#461: Deborah Cohen, BBC & ITV journalist: Has the Internet Hijacked Our Health?

0:02My hypothesis was, oh, I wonder if influencers are making us sick. It has the power to drive human beings to take actions and behaviours that are against their interests. I mean, it's crazy. It's like Cupid's arrow. Like you would hugely regulate Cupid's arrow, of course.

0:23Hey, buddy. This week, this is going to be a great episode. I've got Deborah Cohn with me, who is a medically qualified investigative journalist, ex-science editor at ITV News, ex-health correspondent at BBC Newsnight. You led their COVID coverage, built the investigations unit at the BMJ, and now has the book out, Bad Influence, How the Internet Hijacked Our Health, which is an investigation into how social media influences wearables, preventative screening, AI diagnosis and longevity culture have blurred medicine and marketing into the same thing. This is fascinating because these are all the worlds that I am trying to do the right thing in.

1:07I'm trying to manage the right influences doing the right things. I'm trying to get medical marketing in the right places to do the right things. And so this is going to be awesome for us to talk about. So first of all, how are you and welcome? Thank you for having me. Fascinating, isn't it? The world sort of how our worlds sort of overlap and intersect. I'm fine, busy. It's the book has landed incredibly well in ways that I wasn't expecting. When, as you mentioned, my background, when you do an investigation, let's say whether it's the BMJ or whether it's BBC, Panorama or Newsnight, you sort of know vaguely how it's going to land you go out you'll get some media coverage and then inevitably you get the complaints in um you just you just don't know and it's yeah so it's been incredibly busy um and it's been shortlisted for the royal society science book of the year again total surprise so it's it's it's clearly quite zeitgeisty i think that is amazing like Honestly, if you told me at the age of what, when did you get to medical school, 18, that I would be in some weird corner of medical marketing doing influencer.

2:26All these things didn't exist. Podcasts, all this stuff just didn't exist. And now there's this whole industry. And it's crazy. And it's doing good and bad things, right? And I think that's obviously the point of your book. Obviously, the title being Bad Influencer. it's it's a very very very strange world that we're living in um and a world where public health seems to have been outsourced to people that we just trust to to do youtube videos on the right things and no real semblance of of genuinely tackling misinformation no no seeming strategy that pulls it all together and we're kind of just sitting back hoping aren't we we're kind of just hoping that things fit in the right places and that bad actors don't win that hoping that light overcomes darkness and all these different things but you're obviously the one that's that's investigated it all so you you tell me where where did this come from like where did well first of all obviously you're you're medically trained as well and and probably worth mentioning your background a little bit but i'm interested in in was this something that crept up on you and this I don't know was it like an annoyance that turned into something that you needed to investigate and then how did this come about it's really good question and and actually the provenance of it is is probably well is exactly why I wrote the book is that I as you mentioned I trained to be a doctor originally and then I went to the BMJ I was an investigative journalist there and then I went to the BBC, so I was reporting on Panorama and then Newsnight and then ITV News.

4:09And when you're in news, news is brutal. It's so fast-paced. You can get up at 6 in the morning. If you're live on air at 10 o 'clock at night, you don't get off till half 10. You're flying. You don't sleep very well because your adrenaline's pumping and then it's sort of eat, sleep, repeat. and um I left for various reasons but but I sort of figured I wasn't a specifically a news journalist I much prefer more in-depth stuff which I was doing on news night but also sort of leading news nights COVID coverage and when I left I thought I'll just go back to doing documentaries but the whole media landscape had totally changed and I'd sort of slightly I hadn't ignored because I was on Twitter or X all the time and stuff, but Instagram hadn't really, I just didn't have time.

