On the Mic with Mike #7: Battling health bunk with Professor Timothy Caulfield

Dr. Mike Strong: Well, hello!

Welcome to another episode of On the Mic with Mike. It's been a little while since we've last chatted— and, you know, we're in the midst of the pandemic, we're all doing our personal protection and such—so today we're going to do an On the Mic with Mike just a little differently. We'll be doing it by video.

But today, we're also going to be talking with Professor Timothy Caulfield. Now, many of you will know Tim's work, and particularly as his books take on the questions of real science versus debunking science and such, [he’s a] prolific writer in this area and a terrific person.

So I'm looking forward to this conversation, and I’ll take my coffee, head up to the office—and why don't you join me there in a few minutes.

Well, I'm really excited today to welcome Professor Timothy Caulfield on On the Mike with Mic.

As many of you might know, but Tim is a professor and Canada Research Chair in Health Law and Policy, a Professor in the Faculty of Law and the School of Public Health, and Research Director at the Health Law Institute at the University of Alberta.

So, Tim, welcome to On the Mic with Mike. As you know, a little bit of this is all about getting to know you and explain how you got to places, but you also have a really fascinating background and what you're doing. So welcome, welcome, Tim!

Prof. Caulfield: Thanks for having me on.

Dr. Mike Strong: So why don't we just jump right in at this point? Because many people will know you. You've been the author of two national bestsellers and an award-winning TV documentary show called A User's Guide to Cheating Death. So you've become really quite recognizable, but never more so than over the past year.

So you've always been known as one of these individuals who's really been at the forefront of battling scientific nonsense or bunk—and you've been everywhere lately, all over the Canadian news, talking about misinformation related to COVID-19.

Prof. Caulfield: Hasn’t it been an extraordinary year? I've been studying various forms of misinformation and how science has been represented for decades, and I've never seen anything like this.

And so we have been studying this information in the context of COVID—thanks to the CIHR and a grant I've received with my fantastic interdisciplinary team. And it really has been extraordinary.

So there is misinformation about absolutely everything to do with the pandemic, of course, about the source of the pandemic, about various cures (and that's something we're very, very interested in). Also, lots of misinformation about the government's intervention, the government's role, which also can be incredibly problematic because it has an impact on trust.

And, of course, now we're seeing misinformation about the vaccines—and holy cow, that's having a measurable, tangible impact. We're talking about saving lives here.

Dr. Mike Strong: So when you say ‘misinformation’, what is it that you mean?

Prof. Caulfield: That's a great question. Now, I use misinformation as the umbrella term to really capture all of the inaccurate information that's being disseminated—mostly on social media, but not just social media.

But you can break it down, right? You can break it down.

There's disinformation—and disinformation is often categorized as that inaccurate information that is being spread with intention. There are individuals or entities that have a particular agenda and they're spreading the misinformation in order to forward that agenda.

Then there may be individuals that are just trying to do what's best for themselves, trying to do what's best for their family. They're curious and they're spreading inaccurate information on social media. And in fact, that's probably the biggest source of misinformation.

So there's various kinds of misinformation out there.

Of course, there's individuals that are also selling products—like immune boosting bunk—and they're trying to exploit the situation.

So there's all these different kinds of categories of inaccurate information out there. But I like to put it all under the umbrella of misinformation so that we can kind of capture all of it, because to be honest with you, yes, it's helpful to get a sense of the different kinds of misinformation, but all of it does harm.

Dr. Mike Strong: So it's interesting, as you phrased it in that manner, and I'm going to phrase this and it probably is wrong, but nonetheless: Is there a malicious intent side to misinformation for personal gain, and then is there just simply [a matter of] ‘I haven't really understood that and I’ve substituted knowledge that I have in play’, so that information—while damaging and can be problematic—doesn't hold the same sort of nefariousness as maybe the first one. Is that a way of thinking about this?

Prof. Caulfield: Yeah, I think that's a fair categorization if you're going to kind of lump them into two broad categories. I think that is fair.

And the first one, the first one, I don't even think necessarily has to be malicious. I think it might even be just they're trying to profit or they have a particular agenda or something that that could be gained from spreading the misinformation.

So there are some that have a malicious intent. They might be trying to use the pandemic to forward a particular ideological position or even to generate hate against a particular group—and we've seen that, unfortunately.

But in addition to that, there are individuals—like, thinking of the wellness influencers out there, the celebrity influencers—they're just trying to exploit this situation to sell product. Right? Which is also infuriating. It may not be malicious in in their heart, but it feels malicious to me!

