This Podcast Will Kill You - Special Episode: Deborah Cohen & Bad Influence

Episode Date: August 11, 2026

If you have a medical question, where do you turn? How often is google or social media your first stop? As you sift through the AI overview and countless reels professing to have the answers, it becomes harder and harder to separate fact from fiction. Do these supplements actually do what they promise? Should I be wary of this commonly prescribed medication? Even if you’re not directly seeking this information, it finds you anyway, preying on health anxieties and promising an easy fix. In this week’s TPWKY book club episode, Dr. Deborah Cohen, medically-trained, award-winning journalist, broadcaster, and editor, joins me to discuss the implications of this flood of health misinformation, which she explores in her recent book Bad Influence: How the Internet Hijacked Our Health. From podcast bros touting peptide injections to TikTok influencers swearing by supplements, Cohen demonstrates that the internet is a wild west in desperate need of consumer protections. But it has also been a double-edged sword, providing community and connection alongside these bad actors. How can we continue to leverage the good of the internet to democratize health information while putting guardrails on nefarious wellness influencers hawking lies for profit? Tune in to find out. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAuSee omnystudio.com/listener for privacy information.

This is exactly right. In the middle of the night, Soskia awoke in a haze. Her husband, Mike, was on his laptop. What was on his screen would change Soskiah's life forever. I said, I need you to tell me exactly what you're doing. And immediately, the mask came off. You're supposed to be safe. That's your home.

That's your husband. Listen to Betrayal Season 5 on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. It's Chelsea Handler from Dear Chelsea. This season, we've got some awesome guests ready to dole out advice. Guests like Tiffany Haddish. Kind of slide into people's DMs. I like Bumble.

Also, girl, Farmers Only.com. At state sales, funerals, auctions are usually good. There's a lot of good men there. Grocery stores near gyms. Darcy Cardin. Sherry O'Terry, Anna Farris, Dave Franco, Madeline Klein, Adam Scott, T.S. Madison, and more.

Listen to Dear Chelsea on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Hello, it's me, Anna Sinfield, the host of The Girlfriends. I'm back with more one-off interviews with some truly kick-ass women on the Girlfriend's Spotlight. I'm going to climb this. It's badness hereditary. Let's see how we can stop killing. I'm not too intimidated by her. What are you talking about?

Listen to the Girlfriend Spotlight on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Erin Welsh, and this is This Podcast Will Kill You. Welcome to the latest episode of the TPWKY Book Club series, where I bring on authors of popular science and medicine books to chat about their latest work. These books span such a wide range of subjects.

There's really something for everyone. Maybe you'd like to learn more about the evolution of language or what's going on with the diagnosis crisis around the world. Maybe you're curious about how refrigeration transformed the world or how our understanding of cancer was shaped by tragedy. You can check out the full list of books featured on this series and upcoming books by heading over to our website. This podcast will kill you.com. Under the extras tab, you'll find a link to our bookshop.org affiliate page, which has a bunch of TPWKY related lists, including one for this book club and one for the kids' book club, which is hosted by Aaron Updike on our socials. Make sure you're following us there if you aren't already.

We always say it, but we always mean it. We love hearing from you, whether it's episode suggestions, book recommendations, firsthand accounts, or anything else that's on your mind. The best way to get in touch with us is through the contact us form or the submit your firsthand account form. You can find both on our website. Two last things before we get to this week's book, and that is to please rate, review, and subscribe. We'd love to make this podcast as long as we can, and this really does help us out. And finally, you can find full video versions of most of our newest regular episodes on YouTube. Make sure you're subscribed to Exactly Right Media's YouTube channel so you never miss a new episode drop. These days, if you have a question about a medical issue, the internet is likely

your first stop. After all, the next opening at your doctor's clinic is months away. And even if you manage to snag an earlier appointment, would you have enough time to ask all your questions and get them all answered? Probably not. Why wait when you can research at your leisure, scrolling through TikToks, asking AI, or listening to a podcast where the overconfident hosts swear by peptide inject, and smart rings, using medical language to disguise what they're really doing, which is inventing a problem and selling you the solution. Increasingly, people are turning towards the internet to seek solutions for many of their health care and wellness needs.

