Communicating science and addressing misinformation

Buddy Creech: [00:00:01] Hi, everybody. I'm Buddy Creech and this is Let's Talk ID. This is our first podcast with me as the host, and we're going to talk about some things that are important for a lot of us, which is how do we communicate science? How do we communicate important issues within health care and health care policy and in medicine to those who need to hear it the most, which are those we serve? And I'm joined today by two individuals I love talking to. Dr. Bill Schaffner is professor of preventive medicine and health policy at Vanderbilt University Medical Center. I've known Bill for well over two decades, and there's probably no steadier hand, certainly over the last few years during the pandemic to give us simple truths in understandable ways and provide clarity in the context of a lot of noise. And so, Bill, thank you for being here. And also Erika Edwards. Erika has been at NBC News for also around two decades as a producer and as a medical writer and reporter for things related to science and medical affairs. And you have seen her work on a variety of NBC outlets, including The Today Show and many others. So, Erika and Bill, thank you for being here today. I'm really excited about this time.

Buddy Creech: [00:01:17] Bill, I'm going to start with you. We're going to get right into this and I'm going to ask you, you've been doing this for a minute. I don't know how you started doing this. I don't know when you became good. You're someone that we look at and we just think he's naturally gifted at speaking to the media. But you probably didn't do that as a junior high kid or a high schooler. What happened? Tell us the origin story of Bill Schaffner.

William Schaffner: [00:01:44] Well I'm blushing with all your compliments, Buddy, but thank you very much. First of all, the Latin root of doctor is doctor to teach. Doctors are teachers. And we certainly many of us in academic institutions are in teaching institutions. Somehow, I got the idea that working with journalists through the media was a way of teaching a larger audience. Now, I have to admit that when I was indeed in high school and in college, I did a little theater. And I've always thought that teaching is a highly refined form of theater. You have to engage your audience, keep them interested, communicate with them in such a way that they want to keep hearing more. That was kind of the beginning. And then I was in the public health service, worked with the CD, where they assigned me to the state health department in Rhode Island, where, as it turns out, I was given one of the jobs of speaking with the media when we had a big flu outbreak. And I began to learn from the journalists, from the local TV stations. And after that, like Popsie, it kind of just grew.

Buddy Creech: [00:03:07] Erika, you work with a lot of folks. Some, like Doctor Schaffner, do it very, very well. Others of us are. I don't know what you would say. We're passable. What is it about folks like Bill that just they they do it for you? Like they they figure it out. They know how to communicate. What are the things that you're looking for in those that you're interviewing so that you can make sense out of some of these complicated stories that you're reporting on.

Erika Edwards: [00:03:35] I wrote down the fact that, of course, Dr. Schaffner started with the Latin root of doctor, because classic Dr. Schaffner, I was thinking that you were going to go on and quote Voltaire, but maybe that's coming later.

William Schaffner: [00:03:50] Later.

Erika Edwards: [00:03:52] I think you said it really well earlier, Dr. Creech. I have dedicated my career to translating science findings, medical jargon into language that everyone can understand. I'm not talking about dumbing it down. That's not what I'm talking about. I'm talking about translating this into language that I can understand. I don't have an MD, I don't have a PhD, I have a journalism degree. I'm really focused on communicating to my Aunt Marge, my neighbor, my kids. These are the people who are really going to benefit or learn from public health officials such as yourselves when it comes to the best medicine, the best medical advice. So I am really looking for folks who can break those barriers, talk really not just to me, but to everyone. Let's get rid of the jargon. Let's get rid of "patients responded favorably." Let's talk about people who got better, who felt better, things like that.

Buddy Creech: [00:04:58] I love this. And I think one of the things that strikes me with you in particular and I don't mean to single you out, but I think you do it as well as anybody I've worked with. And certainly we got to work together a lot during the pandemic is you tend to be able to ask the next really good question based on what I or one of my colleagues have said, which means you're actually listening to what we've said and of anyone, I love the fact that you're not looking for a quote. Or something just to fill column inches. You're really seeking to understand the thing that you're trying to report on. And I love this. And I think for anyone in journalism or who is seeking this route, you're a great model of that because sometimes you're asking as a parent, sometimes you're asking only as a reporter because it doesn't have necessarily this personal connection. But gosh, I remember a lot of conversations as we think about vaccines, and vaccines rolling out for COVID, and there were just such great questions, not just at the outset, but follow up questions that were really fantastic. So kudos to you for being able to set up a dialogue and not just a series of itemized responses that I might be able to make up in my kitchen.