And then you have the other category, and you're right. There's so much—I call it the chaotic information environment—and I think that you get these individuals (many people—we know it's a large percentage of Canadians), they're just trying, they’re just struggling to find out what's real and what's not real.

A really interesting study from StatsCanada that came out in early 2021 found that ninety-six percent of Canadians admit that they see misinformation.

And it's really one hundred percent, but the mere fact that ninety-six percent of Canadians recognize that is incredibly telling.

Dr. Mike Strong: So, is that—so, you know, as you're talking and having looked into some of these areas before to think about them—is there a sense that there is a form of misinformation that goes back to the beginning of time? There's always, always going to be that.

But is this form that we're talking about now, where it's an informed environment that we live in—you can get information anywhere you want to get it from—and how you synthesize that and put that into your own belief systems allows you to have this sort of misinformation that can be problematic for health. But that wouldn't necessarily have been there 30, 40 years ago, maybe even 20 years ago before we got into the social [media].

So is one more, you know, a longer [type that] has been with us all these years—and [is] what we're seeing now, something new and different?

Prof. Caulfield: I think you’re right on both counts.

So, misinformation has always been with us. But I do think that what we're seeing today is different, both qualitatively and quantitatively.

So it's different qualitatively because we're starting to see misinformation increasingly be attached to, for example, ideology. And it can be weaponized for a particular ideological thing—and, of course, you can think about in the political context, but you can also think in the health context, because we're seeing it with vaccines, right, where misinformation around things like choice and freedom and liberty—those kinds of intuitively appealing ideas—are being used as a way, almost [like] a Trojan horse, to get across misinformation.

When you're focused on this ideology that perhaps resonates with you, it allows those who are pushing the misinformation to sidestep the science.

So we're definitely seeing that. But I also think that from a quantitative perspective, you probably can guess where I'm going with this: social media. It has transformed it.

Yes, misinformation is coming from other sources, right? It's coming from friends and it is in the conventional news media, [but] not as bad as it has been in the past. I think, actually, conventional news has done a pretty good job here. But this is largely (not entirely, but largely) a social media phenomenon.

And there's been studies that have highlighted that. We've looked at this from different directions. This is largely a social media phenomenon. And we know that people who get their information from social media—from Facebook, from Twitter, from Instagram—are more likely to be misinformed or more likely to believe misinformation.

Now, yes, we have to be careful about that kind of data (correlation [vs.] causation), but I think we've come at it from enough directions, from a methodological perspective, that we have a body of evidence that says that's true and it's not going to surprise anyone. It also feels intuitively correct.

Dr. Mike Strong: So, it's interesting. Let's take that a little bit further, then, because I think one of the things that we've done—I think really well in Canada—is we've made fairly clear that our decisions that we're making with regards to the options that are available to us are driven by evidence or driven by science. And so you hear that coming from multiple different levels. And we know from the literature, as well, that physicians [and] scientists still hold a pretty high level within the overall community of respect of opinion with them going forward.

But is there a risk that—as we say, more and more, we are going to make evidence-based decisions driven by science—that the voices out there that say ‘but the science isn't good’ or ‘we don't believe the science’ can overwhelm that? Is there a risk of that?

Prof. Caulfield: That's a really fascinating question. I don't know if there's a risk of that, so let me unpack that a little bit because I think that one of the reasons that might be driving that question is the fact that we have now a public that is watching science unfold.

And I think the entire population, almost the entire population, is watching.

And that doesn't always happen. We don't always have this intense scrutiny of how science is done.

And so I think what's happening is, as I always like to say, is that the public's watching the sausage being made and they don't like what they're seeing. So they're seeing retractions, right? They seeing scientists disagree with each other. They're seeing the slow and iterative process of the accumulation of a body of evidence—around masks, for example. And I think when you're watching that play out, it can look ugly. It can look messy.

But you know and I know that's how science happens. That is science.

So I think that this this should remind us of a couple of things.

Number one, it's a reminder of how important it is to do science well. Because it's so easy to lose public trust. And when the public is watching, they're seeing the falls, they're seeing the missteps. It's important to make sure that science is done well [and] in a way that is trustworthy. Right. So that's number one.

Number two, I think it also highlights how important it is to communicate science well. And I was lucky to co-author a report for the Royal Society of Canada on exactly this (how should we communicate science). And I think it's really important.

One of the things we've learned is we need to do it well, because if you're too dogmatic about something and then the science changes, you're going to lose public trust. And we saw that—again, the mask debate is a good example of it, right, or hydroxychloroquine is another good example.

