh, Australia, it's happening too.
[18:37] SPEAKER_00: And they traced the origin of these tics back to TikTok.
[18:43] SPEAKER_00: And during the pandemic,
[18:44] SPEAKER_00: there was influencers who said they had these Tourette's-like tics
[18:50] SPEAKER_00: and they were explosive,
[18:51] SPEAKER_00: very visceral tics and there were patterns of the same behavior.
[18:56] SPEAKER_00: And there were all sorts of theories around this.
[18:58] SPEAKER_00: One of them was social contagion.
[19:02] SPEAKER_00: But the paediatricians eventually when they drilled down, actually it was a presentation.
[19:07] SPEAKER_00: And you think about in history when social contagion has happened,
[19:11] SPEAKER_00: you know,
[19:12] SPEAKER_00: classically the Arthur Miller's Crucible where the social contagion was happening,
[19:16] SPEAKER_00: where people were being accused of witches and there was fear in the community.
[19:22] SPEAKER_00: There was a lot of fear and young people were seeing their relatives dying or on
[19:28] SPEAKER_00: the news or they couldn't see their friends.
[19:31] SPEAKER_00: And so you had this sort of cauldron where fear and concerns were bubbling along.
[19:36] SPEAKER_00: And what they said to me and what was published in medical journals as well was
[19:42] SPEAKER_00: that these were expressions of fear and anxiety in young people.
[19:47] SPEAKER_00: Some of it was pure copycat behavior.
[19:49] SPEAKER_00: But for each young patient that came through the door,
[19:52] SPEAKER_00: they'd have to really explore what was going on beneath the surface.
[19:57] SPEAKER_00: But there was no doubt that these behaviors, these symptoms were absolutely real.
[20:02] SPEAKER_00: They weren't faking it.
[20:05] SPEAKER_00: But it was this sort of copycat behavior that was triggering this sort
[20:10] SPEAKER_00: of mass nocebo effect, if you like.
[20:14] SPEAKER_00: But there were ways of showing distress.
[20:16] SPEAKER_00: Now, what was interesting,
[20:18] SPEAKER_00: what happened in the UK was that some of the pediatric neurologists decided to get
[20:24] SPEAKER_00: in touch with the influencers that were, you know, were sort of behind these tips.
[20:31] SPEAKER_00: And they found that they were selling merchandise.
[20:34] SPEAKER_00: They found that they were monetizing their symptoms,
[20:37] SPEAKER_00: and the more viral you become, it becomes a perverse incentive.
[20:41] SPEAKER_00: And the more extreme your behaviors,
[20:43] SPEAKER_00: the more likely you were to go viral,
[20:44] SPEAKER_00: the more likely you were to drive money and revenue streams,
[20:48] SPEAKER_00: and you could promote your merchandise.
[20:51] SPEAKER_00: So what started off...
[20:56] SPEAKER_00: As a behaviour actually created very real symptoms in young distressed people.
[21:04] SPEAKER_00: And we've seen some patterns around this.
[21:07] SPEAKER_00: This happened in Colombia over the HPV vaccination as well,
[21:12] SPEAKER_00: where there was sort of epileptic-like symptoms.
[21:17] SPEAKER_00: But again, it was all viral through YouTube and platforms like that.
[21:22] SPEAKER_00: There was sort of mimicking behaviours.
[21:25] SPEAKER_01: Yeah, I mean, it's actually amazing.
[21:27] SPEAKER_01: It's like this viral contagion power of suggestion and then gets actualized
[21:34] SPEAKER_01: as true Physical symptoms.
[21:39] SPEAKER_01: And here are these teenage girls with TikTok.
[21:41] SPEAKER_01: I mean, this got 5.8 billion views as you reviewed in the book.
[21:45] SPEAKER_01: I mean, it's incredible.
[21:47] SPEAKER_01: But this is only one of many examples of this nocebo harm induced.
[21:54] SPEAKER_01: I want to have you go through a few others because I think they're fascinating
[21:58] SPEAKER_01: and I didn't know about them.
[22:00] SPEAKER_01: The one with the bioresonance of the hair strand,
[22:04] SPEAKER_01: Where the hair is dead and it doesn't have any quantum properties.
[22:08] SPEAKER_01: And there was a,
[22:08] SPEAKER_01: I guess it was a woman that was testing herself because
[22:12] SPEAKER_01: of gastrointestinal symptoms.
[22:14] SPEAKER_01: Can you take us through that one?
[22:16] SPEAKER_00: Yeah, and it shows up in different ways.
[22:18] SPEAKER_00: And actually on that note,
[22:19] SPEAKER_00: there's some really interesting experimental work going on in Australia at
[22:22] SPEAKER_00: the moment, in Sydney, where they're showing people symptoms, side effects of drugs.
[22:28] SPEAKER_00: And I think sometimes we forget the mind-body thing.
[22:33] SPEAKER_00: Component in healthcare, we sort of go down the very biomedical route sometimes.
[22:38] SPEAKER_00: And if you think about that Cartesian dualism,
[22:41] SPEAKER_00: you know, with Descartes where we separated the mind and body.
[22:45] SPEAKER_00: And that is something I think that we perhaps don't talk about enough.
[22:49] SPEAKER_00: We talk a lot about placebo,
[22:50] SPEAKER_00: but that placebo effect and what they're doing
[22:52] SPEAKER_00: in Australia is they're showing people potential side effects of drugs
[22:55] SPEAKER_00: on social media, comparing to read it.
[22:58] SPEAKER_00: Reading it in a leaflet and they're finding that people are expecting to get
[23:01] SPEAKER_00: the side effects more if they see it on social media.
[23:04] SPEAKER_00: That visual imagery is incredibly powerful.
[23:07] SPEAKER_00: But with the bioresonance testing,
[23:12] SPEAKER_00: and again,
[23:13] SPEAKER_00: this is one of the challenges with communicating uncertainty in medicine
[23:16] SPEAKER_00: and testing.
[23:17] SPEAKER_00: It starts with,
[23:18] SPEAKER_00: and this is all on the record,
[23:20] SPEAKER_00: a young woman, Ellie Matthews, who is having abdominal symptoms, bloating.
[23:27] SPEAKER_00: Has insurance in the UK and goes outside the National Health Service
[23:33] SPEAKER_00: and has all sorts of ultrasounds and tests and they can't find anything.
[23:37] SPEAKER_00: And, you know, oh, we can't find anything.
[23:38] SPEAKER_00: Don't worry about it.
[23:40] SPEAKER_00: But that doesn't alleviate her symptoms.