5:06That wasn't where I was going to source information from, you know, particularly during pandemic, a lot of the experts were on X. So I just really, TikTok, all that, I wouldn't say it passed me by, but I just wasn't very interested. And it didn't have time, it didn't have the bandwidth or the capacity when you're working that intensively. and then I sort of looked around I was like oh my goodness me the media landscape has totally changed so legacy broadcasters I'm going to sound like I'm out of succession now like the BBC or Channel 4 or ITV or Sky all had to be on social media they have to do vertical video and then equally what was traditional print whether that's Guardian the Daily Mail or the Times telegraph or cern or whatever they they equally have to be on these platforms and you don't need the big camera crews that you used to need you just need a smartphone and everybody's sort of a journalist and i and someone said to me oh do you want to be an influencer and i was like do i hell so for me that's when i was on telly being on telly wasn't the be-all and end-all i like the process of journalism and putting stuff together and and things like that um and and i thought but i need to understand it and i and then i was at an over diagnosis conference because there's this movement i'm sure you know in health care about too much medicine over diagnosis we over treat and my hypothesis was oh i wonder if influencers are making us sick so i think in in health people understand that a drug has benefits it has harms but they're not always aware that a diagnosis has a harm itself or a diagnostic test or a screening test or a questionnaire they can have harms in different ways and so that was where I started out and and then I think I kept a very open mind in the book I spoke to over 200 people um including sort of you know influencer agencies and um academics and doctors and people content creators and people that use these platforms to self-diagnose or or find out about health and so it sort of took me on a bit of a journey really but but the things that really struck out is as you said we are in this sort of wibbly wobbly world and then now we've got large language models on top of that we're navigating this totally new information ecosystem or what demos calls the information supply chain which I think is a really interesting way of putting it you know information is being supplied to us where's it coming from who's who's influencing that information which I've spent a whole career doing as an investigative journalist so we are in a very different world for better and worse and I don't think it's all bad and I don't think it's all good it's just different and the benefits are different and the risks are different with this new space of information you touched on the shift of power which is really interesting in legacy media versus now and this is where the kind of inverted commas influencer movement is sort of born from this ability to democratize uh building an audience now and therefore like the i think for for so many people and companies the editor of the times the the editors of the science editor the bbc or like the editors were your gateway to all to information reaching all of your customers they owned that very bottlenecked gate into you get through them and all of a sudden your message them and probably the conference owners or whoever chooses who's on the conference floor they they were kind of your gateway whereas then as soon as the ability for anyone to build audience came along all of a sudden that power of legacy media gets threatened and one thing that i've seen on a few different cycles now in my 40 years on this planet is that when power gets threatened it reacts and things happen things change it seems that and you're right they end up on the platforms trying to also build audience and they do it in very interesting ways and you look at the way the daily mail like fully just leans into the algorithms of like i'm just going to go for outrage stuff or emotion stuff and go really hard and build audience that way or whatever it is but um obviously the the fact that these influences exist has been threatening there's then then then let's apply it to health care and you go well public health england disappeared and then all of a sudden well you know thousands of years ago the the the doctor was the orator and actually that that was part of being a medic and of course it's written into guidance of being a good doctor is that you can and should do that in your community and okay well here's social media and here's ways of building a platform in order to do that the tricky thing is then who's responsible where's the responsibility for the information supply chain like you correctly said and then we end up in this really weird spot where it becomes really financially and economically viable to talk about healthcare stuff because it gets you views which gets you reward the tricky thing about that exactly like you say as medics and as medically trained people generally our ethos has always been don't over investigate don't over treat if it's not broken don't fix it if it's if you don't think it's broken don't even test it and that's broadly been our hypothesis particularly in hospital medicine and secondary care as you'll know the tricky thing on top of that is then the prevention stuff of oh well actually if you do get your cholesterol checked you might be picking up something that is going to affect you in 60 years and then it's a hop skip and a jump to oh you might as well have a full body mri and then and then here we are and then of course influencers explaining all these messages is then economically viable again because people are interested in because it plays on our fear and fear is obviously a great mechanism to get views and so for me that's kind of where the world is and there's a there's a continuum there and somewhere along that continuum is really useful really good advice for some people but also on that continuum it's just very easy to get lost and end up in this world of permanent stress where you're worried about things that you don't need to be so i'm incredibly intrigued in about how you did the research and what your conclusions were when looking at this continuum because i don't know where you can draw the line or if you should draw the line because on one hand you know if an influencer or a wearable even like get someone to act on their health early who otherwise wouldn't is that a good thing it's like well it might be but at what cost were they stressed 24 7 and so i don't i don't know where you put the line there of of good and evil good and bad and i'm super interested well that's where evidence comes in doesn't it and that's where study comes in so and again a lot of the time in the book i can't definitively conclude because a lot of the time there's an absence of high quality evidence so you haven't done the randomized control trial you haven't done to to kind of weigh the the benefits and the harms or if it is it's only on a small scale so the wearable example there is some evidence actually that wearing a wearable in terms of exercise um improves you know your your adherence for a short period of time but again it gets better if it's got wraparound support it's like giving someone a scales sit on the scales is that going to make them change their behavior to a degree but actually it's the other stuff that you put around it that that helps people so each of these things i think that's why we have evidence-based medicine it it needs the evidence so sometimes it's you know and if you mentioned screening is it picking up the odd case is that that may be fatal let's say in full body mri does that outweigh all the potential over treatment that lots of other people might get or all the anxiety and some of that is a judgment call but and we decide where what we want to do you know we have authorities to do that in the national screening committee in this particular case but to make those decisions we need good evidence and so a lot of the time i i was having say there isn't good evidence for this or what evidence exists suggests this i couldn't be overly prescriptive um because i don't know and what you don't want to do is debunk bad science by doing bad science yourself so everything in healthcare as you said is a trade-off everything has some things have a benefit some things have a harm some things the harm outweighs the benefit and you'd hope the benefit outweighs the harm if you you go down a particular intervention and how you then apply that on an individual level it's about patient preferences or user or consumer preferences but it's got to be predicated on good evidence and and that's where i think i sort of come to in this and and it's a balance of telling people something's available let's say if you're a full body screening making sure that evidence or the lack thereof for for all sorts of different conditions consumers have access to that and that and it's not overhyped and that's where i think companies get into trouble is where the hype then outflanks the evidence um and and it's tricky because these things can take decades to build up and then you've got the trade-off between innovation and giving people what they want and actually doing potentially doing harm and that that's a tricky line and government obviously wants to encourage innovation but then are you delivering net good and then further down with when it comes to health is and this was something that pan Patrick Chinnery who's exec chair of the MRC said to me when I was writing the book and he said well what's the impact of all of this on the nhs because you may think you get benefit but if you can't afford any of the follow-ups you end up in the nhs and that then displaces care from somebody else so these things are working in a vacuum so roughly that is sort of where i sit is i can't overly conclude but anecdotally you speak to fertility specialists in the nhs and they're saying well it's full of women coming in with amh tests and there isn't good evidence for amh testing and fertility and that has an impact um so these are all the big questions i think and it's it's what do we want society to look like and what what do we want our our health to look like it's such a good point by the way that you know people are going searching for for an amh test You could swap that out for anything that someone has said online.

