Dr. Reed Tuckson (00:04):

Health is not isolated from what’s going on in the rest of the society, so we are living in a time of absolute misinformation and disinformation and the destruction of our faith in almost every institution that governs social life.

Speaker 2 (00:28):

Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn (00:38):

When I was 10 years old in 1962, I stood in line with hundreds of other kids to get my sugar cube doused in oral polio vaccine, and no one complained or raised a fuss. Today, I have a hard time imagining that composed scene from 62 years ago at a neighborhood school gymnasium in New Orleans. As conspiracy theories abound, only intensifying in the aftermath of the COVID-19 pandemic, the life and limb-saving vaccine would probably be met with skepticism today and outright science denial, based on fuzzy science or no real evidence at all. This science denial has consequences. Diseases like measles, which were declared eradicated in the US in 2000 are making a comeback. Because half-baked is often accepted today as writ, what’s to be done? We’re going to discuss a response with Dr. Reed Tuckson, managing director of Tuckson Health Connections and co-convener of the Coalition for Trust in Health & Science. Reed has dedicated himself to fighting back against misinformation, which undermines trust in medical care and public health, and at worst even kills. Reed, thank you so much for joining us today on this timely and sensitive subject.

Dr. Reed Tuckson (02:02):

Hey, thanks, Chip Kahn. I really appreciate this and I’m glad to be with you and your audience.

Chip Kahn (02:07):

Reed, to get started, comparing today to my childhood in 1962, a lot’s happened since then, but what’s going on to enable conspiracy theories to become incredibly potent in our nation and really across the globe on health matters?

Dr. Reed Tuckson (02:24):

I think the big challenge that we in healthcare are facing, Chip, is that health is not isolated from what’s going on in the rest of the society. So we are living in a time of absolute misinformation and disinformation, and the destruction of our faith in almost every institution that governs social life. Whether it is the police, whether it is the mechanisms of the criminal justice system, whether it is how we view politics, whether it’s organized religion, on and on and on, we are seeing this underpinnings failing and falling of all of these institutions. And healthcare is a part of it, and what we are seeing is this sense of tribalization, polarization, this sense of me against thee, the sense that my loyalty to a set of tribal issues, regardless of whether there is facts or not, to bolster our particular opinions is more important than facts.

(03:21):

Combine that with this incredible new social media, this incredible ability to speed false information, not only widely but directing it where people want to go, this weaponization of information is an unprecedented challenge for any of us trying to do this kind of work. So I think it’s this combination of this distrust of elites, this sense of us against them, me against you, my tribe more important than your tribe, combined with a dissemination mechanism that is being very deliberately controlled by people who want to vomit mischief and discontent, all of that rolling throughout the society and having it then also impacting on healthcare.

Chip Kahn (04:13):

Let’s dig a little deeper into this trust issue and look at it from a healthcare perspective. How has this broad tolerance and even acceptance of misinformation, fuzzy science or half-truths impacted healthcare, healthcare delivery, public health, and for all of us generally and actually at our individual family level and level as a patient?

Dr. Reed Tuckson (04:38):

I think it begins fundamentally with the way in which individuals decide to make their choices about their own health, the health of their families, and the health of their communities. What we are seeing is people who do not have a clear sense of facts, people who do not have oftentimes the background to interpret or understand the new developing complexity of science, who are being manipulated in very disingenuous ways, they then are having a hard time deciding on what is truth, what is good for them versus what is harmful for them, and the relative importance of them making a decision in the best interest of their own lives versus the best interest of their tribal affiliations, their political affiliations. It’s very frustrating when we see a political perspective overriding a health perspective. The result of that, of course, is that people become sick, and unnecessarily, we see people die. In the last COVID experience, we know that estimates are as high as almost 300,000 people died who shouldn’t have died because of this chaos and confusion around what is true and what is not true, what makes rational sense for people to behave.

(05:53):

But what I think also, Chip, is a more fundamental concern that I have, and that is a sense that somehow, we are becoming comfortable with devaluing human life, that we are not as concerned as you would’ve thought we would be about whether we live or whether we die, and whether or not people who are vulnerable are protected. So I think that what you’re seeing is people who have this willing sense of, “The only person important in this drama is me. I refuse to be discomforted to save a vulnerable person’s life.” So if someone has a pre-existing condition or suffering with a chronic illness, that makes them vulnerable to a virus, there are so many people in our country who have gotten to a place where doing something that would help protect that vulnerable person is less important than whether or not I am in convenience as an individual.

(06:49):

And I think this is really kind of getting at the heart of it, but I’ll conclude that answer, Chip, by thinking back to the young you and that is, are we going to see parents now making choices and decisions about whether they vaccinate their children against preventable childhood illness? And we are seeing a heck of a fight now across this country in almost every state, where people are trying to roll back the ability for the public health apparatus to immunize our children, to protect not only the individual child, but all of our children who share the same time and space as that child. This is a very frightening situation, and again, one that is going to be very hard to overcome in the days and weeks and years to come.

