 Hi, hi folks. Good afternoon. Big welcome to the Berkman Luncheon series. I'm Rob Farre, some of the research director here at the Berkman Center, and I have the honor and privilege to announce our speaker today, Dr. Brittany Seymour. Before I get to that, a couple of housekeeping items. Number one, we are being live webcast, so be careful what you say. The internet will hold it against you. We have a hashtag at Berkman if you want to tweet this out. And without much ado, I want to turn it over to Brittany. Brittany is a professor at the dental school here. She focuses not only on oral health but epidemiology. And fortunately for us, she is also a fellow at the Berkman Center where she's helping us to understand digital communication in the area of digital health. This is a topic that is not only super fascinating, it is very, very important as you might imagine. People's lives are literally at stake. This is an area of study, certainly pertinent to many, if not everything we do at the Berkman Center, which is trying to understand how people know what they know, where they learn, what they learn, and how that translates into behavior. It applies not only to health but to politics, economics, and so on. I think it's a great opportunity to talk to you. It's all over the place. But today we are going to talk health communication with Brittany. And we're going to talk for like 20 minutes, half an hour, lots of time for questions. So start thinking about how you're going to quickly and concisely ask questions of Brittany afterwards. And I don't think I've forgotten anything important that needs to be said before I turn it over to you. No, I'll say it when you turn it over. Thank you for coming. So I'm Brittany. I got interested in this topic of kind of misinformation on the internet as a health care provider. And first with individual patients that would come to me with questions or concerns from things they found online, and now more from the population health perspective. And I'll talk about some case studies, for example, community water fluoridation, vaccinations, things that require community buy-in and have a foundation of kind of community-driven information and research. So how this all works for improved health outcomes, ideally, or in some of the examples, poorer health outcomes. But before I get started, I'm a couple of things. So I'm a health care provider with a degree in public health. So I come from the health world. And that's the way that I see this work and the way I talk about it. And I'm also, I've given this talk or related talk to health audiences quite a lot. But my impression is that this is a more diverse audience than typically who I'm talking with. So I'd love to just hear from you quickly who you are or why you're here and interested. And if you're just a Berkman lunch series regular, that's fine. But if there are specific reasons why you're interested in this topic or here today, I'd love to hear that as well again so I can kind of gauge how we might be able to cater the conversation. Anyone care to? Yeah, thanks. Well, I'm interested in what you might call the social physics aspects of this, that is how does information propagate and what does the better systems of identity and then identity management. Okay. I'm interested in that too. So let's see how we can talk more about that. Identity and information diffusion, definitely some key themes into what we want to learn more about. Yeah. Hi. I'm a local sort of accuracy blogger. I worked for epidemiologists for decades early in my career, South Epidemiology, yes. Great. But I also wrote about quality Cambridge Floor, a couple of years ago that we went through a really naive, oh my God, they're poisoning water. Right. Right. That's kind of a regular part of my life as a dentist that we're poisoning people, yes, which we're not, but that message gets conveyed. It's a bad way. Right. Hey now. Okay. So you think about Flint, Michigan. Right. Right. Which I've also blogged about. It's a really important discussion. And I'm glad to hear that you have some background in discussing fluoride. Yes. I believe a seminar series from the local engineering society, the actual P-group and ACM group that addresses some of these issues. We're actually going to have a meeting that talks about some of the things you might be able to discover with them. But I've also sometimes hung around the fringes of something called the Personal Genome Project. And I'm not sure if you know where it is. That's where I mostly work with medical school. You then have an open humans project. Okay. And I recently spent some time looking over their consent form and all the things that potentially go wrong. Yeah. And you were personal genetic information and under information, because now they're also collecting a lot of environmental information that can actually trace where you've been on a lot of other things. Right. Right. One of the things that's been pointed out is that with the last four digits of your social security number and your birth date and your symptom, you essentially give it away who you are. Right. This is something that you're asked for all the time on the phone when you're talking to financial institutions. Yeah. Yeah. Yeah. And these kinds of technologies and kind of open access data sets in health and how we can optimize those, right, for improved health, because more data is more knowledge while still protecting individuals. That's a big ball in the air right now. So. Right. Right. So, okay, good. That's helpful. Anyone else? And I hope as we continue the discussion, you feel comfortable introducing yourself and talking about why this topic interests you. So I've had the pleasure of joining Berkman as a fellow this year, and my learning curve in this area has been very steep. Again, from my