Erika Edwards: [00:06:16] So here's the deal. Journalists are always tasked with get a headline. Fill 500 words, fill two minutes, what have you. And there are reasons for that, but there are a lot of people who are genuinely passionate about these stories. They're genuinely passionate about translating what you're saying to the public. And I think it just makes it easy when I can speak with folks like you and Dr. Schaffner, who are also as passionate about your patients, what you're learning, what you're not learning, what are the questions that we have? Even if it doesn't impact me, it's always personal. It's always personal because it's always going to impact if it's the readers, if it's the viewers, if it's my mom, if it's my dog, I don't care. It's always personal. So that's where I start and then the conversation continues.

Buddy Creech: [00:07:13] So that's a great word. I think a lot of us in infectious diseases, we got that passion. It's part of the reason we went into the field and I think some of us doubt, especially early in our careers, our ability to actually perform, our ability to actually have a good conversation that's not, well, embarrassing at one level, misleading on another. And so, you know, Bill, I'm going to assume a couple of your answers that you might give to this, because you were part of my initial media training back in the day. So I know some of your tricks, but our listener doesn't. So can you comment a little bit about your general approach when you get that email from our news coordination team or you get that call from someone you've worked with for years? I usually start emotionally running in place. I think you probably have a better, more functional response to that. Can you walk us through those first steps when you get that call of "can you talk to me about this story?"

William Schaffner: [00:08:14] So the first thing you would like to know is what is the journalists actually interest? What's their so called news hook? Why are they interested in this? And you're entitled to ask. And sometimes you can get help from someone in your news office to clarify that before you engage. Then the next thing is as just as you have said when I've tried to encourage young people to do this, they see it as a pop quiz and they're very worried and it gives them real anxiety. Will I be able to answer the question? What we would like to do is take, with all due respect to Erika, the locus of control, as it were, from the journalists to us. And the important concept there is what we call the Saco. You have to ask yourself, all right, the journalist is interested in such and such an issue. What is it that I would like to say? What's my single overriding communications objective? And what we tell young people when they start out, jot it down. You don't have to write whole sentences. Oh, Erika wants to know about influenza vaccine, what do I want to say? Well, who should get it? How good is it this year? What are the side effects? Okay, got it. Those are my three messages. You'll have to practice this a little bit. No matter what question Erika asks me, I'm going to bridge to my messages. I'm going to do everything I can to get my messages out. Well, then I'm a little bit more in control and I'm able to teach. I'm able to get information out that I think an average person is interested in and then try to do that in a very reasonable conversational fashion.

Erika Edwards: [00:10:18] Well, what's funny about that is sort of basic guidance when it comes to live television. If an anchor asks me a question that I don't know the answer to, I say, You know what? That's really interesting, but what I can tell you is this. No one's immune to that fear in their heart. We all just want to get across the best messaging possible. When you're put on the spot, that's certainly uncomfortable. If it's not live TV, however, you can always just hit pause, say, Listen, I want to make sure that I'm answering this question in the way that I need to and the way that like, what are you really asking me? Can you repeat the question? What are you really looking for in the story? That's totally okay.

Buddy Creech: [00:11:01] Okay. That actually helps me a lot because I think I sometimes use phone conversations, especially as I almost give it the same level as live TV, in part because I want to make sure I don't say anything that could then be taken out of context, especially if I'm working with someone I don't know. I think we always have to treat if we're on the phone with somebody, we're on the record and we want to be able to give good advice and we want to land it correctly. But I do think that's important to set an expectation that we can establish a pause. We can ask for further clarification so that we're answering in the most accurate and precise and most helpful way. I'll tell you this. My favorite exercise in building a SOCO was when we did our media training with Dr. Bruce Dann. Now, you know, 20 some odd years ago, what we had to do was come up with our SOCO. And then he interviewed us and he had no idea what our SOCO was, and we had no idea what the purpose of the interview was.

Erika Edwards: [00:12:04] What's a SOCO?

Buddy Creech: [00:12:04] The SOCO is that single overriding communications objective, that is the best way for us to go into an interview.