Chip Kahn (07:34):

In that moment of COVID-19 that you’re talking about, obviously, whatever was going on before that, it exaggerated it, elaborated upon it. It made it more of a societal factor because it just touched all of us and it was really like a war, and clearly in wars, mistakes are made in contending with something that’s unfettered and unique like a pandemic that we all experienced. What do we need to do if we understand that mistakes were made, even with the best of intentions? How do we overcome that in terms of how that affected some of these misperceptions that you see on social media, examples that people use, which on the one hand, out of context seem troublesome, but if you understand the big picture, we’re just part of an iterative process which is contending with a crisis?

Dr. Reed Tuckson (08:32):

I think this is an important issue and I think that all of us who do the kind of work that I do, that you do, we always have to remember that we should be honest, transparent, and open with people about what we know and what we don’t know and the limits of that knowledge. But even within that context, we still have to face the challenge of what do you do when you have uncertainty and when death is a predicate of failure?

(09:00):

You’ll recall your colleagues working in hospitals all across this country at the beginning of the pandemic. We saw them having to put their lives on the line every day as people were rushed into these hospitals, and unfortunately, so many of them died that they had to have special freezer trucks outside of the hospital just to store the bodies. There was a lot at stake in this pandemic, and as a result, those in the health system were putting everything they had on the line to try to save their fellow human beings, their fellow American citizens. We didn’t have all the answers, but even without the answers, sometimes action is required, so you do the best that you can and you try to be as transparent, as clear as you can, but you still have to make recommendations.

(09:47):

What is very irritating and I think quite frankly exasperating is that those of us who have the responsibility for the protection and the preservation of human life are doing what they can do best. Those who have no responsibilities but still feel entitled to nitpick, to throw hand grenades at it, and spout off with all kinds of unfounded rhetoric, when the consequences of their recommendations, they’re not accountable for them. They can just get out there and do whatever they want to do, while the rest of us are going to have to clean up the mess from the confusion that others have created. So to be very specific to your question, yes, we in the health apparatus have learned a great deal about how we need to be even more careful about being clear about what we know and what we don’t know, and the reasoning behind the advice that we are giving, even as we try to get the information and the facts, to bolster even better recommendations for people.

(10:48):

I think though the dilemma that we face is as we learn and as we grow and as we get more information and midcourse correct as we get that information, we are then accused by some of these naysayers, some of the confusion mongers, “Well, you don’t know what you’re doing.” So the whole idea is that you do the best you can. You work your tails off to get better information, and then you’re honest when you say that we’re going to have to modify our original thinking to a better idea because we’ve learned more, and now we’re being criticized for that. So even when we try to do it the best we can, there’s still sometimes room for criticism by others. But that’s okay because our job at the end of the day is to save lives and to do the best we can, and the criticism, I think we’re big and bold enough to be able to handle.

Chip Kahn (11:40):

So we have to be frank with ourselves that misinformation is out there. The purveyors of misinformation are out there every day. And whatever the issue is, it may be vaccinations one day. It may be other treatments or other kind of care another day. They’re going nonstop, so we need remediation. You and other healthcare leaders have formed the Coalition for Trust in Health & Science. What are you doing and what’s the agenda of the coalition to get us back on track as a society, returning us to better acceptance of what’s proven and at least the best judgment about the science that we have?

Dr. Reed Tuckson (12:22):

The first thing that I think that we are doing is the fact that the health system across the entire breadth of the health system from end to end, from the basic science all the way through to how that science is implemented in the clinical arena, the public health arena, the health policy arena, all of these organizations have now come together to make a statement that says we care so much about how we engage with the American people. We care so much about ensuring that the American people have the opportunity to make personally appropriate choices and decisions about their health, their family’s health, and the health of their community based on the best scientific evidence available to them. We care so much about that, that we’re going to come together and say to the nation that we pledge ourselves to work together on behalf of the best interests of the American people in this regard.

(13:15):

Secondly, we are dedicated then to ensuring that all of every health and medical encounter, that every one of those is based on trust. We are continuing to hold ourselves accountable as an industry that says we know that how we treat every single person has got to be an encounter that enhances the trust that we want to earn and that we want to be perceived as being.” We know that no one is perfect. There is work that we can always do as individuals, as individual companies, as an entire collective industry. So we all know that you have to work on earning trust every single day, and we will continue to do that.

(14:00):

Finally, we have to make sure that we’re educating the health system as to how best to engage with the American people to have these kinds of conversations about the decisions that people make. We cannot be standing on top of a mountaintop, throwing down edicts to the population. We have to learn to listen, to have dialogue, and to engage in a collegial, respectful way with the American people and give them the best information from the best sources, so that they can at least know what the facts are, what the best guidance is, and where that guidance comes from, the legitimacy of that guidance as they make those choices.

(14:40):

And then I would conclude with one last thing, which I think is critical, and that is we have to enhance the science literacy of the population. Healthcare, as you know, Chip, is very complex these days. The science of genetics, genetic medicine, all of these new innovations that we are seeing, which are so exciting that are available to help treat and prevent disease are based in complex science. And we’re going to have to help the American people to understand that science, so that they can feel confident when health professionals give them new medicines, new vaccines, new health guidance, that they can have a sense that they can understand it and can participate in the use of that information, as appropriate to their circumstances, their family, and their community.