And I think it's really important to communicate not only the conclusions of science, but a little bit about the process and a little bit about the uncertainty and how science does evolve.

And lastly, I'll say, I think it really speaks to the importance of educating the public about the scientific process. We have to tell stories, not just about—and, you know, CIHR is getting better and better at this, I think—not just about the conclusions, but about the process, about the people that do the work, about the individuals that are invested in this, because I think that brings the public along on the ride. And it's a fascinating ride. And if you're with us on the journey, I think it gives us a lot more room to tell them about where the science is going.

Dr. Mike Strong: So that's a beautiful segue into asking you about: What's “science up first”?

Prof. Caulfield: Hashtag! #ScienceUpFirst

It is a national movement. And to be honest with you, we hope it becomes an international movement. At its core, the goal is to spread credible information on social media.

As I said before, we know that social media is one of the primary sources of misinformation. It’s driven all the polarization; it’s driven the conspiracy theories. So we want to flood social media with credible content—and content that responds to the public, that allows us to really listen to what the public is concerned about, and give them credible, shareable (and by that I mean if it works well on Twitter, on Facebook, on Instagram).

And it really is, we want to create like an army. An army! So, tens of thousands of people that are sharing this information.

And the other thing we're doing is we wanted to make it really simple to become part of the team. So all you need to do is follow ScienceUpFirst on Twitter, on Facebook, on Instagram--and we're going to be on TikTok also—and share that content.

And you can also become part of the team by actually becoming, if you're a scientist, becoming one of the individuals that helps us vet the content. So we're creating new content and we're sharing the credible stuff that is already out there.

And it's been tremendously successful out of the gate. I think in the first two or three weeks, we had fifty million impressions. We're getting thousands of people sharing content.

So, yeah, we hope that this is something that survives the pandemic, that it really becomes kind of a movement and something that if you're a grade six student who is interested in science, you can become part of it. And if you're someone who's sequencing the genome of the woolly mammoth, you can become you can become part of this movement. We want to make it something that everyone's proud to be part of and will live on past the pandemic.

Dr. Mike Strong: So, you talked about reviewing and looking at some of this material. And so, you know, for our colleagues who are out in the field [and] are going to be saying ‘hey, you know, this is pretty cool. I wouldn't mind being part of this.’

So let's assume that somebody like me—and I do well to turn on the computer every day and get my confocal out. So that's about it. So how much of a time commitment is this going to be for a scientist to say, ‘I want to be part of this and to bring some of these information and discussions forward’?

Prof. Caulfield: Well, the good news is I think more and more scientists are becoming part of this conversation. They're recognizing how valuable science communication is.

And I think that's an interesting shift we could talk about, too. When I first started working in this area, this kind of science communication was viewed as important, but kind of fringy. But now it's even in grants, research grants. They want to know what your KT [knowledge translation plan] is. They want to know how you're going to engage the public. So that's an awesome shift.

The reason I bring that up is there are more and more scientists and clinicians out there that are interested in this and are devoting time on social media to doing this. And they're enjoying it because it is a great community.

But you can devote as much time or as little time as you want. And we really wanted to make #ScienceUpFirst nimble like that. So if you just want to get on social media and share the content, that's all you need to do. I mean, that almost takes no time at all. Also, maybe you're not on social media so much, but you have patients that you engage with. There's going to be content there that will hopefully be helpful to you and helpful to your patients or maybe even your community more broadly.

So you can get engaged in a variety of different ways and you can dive in all the way and become a science communicator yourself.

And maybe you're creating content, you're creating your own videos. And that might be something that we're going to want to share on #ScienceUpFirst, because that's the other thing I think is very important to highlight. We want to partner with people, right? We really want to make this not a centralized thing. We want to make this something that really has a life of its own.

Dr. Mike Strong: So I'm kind of putting myself in your classroom right now. I'm sitting there and listening to and I'm going, ‘Great. I get it. I actually get it.’

But you've taught me about metrics, and you've taught me about measurable—and I'm kind of playing the role here a little bit on that—so how will you know when you're into this, other than the number of hits and everything? We talk about scaling up and we talk about impact on health outcomes, right, and particularly in the midst of a pandemic when, as you know, it's evolving so rapidly. How will you know that you're on the right track?

Prof. Caulfield: Well, I think that one of the great things about social media is that you have these huge N [numbers], right?

We actually do social media research and so you get a lot of metrics. You know, it's really nice. And so one of the ways that we can study the impact that we're having is to see who—we do this kind of a network analysis, right—and we can see who's listening [and] where is our message spreading. And you can kind of map it.