But even if you aren't actively searching for this type of content, it finds you anyway. The proliferation of wellness influencers and the commodification of health anxiety has had profound impacts on our relationship with medicine, expertise, and truth. In today's episode, I'm joined by Dr. Deborah Cohen, medically trained award-winning journalist, broadcaster, and editor to discuss these issues, which she explores in her recent book, Bad Influence, How the Internet Hijacked Our Health. Extensively researched and compellingly written, Bad Influence Uncovers the insidious manipulation by those seeking to make a profit and the way they prey on vulnerable individuals simply looking for help. As Dr. Cohen demonstrates, the internet

is a double-edged sword, rife with this type of exploitation, but also a source of empowerment and community. Navigating this virtual landscape has never been more challenging, with marketing masquerading as medicine and an endless supply of snake oil salesmen in their newest iteration as podcast bros and one simple trick, clickbaiters. Dr. Cohen pulls back the curtain on the the underbelly of the wellness industry and in so doing makes an urgent call for regulation to protect consumers. Until that happens, if it ever happens, she leaves readers with a crucial piece of advice. Ask yourself why you're seeing what you're seeing in your feed. Who's telling you this stuff and why? Bad influence is a timely and necessary guide to the wild west of internet

wellness and the nefarious health influencers spreading lies for profit. I'm very excited to bring this conversation to you all. So let's just take a quick break and get started. Dr. Cohen, thank you so much for joining me today. Thank you for having me. And thank you for being interested in the book. Oh, of course. I mean, I was so excited to come across your book and to read it because it explores so many of the things that I feel like on this podcast we're constantly confronting.

It's this kind of one-to-punch between these active disinformation spreaders along with worsening access to, medical professionals, and it's created this perfect storm of just where do you get good information and how do you recognize the good and the bad? Was there a moment in the construction of this book and the production of this book where you said, okay, this needs to be a story that I want to tell? It was quite early on. The reason I wrote it, there was a few things happening at the same time. So one of my cousin, I'm from Liverpool in England, and I was at my auntie's birthday party, one of my cousin's friend said to me, she'd just bought an AMH test. And I was like, why have you done that?

And she said, I want to know how fertile I am. And I said, is it really going to tell you that? And people in Liverpool, if your audience don't know, were very direct. There's no smooth talking. It's all very direct. I was like, why have you done that? And I said, well, what are you going to do with the results? Say if they're low, what are you going to do? And she went, well, I'm going to go and see my GP or primary care physician. And I said, well, what are you going to do if the normal? And she looked at me and she said, I'm going to go and see my primary care physician. And I said, who isn't going to be able to use the results because it isn't telling you anything about your fertility. You've just wasted 160 pounds, so $200. And that was sort of the start. And I said, where did you get the information from? And she said, where did you get the information from? And she said, said, oh, Insta, as if I was stupid.

You know, why wouldn't you go to Insta be health information? But doctors couldn't give her the information she needed because she couldn't conceive. She was struggling to conceive. There was no real medical reason for it. And it was an obvious place to go. And there, it was all sorts of clinics

were offering that as a solution, the ectaner test. And then other friends I noticed who, university educated, smart. And again, going online for, information about hormone replacement therapy or menopause hormone therapy, whichever turn you want to use, testosterone, full body screening, ADHD information. And there are problems with the access for healthcare, whichever part of the world you're in, and it differs according to what

part of the world you're in. We've got a national health service in the UK and there's massive waiting lists. But equally, a lot of the book, I speak to a lot of US-based physicians and patients and influencers and different challenges, but even still challenges, getting access to healthcare. And traditional healthcare services can't provide an answer. There's always someone online who will. And there was noticing an increasing growth of that. And then people sort of having to, in my day job as a journalist, I'll sort of go, well, why are you coming to me with that information? What's your agenda?

What's your, why are you telling me that? the benefits. I'm looking for the harms. I'm looking for the evidence. And they were having to be almost their own mini-journalists online, but without the background that I had or that training that I had to critically appraise information. And perhaps that's some of that automatic skepticism, if I get a press release, I'm thinking, yeah, why do you want me to cover that story? So as a journalist, I'm naturally skeptical. And that's what was supposed to be. But people were being bombarded with stuff and didn't really know what to make of it. I want to dive into the influence in your title.

Who is doing the influencing, the bad influencing, where are they influencing? And who is being influenced? Can you sketch out the major areas where this is happening? So I think we've talked about for many years on medical journals or in academia or in healthcare. Generally, there's always been commercial actors that influence our health. We know the tobacco industry sat on the harms of smoking for decades, even though they knew it was causing lung cancer. We know the drug industry asks certain questions to get certain answers. You know, you can be clever in how you do your randomised control trials.