[23:43] SPEAKER_00: And this is the power of the algorithm where clearly she'd been seeing stuff online
[23:49] SPEAKER_00: and hovered on stuff that then sort of confirmed what she was suspecting.
[23:54] SPEAKER_00: So you get this element of confirmation bias that There's definitely something going on here.
[23:59] SPEAKER_00: I'm not happy with it.
[24:00] SPEAKER_00: And her algorithm is feeding her more and more information.
[24:04] SPEAKER_00: And it's what actually interesting one health psychologist said to me.
[24:09] SPEAKER_00: This idea that the power of the algorithm,
[24:12] SPEAKER_00: the algorithm knows you better than you and it surfaces information
[24:15] SPEAKER_00: that you're not aware about.
[24:16] SPEAKER_00: And you see that in ADHD as well and other conditions.
[24:21] SPEAKER_00: But one health psychologist said to me, your algorithm knows your neuroses better than you do.
[24:27] SPEAKER_00: And it was this idea of food intolerance.
[24:32] SPEAKER_00: Perhaps it was a food intolerance and the way influencers were describing it to her,
[24:37] SPEAKER_00: it resonated.
[24:38] SPEAKER_00: It was like, yeah, that's it.
[24:39] SPEAKER_00: That's what I have got.
[24:41] SPEAKER_00: And offered all sorts of tests for it.
[24:43] SPEAKER_00: Well, there's not really that many food intolerances you can test for.
[24:47] SPEAKER_00: I mean, there's lactose intolerance on one or two others.
[24:51] SPEAKER_00: These are obviously very different to allergies.
[24:54] SPEAKER_00: Yeah.
[24:55] SPEAKER_00: And she found this test, it was only like 20 quid, so what, $30?
[25:00] SPEAKER_00: And thought it was a real simple, easy way, cut off a piece of hair, stick it in the post.
[25:05] SPEAKER_00: She sort of didn't think too much about it.
[25:08] SPEAKER_00: Then got back these reams of documents showing her all sorts of food
[25:13] SPEAKER_00: that she couldn't eat, like flashing reds.
[25:17] SPEAKER_00: So she went on to social media to share this.
[25:20] SPEAKER_00: She wasn't actually being sponsored by the company,
[25:22] SPEAKER_00: but she thought, well, if it's going to help me, look what I've got.
[25:26] SPEAKER_00: It's going to help somebody else.
[25:28] SPEAKER_00: And then eliminated all these foods from her diet,
[25:31] SPEAKER_00: like bananas and cheese and stuff that was quite healthy.
[25:36] SPEAKER_00: And it was only when she thought, hang on, is this really helping?
[25:41] SPEAKER_00: And in some ways she thought it was.
[25:43] SPEAKER_00: And she actually said to me, it was possibly placebo effect.
[25:47] SPEAKER_00: And that she then thought, oh, maybe testing your hair for food intolerance isn't a good thing.
[25:55] SPEAKER_00: But yet her video was still out there.
[25:57] SPEAKER_00: Her reel was still out there garnering lots and lots of views.
[26:02] SPEAKER_00: And what was interesting, there was a study done and it was published in the Lancet.
[26:05] SPEAKER_00: It was done in the UK in the 90s where I think it was about 20% of
[26:09] SPEAKER_00: the population thought they had a food intolerance.
[26:14] SPEAKER_00: But when they actually tested it, it was less than 2%.
[26:18] SPEAKER_00: There was only a tiny percentage of that.
[26:20] SPEAKER_00: And they did blinded food tests of the foods that they thought they were intolerant to.
[26:25] SPEAKER_00: But this idea of I get this symptom after I eat this food,
[26:29] SPEAKER_00: even if you don't, there's a powerful nocebo effect there as well.
[26:32] SPEAKER_01: Oh, yeah, yeah.
[26:33] SPEAKER_01: No, this is big.
[26:35] SPEAKER_01: Food fear, engendering food fear.
[26:37] SPEAKER_01: So there's questions that have been coming in.
[26:41] SPEAKER_01: Before I go on to the next,
[26:43] SPEAKER_01: these are remarkable anecdotes, but I'll just yield a couple of those.
[26:47] SPEAKER_01: And by the way, if you have questions, just put them in where it says right message.
[26:51] SPEAKER_01: We'll try to get to them.
[26:53] SPEAKER_01: Stephen Korn says, how do we address this transparency issue?
[26:58] SPEAKER_01: Because obviously a lot of these things
[27:01] SPEAKER_01: that are getting amplified don't Even disclose the profits, even on a per basis.
[27:09] SPEAKER_01: Each supplement they sell, each this and that, they have hidden financial benefits.
[27:17] SPEAKER_01: Do you have any ideas about how to fix that?
[27:20] SPEAKER_00: Well, I mean,
[27:20] SPEAKER_00: there is potentially,
[27:22] SPEAKER_00: and this is what's interesting,
[27:23] SPEAKER_00: is actually of all the health interventions,
[27:26] SPEAKER_00: for want of a better expression,
[27:27] SPEAKER_00: that are offered on social media,
[27:29] SPEAKER_00: the drug industry, pharmaceutical industry is the best regulated industry.
[27:34] SPEAKER_00: And there is the sunshine act around it.
[27:36] SPEAKER_00: And that, I think, includes medical devices as well, doesn't it?
[27:39] SPEAKER_00: But things like hip implants and all that kind of stuff.
[27:43] SPEAKER_00: So there is the argument, and there are patient groups that are working on this.
[27:49] SPEAKER_00: Someone called Sneha Dave that leads
[27:52] SPEAKER_00: a US-based patient group called Generation Patient that is advocating for this at
[27:58] SPEAKER_00: the FDA.
[28:00] SPEAKER_00: There should be some kind of equivalent for influencers as well.
[28:03] SPEAKER_00: So there should be,
[28:04] SPEAKER_00: if you are a patient influencer,
[28:07] SPEAKER_00: it should be published in the same way as doctors
[28:12] SPEAKER_00: because you're clearly having some kind of effect.
[28:17] SPEAKER_00: And again, there's an absence of data here about the impact.
[28:22] SPEAKER_00: There's stuff,
[28:23] SPEAKER_00: and I think it was JAMA actually only a week or two ago had,
[28:29] SPEAKER_00: it was Aaron Kesselheim had a piece looking at celebrities on social media.
[28:34] SPEAKER_01: Yeah, it was the New England Journal.
[28:37] SPEAKER_00: New England Journal, yeah, yeah.
[28:38] SPEAKER_00: Sorry, I got the wrong journal.