Chip Kahn (15:26):

That’s so helpful, Reed, you brought up the role of medical professionals and obviously, I work with hospitals. What do hospitals, those medical professionals, public health professionals need to do to play their part in renewing faith in preventive care, in acute care in this country?

Dr. Reed Tuckson (15:47):

I think the first thing we really have to do is to do what I sort of alluded to at the very first question you asked, and that is this general societal distrust and upset, and anger, and division, and polarization, and tribalization. We have to listen. I think that we have to recognize that we are so often now giving therapeutic and clinical or preventive guidance to people, who may not be able to hear it well because of their own particular social environment, their own particular ideological issues, whatever it may be. So I think we have to really double down on taking the time to say to the person that we are engaging in this therapeutic relationship that I care about you, that I want to listen to you. I want to hear you. How you think is important to me, and I want you to hear how I’m thinking and why I’m giving you this advice.

(16:42):

So more than anything else, we have to listen. We have to stay calm. We cannot continue to point fingers and wag our fingers at people who we don’t agree with. We have to give people our very best. We have to earn that trustworthiness that has to be earned on an everyday basis. But at the end of the day, Chip, I think we also have to be very clear about facts, about truth, about the science, and we need to tell people what we know, why we know it, why it’s reliable, and then finally, we have to tell people what we don’t know.

(17:15):

And when we don’t know the answer, we then have to engage with our patient, with our customer, our consumer. We have to engage with them in a way that helps them to make the best risk-based analysis of how to manage uncertainty that looks at the risk for the individual, that looks at the risk for the family, and it also looks at the risk for what happens to those who share our time and space. And try to remind folks that it’s not just about you. It’s about all of us and whether we all live or whether we die, and particularly concerned the elderly and the medically vulnerable, and have a sense of ethical responsibility as human beings to each other.

Chip Kahn (17:56):

To sort of close out, Reed, everything in healthcare today is about outcomes, so let me ask an outcome question, which is with misinformation so pervasive, how can we assess whether you at the coalition or those of us in healthcare, whether we’re making progress or not in terms of turning terrible situation around?

Dr. Reed Tuckson (18:18):

I think it’s going to be very difficult, and the reason… I don’t want to hedge away from an answer here, Chip, but I think we recognize that this is going to be a generational fight. There is nothing about this that’s going to be easy over time. We are in this for the long run. I think some of the ways we will know if we’re making a difference is going to be, of course, surveying the attitudes and the knowledge of individual patients and consumers whom we are engaging, and we’re going to see many healthcare institutions, I am sure, taking a sample of the quality of their relationship with people. I think that’s one way to do it. As I said, how does the public feel when they come into the healthcare arena? And I would expect that your hospitals will be doing some of that. But overall, I don’t think that we’re going to see any easy fix.

(19:07):

We’re coming into a presidential election season where we know and can fully expect that information of a variety of veracities will be thrown about. We know that our kids are getting ready to go back to school for the year. We know that there are bills in numerous state legislatures trying to roll back mandatory vaccinations. We know that the turmoil around institutions like the Supreme Court and other court systems is going to continue and so forth and so on. So my point to you, Chip, is that this is going to be a long-run fight, a long-term effort. It took a long time to get here, and it’ll take a long time to go away, but be that as it may, I think that all of us on my side of this are dedicated to making sure that every single encounter with a patient or a consumer gives us an opportunity for a health and healing conversation, as opposed to one that leads to death and unnecessary, preventable misery and suffering.

Chip Kahn (20:02):

Reed, thank you for this conversation, which I think is going to be incredibly helpful to our audience, and thanks for your leadership. I just really appreciate you being with us today.

Dr. Reed Tuckson (20:12):

Well, thank you very much. I’ve got plenty of energy to keep working with people like you. Let’s get at it. Let’s help the American people have the evidence to make personally appropriate choices and decisions for themselves, their families, and their communities. I remain clear about the challenges but optimistic about the future.

Chip Kahn (20:29):

Thank you, Reed.

Speaker 2 (20:33):

Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the federation on social media @FAHhospitals, and follow Chip @chipkahn. Please rate, review, and subscribe to Hospitals In Focus. Join us next time for more in-depth conversations with healthcare leaders.

Reed V. Tuckson, MD, FACP, is Managing Director of Tuckson Health Connections, LLC, a vehicle to advance initiatives that support optimal health and wellbeing. 

Currently, Dr. Tuckson’s focus is on his role as a Co- Convener of the Coalition For Trust In Health & Science, which is dedicated to bringing together the entire health related ecosystem to address mistrust and misinformation. In addition, he continues to advance his work as a co-founder of the Black Coalition Against COVID, a multi-stakeholder and interdisciplinary effort working to mitigate the COVID-19 pandemic in Washington D.C. and nationally by coordinating the four historically Black medical schools, the NMA, the National Black Nurses Association, the National Urban League, and BlackDoctor.org. 

To find out more about the Coalition For Trust In Health & Science, please visit: www.linkedin.com/company/103847837