background and my training as a health care professional, we value science, we're taught from a science-based perspective, and to us, that is the truth. That is our ultimate truth. And those who develop and create the knowledge through the scientific process are the authorities and the experts. But when it comes to the internet, I'm quickly learning that that definitely is not the case. And maybe it shouldn't necessarily be the case. So given that, what does that mean for health communication, knowledge dissemination, and information sharing when ultimately we still need to rely on solid science for the best health outcomes? And that's kind of the big question that we're interested in when it comes to utilizing the internet and its capabilities to communicate. So I'm going to talk about, I kind of introduced briefly why I do the research. I think it matters a lot. I think it matters more than we even fully realize in the health profession. And we need to kind of do some catch up when it comes to the field of health communication and how we use new media and technologies. I'll talk about or I'll introduce three case studies that we've completed looking at kind of network science and internet research. And then the so what and the now what. So why does this really matter and now what can we do moving forward? And that's the part that I hope can be really discussion based because we don't have definitive answers why this matters yet. There's still a lot still that we need to discover and a lot of unanswered questions and then now what is definitely an open-ended discussion? Where can we go with this? Where should we go with this? Okay, pop quiz. Does anybody know, and some of you who might know this already from hearing me talk, but does anybody know the most common disease in the world? Malaria, it used to be up there. We've made some improvements, but still common, not the most common. That's a philosophical discussion that we should have maybe over a meal. Any other guesses? That is one of the leading killers still, but not quite as prevalent as the one I'm about to tell you. Anyone who's heard me talk know? Cavities, cavities. Dental carries as it's called the most prevalent disease in the world in both children and adults, and we just found this out in 2010 when the global burden of disease study was completed. Cavities. Now the thing about dental cavities, they're highly preventable, and we know how to prevent them. One of the best modes of prevention here in the United States, and globally are access to fluorides. And in the U.S., we practice fluoridation of drinking water, because it was named as one of the most prominent public health interventions in the 20th century because of how cost-effective and efficient and successful fluoridation has been. But despite that, we have a lot of challenges in water fluoridation. Right here in our local communities, we still continue to have communities contest if they want to continue fluoridating their water or not. And so the science becomes central to the discussion. Is fluoride safe? Is it dangerous? Does anyone recognize this study? Yes. Okay, do you want to... This is probably the most cited, you know, normally in the headline, Harvard finds fluoride toxic or something that you can find on any anti-fluoride website or Twitter. Right, right. So it's kind of nicknamed the Harvard study. One of the lead researchers is affiliated with the School of Public Health and did a meta-analysis basically looking at studies done primarily in China and some other countries where fluoride levels in water are at naturally very high levels that aren't found here in the United States. And their conclusion was that fluoride at those levels in water may have some neurotoxic effects in the developing brains of children or they may impact IQ. The studies have been criticized pretty extensively within the dental public health and public health communities for being very flawed. And yet we still see their findings brought to communities and applied to community water fluoridation when in fact there's no link at all. Research in this study don't even exist here in the U.S. in our public water supplies. And yet we see right after that study was published that evening that very day when it was released online the media headlines were putting the next generation of brains in danger. I mean that's catchy and scary, right? And that propagates very quickly back to somebody's discussion about how information spreads. These kinds of headlines specifically within 24-48 hours really created a platform for this study that still exists today. So these four news sources published that headline are similar and I just kind of tracked their metrics online over the weekend how many Facebook shares, how many tweets are they getting with these headlines and it was, you know, thousands and thousands by the end of the weekend and two years later we're still working with the organization that has resulted from these studies at the community levels. My hometown in Durango, Colorado just voted to put fluoridation up to see if they want to discontinue fluoridation in Southwest Colorado now. And this study is brought to the table every time. So what does this mean when this study has really been kind of misused at the local level and it's impacting health? So we did we decided to kind of do an exploratory project with a couple students, very savvy students mind you I'm from health, I don't have computer science training or any kind of background. So it was a couple interns and we just spent the summer looking, what does the internet look like when it comes to fluoridation and that study? Do you have a question? Yeah. Yeah. Really good question. There are thousands of studies that have been done. There's a database of about three to four thousand studies