[28:40] SPEAKER_01: Okay.
[28:42] SPEAKER_01: Yes, about the celebrity influence.
[28:44] SPEAKER_01: Yes, absolutely.
[28:46] SPEAKER_01: We're going to get into that in just a moment with Total Body MRI.
[28:51] SPEAKER_00: But we don't know.
[28:52] SPEAKER_00: All the evidence so far,
[28:54] SPEAKER_00: and I know I'm slightly digressing here,
[28:56] SPEAKER_00: but all the evidence we know about the impact of prescription drug advertising comes
[29:01] SPEAKER_00: from TV, newsprint,
[29:05] SPEAKER_00: Which has clearly defined adverts.
[29:08] SPEAKER_00: Whenever I go to the US and I'm in my hotel and I turn on the TV
[29:11] SPEAKER_00: and there's drug ads, I'm like, oh, by the end of it, I'm like, oh.
[29:17] SPEAKER_00: We're not used to that in Europe.
[29:18] SPEAKER_00: So it's a brave new world for us.
[29:22] SPEAKER_00: But that's with the glossy ads.
[29:23] SPEAKER_00: What we don't know is the impact of that when it's those parasocial relationships
[29:29] SPEAKER_00: and those intimate relationships that have already been built up.
[29:33] SPEAKER_00: And so I think there are big questions around that.
[29:35] SPEAKER_00: And how do you even study it is one thing.
[29:39] SPEAKER_00: So going back,
[29:41] SPEAKER_00: and actually,
[29:43] SPEAKER_00: the only evidence I know from Europe actually comes from a PR company,
[29:46] SPEAKER_00: either Edelman or Ogilvy,
[29:48] SPEAKER_00: I can't totally imagine,
[29:49] SPEAKER_00: I think it was Edelman,
[29:50] SPEAKER_00: where 30%,
[29:51] SPEAKER_00: their survey suggests 37% of European patients who are surveyed,
[29:56] SPEAKER_00: when we have a ban on that to consumer advertising,
[30:00] SPEAKER_00: have been I've gone to inquire about a drug based on what they've seen
[30:03] SPEAKER_00: on social media.
[30:04] SPEAKER_00: And equally, physicians have prescribed on the basis.
[30:09] SPEAKER_00: The percentage isn't as many, but it shows you that that information is being carried forward.
[30:14] SPEAKER_00: But we have an absence of evidence of the impact of this.
[30:18] SPEAKER_00: And actually,
[30:18] SPEAKER_00: Professor Patrick Chinnery,
[30:20] SPEAKER_00: who is the exec chair of the Medical Research Council,
[30:24] SPEAKER_00: the big research body in the UK,
[30:26] SPEAKER_00: funder in the UK,
[30:28] SPEAKER_00: asked me a few times when I was writing the book,
[30:30] SPEAKER_00: he said,
[30:30] SPEAKER_00: What's the impact of all of this, both on patients but our National Health Service?
[30:35] SPEAKER_00: What's it doing to demand and the impact on demand?
[30:39] SPEAKER_00: And the answer is we don't know,
[30:41] SPEAKER_00: although politicians in the UK are starting to take a bit of interest.
[30:44] SPEAKER_00: I've had a few meetings with various MPs about this issue.
[30:48] SPEAKER_00: But going back to the transparency issue,
[30:50] SPEAKER_00: there has to be transparency, but I think we need to be a
[30:55] SPEAKER_00: One thing I say to people who,
[30:58] SPEAKER_00: and we're cognizant of this in healthcare, we talk about this on medical journals.
[31:03] SPEAKER_00: I worked on the BMJ for 12 years and we have the International Consortium
[31:08] SPEAKER_00: of Medical Journal Editors checklist of conflicts of interest
[31:11] SPEAKER_00: and those declarations are published.
[31:14] SPEAKER_00: You know, there are flaws in the system, but it's a step.
[31:18] SPEAKER_00: And I think one of the things that I say to people is,
[31:22] SPEAKER_00: first of all, ask, why should I believe you?
[31:25] SPEAKER_00: Why are you on this platform?
[31:27] SPEAKER_00: And there are some perfectly legitimate people on there who genuinely want
[31:31] SPEAKER_00: to help people share their experiences,
[31:33] SPEAKER_00: provide community,
[31:35] SPEAKER_00: provide support for people that have,
[31:38] SPEAKER_00: you know, illnesses, acute chronic illnesses that want to stay healthy.
[31:42] SPEAKER_00: So for example,
[31:43] SPEAKER_00: I I spoke to a breast surgeon,
[31:46] SPEAKER_00: UK breast surgeon,
[31:48] SPEAKER_00: and when she had breast cancer herself and was going through chemo and radiotherapy,
[31:54] SPEAKER_00: she had a whole community of support on social media that gave her tips
[31:58] SPEAKER_00: when she was having all the sickness associated with chemo.
[32:02] SPEAKER_00: So there are very, very much positives there.
[32:04] SPEAKER_00: But what I do say to people is, Think about why someone's on that platform.
[32:09] SPEAKER_00: Ask them, are they trying to sell me something?
[32:11] SPEAKER_00: Are they amplifying and becoming more extreme in their voices?
[32:15] SPEAKER_00: Like we heard with TikTok tics and we see with ADHD because they know they're going viral.
[32:21] SPEAKER_00: So I think there's an element of literacy, health literacy around it.
[32:27] SPEAKER_00: One of the issues is sometimes the adverts, they're not obvious.
[32:30] SPEAKER_00: You get the little hashtag ad at the bottom of the comments beneath the reel or
[32:36] SPEAKER_00: the post and we sort of skip past them.
[32:39] SPEAKER_00: But that sort of healthy scepticism possibly should be We should learn much more
[32:46] SPEAKER_00: about that,
[32:47] SPEAKER_00: understand the algorithm or teaching around the algorithm
[32:51] SPEAKER_00: if governments don't do anything about the algorithm.
[32:53] SPEAKER_00: Although I did notice this today that France has instituted a social media ban for
[32:58] SPEAKER_00: the under-15s.
[32:59] SPEAKER_00: But equally,
[33:01] SPEAKER_00: my girlfriends that are thinking about menopause hormone therapy and things like
[33:05] SPEAKER_00: that are turning to social media.
[33:07] SPEAKER_00: So I think we need to be a lot more health literate and there does need
[33:11] SPEAKER_00: to be more transparency.
[33:12] SPEAKER_00: If we require that of physicians or we require that of adverts generally on TV
[33:21] SPEAKER_00: or radio or in magazines or in newspapers,
[33:24] SPEAKER_00: then we need to really be mindful that these are new ways of advertising
[33:29] SPEAKER_00: and marketing and there should be more transparency around that too.