Erika Edwards: [00:12:12] It's such corporate speak.

Buddy Creech: [00:12:14] It is but you know what it means. It's my line. It's the line I'm going to keep coming to no matter what. And so if you ask me about myocarditis from COVID vaccines, I'm going to say there's an extraordinarily low risk of myocarditis after the second dose of vaccine in some age groups, particularly in boys. But it pales in comparison to the myocarditis risk we see after COVID disease.

Erika Edwards: [00:12:39] SOCO.

Buddy Creech: [00:12:39] And it almost doesn't matter what question you ask me, I'm going to come back to that well crafted sentence, that exercise of practicing a, I dare say, a response to a question rather than an answer to a question that can be very helpful, especially when asked a more controversial question. So, Bill, I'm going to ask you, what do you do when you get that dreaded controversial or that question that's a little bit, well, it just pushes things a little bit and you feel like you might be getting over your skis just a little too much. How do you reclaim control beyond just coming back to your SOCO? Is that the one trick or, I'm asking for some inside baseball here, so I don't want you to show all your tricks because then we'll steal some work from you. But I'm curious what other tricks you go to?

William Schaffner: [00:13:28] Well, first of all, I would like as many people who are interested in doing this. We need as many good teachers locally as well as nationally out there. And as some of you may know, I have a motto. The locals come first. We live right here in Nashville. And if a local journalist gets to me, I will do anything I can to make time for them because they're our neighbors. But there are several things you can do. One is you can do exactly as Erika said before. You know, that's an interesting question. But what's more important is and there have been times, however, when I've said and as you can imagine, this came up a little earlier in the COVID epidemic, when I say, well, I stay out of politics, let's stick to the scientific medical aspects of this, and then I'll provide my answer. In other words, I'll make a bright line. Now, you can actually have that discussion with the journalist beforehand and say, I'm not going to get into the politics. I know that that's of interest to you and your audience, but I would prefer to just keep it on the medical side. And most journalists will understand and honor that. Others will try to get you a little bit more to the edge. I understand that because part of the reality is COVID did have political overtones, but it was something that some of my colleagues might get into, but that's not something I do.

Erika Edwards: [00:15:00] Here's my rule when it comes to speaking with journalists, being a journalist, I never use the camera as my reporter notebook, meaning I want to speak with you ahead of time to get all the nuances, the details, the context for me to create a very well rounded, well articulated story when it comes to being on camera, That's when you switch. That's when you no longer speak with me or your colleagues. That's when you reach out to your neighbors. It's a very nuanced sort of messaging. But again, as we were saying earlier, it's always worth I mean, you could always reach out to the reporter because I guarantee you that reporter is going to know the second you say what they're going to use. So it's okay to say, you know what, I know that maybe this is more important. What are you thinking of using? Can I say it better? Can I say it differently? You can have that conversation if it's on tape to make sure that your messaging is really what you're comfortable with saying.

William Schaffner: [00:16:07] Public health has political overtones because it's out there in society. It has those ramifications. The trick is how to do that. I'd like to stay away from the political side, but there were times when I had to address questions rather than using specific names. I would occasionally say, Well, we have heard from political leaders in Washington that. So that doesn't personalize it. And that's an easier way for me to glide off the edge of that subject and get back to the importance of vaccination.

Buddy Creech: [00:16:45] Well, and I think that comes back to this idea that at one level we are teaching and at another level, we're almost engaged in what could be considered counter teaching. It's this idea of you have heard it said X, but I'm going to tell you why. You've heard a narrative or you've heard a result. You've heard this, but I'm going to try to unwrap that a little bit. I'm going to try to detangle that a little bit and give you a different approach. And I think I'm particularly sensitive to this around vaccines. And Bill, you and I talk about vaccines with the public a lot. We have both dedicated large portions of our careers to thinking about how we build better vaccines, how we get those shots into arms. And I guess one of the things that is sometimes lacking is an acknowledgment from us that there are concerns or that we hear either the fears or the anxieties or the frustrations of a parent, or a patient, but that we have a different perspective. Do you want to talk a little bit about that? And Erika, I'm going to ask you the same thing about this idea of how do we best acknowledge fear, anxiety or even misinformation and then offer a different approach, offer a different not a different narrative? That sounds like neither are true, but I'm trying to figure out how we address that misinformation that is so prevalent right now with more true information.