and as we know we don't go off of one single study or even a handful of strong studies. We really look at the body of evidence and the scientific consensus and expert opinion and all of that has been done numerous times and the conclusion is always the same. It's safe and effective and the only harmful side effect that has been demonstrated is speckling of the teeth in above recommended levels. Yeah. Doesn't that same journal published any follow-up? The journal published responses. Yes, thank you for bringing that up. So of course as you can imagine after that study came out there was a lot of negative feedback from the dental public health and public health communities and they did publish a couple responses from experts on water fluoridation. But those don't make the headlines the same way a scary... Absolutely. Right. Yes. Yeah. I know. I think that's part of it. I think it is a volatile topic. I think the researchers come from background of environmental toxins. They kind of broke ground about lead and really paved the way where we initially thought lead years and years were safer than it's been found to be and so that's their background. That is their motivation, which I understand. I think lead and fluoride are very different and can't really be placed in the same bucket. But that's partly in part why. Yeah. So anyway what we did, we went to Facebook just to see how people are talking about this study and why it keeps coming up and is it part of the way it's discussed on the internet. And these are three just kind of randomly selected Facebook groups who came together around fluoridation to protest it or because they don't want fluoride in their city or their country. And we wanted to see what does that dynamic look like. And so we used the study as we just searched who was talking about the study and found about 17 Facebook groups. We mapped out three of them just to see and we can see that one of these is based in the U.S. and other is based in Ireland, but you can still see how connected they are. They have linkages and friendships with one another over this common issue of no fluoride in my water and that comes back to identity. It seems that the identity around no fluoride really forms strong relationships and bonds with these groups. And so you're familiar with the term six degrees of separation in the real world and the experiment that led us all to kind of the theory that we're all separated only by five or six other people. Facebook a few years ago found that it's separated by four degrees and we ran that same algorithm on our anti-fluoride groups and they're separated by only two degrees. So back to identity and kind of these social connections that occur around that identity very strongly held beliefs within these communities. Which of course when you have these norms and values and you introduce scientific evidence based information that kind of counteracts those norms, it's going to be rejected because it's a violation of a social norm for these groups. So what does that mean? Is there hope? Is there anything we can do? We also looked at where this article lives. So it's published in one place that's the scientific abstract aggregator where the actual article lives. But actually where it's being discussed and talked about is in all kinds of places as you might imagine on Facebook, within Facebook groups in the media. Most of it is in blogs and we found that over ten percent of the time within any given conversation on the internet about this article we couldn't actually find a link to the article itself. So then the messengers, the people talking about this article become really key influencers in how the narrative moves right? Their sentiment and how they discuss this information is the only way that people get the information when they can't find the original article. So what does that mean and who's discussing it? Does that become extremely important and we think yes. I'll briefly take you through another case study. I think this one's going to feel a little more familiar just because of the amount of popular press it's received. Childhood vaccinations of course are really heated topic for a lot of communities around the world and in particular specific communities in the US. Vaccines was named the number one public health achievement in the 20th century by the CDC. You'll see in the last couple of decades we saw the largest gain in life expectancy in our world's history combined and a lot of that is due primarily to vaccines and water sanitation. Improved water sanitation practices. So vaccines have been literally life changing for people living around the world and yet this is a map of the vaccination rates for the 2013-2014 school year of the US. Any states that are shades of red are below optimal protective herd immunity or community protective vaccination rates meaning children in those communities and unvaccinated community members are at risk of coming down with the disease if they're exposed. And so this was this kind of started to set off alarm bells as communities started electively not vaccinating their children and then sure enough not surprisingly but really tragically we saw the largest measles outbreak happen in 2014 that we've seen in the US in almost a generation and a lot of that centered around the Disneyland outbreak which you notice California's red. So again, none of this is surprising but it's definitely disturbing and here we go again same thing. Does anybody recognize this study? Yes? The famous British guy, right? Andrew Wakefield right? This is the study that kind of created this now almost cultural phenomenon that the MMR, the measles, mumps and rubella vaccine causes autism. Now within the science community that has been debunked and debunked and debunked over and over and over but this perpetually