[33:34] SPEAKER_01: Yeah, no, I think this is vital.
[33:37] SPEAKER_01: What you're reviewing is one of the reasons why I like your Bad Influence book
[33:40] SPEAKER_01: so much is you don't just go through the problems.
[33:42] SPEAKER_01: You go through, you know, how can we be better, which is equally important.
[33:47] SPEAKER_01: You know, it's Coming up with potential solutions to mitigate this mess that we're in.
[33:54] SPEAKER_01: Now, you touched on the pharma and the direct-to-consumer ads,
[33:59] SPEAKER_01: which has driven me crazy for decades.
[34:02] SPEAKER_01: I actually worked with a senator back when I lived in Ohio,
[34:06] SPEAKER_01: Senator Sherrod Brown, to put out a bill.
[34:09] SPEAKER_01: To outlaw direct-to-consumer ads.
[34:12] SPEAKER_01: It didn't go very far.
[34:13] SPEAKER_01: It never has.
[34:14] SPEAKER_01: And as you pointed to,
[34:16] SPEAKER_01: the US and then also New Zealand are the only countries in the world
[34:20] SPEAKER_01: that allow direct-to-consumer advertising.
[34:23] SPEAKER_01: And they're immensely successful or they wouldn't pay all this money.
[34:27] SPEAKER_01: But one of the things that is out there now,
[34:30] SPEAKER_01: which besides the microdosing of GLP-1 drugs where their data is zero,
[34:36] SPEAKER_01: I mean, you have nothing.
[34:38] SPEAKER_01: But the other one that is just galling is the Pronovo, the total body MRI.
[34:45] SPEAKER_01: So it's advertising for people to get a total body MRI.
[34:49] SPEAKER_01: It's all part of this proactive CEO of your health, and it also brings in the celebrity.
[34:54] SPEAKER_01: It started with Kim Kardashian, and now it has all these other celebrities.
[34:59] SPEAKER_01: And as you mentioned,
[35:00] SPEAKER_01: In that recent New England Journal piece by Aaron Kasselbaum,
[35:03] SPEAKER_01: he discussed this total bond MRI.
[35:06] SPEAKER_01: And all the data we have is that it does more harm than good,
[35:10] SPEAKER_01: as you reviewed in the book with the clinical cascade
[35:12] SPEAKER_01: of all these other rabbit hole testing and these cysts that,
[35:16] SPEAKER_01: you know,
[35:17] SPEAKER_01: and I've had patients,
[35:18] SPEAKER_01: as I mentioned in my book,
[35:20] SPEAKER_01: in superagers who they had almost bled to death from a liver biopsy
[35:24] SPEAKER_01: or There are collapsed lungs from a lung biopsy.
[35:27] SPEAKER_01: This is not innocuous, but it's being marketed.
[35:30] SPEAKER_01: And in the book,
[35:30] SPEAKER_01: you tell a story about a woman who paid,
[35:33] SPEAKER_01: I think, $25 or $2,600 to get a total body MRI.
[35:38] SPEAKER_01: Can you review that one?
[35:40] SPEAKER_00: Yeah, and it's fascinating that you raise that issue in your book as well.
[35:44] SPEAKER_00: I think there's a sense that we understand when we have a drug
[35:48] SPEAKER_00: that there are benefits, And there are harms.
[35:52] SPEAKER_00: It sort of seems you're taking this thing into your body and,
[35:54] SPEAKER_00: you know,
[35:55] SPEAKER_00: that makes sense and you weigh the benefit versus the harm and your preferences and
[36:00] SPEAKER_00: whether you do it.
[36:01] SPEAKER_00: I think what's shocking to people sometimes
[36:04] SPEAKER_00: or hasn't perhaps crossed their mind is diagnosis has a harm as well,
[36:08] SPEAKER_00: you know, for benefit for some but also a harm, but actually testing does.
[36:14] SPEAKER_00: And we're not just talking,
[36:15] SPEAKER_00: let's say,
[36:16] SPEAKER_00: the radiation from x-rays or CT scans,
[36:19] SPEAKER_00: but actually testing The whole process of screening in this particular instance,
[36:27] SPEAKER_00: and I go back to what I say about Barry Kramer saying,
[36:29] SPEAKER_00: you know, you're sick until proven healthy.
[36:32] SPEAKER_00: And you can understand why earlier is always better.
[36:36] SPEAKER_00: It's catchy.
[36:37] SPEAKER_00: It's a catchy term.
[36:38] SPEAKER_00: It's easy.
[36:39] SPEAKER_00: And when you hear people say to me,
[36:41] SPEAKER_00: and people say to me, I just want to know what's going on inside me.
[36:44] SPEAKER_00: I sort of say, why?
[36:47] SPEAKER_00: Well, I might catch something.
[36:49] SPEAKER_00: You might catch something, there might be nothing.
[36:52] SPEAKER_00: And where does that take you?
[36:54] SPEAKER_00: And one of the issues is the more sensitive this tech gets,
[36:59] SPEAKER_00: The more things we're going to pick things up that we're not going to know about
[37:04] SPEAKER_00: in medicine,
[37:05] SPEAKER_00: you know,
[37:05] SPEAKER_00: our prognostic ability seems to sort of lag behind our ability to pick things up.
[37:12] SPEAKER_00: We're catching up.
[37:13] SPEAKER_00: We don't always know what things are.
[37:15] SPEAKER_00: The idea that more data is always better.
[37:17] SPEAKER_00: Well, is it?
[37:19] SPEAKER_00: Yes.
[37:20] SPEAKER_00: It's these things that we talk about in healthcare.
[37:22] SPEAKER_00: If you measure a biomarker,
[37:24] SPEAKER_00: you sort of need to know what that biomarker implies,
[37:26] SPEAKER_00: both in the short term or the long term,
[37:28] SPEAKER_00: the surrogate outcome,
[37:29] SPEAKER_00: if you like,
[37:30] SPEAKER_00: the surrogate and where that leads to some primary,
[37:32] SPEAKER_00: different sort of primary outcomes if you do and don't do something about it.
[37:36] SPEAKER_00: So in the book, I tell the story about a woman and she's in the US.
[37:40] SPEAKER_00: We have Prenuvo in London.
[37:43] SPEAKER_00: So it's not just in the US as well.