Now, for something like the spread of misinformation, you can see #ScienceUpFirst in this node—and even if it shifts a little bit, that matters. Because that means we're talking to new people and with something like the spread of misinformation, even a little bit of movement matters. We're talking about moving the needle here.

And the other thing that is really important, and so I'm glad you brought this up, is another crucial element to #ScienceUpFirst is we want to make our communication strategy science-based. So we're really trying to look at what does the evidence say about how we should communicate. And this is some of the work that we're even doing at our institute [about] what works. And we want to base our communication strategies on that.

And the good news is there's a growing body of evidence that debunking—not a great term, but I think it's become the term of art—but debunking does work. It does work.

It may not feel like it works, but it does, especially if you look at it on a population level. And that's the way I think we need to think of something like #ScienceUpFirst. It's a population-based initiative. We may not change the mind of that crazy uncle that you have that put the post on Facebook, but in the aggregate and over time, we hope it will have an impact.

I always like to say, look, it may not feel like debunking works, but imagine a world where people didn't try to do this, like where there wasn’t credible information on social media. It would be even worse.

Dr. Mike Strong: So let me move to a slightly different topic right now, and I think we all see this for sure, is the level of anxiety that has come to exist in the population. I see it amongst my friends. I think we all feel it at some point. You get up in the morning and you hear about an emerging variant, and before the day is done, you’ve heard of a second emerging variant. And I don't want to wake up tomorrow. Like, I just I've had it. This thing is not a sentient being, but, my God, it's driving us nuts.

We'll be on top of it. That's not my worry.

But even for those of us who are living this and going through it every day and have this anxiety, those pressures are there. I talk to my colleagues. I talk to family members, and it's magnitudes greater for them.

So you've recently written on this and started to focus a bit around the age of this anxiety. Talk to us a little bit about that. How did you get into that to begin with? And I think I can understand how we got there in this context. But where do you want it to go?

Prof. Caulfield: Well, you're right. I am fascinated by this.

And I think I've used this phrase already, this ‘chaotic information environment.’ And there really is interesting research emerging about the impact that it has on how we interpret the information that we're getting—you know, interpret the content that we're seeing on social media—the impact it's having on our mental health (increasing anxiety), and also on our sharing behavior.

So there is this fascinating research that shows that there's this horrible cycle that's forming. So you're getting your news from social media [and] being constantly bombarded about all this information about the pandemic—but we can talk about other health topics, too, but [let’s say, for example] about the pandemic—does increase our anxiety, increase our stress levels. That, in turn may have an impact on our ability to critically assess the information that we're seeing in the chaotic information environment, and there's a little bit of evidence to suggest that it might increase our sharing behavior.

So you can see this horrible cycle: we share, we feed the machine that creates more anxiety, and around and around it goes. So any intervention that we are going to introduce needs to try to break that cycle, try to get people to reflect.

And so [with] my new book, I try to invite people to do that, and I talk about what the evidence says around that, but also to highlight all those cognitive biases that we have that play to this.

So we do have a negativity bias. We are hardwired—and that's not a great term because it is so much more complex than that—but we do seem to have an evolutionary predisposition to respond to negative news. No surprise, right? You should remember the bad stuff, but that plays out terribly now.

For example, there is really interesting research that suggests that negative headlines outperform positive headlines. So that takes place in the context of the news, but it all also takes place in the context of our head. So we have that kind of bias and we have also the availability bias. We remember dramatic things. So that's one of the reasons that these anecdotes and testimonials will often outperform data. So you remember the story about the person that had an adverse reaction to the to the COVID vaccine, but you ignore the research from the CDC that has looked at millions and millions of moments, of data points. The anecdote wins out. So [it’s important to] remind ourselves of those cognitive biases.

And lastly—I could go on and on—but the last one I'll point to is that it also reminds us that teaching critical thinking has an impact, [as does] inviting people to pause—to pause, to relax, to reflect. And my colleague, Gordon Pennycook at the University of Regina, who also receives funding from the CIHR as part of our research team, he's done research that's found that that simple nudge, that simple nudge, inviting people to pause, inviting people to reflect, can decrease the spread of misinformation. And I know it sounds ridiculously simple, but there's actually evidence to back that up. And actually his work has been replicated by other laboratories. So that's a really good example of an evidence-based intervention. Just asking people to reflect, to relax, to pause. That can have an impact on the spread of misinformation.