lives on the internet and continues to be an issue. Does anyone know what happened with the Tribeca Film Festival last month? Robert De Niro what happened? We had this anti-vaccination called Vaxed and it was entered into the film festival and it was going to be shown and there was a lot of pressure from Robert De Niro or I guess it was in charge of the festival to withdraw and he did but really budgingly and I don't think he really he presented what happened He has a child an autistic child Robert De Niro does and feels that every angle should be explored right? Fair enough Do we know who produced that that movie? This guy, right, right So some conflict of interest going on and with enough media and community pressure they withdrew the film because they felt it was going to perpetuate misinformation in harmful and dangerous ways but again, controversial truly, when you think about freedom of speech and all that read about it, it's really interesting the process and how the film festival ultimately decided to make the decision not to show the film but anyway, this study has also been retracted the author has lost his license so I think this is a big deal to retract a study like this, it's a big deal to withdraw somebody's license to practice medicine a loud and clear message and yet we still see it coming up Does anyone know who that is? Jenny McCarthy Why am I showing her? Jenny McCarthy Jenny McCarthy, right a parent of an autistic child who kind of she became, right so someone just said the celebrity spoke person for the modern anti-vaccination movement although she would say that's not true but nonetheless she kind of rehashed some of these issues and we kind of thought that the internet made it more possible for this to get more traffic and it had, because the original study came out in the late 90s kind of pre-social media, pre- web 2.0 and they were able to kind of calm those fires but then Jenny McCarthy managed to drum up quite a following and a lot of concerns so this is a Google trend, nothing fancy here but what we found interesting is that anytime she had a public appearance, she wrote a book she was on Oprah, she was on Larry King anytime she had a public appearance people were going to the internet and googling her and googling vaccine and googling autism and that's a pretty tight correlation to deny that she is not somewhat influential in this and this is back to authority, who's the authority when it comes to this kind of discussion, if vaccines are safe and how does she manage to influence people and actually impact their behaviors where they go to the internet looking for this information and what we've seen happen is initially she was kind of pegged as anti-vaccine, she came back with the phrasing no it's just too many too soon, do you remember when that did too many vaccines at too young of an age or green our vaccines take the toxins out, make them cleaner and greener, what that ended up doing is look at the explosion of concerns now that the CDC directly addresses on their website, so it's propagated by these kind of social influencers and now we have quite a landscape of vaccine blogs and alternative information sources beyond what in health we would consider the traditional kind of gatekeepers of the science and the truth, so what does that mean for health outcomes? I think the measles outbreak is a pretty dramatic side effect of what is possible and so what we want to do in health is how is it possible to combat this, when we map out the people that are publishing and sharing information about vaccines what do these networks actually look like and if we color code them it might be a little difficult to see the colors but with this vaccine network we mapped out about six months over 2014-2015 including when the Disney outbreak happened so really rich media publishing about that issue, we have down here the mainstream media community and they're clustered together because they link to each other a lot. Here this small red community with the giant CDC node is the health and science community health and science community relies heavily on the CDC and itself then up at the top we have these two communities one is the kind of the vaccine hesitant or anti-vax group and then right next door is the pro-vax group which was interesting to me that there's a pro-vax group that identifies differently than the health and science community but actually the function of that group is they're directly combating whatever is being put out by the anti-vax group so look at this blog here's why it's bad here's a blog that you should be reading instead so really interesting dynamics and if we think about the health and science community we live in this very small kind of self-connected world and we're not efficiently getting our information and messages out to the rest of the information landscape so what can we do I'm going to skip a little bit ahead and just talk about we saw similar findings with Ebola we did a case study on Ebola and you can see we saw color coded communities and a lot of the information that was shared was driven by fear and by social media and some of the policies and recommendations that were implemented in the U.S. during that time were violations of the international trade agreements so although we can't say causally what's happening on the internet impacts real life I think there's enough that we can infer that these conversations influence people's behaviors and decisions and their health and that's why we do this work because that's what matters that's what Rob was saying people's lives are at stake we need to get this information out in the right hand so people can feel empowered to make the best health decisions for themselves and for their families so preliminary patterns that we're seeing and I'm about to wrap up so