[37:45] SPEAKER_00: And then Neco Health,
[37:46] SPEAKER_00: so Daniel Ek,
[37:48] SPEAKER_00: who set up Spotify,
[37:49] SPEAKER_00: he's on the case now with Neco Health and there's been
[37:53] SPEAKER_00: a massive PR push around those.
[37:57] SPEAKER_00: And actually screening as a journalist is one of the hardest things to tell or one
[38:03] SPEAKER_00: of the hardest stories to tell because we always think,
[38:05] SPEAKER_00: well, if it saves the life, why wouldn't you do it?
[38:08] SPEAKER_00: It's quite hard to argue against that.
[38:10] SPEAKER_00: What you don't see Is all the over-diagnosis,
[38:14] SPEAKER_00: the false positives,
[38:15] SPEAKER_00: the false negatives,
[38:16] SPEAKER_00: the anxiety,
[38:18] SPEAKER_00: the going down these rabbit holes,
[38:20] SPEAKER_00: these clinical cascades of more and more invasive tests that are costly
[38:24] SPEAKER_00: and potentially lead to harm.
[38:26] SPEAKER_00: And obviously you've got your preventative services task force in the United States.
[38:31] SPEAKER_00: We have our national screening committee in the UK that have very strict criteria
[38:36] SPEAKER_00: for That were developed by the WHO several decades ago that determine what is
[38:44] SPEAKER_00: a good screening test.
[38:47] SPEAKER_00: What you need to show to be rolled out as screening.
[38:50] SPEAKER_00: So whether that's breast screening or cervical screening or bowel screening.
[38:54] SPEAKER_00: And what's interesting with a full body MRI,
[38:56] SPEAKER_00: there isn't a single medical body in the world that recommends them
[38:59] SPEAKER_00: for screening purposes.
[39:01] SPEAKER_01: They recommend against it, yeah.
[39:03] SPEAKER_00: They recommend against it.
[39:04] SPEAKER_00: And you think,
[39:05] SPEAKER_00: you know,
[39:05] SPEAKER_00: cynically,
[39:07] SPEAKER_00: there are radiologists,
[39:09] SPEAKER_00: because well and truly cash in if they wanted to offer it,
[39:12] SPEAKER_00: but actually the American College of Radiology specifically recommends against it.
[39:17] SPEAKER_00: Yeah.
[39:19] SPEAKER_00: And so I follow a story of a woman that did have the odd migraine and she saw
[39:25] SPEAKER_00: a friend had become an influencer on social media
[39:29] SPEAKER_00: and started promoting these full body MRIs.
[39:32] SPEAKER_00: And she thought, well, why not?
[39:34] SPEAKER_00: I don't believe we take preventative medicine seriously enough.
[39:38] SPEAKER_00: There's a disincentive here.
[39:40] SPEAKER_00: We want to get everybody onto drugs and treatments.
[39:43] SPEAKER_00: And I think that's where from picking this idea that we want people to become sick
[39:48] SPEAKER_00: or health systems want people to become sick because that's where they make
[39:52] SPEAKER_00: the money.
[39:53] SPEAKER_00: The irony was she turned to Prenuvo that was making a lot of money to get the checks.
[39:59] SPEAKER_00: And she went through a full body MRI and they found lesions.
[40:05] SPEAKER_00: They found one on a cerebellum in a brain and she found one on a Her kidney.
[40:10] SPEAKER_00: And she went into absolute panic mode because she'd been having headaches.
[40:14] SPEAKER_00: Then that clearly for her was a source.
[40:19] SPEAKER_00: She went to see her neurologist who did a scan and there was nothing on the neurologist's scan.
[40:26] SPEAKER_00: And then which one do you believe?
[40:29] SPEAKER_00: If you've got one showing a positive and one showing a negative, which one do you believe?
[40:34] SPEAKER_00: It's a real dilemma.
[40:36] SPEAKER_00: So then she went back to Pranivo and they did a scan and they found nothing.
[40:41] SPEAKER_00: But they actually had a complementary full-body MRI and it was clear.
[40:46] SPEAKER_00: So effectively, it was artifact.
[40:48] SPEAKER_00: It was a sort of expensive floor of the test, if you like.
[40:51] SPEAKER_00: Meanwhile, she spent thousands upon thousands of dollars and had huge anxiety and worry.
[40:59] SPEAKER_00: And now is still left with the idea which ones of these tests are Are actually right.
[41:08] SPEAKER_01: If I could recall in the book, she got an automated message.
[41:12] SPEAKER_01: You have a brain lesion.
[41:14] SPEAKER_01: I mean, how would you like that, right?
[41:16] SPEAKER_00: It's a quick phone call.
[41:19] SPEAKER_00: She thought she was going to see a neurologist,
[41:22] SPEAKER_00: a doctor, a physician, to get the results, and she didn't get that.
[41:25] SPEAKER_00: That wasn't what the influencers had said that were marketing this.
[41:28] SPEAKER_00: And Prenuvo were clever.
[41:30] SPEAKER_00: And this is, as someone that's worked in the mainstream media...
[41:34] SPEAKER_00: They then went to New York Fashion Week and were giving sort of Zappos and
[41:39] SPEAKER_00: the fashion designer, you know, these, they were marketing it there.
[41:43] SPEAKER_00: So you've got all this sort of clinical utility chic meets high fashion in you
[41:48] SPEAKER_00: and they were posting it.
[41:50] SPEAKER_00: And then newspapers then picked up on this was going on on social media with the celebrities.
[41:56] SPEAKER_00: And so then you get the mainstream press coverage as well.
[42:00] SPEAKER_00: And the mainstream press feeds off social media.
[42:03] SPEAKER_00: So you get this weird symbiotic relationship.
[42:06] SPEAKER_00: Sometimes it will unpick the misinformation on social media,
[42:09] SPEAKER_00: but sometimes it will follow the trends.
[42:11] SPEAKER_00: Then Vogue, you know, you've got these glossy pages and Vogue dedicated to full body MRR.
[42:17] SPEAKER_00: So this marketing then sort of trickles down.
[42:21] SPEAKER_00: And you can understand why a celebrity might think, oh, well, Earlier is always better.
[42:27] SPEAKER_00: And we know that isn't always the case.
[42:30] SPEAKER_00: And it was Gilbert Welsh from the US and Steve Woloshan that have written about
[42:37] SPEAKER_00: the idea that,
[42:38] SPEAKER_00: you know,
[42:38] SPEAKER_00: what happened in South Korea when they rolled out thyroid screening
[42:43] SPEAKER_00: or they offered screening and they included thyroid on it.