16:47Therefore, it kicks off a volume of people taking an action that is unnecessary and appropriate. And you think about the emotions that those people have had as well. Again, fear or concern or even intrigue even. All of that comes at a cost, like you say. And I remember it was only a couple of weeks ago. I was at a barbecue speaking to one of my friends who's a lawyer. And she was saying that really sad, you know, one of her friends had got diagnosed with a brain tumor and she was asking, you know, would, would the full body MRIs have picked that up? And should she and her friends all be going for full body MRIs?

17:28And it's like that, that sentence or those two sentences just escalated in terms of, I get it. I, I, I know that she sees the link between, between those two things. but as i i tried to explain to you exactly what you said of like the the testing comes at a cost you can't that there is there is no there is no free lunch like if you have a ct scan an mri scan you're paying for that in time at the very least but also in concern but also what's worse is that let's say you know it picks up a lung nodule and someone sticks a needle into it and you end up with a haemothorax then you end up on it like all of these things are real so would it have picked up her brain tumor yes at the individual level maybe i don't know about the resolution to be honest of screening mris and whether it would have done but at the same time like at what cost becomes so unbelievably important i just want to pick up something else you said as well about um where hype outflanks evidence it's so interesting like before we recorded this podcast i did i was reading about everything you're doing and and looking up um a lot of the work that you've done and written and things like that and i started to ask myself am i part of the problem here um because at the end of the day we do marketing for health tech companies and and we help them do that stuff and you know we started managing a healthcare content creator that we believe does the right things there are reasons but at the same time we're still doing that and i think it's really interesting we would be so much better off financially if we relaxed our rules on the evidence that we require um before bringing a client on and i thought that was like it was quite interesting so i was trying to figure out you know what like am i actually part of the problem it was actually things like well i saw an ad on instagram the other day uh and that was this week so less than seven days ago and it was basically it basically said it was aimed at employers and it said if your employees take glp ones they'll have less time off you'll have a better bottom line like i'm just somewhere i'm like summarizing what the ad was and jess jess actually found it she showed it me and i was just i just couldn't believe it i i was like hold on a minute how is that appropriate message like what how many people has had to go through how many structural organizations has that had to go through what rules is that playing by like i i just couldn't believe it and then i was like well actually no i'm i don't think i am part of the problem because there's no effing way that that is getting done on my watch for anyone that we like it's not even close to the sort of stuff that we do and so it just like it's just lawless out there on on social media and i mean is it i don't know that there are obviously there are obviously asa rules and all the rest of it and abpi if you're farmer and all that stuff that we of course abide by and follow to the letter but it's just what this again this spectrum of stuff is wild to me and the problem is is you see that example i suspect the provenance was i think there is interest in government about the use of glp1s in productivity interesting and and i suspect that's but you can't say there isn't the evidence for that so so we know the side effects of glp1s people feel really crap you know literally there's nausea and vomiting and and gastric side effects and things like that.