we can talk more about this and this is really what's still rich for discussion is how do we make meaning of this how do we make impactful changes can we and if we can't does that mean we need to rely on stricter policies online information in and of itself is we're doing a pretty good job in health the CDC's website is a popular source the WHO's website was prominently linked to and featured during the Ebola outbreak so when it comes to just putting out information on the web we're doing a good job in health it's getting linked to but the social use of that information what people are actually sharing how they're talking about it the message is getting mistranslated re-translated lost in the conversation so when it comes to social use of the information that we're putting out there we're not doing such a great job there's a disconnect between what they're directly linking to when they go to the internet and what's being shared across networks and between social media groups, yeah in the internet era I would my instinct is that it's different yeah but it's certainly communities and their own views on things which might be quite different than other communities and we've been doing that forever that's a really important question was so is this better or worse than before the internet yeah yeah so Vice did a piece this week on Pakistan and immunization of babies for polio and they're having big problems and this is not because of the internet this is because somehow the story is that these vaccines cause infertility right that's really it's really a plot you know it's a kind of conspiracy theory so this question of how information how information kind of spreads around in a community and you know this is one way but the question was you know do you get the same thing when you don't have the internet is it better or worse I mean there's certainly a lot of old wives tales that were around that impacted people's behavior before the internet so the other piece that I saw this week John Oliver you saw that yeah so the way media presents science results and findings it just sucks it's really bad and you know you have to have equivalence you have an expert says it so you have to have somebody who says it's not so and so this whole thing about how do we deal with evidence versus lack of evidence that to me is like you know one of the big cores of the problem right thank you yeah great examples yeah I remember being a kid in Memphis Tennessee in the early 60s and fluoridation was a big controversy actually don't remember what they ended up deciding on but you would see ads in the newspapers you know from anti-fluoridation groups now back then anti-fluoridation groups were sort of considered to be part of the right wing fringe they belonged you know the John Burke society and you know people like that so it's a little strange you know decades later to be seeing it coming from the other side of the political spectrum you know places like Vermont or Oregon where I would expect people to be enlightened no comment but I hear you which is very interesting because I mean that's one of the things I sort of one of the threads I chased when I was writing about this in Cambridge because it just sort of stunned me to you know that it had any traction here and I mean what I mean you if you the thread that links them is sort of the anti-corporate movement I mean there is at the you know the right wing conspiracy were you know the communists who were also the bankers who were controlling the world here where you find it coming out of the left wing you know that I found in Amy Goodman piece where she credulously was interviewing somebody who this is toxic waste that the corporations are dumping you know on America it's not by the way it's an insane thing you know to think I mean what does that evoke that people are sneaking into water reservoirs picking up trucks with with barrels of toxic waste I mean it's a meaningless statement but that's exactly that's the thread there and it's fascinating how it's gone right well and so this is kind of back to identity right and so when we first started talking about this issue and I presented our findings about fluoridation and there are city council meetings happening left and right and there's better information David Weinberger who some of you may know another esteemed colleague of the Berkman center pulled me aside you know new at this I still consider myself new he says Brittany this is not a problem of information this is a network challenge this is about social networks and social identity and the information is secondary to that and that changed everything for me because we can pound these groups with the right information all we want but if it doesn't fit within their identity their network and we're seeing that right when we map out these information environments we're not going to get through to them so what does that mean yeah what are the what are those networks look like for different kinds of stories right like either good science or you know whatever happens to be causing or curing cancer this week right I mean what's the comparison is it a similar network is there a healthy network do you want to comment on that Rob only because you're more of a network expert I would say between the two of us that is that is a wonderful question and there's no such thing as a normal network I mean would a normal network be everyone agrees and there's consensus and there's just one big clump of truth I mean the world doesn't work that way and the question is is there a flow of information and is there some kind of debate going on and the best we can tell is that there's a little bit of flow of information on different topics but that the level of discourse and dialogue is probably not what we would hope it to be in an ideal world the