[42:47] SPEAKER_00: And what was happening is more and more people ended up having their thyroid removed
[42:51] SPEAKER_00: and having the replacement hormones, but they didn't shift the dial on deaths.
[42:55] SPEAKER_00: And so people were being overtreated because the thyroid cancer was not going to kill them.
[43:01] SPEAKER_00: But these things,
[43:02] SPEAKER_00: I think,
[43:02] SPEAKER_00: in people's minds,
[43:03] SPEAKER_00: this sort of idea of overdiagnosis as well, is quite hard to get your head around.
[43:09] SPEAKER_00: You hear the cancer word, and it sends the fear of God into it.
[43:12] SPEAKER_01: Oh, yeah.
[43:12] SPEAKER_01: You know, what's crazy about this, too, is that it doesn't prevent.
[43:17] SPEAKER_01: That's what it's...
[43:19] SPEAKER_01: Prenovo, Prevent, it's detecting things.
[43:23] SPEAKER_01: So if it does detect the cancer in a very small percent, I mean, a rare,
[43:28] SPEAKER_01: true positive,
[43:30] SPEAKER_01: there's already billions of cells there,
[43:32] SPEAKER_01: you know, The argument that it's actually early detection is still questionable.
[43:36] SPEAKER_01: But on the other hand,
[43:38] SPEAKER_01: as documented in multiple articles,
[43:40] SPEAKER_01: the chance of having a benign finding,
[43:44] SPEAKER_01: which requires extensive workup,
[43:46] SPEAKER_01: is much, much higher than picking up an actual cancer.
[43:52] SPEAKER_01: Deborah Pulaski's had a couple of questions along the way.
[43:55] SPEAKER_01: She started out right when we started talking about, should we just be using concierge doctors?
[44:00] SPEAKER_01: And she also just made the point about that REMS bone scan,
[44:04] SPEAKER_01: I'm not even familiar with that,
[44:06] SPEAKER_01: has been marketed and the DEXA scan help people get their bone density,
[44:12] SPEAKER_01: but also to get muscle and fat data.
[44:17] SPEAKER_01: So maybe you could comment about...
[44:20] SPEAKER_01: Should we, I mean,
[44:21] SPEAKER_01: I don't think concierge physicians are as popular in the UK as they are in the US.
[44:29] SPEAKER_01: Oh, they are?
[44:30] SPEAKER_00: Yeah, well, we've got problems with our NHS.
[44:33] SPEAKER_00: And wherever you've got a gap,
[44:35] SPEAKER_00: wherever you've got a need, there's always someone there to fill it.
[44:38] SPEAKER_01: Yeah, well,
[44:38] SPEAKER_01: that's interesting because I have a real strong view about,
[44:42] SPEAKER_01: you know, egalitarianism in medicine.
[44:44] SPEAKER_01: And, you know, I had the privilege to help with the NHS review for a couple of years.
[44:48] SPEAKER_01: And I know that's kind of central to the ethos of the UK.
[44:55] SPEAKER_01: But, you know,
[44:56] SPEAKER_01: I don't know that that's the solution to what we've been talking about
[44:58] SPEAKER_01: because it isn't even the physicians here.
[45:00] SPEAKER_01: They've been basically put aside, crowded out by the influencers.
[45:05] SPEAKER_01: So I don't know if you agree with that point.
[45:08] SPEAKER_00: I think there's some, there's some that capitalized on it.
[45:11] SPEAKER_00: And this is where I, I guess, have a few issues.
[45:15] SPEAKER_00: And I think possibly with my background is that there are doctors,
[45:21] SPEAKER_00: physicians that are promoting stuff,
[45:24] SPEAKER_00: glucose monitors or clinics that prescribe whacking great doses of estrogen
[45:30] SPEAKER_00: that are not recommended by our regulators or our National Institute of Health
[45:35] SPEAKER_00: and Care Excellence, NICE, As it's called.
[45:39] SPEAKER_00: And they are using social media as a platform to offer their services.
[45:44] SPEAKER_00: It's like a front door for them.
[45:46] SPEAKER_00: And then they offer telehealth.
[45:49] SPEAKER_00: And that is one of the big changes I think we've seen is that massive rise in telehealth.
[45:54] SPEAKER_00: And that happened again a lot during the pandemic.
[45:57] SPEAKER_00: I'm aware it happened in the US and in the UK.
[46:01] SPEAKER_00: Our general practitioners,
[46:02] SPEAKER_00: our primary care physicians had to suddenly pivot To doing stuff online.
[46:06] SPEAKER_00: And so people got used to telehealth and social media is a front door to that.
[46:12] SPEAKER_00: And what concerns me,
[46:14] SPEAKER_00: I think, in some of this and you hear is
[46:17] SPEAKER_01: physicians that are exploiting the system.
[46:20] SPEAKER_00: And whether that should or shouldn't surprise me, I don't know.
[46:23] SPEAKER_00: But you hope that they would know better.
[46:25] SPEAKER_00: So they'll develop the parasocial relationship.
[46:28] SPEAKER_00: I'm like you.
[46:29] SPEAKER_00: I'm just like you.
[46:30] SPEAKER_00: And they have this hero's journey where I was feeling rubbish.
[46:35] SPEAKER_00: I wasn't feeling well.
[46:36] SPEAKER_00: And then I discovered a glucose monitor,
[46:39] SPEAKER_00: continuous glucose monitor, and I changed my diet accordingly.
[46:42] SPEAKER_00: And guess what?
[46:43] SPEAKER_00: You can do it too.
[46:45] SPEAKER_00: Or I took these supplements.
[46:47] SPEAKER_00: And guess what?
[46:48] SPEAKER_00: I'm a doctor and I'm doing it.
[46:50] SPEAKER_00: So then they lead into authority bias.
[46:52] SPEAKER_00: So they built up this parasocial relationship and then lead into authority bias.
[46:57] SPEAKER_00: And I was on a panel recently with Naomi Oreskes,
[47:01] SPEAKER_00: who wrote Merchants of Doubt about the tobacco industry and Marion Nestle,
[47:04] SPEAKER_00: you know, with her work around the food industry.
[47:07] SPEAKER_00: And there were playbooks that they explored and they explored in those books.
[47:12] SPEAKER_00: There's also a social media playbook.
[47:15] SPEAKER_00: And that's different to what we know of old with the tobacco industry.
[47:20] SPEAKER_00: And they use this social media playbook to quite great effect.
[47:26] SPEAKER_00: Particularly in interventions that perhaps aren't regulated in the same way.
[47:31] SPEAKER_00: So the wellness products where you can use anecdote,
[47:34] SPEAKER_00: they'll push the anecdote until the trial has been completed.