Dr. Mike Strong: Terrific. Thanks for that. And listening to you, you know, it's clear the passion that you've got behind all of this. I mean, that's very clear.

One of the things that we put this together, the whole On the Mic with Mike was, you know, there's a whole generation behind us that's thinking about science—and I think, what I'm certainly hearing, is thinking about it more now. I worry that we're going to have a crush of new virologists coming. But nonetheless, it's about science. And this passion that you've got: where did it come from?

Prof. Caulfield: You know, I get asked that often. I think I've always been a science geek. I've always been obsessed with what the evidence says behind a particular belief. Even when I was a kid and I was still believing in some of the more pseudoscientific things, you know, I've always been interested in what does the evidence actually say?

And then when I became an academic in the early 90s, right out of the gate, I kind of thought I was going to be more of a traditional law professor. And right out of the gate, I had these terrific mentors. How important are mentors, right? How important are mentors. Bartha Maria Knoppers, Justice Ellen Picard, and Gerald Robertson—these were people that opened up my eyes to the reality that you can be any kind of academic you really want. Bartha is great at this. You know, she was a pioneer in the idea that you can have these big interdisciplinary teams. And so I'm really, really fortunate that I had—and Ellen's the same: A law professor can do all these things.

So I was really lucky out of the gate to have mentors that said ‘do something that you're passionate about.’ And so I was able to work with—because I often don't have the methodological skills to do a lot of the stuff I'm interested in, so you know what you do? You partner with someone, you find a friend, another colleague who is doing it, who has those skills and you work together. And first of all, that's tremendously fun. It's really exciting to have these great colleagues. But then you bring together all these different disciplines. And I've been so lucky to be on these great teams that have done exactly that.

And as I said, right out of the gate, I mean, I actually think I was a little surprised when I first started working with Bartha. I was like, ‘What? I can…? This is what my career can look like?’

And so I'm so grateful that I've had these wonderful minds in my life that have kind of led the way.

Dr. Mike Strong: So, you know, it's interesting you say that. Your career could have gone differently, right? I read somewhere that you were actually in a punk rock band. Is that right?

Prof. Caulfield: That's right. Yeah, I was. If you asked me, let’s say I'm 20 years old or even the age of some of my kids right now and ask, what are you going to do? ‘I'm going to be a rock star!’

Not a good career choice. And I was I was down that path quite deep, actually. It wasn't like it was something I was just doing in my basement. I opened for The Ramones. I had albums. I can see one of my vinyl albums from here. We were traveling around Canada.

But my mom played a trick on me. (Rest in peace.) She was very, very clever. ‘I'll support whatever you want to do, Timothy. I support you, but promise me you'll get a university degree.’ That was her thing—you just have to get a university degree. You can do whatever you want. And I think she knew that once I got into it deeper and deeper and deeper, the passion would be there and I would realize that this path made a lot more sense than the rock and roll path.

It's not an easy way to make a living, by the way, being a rock star.

Dr. Mike Strong: I think being an artist of any sort right now is very, very hard as well.

Well, listen, before we go, you know, there's always a question that I like to ask towards the end of these interviews, and that is: if you could sit down and have a conversation with anybody you wanted from any time period, who would it be?

Prof. Caulfield: Oh, my gosh. I'd love to talk to Dwayne ‘The Rock’ Johnson, but I'm not going to say that. He seems like a really fun guy.

It's a cliché. It's a cliché – is that OK?

Darwin.

I mean, and I think Lincoln? There's so many. Lincoln would be would be fascinating.

Curie!

Oh, my gosh. Where do you stop? Where do you stop?

So maybe I'll land on The Rock.

Dr. Mike Strong: You know what? Terrific place to land.

Listen, Tim, this has been wonderful. And I have to say, first off, thank you for what you're doing. I think all of us as scientists, as clinician-scientists or practitioners, you know, this constant having to make sure that people understand what the real evidence is—it’s increasingly a bigger part of our time. Knowing that there are people out there who are also saying to the whole of the community that ‘you need to listen to science and here's what's happening,’ I think it's a tremendous help to all of us.

So on behalf of the whole community, I just want to say thank you.

I look forward to when we can have a chat, perhaps not over a screen, and I wish you nothing but continued success.

Prof. Caulfield: Thank you so, so much. I really appreciate the opportunity.

Dr. Mike Strong: So that's it! That's another one of our episodes of On the Mic with Mike. Today, we've been joined by Professor Tim Caulfield, and I look forward to seeing you again.

In the meantime, take care, use your personal protection, and we'll see you again very, very soon. So have a good one.