notion that people who know the truth are convincing the people who were mistaken what the real truth is hard to see evidence of that right now thanks yeah does that answer your question yeah just point out there is a network of enlightenment which I think has been is centered at the Berkman Center the there is work that's kind of related to this about the effectiveness of meetings which I know is going on and that seems it's not exactly the same thing and one has to also consider for instance on identity maybe the right to be ignorant is the right to have views that are different than those of some at least in somebody's mind dominant culture but that's the social physics aspect of the thing and they've got some measures and apparently measures that are sufficient interest that there's spending by business on behind the measurement of effectiveness of meetings what does the conversation look like in an effective meeting yeah so can I elaborate a little on that term measurement I think this is why this research excites me so much is because we now have tools that allow us to map and measure these information networks and we still have a lot more information to learn about them but the fact that we can measure them means data and data means we can design interventions and test them in ways that weren't possible before so to me that's really where the possibility lies with this work is testable measurable interventions that may or may not work and if they don't work we need to know that if we're pumping all these resources into improving our digital communication it's probably not going to make substantial changes we need to know that and then we need to have conversations with policy makers and I mean that's just a different approach right but if it's possible to improve our communication approaches and reach new audiences with our own messages and information to me this research is going to get us one step closer to actually being able to do that and track it and measure it in the back there yeah I had a question but now I have a prequel kind of question before that so I heard you say there networks and identity so could you first clearly define what we're talking about when we say networks here is it anything more than the underlying webs of connection and interactions between people and kind of the pathways of information yes that's what you mean by network so my question is as a part of the project that you alluded to have you also actually talked to these not the spokespeople but the regular people the common people who are part of those groups because I think and as a part of the sociology course and I think it's not just the problem of not effectively disseminating information it's not like they think that vaccine causes autism because they haven't heard that the scientific consensus says otherwise it's not always the case it's almost always not the case they have heard it and the centerpiece here is their perception of science and scientists because if you actually talk to them they will cite examples historical examples of scientific consensus used to real consensus not just local consensus real like universal kind of global-esque scientific consensus used to justify things like racism it's not even that far back in history and that was really consensus and they would say okay now you have consensus I don't need you care the perception they have of science that's something more profound that yeah that's the main question what are we going to do with that and what are the ways of yeah first your comment emphasizes an underlying theme and theory that we're working on that it's really not a problem of information and we seem to be finding that but also back to your comment about John Oliver's piece where he talks about how the media makes science look one day it's this study and the next it's a different study that says exactly the opposite and it makes us sometimes look like we don't know what we're doing at all right whereas for us that's the process that's science we always are collecting more data looking to improve and better ourselves but then depending on how that's presented it can look like we may not know what we're doing and sometimes we don't and we admit that and the discourse about our limitations is very different than the discourse on the broader internet right about those limitations of science so I don't know I may bring the techies down upon myself I find your talk it's very informed and informative but I find you potentially a little protecting the scientific and medical community now I'm a skeptical person and I enshrine the precautionary principle my younger son got all his dental care at Children's by the way and I allowed them to paint his teeth with fluoride I must confess that I do filter my Cambridge tap water to get rid of fluoride as well as other nasty things in it or things I consider suspect so in the case of I just wondered what your position on mercury amalgamate is because it was used at that time routinely just a couple of years ago routinely at Children's and I had to tell them not just one time but every time not to put mercury amalgamate in my kids mouth and of course I think they were putting this fennel in A in it and I only discovered that until later so sometimes the solutions or the alternatives are not clear but so what's your position on mercury amalgamate? that it's safe there's been a global pact to reduce the use of mercury worldwide for environmental reasons and that definitely impacts the dental profession but as far as use in the dental offices and the way it's used the science says it's safe but you know your concern is common and I was by default because of the choices from my patients of mercury free practice although I was fully equipped to do dental amalgam the mercury filling nobody wanted