21:00And does it actually improve? I mean, we don't know, but there is, I suspect that's the provenance. But to me, that claim on an individual, on an organisational level, really? You know, and again, it's that grey line of advertising where it's, very difficult for the advertising standards authority to regulate its regulatory whack-a-mole even we have to to to direct to consumer advertising prescription drugs which in theory is banned i did a piece for the bmj a couple of weeks ago about this we have a ban most of the world other than the united states and new zealand about advertising prescription drugs you know all this stuff anyway well what i noticed was chloe kardashian coming up in my feed advertising a prescription only migraine drug how's that possible i put it to the i i put it to the advertising i put it to um meta and edlin and answered on their behalf don't worry this has all been legal so it's fine it's gone through the bmj lawyers and it's published and they basically said this is you know uh we're not going to answer this and i i saw it on youtube and google said we've not broken any rules and actually to be fair it's a gray area the advertising standards authority said well if it's intended for a u.s audience then oh but then okay it wasn't immediately clear to me it was a u.s audience but it used an american brand name rather than generic name but stick that into google and there's pharmacies you know in the uk that will prescribe it with that brand name so yeah it it's real and then the other issue is the the relationship with patient influencers in the u.s under companies that comes into our feed and then you have to ask how much of this do we want and how much is this okay you know the argument is oh it's it's educational so and you're you're far more specialist than me in this how much is educational how much is pure marketing how much is driving expect patient expectation and patient demand so when i i did some of my medical training in france and um french gone to now but anyway my french but but they use the brand names for the drugs well we were trained weren't we we use the generic names they were trained using the brand names and then when i was in france there was an active sort of campaign to try and stop people so they come in and you know say instead of you know paracetamol and obviously that's more more sort of expensive than than than you know your generic paracetamol so there was active sort of campaigns to try and stop that so but if things are being marketed that way it increases the cost increases expectation if you come in demanding a prescription the evidence seems to suggest you're more likely to get a drug whether it's needed or not as opposed to a non-pharmacological intervention so there's all these sort of big questions and it and i don't think we know the answers because it's really hard to study because you don't always know who in the patient influences case who they are and then it gets mashed up your adverts hashtag and buried right in the bottom of a post oh it's useless it's irrelevant yeah it's irrelevant and it gets it get mixed in with personal anecdote and then if you're exactly how do you regulate the personal anecdote you can't say to someone no that wasn't your experience yeah it is it is i remember going to a youtube event a while ago i ended up writing a forbes article about it actually um the i mean they they open with the fact that you know on youtube and in videos anecdote is as important as evidence when you're curating a feed i'm kind of butchering that but they were just saying that you know human storytelling is great because humans want to hear it and they want to listen to your lived experience and it was a youtube health event so they've you know they were launching the health shelf and and all that sort of stuff as to raising you know the the videos of accredited doctors and all the rest of it so you can see that you know they're trying to do stuff to help definitely um but you know they they raised the importance of of anecdote and that's the thing you know someone that's following one of those people that hears an anecdote it's very easy in that scenario where you've built a relationship with an influencer or someone that you watch the youtube videos of it's very easy to then just think that n equals one and that's applicable and that's just human nature i think and i think if there's anything that i've learned about from reading your stuff in in in preparing for this it's been that there is the way that I feel about it now is that there is a cost to moving health care information from somewhere to somewhere else if that goes through people there is a cost to that and actually there is a cost to that in the way that they feel potentially negatively but actually even as you say driving expectation and demand that's very easy to do when it's something as sensitive and as frankly precious and important as health information and I think that's what I've learned and that's something that I'm going to take forward which is that I'm going to treat that very differently I think and I actually I actually think it it should be regulated differently if you are moving health care information it should be treated differently to any sort of information because it has the power to drive human beings to take actions and behaviors that are against their interests and therefore if you're not regulating it at source if it was a drug you'd regulate the heck out of this thing because it was so powerful you could drive people to do all these things and pay for all these things and get answers to all these things if i mean it's crazy it's like cupid's arrow like you would hugely regulate cupid's arrow of course so that's that's something that i think i've definitely picked up which is that i don't and you're right and in the source of that is evidence it needs to be evidence what you say it can't be like anecdotes okay but anecdote without caveat then becomes the same thing and and that's tricky and so and again all of this is absolutely fine well it's not absolutely fine but all of this and in fact that's something i've learned actually i was gonna say all of this is absolutely fine it's if it's in good faith it's actually not because you're still even if it's in good faith it's still going to drive people to potentially do things out of their interests and so uh yeah oh i've i've definitely learned a lot for without talking to you now i've learned a lot from you just from just from like researching it but um yeah i find that fascinating like the power of the information and how we end up regulating it yeah it's really hard that's one of the hardest things you know when I was at ITV News when I was on the BMJ I didn't have to worry about case studies ITV News you have to have a case study I had to tell stories through people because storytelling is is everything you know and we do that in journalism all the time I've just got something with the Sunday Times at the moment and again it has to be told I have to have several case studies people respond to people they don't necessarily respond to just bold statistics or experts bluntly um and the and it's finding and the trick for me was always finding the right case study to explain the evidence or then talk to people if and sometimes i had no choice because the case studies were fine for me but try to use their stories in a way to best explain the evidence even when it's not applicable to them But for this person, they didn't have this particular side effect.