William Schaffner: [00:18:17] Well, just as Erika said before, we're having a conversation with our Aunt Susie. It's a little like talking with an individual patient. If an individual patient expresses their hesitancy or their skepticism, for example, about a vaccine, the first thing you want to do is acknowledge the validity of their concern. You know, I hear that a lot. That's one of the most frequently asked questions I get. And if you do that, all of a sudden the person who's asked the question is at ease. He's heard me. And then you can provide some counter information. Now we have a tendency to provide a lot of facts. Facts are important. You can't go forward without some basic information. But, you know, facts alone, information is rarely sufficient to change behavior. You've got to change not only how people think, but how people feel. As the psychologists tell us, it's their attitude that matters. How comfortable are they? Are they reassured? Is everyone in their social group doing the same thing, or am I going to be an outlier and be uncomfortable in my social group? And so you can sometimes say some things to normalize vaccination? Well, I've been vaccinated. Everybody in my family's been vaccinated. If you're talking to a patient in the office, you can say everybody in this office has been vaccinated and we're trying to provide that same degree of protection to absolutely every one of our patients. So you're socially normalizing the behavior and you're doing it in a very gentle way. And you never disparage the concept because getting into an argument won't help you. And the other thing you have to realize is, psychologists have really retaught us this during COVID, if people have firmly fixed beliefs and then they encounter information that's contrary to their beliefs, the normal human response is to double down on the belief. You hunker down and so just going heads on and saying, no, you're wrong because that will get you absolutely nowhere.

Erika Edwards: [00:20:47] Fear in a mother's heart is very strong. It's very difficult to get that fear out of a mom's heart. And I'm speaking from my own experience. I've covered health and science for almost 20 years. My kids are much older now, but I remember specifically asking my pediatrician. I said should my kid be getting these vaccines right now? Like, is that okay? Even though I knew, I knew. And I've even spoken with probably Dr. Schaffner and many other experts, when it gets into your soul and it gets into your heart, it's very difficult to think in terms of facts and science and rationality. So I get a lot of emails from people reacting to stories that I do, and a lot of them, 90% of them are angry, but some of them are just fearful and they are asking questions and they're thoughtful. And I respond to every single one of those. I am not the expert, but I point them to experts like yourselves. It's those people who are just sort of questioning. They're hearing these this misinformation or these other viewpoints that they're wondering like, really, what's legit? Why should I trust Dr. Schaffner? Why should I trust Dr. Creech? It's not my job to do your PR for you. It's my job to respond to them in ways that are thoughtful and that I maybe give them additional resources because it's those people who are most open to science, even though that fear has gotten into their heart.

Buddy Creech: [00:22:28] And I think this might be an approach with some of our more anxious parents or even some of our colleagues who may have really deeply held misconceptions is to match temporarily their level of anxiety or fear or concern. Not just acknowledge it, but almost provide some simpatico there to say, okay, I get it, and then slowly start to de-escalate that. Slowly start to dial that down. You know, we've been doing this with with friends who in our social circle, we have a few friends who are either incompletely vaccinated or have pursued just alternative vaccine schedules and I love having conversations with them because I can match some of their anxiety and then begin to turn it down. The other thing that I'm particularly sensitive to right now is that most people don't like to think that they've made a bad decision, especially as it relates to their family. And so the only way to get them over that hump is to hopefully provide some new information that they didn't have at the time of their previous decision. And so now they have a psychological out for changing their mind and I wonder if there are some code words or some, I don't know what the right word is there, but some words that we can practice as a field to really acknowledge that this is a new thought or that we're providing something that parents might want to take into consideration that wasn't known before. Erika, it seems like that's the business you're in is trying to give people access to new information. So how do you create stories that really do resonate and do provide ability to have people change their minds about something?

Erika Edwards: [00:24:13] It's not my goal to change people's minds. That's not my goal. That's when I start out on my day. I'm not thinking. I want to make people want to get a vaccine or I want to make people do X, Y, or Z. It's just to create a really safe place where they can get facts. All journalists are biased, but I want to make sure that I am reporting in a way that is most clear, fair, factual, as unbiased as I possibly can. That's all I can really do at the end of the day.