them and one they're not as pretty they're silver and we have prettier materials and that's also the direction we're going but I never felt like I was putting my patients at harm by using those materials but I think it's phasing out for multiple reasons anyway thanks for the question they're done particularly with young children in dental offices and it seems to have increased a lot there's a lot of literature saying you should minimize radiation exposure and yet when my kids went in as early as four we were sort of encouraged to irradiate their faces with full dental x-rays when they just saw their baby teeth and no evident problems I would push back on this and was treated like a baxer for questioning this and ultimately I had to say you know what I don't want my daughter having her face irradiated if you're not telling me there's a real reason for it and I said give me that where's the science that says if she has x-rays every year at age four, five, six, and seven that later in life she'll be better off with her dental health and of course they weren't able to produce any similarly when they all three kids got sent oh you need to go to the orthodontist and the orthodontist insisted they all needed some minor adjustment costing thousands of dollars and more radiation to expose their faces to get this treatment I again what's the evidence that doing orthodonture for these apparent minor adjustments will produce a better outcome later in life and again the line went dead so maybe I'm a baxer but in this case but I said no to some of these things and I didn't see evidence coming back I guess all I'm saying is there's a flip side to this that maybe there's a reason to have people questioning and sharing and yes the baxer and the fluoridation is pseudo scientific and unhelpful but maybe there's other ones I guess I'd long windedly like to just see what your view is on the radiation question sure I love that people are taken to the end of having a dentist in the room I'm happy to play that role too it is a that's heavily determined by insurance companies but dental radiology in the dental world has come a long way you know I'm not sure how old your children are or were when they were getting but today today today's kind of standard of care for children is a full series every year or two to see how the teeth are developing and growing and then a few kind of updated ones at their six month checkups to make sure they don't have cavities cavities move quickly in kids teeth they can come back and have a bombed out tooth in a very short amount of time so we're proactive with kids but today the technology the radiology you can get the same amount of exposure walking in the sun from your car to the practice that you that then you'll get at with the full series of x-rays it's very very low exposure it's digital right the tech yeah but we're seeing the same thing with CT scans and how regularly they're used for diagnostics right and that they may not be as diagnostic as we'd hoped and are we exposing people unnecessarily to radiation so it is a topic and digital x-rays that's been a big focus is reducing the radiation exposure as far as ortho I don't know I mean yeah well and so that gets to the way our health systems operate and that every office operates within its own health records and if you want to be extremely diligent and transfer all your records yourself you can but there's no easy way for these systems to talk to one another which is off topic but another discussion that's worth having is should we consider systems health record systems that talk to one another so that you don't have to take the same x-rays twice in a month and then I just want to talk more a little bit to answer your question about kind of authority and truth and I would I would say it's been humbling doing this research from the health world I was earlier on and I won't say who and it was not Rob but somebody I've been working closely with said I'm judgy and I was like oh yes I am judgy but that's why I try especially with non health audiences it's a very different reception as you can imagine when I talk with health audiences than with non I always remind people I come from the health world that is I have had very sick children in my hands because of the lack of these interventions that's my lens that's where I come from I have really worked to put myself within the identities and mind frame of these these other communities and where people are coming from I don't think the vaccine hesitant families say I want to be ignorant I'm just I've decided that's not you're right they don't say they're not like I am going to ignore the information and remain ignorant no one decides that that it's much more nuanced and much more complex so I'm somewhat limited in my approach and views on these topics because of my background and my identity as a health care provider right so identity I think is a big key theme in all of this I saw it on the hand yeah to kind of talk about the sociology of this I mean it's an old-fashioned idea actually but I like the category of experience like what lens are people looking through the ground in a very specific case I remember a great study by Adam Ashforth an anthropologist of why people in South Africa when AIDS started to spread in the heterosexual population didn't trust the idea of using condoms and things like that and the folklore was AIDS was caused by witchcraft that somebody would hire a witch doctor and do something to you and then you'd get it and his analysis of all the details was that if you're a an African in South Africa and some white guy in a suit comes to you once a year or white guy in a white coat and says oh here's all this stuff and this is right after apartheid has fallen that whereas this disease it didn't happen right away right you know