29:16But the evidence says this. So it's how you use those case studies or case studies, really, how you use those. And you've got to use them sort of cleverly. and I think but it is the power of storytelling we're humans, we thrive on stories and in terms of regulation of information again it's it's sort of hard to do because then you have to decide what is your what's your and this is one of the issues I have personally with misinformation it's what is your evidentiary standard 100 so so before you say something do you have to have a randomized control trial do you have to have i'm not gonna say you're not gonna say a lot if that's the case exactly so so what is your evidentiary standard how do you explain that stuff might be based on very high quality evidence but it's it this is this is the state of the evidence now and it may change because science we know is iterative it changes clinical practice changes as new evidence you know comes about and that is the very nature of of healthcare healthcare is is also inherently uncertain um and you do studies to reduce that uncertainty so everything's risk isn't it medicine's basically got statistics well i'll tell you what that was all i mean you led covid coverage right one of the things that fascinates me about this which is where where's the line between genuine theory and misinformation and where you draw that line is the difference between censorship and free speech and it's and it and you led covid coverage right if you just There was one point in time, I remember it very clearly, where if you talked about the lab leak theory, you were just some horrendous right-wing, crazy conspiracy theorist.

31:31And that would have, if we put all these rules in place, that would have been censored out. It turns out that's quite an accepted potential, probably most likely theory years later. And so you're right, things move on and things change. And it's tricky, this. And you're an investigative journalist, so you probably have to walk this line quite a lot of what you do and don't say, what's crazy conspiracy versus, hold on a minute, these things, when you link them all up, are a decent theory here. So that I find also quite fascinating and tricky as to, But is it the platforms that would have to do that?

32:16Is it a policy at government level that would have to do that? And how do you put a line in place that can move without having an egg on your face? It's so tricky. And it really is. And I think during the pandemic, scientists did themselves no favour. You know, they shut down any discussion about the origins very, very quickly. That's interesting. they did themselves and and they were overly certain and it was that's interesting and we couldn't have discussions so when i was i never used this is why i don't really like the term misinformation because again evidence changes i i feel for me it's an overly certain term when evidence changes and we have to assume that we have all available evidence and people say based on available evidence or this or that or anything else.

33:08And again, available evidence presupposes everything has been published in the first place and people always act in good faith. Or clinical guidelines. I permanently investigate clinical guidelines. Am I purveying misinformation? I don't know. Where's your marker? And again, it was interesting because I was like, I guess, the most specialist person at it sorry at the bbc or news night at least anyway reporting on sort of with my background and at times people will say to me oh what's the answer and i say i don't know and when you've got your specialist in your team not knowing the answer but but i didn't know but what concerned me about that is is what you said it's how you're put into buckets sometimes for asking questions and i think you have to allow people and support people to ask questions and help guide people as opposed to go so i ban the terms anti-vaxxer anti-masker anti-lockdowner i'm like people are going to have questions about vaccines that is okay let's distinguish between people the willful disinformation which i think is different well it is it's politically motivated and knowingly wrong and confusion and equally I saw pediatricians that I knew who were really concerned about the closure of schools who were saying can we talk about kids here they were called lockdown skeptics or anti-lockdown so I'm like that isn't okay that is a genuine policy question that's a general conversation we need to have so I remember raising the issue in a piece I did in April 2020 on Newsnight asking the question what's the impact of closure of schools.