Buddy Creech: [00:24:48] I think that's helpful. Bill, what are your thoughts on this idea of really trying to provide new information to individuals to make better decisions for themselves and their families?

William Schaffner: [00:24:59] Well, a couple of thoughts very quickly. One is you can do exactly what you've said, Buddy. Namely, acknowledge that, you know, back then we thought that. But now we've gathered some more information that's really quite reassuring. Hear that word? Reassuring? Not so much to the brain. To the heart. Right? That's how you feel about it. Reassuring that lets us know that X, Y, and Z. Another thing I've often done here I am communicating with Erika through the media, but I can evoke all the listeners to this podcast or talk to your local doctor. You know that doctor is there for you caring for your children day in and day out. You can trust them. Please, you don't have to listen to Doctor Bill talk to your doctor once again, reassuring and normalizing the issue. One of the most difficult things I've discovered during COVID or relearned but relearned vividly is that, you know, when COVID hit the scene, we all opened up our proverbial textbooks and looked at the COVID pages and they were blank. We knew nothing. And as we've learned more, we've been able to tell people more. And sometimes we've had to change our minds that keeping up has been a stretch for all of us, but it's really been a stretch for the public. They have to keep doing their homework. They have to keep listening and changing their minds also. And I have found that that's very hard. So I'm very tolerant of that. And I frequently say we're all learning together. And there are new things that we've learned since the last time we spoke, and we're going to learn some more things. So if we get together two months from now, there'll be new things to learn. That's just the way it is with COVID. And I try to be somewhat reassuring about that and emphasize that that's good because the more we learn, the more we understand, the better we understand, the more we're in control and can cope better with this virus to protect us all.

Buddy Creech: [00:27:26] Yeah. And I think that provides the transparency that those that we care for and those that we talk to so desperately want, they want us to, for lack of a better phrase, they want us to show our work so that maybe we can provide that this is a work in progress and that's okay. Erika, how do we do that in a way that provides reassurance that we know what we're talking about, but that the story isn't complete yet?

Erika Edwards: [00:27:52] Public health messaging in the pandemic has changed so often we try to follow it. We understand why it's changing. We're trying our best to explain why it's changing. Then it's led to a lot of mistrust, distrust in the media, a lot of mistrust in public health, science in general. I guess I would turn that back on you, you know, how do you help us, those who are really dedicating our lives to trying to figure out how to communicate science and health and medicine to the lay public, those who are most in need of this information. How have you dealt with that over the pandemic?

William Schaffner: [00:28:36] So, Buddy, as with individual patients who express skepticism and concern, the first thing I'm going to do is acknowledge to Erika that we in infectious diseases and public health haven't always done a very good job. During this pandemic - that's the first thing we have to acknowledge. Unless you define the problem, we're not motivated to find a solution. Tom Frieden has said it very well. Public health communication regarding. Yes, public health communication has to, first of all, be based in science. Second, it has to be clearly stated in a way that the average person can understand it and accept it. That means it has to be simple. I think many of our public health recommendations have been too elaborate, too epidemiologically precise. As our southern grandmothers would say, boil it down, keep it very simple and then repeat. Repeat. And you have to have trusted messengers. From a personal point of view, I think it is better in a pandemic circumstance to have the lead communicators be in public health, with our political leaders standing behind them and supporting them. If information comes out of Washington, it has to have a political veneer and will be less trusted. That's why I love the CDC being in Atlanta. In the past, with Ebola, 2009, swine flu. Et cetera. Zika outbreaks. The information came from the public health leadership. We bollocksed that up. I think there are lessons to be learned. Obviously, the public health leadership needs to converse and be on pretty much the same wavelength as the political leaders. That was not the case during COVID. I'm sad to say. But if that is the case, then I think public health to the fore, politics, supporting public health, then that becomes better. Would love to hear from Erika.

Erika Edwards: [00:31:06] Clearly, I have a lot of questions and I don't want it to turn into me interviewing you, but I'm very curious. Your thoughts, your feelings as we moved into this pandemic when all of a sudden it became not a CDC and FDA led discussion to a White House discussion. This is not Democrats versus Republicans. I'm just curious where the messaging became more of a political message. How did you feel about that?

William Schaffner: [00:31:35] That's a very interesting question, Erika. But what's really important is that I -

Erika Edwards: [00:31:39] See I see that you're diverging right now. I see that. I hear it. I know what you're doing. Dr. Schaffner. Answer the question.