like you'd have sex and nothing would happen for a year and a half or who even remembered and so his argument was basically the witchcraft theory from the ground actually made a whole lot of sense and the trick was finding out from what perspective this stuff that sounds nutty or kind of like a form of denial where you know exactly how does it make sense and and then I think the network stuff you're doing is fascinating with that regard but that anthropological move I think to kind of is still a necessary part of trying to solve the whole puzzle I agree I think what we're seeing online is nothing new when it comes to misinformation and how it's communicated and how it diffuses through networks we've seen this in live networks for decades and centuries right and now it should be no shock that it's happening in digital networks too and we'll yeah we could take a couple more questions and then okay yeah as long as everybody's already gone for hasn't gone as already said okay grab a cookie if you want there's still I think one this is out of your field and away from the talk but one reason I think there's skepticism toward what seems like authoritative information from the medical community is that there's been some like dizzying U-turns in some areas like nutrition is what I'm thinking of like apparently I should not have been drinking I should not have been needing margarine and skim milk all this time I should have been eating butter and full fat milk and this seems to be a very sudden U-turn a rather important field of health and when that happens it causes a lot of confusion among the public and you're not sure what you should be believing right and then this comes back to the issue of trust and who is the authority over any given topic yeah nutrition is a big one we haven't mapped that one yet for a reason I'm a little scared of that topic for now I'll share a little bit of personal experience some of the epidemiologists I worked with were nutritional epidemiologists and these flip-flops once you're inside the science you know are fascinating to watch you know I remember this was in the 90s a scientist coming to the place I worked talking about oh my god trans fat we're killing people and I always sort of map that to the person standing up talking about fluoride and saying you know oh my god fluoride we're killing people you know sometimes you know people are whistleblowers and sometimes there's a truth there I mean the same thing with you know would be true with flint etc so I mean there's this my father was a plumber in New York and he got his plumbing license plumbing contract he had his plumbing license you know laid in life and one of the things the practical test was wiping a lead joint in a pipe right right but this was this was the 60s and he was saying oh my god lead are you kidding me but I mean you know the practices don't actually necessarily map to current science and you know there are legs there and it's really hard you know when somebody's saying fluoride bad you know no no the scientists have it right this time I mean fluoride is there's so much history with it that you almost can but you know skepticism and who wants to take that gamble with their kids right yeah absolutely did you have a comment I was thinking that I don't know increasingly there might be some cynicism amongst the public because you have to look at certainly many fields where where research is done you have to say like certainly pharmaceuticals and other places where where's the source like who has a vested interest in the outcome and so that it may sway the research findings are you know sort of like follow the money you know sure and that made people are becoming like who is the benefit you know it's not may not be pure or people are willing to sway their or put not to say put their reputation on the line but of course they need to have their lab or whatever their institute to keep running right right that may have an unfortunate effect yeah again another recurring theme is trust and the imperfection of science and the reminder that it's a process and often that process takes years if not generations and so we'll go back to this slide as a friendly reminder though that it does work we do see improvements in health it is a standard of care that we are held to to practice part of that is vaccinating young children applying preventive measures like fluoride to children's teeth that is within standard of care it's to the best of our knowledge evidence-based medicine for optimal health outcomes but it is imperfect and sometimes people get sick or die because of the medical intervention that we have offered them health care is one of the most dangerous activities people can engage in in the US is getting health care that's sad it's as dangerous as mountain climbing per people engaging you have high number of deaths we're not proud of that and we are working on that but unfortunately it means that we will cause some harm in the process and we do take that oath I still got my hood and took the oath and we practice that way every day but ultimately unintentional harm does occur we're getting better but we're not perfect so what does that mean in the interim we don't want to be so paralyzed with caution that we backtrack to measles in the US again right? so how can we operate and practice within this environment today is it possible to prevent the next measles outbreak or are we going to be you know reactionary do we just manage the outbreak once it happens and I don't know but as someone with a population health degree I would like to think prevention is possible and that we can empower people to make the best decisions for themselves based on the science and maybe in 5 years I'll abandon that optimism but as of now that's where I stand thank you and on that thank you