34:51I got so much abuse. Wow. And any given day, I was either a COVID denier or I was part of some big conspiracy theory being led by Bill Gates to infect us all and promote that to you. I mean, I laugh. I shouldn't laugh. But no, no, I remember it. I could be accused of either. And that's one of the challenges of being centrist, you know, on this particular issue. And I think in terms of regulation of information, If we look at how information is regulated to a certain degree, as a broadcaster, I'm regulated by Ofcom. YouTube's not within that code. Podcasts aren't within that code. I don't know.

35:36I'm regulated by defamation. So if I blame somebody, I can be sued. And also, Ofcom, are you fair and balanced? if so it is is the press regulator it used to be the pcc the press complaints commission so we are regulated to a certain degree now we can argue the toss about whether that regulation works i'm not sure it always does and we we've got quite you know we can talk you know the media is the media and we can have conversations about that um and it stokes fear and it's always stoke fear and and you know if you look at the headlines and you double down and that's how you get people in um but then we've got this whole other world that isn't there's barely regulated in the first place and and that is social media platforms and and youtube and and things like that 100 % do you remember the um i mean it was super recent he's had a few of these cycles the old stephen bartlett stuff where he gets all of these like rogue health claims and because it's the biggest podcast on and apart from Joe Rogan, maybe, and all these things.

36:45And again, him and some of his guests know better at times. I remember thinking at the time, it seems that whenever, within a structure of consumer capitalism or whatever, policy has to come in and restrict it in areas where it gets too powerful. And at the other end, it has to come in with policy to protect, you know, people that don't have it all and have a social welfare state and all the rest of it. So policy restricts what we've decided is the best way of doing things. And I think you're right, you know, when something as powerful as media, the BBC, that projects information to so many people, it has that power, it has to get regulated, hence Ofcom and all the rest of it.

37:32podcasts have now got to that stage certain podcasts have and it just seems to make sense for me that once you go beyond a certain listenership that you are subject to those rules because it otherwise you are too powerful and you've got you've achieved that power on the incentives that are purely to build audience so outrage and extreme opinion and all those things it's not it's not like you've built that audience on the back of good faith evidence-based blah blah blah and all of the things that we know are necessary when you're operating within a regulated framework and so therefore when something gets a load of power through means that are optimized to literally get power surely surely we can find a way because it doesn't seem i don't know for me like i mean i've done a bit in policy at you know hee and the rest of it like it doesn't it doesn't seem so far beyond me that you could regulate that stuff but i mean i might be wrong maybe it is just behind a commercial barrier but it is and and what are you regulating because books are full of misinformation like books you just turn out a book or what are we trying so you regulated I could put out dodgy health information on the BBC and that would get complaints and stuff in and there might be on that level but it wouldn't necessarily put me in breach of the Ofcom code so what are we trying to regulate if and Stephen Barlow he's mentioned in the book several times he is you know he's put on lots of problematic stuff he surfaces people with quite fringe views and that's what gets people listening and you've got to fill the airtime um and that's one of the issues with podcasts isn't it is is saying well what do we really need to do well we need to exercise not drink too much don't smoke you know don't be lonely keep your social interactions how many podcasts is that gonna how many podcasts can you do after that so you've got to constantly find something new and novel to say that that's obviously in the longevity space but what is it we're trying to say we do have freedom of speech um do we need to be more discerning consumers of information what what does and these are all questions i know offcom are asking and one of the interesting they they had around podcasts for sponsorship actually and how the yeah and and there was one or two british podcasters i won't say uh on it i'll tell you i'll tell you off air even though it's named they're named in ofcom yeah for for sponsorship and i'm particularly in one of the concerns that came and it wasn't just about health it was across the board but what came up it's particularly concerning if doctors have sponsorship and use their platforms to promote because it looks like advice and we have to be careful the medical profession has had to be careful it's gmc you know your gmc requirements are if you have taken money you've got to offer people a range of options and you can't simply promote the the drug that you've got the the relationship the drug company with but but we've outstripped that now uh and that you have to be you have to be careful and and you then a mouthpiece simply for a company if you're a doctor what what does that do to your gmc regulation you're not supposed to what do you think is a way forward program what does progress look like with all of this because you know in the book you know look at i mean there's this stuff on prevention there's stuff on regulation wearables ar like the all of that complex of things and we're going the direction that we're going what does progress look like for you what what are some immediate things that could to change or or attitudes or knowledge that you think would help people where do you think power should be who do you think's responsible for all of this like how do we how do we as an industry start to start to push forward here and by the way one of the reasons i ask this is because i i think that i play a long game with some ex and everything that we do and everything that we try and do and you know you've spoken to our team at one of our team days and so you know what we're like that i i just think that we never want to cash in on any quick wins and i think if we're set up doing the right thing for the long term that ultimately there's a simon cynic book called the infinite game i think it is i've got it around there yeah the infinite game um which is basically like as when you're trying to build something in the world and put it in the world like other people might be ahead like for now like this might be like this and you should be doing okay yeah for now it's fine i just kind of think that if i set things up in the right way and do the right things and have the right value system then actually if i enact the value system over time it'll play out absolutely fine so i'm asking this kind of selfishly because i want to know where to stack the chips and stack the resources that we have to push this world in the right direction so i'm just wondering if you if you were in my shoes you know running communications for health tech companies and potentially starting to manage influencers like how would you how would you manage this so that the world became a better place not a worse place it's so hard because it's on so many levels and yeah this conversation with nhs england and their social media team and there isn't and there isn't there isn't a simple solution and and that that's the thing because we we want sort of simple solutions and there isn't a simple solution and someone from uk hsa asked me the other day what platforms you need to be on and I laughed