[47:40] SPEAKER_00: And there was one Oxford academic said to me,
[47:44] SPEAKER_00: it's like we've changed medicine,
[47:46] SPEAKER_00: turned medicine around in some ways, where we used to have the null hypothesis.
[47:50] SPEAKER_00: We assumed something didn't work and then we set out to show whether it did or not.
[47:56] SPEAKER_00: Now we accept the alternative hypothesis.
[47:58] SPEAKER_00: This works until it doesn't.
[48:00] SPEAKER_00: And we might get the heck out of it until actually people get tired of it
[48:04] SPEAKER_00: or have moved on or went out to work.
[48:07] SPEAKER_01: Oh, you could have a long runway before that happens.
[48:11] SPEAKER_01: Absolutely.
[48:13] SPEAKER_01: You know, you get to the kind of raw feeling I have about this term wellness.
[48:19] SPEAKER_01: I absolutely agree.
[48:20] SPEAKER_01: Hate this term because you bring it into the wellness industrial complex.
[48:25] SPEAKER_01: And the point about it is, you know, you're sick until proven otherwise.
[48:28] SPEAKER_01: And this is, you know, the campaign to maintain wellness or get to wellness.
[48:34] SPEAKER_01: Linda Mosell asked about these influencers with no professional
[48:43] SPEAKER_01: training
[48:44] SPEAKER_01: who are marketing counseling.
[48:47] SPEAKER_01: Do you want to talk to that one?
[48:49] SPEAKER_00: Yeah, and certain terms that are protected and certain terms that aren't.
[48:53] SPEAKER_00: So the word coach and therapist, they're not protected terms.
[49:01] SPEAKER_00: Anyone can set themselves up.
[49:02] SPEAKER_00: And there's a whole sort of Ponzi scheme,
[49:05] SPEAKER_00: if you like,
[49:06] SPEAKER_00: around coaching where you become a coach and you set up a coach
[49:09] SPEAKER_00: to train more coaches.
[49:12] SPEAKER_00: And it grows.
[49:14] SPEAKER_00: And what's interesting about China,
[49:19] SPEAKER_00: Actually,
[49:19] SPEAKER_00: you have to have a qualification if you're going to do health advice
[49:23] SPEAKER_00: on their social media and you're not allowed to promote service.
[49:25] SPEAKER_00: I'm not advocating this necessarily happens and I'm not sure it'd go down very well
[49:29] SPEAKER_00: in the US or the UK for that matter.
[49:31] SPEAKER_00: But they've taken quite an extreme approach to be able to talk about health on the platforms.
[49:36] SPEAKER_00: I mean, the question I have about that is actually one of the powerful things
[49:40] SPEAKER_00: about social media is sharing experience and actually sharing Maybe that's
[49:44] SPEAKER_00: the right thing to do, though,
[49:45] SPEAKER_00: because if you're going to give mental health counseling and you have no background,
[50:00] SPEAKER_01: You know, that could really take a person off the tracks.
[50:04] SPEAKER_01: I mean, you're bringing up a whole other model here that can deal with it.
[50:10] SPEAKER_01: There's another story that I thought was fascinating that I wanted to get into,
[50:15] SPEAKER_01: which was the BII, the Breast Implant Illness.
[50:20] SPEAKER_00: Yeah.
[50:21] SPEAKER_01: Can you review that one?
[50:23] SPEAKER_00: And that is a very thorny subject.
[50:26] SPEAKER_00: Yeah.
[50:27] SPEAKER_00: There's this idea of illness.
[50:29] SPEAKER_00: There's that whole syndromic illness that is affecting women that have had breast implants.
[50:36] SPEAKER_00: And breast implants have had a real checkered history.
[50:39] SPEAKER_00: They were put onto the market with an absence of evidence,
[50:42] SPEAKER_00: an absence of long-term follow-up in the Institute.
[50:44] SPEAKER_00: And they were taken off the market by the FDA, except particularly for aesthetic reasons.
[50:50] SPEAKER_00: And they were only allowed for reconstructive surgery.
[50:53] SPEAKER_00: And this was in the 90s.
[50:54] SPEAKER_00: And then the Institute of Medicine did a really big report And found an absence
[50:58] SPEAKER_00: of evidence of harm.
[51:00] SPEAKER_00: But the companies that made them were required to do sort
[51:03] SPEAKER_00: of much longer studies looking at the impact.
[51:07] SPEAKER_00: And we've had scandal after scandal around breast implants.
[51:10] SPEAKER_00: We've had in Europe,
[51:13] SPEAKER_00: we had the PIP implant scandal that was basically silicone,
[51:17] SPEAKER_00: industrial silicone put inside the implants and they were leaking into women.
[51:21] SPEAKER_00: And then we've had implants removed.
[51:25] SPEAKER_00: And we've had the emergence of BIAAL,
[51:29] SPEAKER_00: which is a kind of blood cancer associated with breast implants.
[51:34] SPEAKER_00: But around it has this idea of these multi-syndromic symptoms associated with breast implants.
[51:45] SPEAKER_00: And it's everything from allergies and brain fog and tiredness, fatigue.
[51:51] SPEAKER_00: There's about 200 different symptoms.
[51:54] SPEAKER_00: And no one's actually found any causal association.
[51:59] SPEAKER_00: So the regulators recognized breast implant illness.
[52:02] SPEAKER_00: And it was a term that came from social media where women who have not felt heard
[52:09] SPEAKER_00: about their symptoms have joined up and have gathered forces and clubbed together
[52:16] SPEAKER_00: to talk about these issues.
[52:19] SPEAKER_00: But we don't really know what's causing it.
[52:22] SPEAKER_00: And There's been all sorts of various hypotheses,
[52:26] SPEAKER_00: whether it's an immune response to the silicon,
[52:29] SPEAKER_00: delayed responses, whether it was silicon migrating.
[52:36] SPEAKER_00: And then some say that there is,
[52:38] SPEAKER_00: again, an element of psychosomatic or psychogenic relationship with it.
[52:46] SPEAKER_00: And another suggestion, it's a mix of them all.
[52:50] SPEAKER_00: And it raises the idea that It's constantly talking about your symptoms.
[52:55] SPEAKER_00: Is that always a good thing?
[52:57] SPEAKER_00: And that has been...
[52:59] SPEAKER_00: So if you've got chronic pain,
[53:01] SPEAKER_00: talking about mapping your symptoms all the time, chronic pain, that's discouraged.
[53:09] SPEAKER_00: Do you want to continue talking about pain?