Buddy Creech: [00:31:45] Yeah, you can't do that after showing your tricks. That's good.

William Schaffner: [00:31:51] I think it was unfortunate in this country that we had such divisiveness, and I think it helped accelerate this distrust in authority and in public health in particular. I think we need to do everything we can to try to restore that trust, to refurbish it. This will not be easy. This will take a lot of time. And apropos of the listeners of this podcast, what they are doing locally in their own areas is providing the solid foundation on which that restored trust can be built.

Buddy Creech: [00:32:34] And as we do that, we become then those who are interested in public health and in science and medicine. We become that plumb line or that North Star for the individual who wants the information, who wants the best data, the best story to help them make good decisions. We're all in this together. We all want the same thing. We want health individually. We want health as a society. We want to protect our kids from illness and from the consequences of disease. If there's anything worse than a pandemic, it's a pandemic during a national election in the US. And that combination of stormfronts was just too much for us to withstand.

Buddy Creech: [00:33:19] Well, I want to finish up with with maybe one final thought from each of you as you think about this new generation of physicians and scientists who are finishing up who have grown up in a world of immediately available information, as we see how various social media platforms have dominated news sourcing for so many individuals, as we see this inherent mistrust that is also deeply entrenched in our political landscape right now, at least in the US. What are some sort of final charges, some final encouragement for those of us who want this to be something we're good at, who want to be able to make a difference in public health and in communicating these truths to those around us.

William Schaffner: [00:34:07] I think the principles remain the same. Science based keep it as simple as possible. Speak the language of the audience to which you're speaking and repeat and be very consistent. Acknowledge when things have changed, then bring people forward. Give them not only the facts, but make them feel good about what's happening now. The details are going to be very different. I'm a social media ignoramus, but this next generation is going to have to deal with that in ways that I didn't have to. And they're going to have to learn how to do that because we in public health are still very reactive rather than proactive in the social media.

Buddy Creech: [00:34:56] Erika, your thoughts?

Erika Edwards: [00:34:58] I think, number one, we cannot let go of our principles as journalists. We do not want to be PR for vaccines, for doctors, for hospitals, for treatments. We need to always be asking questions like. Why are you doing this? What's the consequence? What are the benefits? What are the negatives? Don't ever be afraid to ask those questions. Those are hard questions and that's okay. I also think that it's okay to reach out to other generations. My kids are on TikTok. We need to sort of be thinking about other ways of getting to reaching other generations in ways that they respond to. They may not be reading my articles. They may not be seeing Dr. Schaffner on NBC Nightly News. They are getting their news elsewhere. This is the generation who has been at home in high school. When it came to the pandemic, they were most affected. We have a really great opportunity right now to reach young people when it comes to respecting public health.

William Schaffner: [00:36:10] Another thing we have learned, again, is that we have an extraordinarily diverse country out there. It's a wonderfully diverse country, and we need to embrace that. We have to get people who look like the diverse populations in our country speaking to those populations. They'll get on their same cultural and linguistic radar. And so we need to diversify our teachers, our communicators, to embrace the wonderful diversity of our country.

Buddy Creech: [00:36:45] I completely agree. And I think this is an important and a huge investment from PIDS, from SHEA, from a number of organizations to make sure that we look like those we serve. When we develop a posture of humility and transparency and we lose a little bit of dogmatism, that's such a better starting posture than what we hear from so many others in the noise that we hear each day. I would also encourage those who want to be better at this, those who want to start this, to seek out those at your institution in your news and media affairs group, to to be trained locally. And if there aren't resources locally, contact IDSA and PIDS. If you're a pediatrician and ask about opportunities for media training, because I think the better trained we are, the more effective we will be, the more effective we are, the more effective our communication will be in such a way that will actually see movement in this.

Buddy Creech: [00:37:50] Well, I want to say thank you to both of you. You've been so generous with your time. This has been an enormously fun time for me. I value both of you so, so much because you're both expert at your craft and I really appreciate it. We didn't get all the questions I wanted to ask at some point, whether Dr. Schaffner gargles with olive oil or canola oil before he speaks because of the the velvety tones that he generates. But that will have to be on another episode of of Let's Talk ID. Thank you, both of you, for your time today. I really appreciate it.