44:10the water cooler moments have gone like unless you've got like the World Cup final that we had last night or you know those live moments that brought everyone together that we used to have those you know we've got such a fractured media landscape I think it's on lots of levels there's a bit of me thinks there should be a a register of influencers who are working with companies um you know we've got sunshine act in in the united states and actually if there's a register with declarations and what they're doing what does that do to transparency again it's an open question i don't know it might have a beneficial effect it might not people might just get used to going oh well they they everyone just takes money so whatever um i think we need definitely better health literacy how people navigate what questions they ask do you think that should we should that start in schools do you think early it's gonna have to and and and but it's on every level really i mean we're not we're not always very healthy the lot the llms might help with that and that that's you know So in potential, that's part of it.

45:19So there are tools that are coming available. Now, how, but then we have to ask the questions, well, you must know about generative engine optimization. How are the bots being influenced in their information? That's a bit of a black box. So we need to understand where our information is coming from better and there needs more transparency around that. But then we need to be more health literate. Some of it is down to regulation. At the moment, the Advertising Standards Authority just can't keep on top of stuff. And one website disappears and all you're leaving for the MHRA website. Another one pops up.

46:01But we're going to have, I think the health authorities have to do better. I mean, they're so slow. So I was talking to someone about Hantavirus and that the outbreak had happened. And then the authorities, it was Public Health Scotland, were about a week before they got their comms material out, in which time you've got other people filling the space. And there's a fear there, I think, you know, you've got to be perfect, you've got to be right, you've got to do this. And obviously you do, but then, so that's one issue. The sum of it, there might be market failure. How many sort of at-home diagnostic tests do we need?