[53:10] SPEAKER_00: Because it focuses the mind back on those symptoms.
[53:14] SPEAKER_00: So there's big questions about it.
[53:17] SPEAKER_00: In trials so far, I haven't found any particular reason.
[53:21] SPEAKER_00: But women are very...
[53:25] SPEAKER_00: Disbelieving of the authorities.
[53:26] SPEAKER_00: And I think justifiably so in some ways,
[53:29] SPEAKER_00: because the evidence,
[53:31] SPEAKER_00: these were put onto the market before there was good research done on them.
[53:35] SPEAKER_00: So you can understand where that skepticism has come from.
[53:39] SPEAKER_00: But then what's happening now is communities are building around these symptoms
[53:44] SPEAKER_00: and they're advocating most extreme kinds of removal.
[53:48] SPEAKER_00: There are different ways of removing the implant symptoms.
[53:52] SPEAKER_00: And one is called unblocked capsulectomy, and that is reserved normally for breast cancer.
[53:57] SPEAKER_00: So it's very aggressive.
[53:58] SPEAKER_00: You take the breast implant in the capsule around with tissue around it,
[54:04] SPEAKER_00: it increases the risk of things like pneumothorax and other complications.
[54:08] SPEAKER_00: But women are being told,
[54:09] SPEAKER_00: this is the only way to get rid of your breast implants to alleviate your symptoms.
[54:15] SPEAKER_00: And surgeons are capitalizing on this and marketing themselves.
[54:19] SPEAKER_01: Oh, my God.
[54:20] SPEAKER_00: As specialists in unblocked capsulectomy,
[54:23] SPEAKER_00: sort of showing very graphic videos on social media of their handiwork
[54:29] SPEAKER_00: and advocating all sorts of therapies to get rid of the toxins.
[54:33] SPEAKER_00: And it was actually some US breast surgeons that investigated these surgeons
[54:38] SPEAKER_00: and said they're charging far more money than you would for other techniques.
[54:43] SPEAKER_00: And there's no evidence for these extra-based techniques.
[54:47] SPEAKER_00: And what is happening in these forums is women whose symptoms aren't resolved
[54:53] SPEAKER_00: by these aggressive techniques
[54:54] SPEAKER_00: or even having their implants removed are being blocked from the forums.
[54:59] SPEAKER_00: They're not allowed to kind of discuss that.
[55:01] SPEAKER_00: And some of the forums are on the payroll of the surgeons who are offering these techniques.
[55:05] SPEAKER_00: And it's pretty corrupt, you know, for one's aggressive expression.
[55:10] SPEAKER_01: Well, you know,
[55:11] SPEAKER_01: this whole thing,
[55:12] SPEAKER_01: corruption is a good term for a lot of things we've been discussing.
[55:17] SPEAKER_01: You've put together an incredible book, Bad Influence.
[55:21] SPEAKER_01: Congratulations on that.
[55:23] SPEAKER_01: What a pleasure it is to talk to you about this and get into some of the,
[55:27] SPEAKER_01: you know,
[55:28] SPEAKER_01: real striking examples,
[55:30] SPEAKER_01: but also the bigger picture that you present,
[55:33] SPEAKER_01: the potential solutions that you have in the book and what we've discussed today.
[55:38] SPEAKER_01: Have we missed anything before we wrap up?
[55:41] SPEAKER_00: That's pretty comprehensive.
[55:43] We've got through a lot.
[55:45] SPEAKER_00: And thank you.
[55:45] SPEAKER_00: Thank you for inviting me on and people listening.
[55:49] SPEAKER_00: There's a lot to talk about, I think.
[55:51] SPEAKER_00: And then we're going to be,
[55:52] SPEAKER_00: you know,
[55:52] SPEAKER_00: in the future,
[55:53] SPEAKER_00: it's what I'm interested in is how social media and the LLMs
[55:56] SPEAKER_00: and how patient journeys map onto those.
[56:00] SPEAKER_00: And I think that is opening up further conversation as well.
[56:04] SPEAKER_01: No, you've really made the case here.
[56:07] SPEAKER_01: We've all kind of had a sense of awareness about the social media and
[56:12] SPEAKER_01: the wellness industry, but you pulled it all together.
[56:16] SPEAKER_01: And I think there's not a better source of,
[56:18] SPEAKER_01: you know,
[56:19] SPEAKER_01: really the state of the mess we're in and the potential path to get out of it.
[56:28] SPEAKER_01: Do you think someday we're going to get this on track?
[56:34] SPEAKER_00: I hope so.
[56:36] SPEAKER_00: I do wonder whether with the advent of large language models,
[56:42] SPEAKER_00: how information will migrate from getting your health information there.
[56:46] SPEAKER_00: I mean, when the book came out, I thought, oh, am I too late?
[56:49] SPEAKER_00: But actually Pew Research did a study published about a month ago saying about 50%
[56:54] SPEAKER_00: of And I think that's an open question.
[57:23] SPEAKER_01: You know, channel, you know, great information either.
[57:26] SPEAKER_01: So, you know, that's a work in progress as well.
[57:29] SPEAKER_01: Well, thank you for, you know, this hour we've had together.
[57:34] SPEAKER_01: It's been illuminating.
[57:35] SPEAKER_01: You brought the book to life.
[57:37] SPEAKER_01: And all your years as an investigative journalist and on the British Medical Journal
[57:43] SPEAKER_01: and all, you know, it culminated in this.
[57:45] SPEAKER_01: I'm sure we got a lot more in store.
[57:48] SPEAKER_01: But really, thank you for all the hard work you did to pull this together.
[57:52] SPEAKER_01: And I think a lot of the people who are listening or watching will wind up,
[57:58] SPEAKER_01: you know,
[57:58] SPEAKER_01: not just enjoying our conversation, I hope,
[58:00] SPEAKER_01: and find it informative, but also getting it even deeper in the Bad Influence book.
[58:07] SPEAKER_01: Thanks a lot, Deb.
[58:08] SPEAKER_01: Really appreciate it.
[58:09] SPEAKER_01: Thank you.
[58:09] SPEAKER_00: Thank you so much.
[58:10] SPEAKER_00: Thanks for your time.
[58:11] SPEAKER_00: Really enjoyed it.
[58:12] SPEAKER_01: Thanks.
[58:13] SPEAKER_01: Bye now.
[58:13] SPEAKER_00: Bye.
[58:14] SPEAKER_01: Thanks, everybody, for joining, too.
[58:16] SPEAKER_01: And thanks for your questions.
[58:17] SPEAKER_02: Thanks.

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