46:32What evidence should be on it? What should we be checking the information? And in theory, this will be Advertising Standards Authority. But we've got to be guardians of information ourselves as well. When we see something we think is dubious, where do you go to? So it's on every level. And then we take China's approach. And China has said you've got to have a qualification if you're going to talk about health. And you're not allowed to promote services or interventions on social media. that is a real sort of sledgehammer go that route i know two different examples of how to skin the cat isn't there because what you're talking about broadly is this acceptance that if we can get to a state of full transparency then we get trust because we've got transparency and that negates then the need if you if you sledgehammer it you just negate the need to trust any individual that they're going to be transparent you just force it but then you're in a state where you feel controlled the flip side of that is can i think what you're saying is can we as a health care industry and a media industry and the two work together can we generate a set of incentives that incentivize full truth and transparency so that we can all then gain trust and have our eyes wide open as to what is going on because then the good actors and people acting in good faith are disincentivised from working with people just for a paycheck and anyone in fact because the good actors probably wouldn't do that anyway the the bad actors really are the ones we need to disincentivise from doing that because if they do do that it's going to go on the thing on the register on the blah blah so i think i think broadly that's kind of what you're saying and actually that's quite a nice north star i think and it's the the issue with transparency has it worked in medicine and i don't know the early stuff around clinical trial publications right and i think it it has cleaned up to a degree but bad actors there's always going to be bad actors find a way there's going to they're going to find a way it's going to find and and that's why there's not and i think there's got to be more transparency there's got to be more transparency around information sources and one thing that i mentioned in the book and i i'm not comfortable with this is one of the ways that scientists promote their products is look at my website i've got all these links to all these publications and it looks really legit but the publications i'm gonna swear are bollocks and the behind access controls so they're used as a totem of look at me i'm scientific as opposed to genuine educational and transparent genuine education and transparency yeah so it's so much and we're so early on i mean even if you think about the the patient influences with drug companies there's a sunshine act in the united states for doctors that they declare their payments this should be the equivalent that on a very basic level there should be an equivalent there um but but then do people then go and use it or does it does it affect their judgment whether they go and see a doctor and that that's a whole other question um so or does it then just become well everyone's on the payroll so i might as well yeah and then it becomes back to what we talked about is that do do people genuinely do do do people creating content genuinely appreciate the power of the information that they are now putting into the ether that they are now that would be where i i'm probably you know people need to understand the power of the information if you're going to promote body mri understand what it actually does and we think the measures i'll go and understand that like that what you're promoting yeah yeah it's a powerful body of my brother i'm going to genuinely invite some people onto this podcast to sell it to me like come on like sell this to me explain to me why this is great and why this is okay and tell me what the version of the future is and like i really want to start to get my head around this because it's been a while since i did any writing for forbes and i miss i miss that like I miss the investigation of it when you talk about investigative journalism and like the interviews you end up having like the not conflict but the confrontation that you end up having with some people that you want to get quotes from and like I miss that stuff because you get to like new information and new insights and I just love getting my teeth into that and I realize I actually miss it so that's actually one area that I'm that I'm gonna do but just what I would say on that one is okay you're great at picking stuff up you're right up but how you know we know we talk about incidental omens don't we yeah when medicine's good when i but where it is we can pick stuff up particularly when it becomes more and more sensitive like some of these very sensitive scanners we don't always know what it means or we're not the good at the prognostic bit so even in breast cancer a lot of breast so we talk with you know dcis total carcinoma in situ do most of those won't go on and produce cancer but then you pick it up you remove it but we don't and we've we've known about breast cancer and stuff for years but but there are still those questions so our ability to detect stuff has sort of outpaced our ability to know what stuff happens to stuff or stuff does someone did explain to me though that when you do extrapolate it to its extreme forget full body mri but just can't just kind of extrapolate the fact that imagine no diagnosis is a burden it's just a fact like you just that you just live your life and it's like oh by the way this thing just needs removing okay good it's gone nothing else so there there is like that was the one thing that i've heard that i've been like hmm interesting this is a path to that but then but but it's not as if you draw a quick line and a hop skip and a jump and then you're there the amount of suffering that goes on in the interim is the juice worth the squeeze and that becomes the question i think the huge things that i'm taking away from this are the the power of information and actually that when you move health care information from a to b through a person that's going to just enact a lot of harm that's one massive thing that i'm taken away from this it could be benefit as well you know get the right take yeah i take that i'm i'm and the book is like i say far more nuanced than the title suggests like i will totally own you can't say to someone go and read the nhs website if they've been reading so looking at social media all the day you're gonna all day you're gonna look at the nhs website and go god it's really boring but if you get the right communicator online they're incredibly powerful 100 you know so so it's not good or bad but there is bad that needs to improve but it's the beginning of the other learning point from this conversation with me which is that the more transparency that we have in this in this system the better and i i actually think what i'm going to take forwards from this is that i think one of our policies is going to or work streams or ways that values whatever is going to be about voluntary transparency like how do i actually take what you've just said about voluntary or about transparency being an answer and how do we front-footed get people there on a voluntary basis and how do we model best how do we model best in practice actually um before it's even necessary because actually those are the only people that i would want to work with anyway and so i think it's that i think that might actually be that's kind of given me a bit of fire actually which is really nice because i think that then makes the world a better place because if they look at oh they've got three or four people on the books there have you seen how they seen how they do this have you seen how they do that like actually and i i yeah i think that's i think that's really interesting so i i appreciate that before we just let you go if people want to learn more and get the book or they want to speak to you or they want to learn more about you, what is the best place for them to do so?

54:54So you can connect with me on LinkedIn or I'm on Instagram, debcoen001 or X is deb underscore Cohen. And I'm something on Blue Sky. Never really took off, did it? I do have a username. And I don't use X as much. I'd sort of use it more for when, you know, looking at the sort of trolling in the football that's, you know, banter and stuff like that but they're the different places and i'm currently building a website so hopefully within by the time this podcast comes out i will have a website which is amazing deb it's been an absolute pleasure thank you for joining me thank you so much really good to chat