We know the alcohol industry, big food, fossil fuel companies. They influence our healthcare. They lobby politicians. They lobby decision makers to create policies that are favourable in. their interests. And we know that they influence the evidence base. And what was really interesting to me was we've got these whole new set of commercial players now. So I was less interested in the kind of classic conspiracy theorists. I was much more interested in these industries that perhaps are shaping, scientific industry should I say, that are shaping our healthcare. So

the office one is big tech. And they host the platforms. They operate the algorithms. They operate the algorithms that influence what we see. They decide what's going to be first in our feed. If it's an advert, you are an obvious advert from a company. You're going to drop further down the feed, but they will surface the influencers that have financial relationships with other companies. So that's the obvious one. So in my mind, I think of it as big tech meets all these little other industries, all these other little companies, if you like, influencers, online pharmacies, telehealth, a big one, your wearables, your apps, it's unfettered advertising. And so you've got all these different commercial incentives that are at play, that are being

surfaced by the big tech companies, whether that's meta or TikTok or Dancebite or Google, YouTube. And they're controlling in many ways what we see in our feed. And I was interested to think about, well, how are these actors shaping our health? And I think there's a big open questions still, because there's an absence of evidence. So I didn't want to be too certain, because what I didn't want to do is debunk bad science by doing bad science myself. You say, that's overstated claimant. And I've made overstated claims. But there's clear that there's something going on. And we know healthcare and our understanding of medicine is shaped by culture, is shaped society and is massively shaped by commercial interests. So they were the, they were the questions

really for me and in what direction are we going. And there was some interesting anecdotes from US physicians actually and one OBGYN at Duke University said to me and she deals with contraception. And she said to me, I know when my young patients come to see me, they spent four hours a day on TikTok getting their information. I've got like 20 minutes with them. And a men's health specialist at a Harvard affiliated hospital. He said to me, he feels he's tilting at windmills where he's got all these men's health providers that are offering testosterone as a drop of a hat.

And he wants to counsel patients properly about health interventions that might actually change their health and actually help their testosterone levels. are losing weight, but it's like they want a quick fix. So, and that's a very long winded way of saying there's all these different actors that are on our platforms that are trying to grab our health, that are trying to shape our health. And influencers as well with certain symptoms, they will change their symptom profile according to what's going viral. So if you take the example of ADHD and you are changing what your symptoms are because you're, you're know it's resonating with an audience, what's that going to do to our understanding of ADHD?

If you look at it through a social media prism. Let's take a quick break. And when we get back, there's still so much to discuss. You've heard the chaos. Now you can see it. Do we want to jump right in? Watch all your favorite podcasts from start to finish right inside the free I-Hard Radio app. Make some noise. Woo-ee! Catch every laugh and eye roll on shows like Bestie Listen. Hey Jonas and Las Culturisas. with full video. I'll just leave that there.

It's the same hosts and the same chemistry with all the hilarious moments you've been missing right on your screen. Open the free IHard Radio app. Search video podcasts and tap watch. In the middle of the night, Saskia awoke in a haze. Her husband, Mike, was on his laptop. What was on his screen would change Saskia's life forever.

I said, I need you to tell me exactly what you're doing. And immediately, the mask. came off. You're supposed to be safe. That's your home. That's your husband. Listen to Betrayal Season 5 on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Jake Brennan.

And on my podcast, Hollywoodland, I revisit some of the biggest stories from Hollywood history, separating the myths people want to believe from the reality underneath them. Like how the story of Marilyn Monroe isn't just the story of a Hollywood icon. Marilyn Monroe has become so iconic that her death can only be explained through conspiracy theories. And for some fans who can't let go, these stories have metastasized from conjecture to accepted fact. So on August 4, 1962, Marilyn Monroe died. Then the rumors started, and she died again. And now, we're going to set the record straight and learn about the way Marilyn Monroe actually died.

The Third Way. Learn more about what happens when fame, media obsession, and conspiracy collide. Listen to Hollywoodland on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome back, everyone. I've been chatting with Dr. Deborah Cohen about her book, Bad Influence, How the Internet Hijacked Our Health. Let's get back into things. It's so interesting what you mentioned about somebody spending four hours a day on social media, on TikTok, scrolling, and that's where they're the vast majority of their information versus this 20-minute time with their doctor. And there's also what they're seeing. And you dive into this when you discuss the nocebo effect. Yeah, it's fascinating. I don't think we talk enough about mind-body medicine in health care. I think we can often follow the biomedical model too much. And some of the more Eastern

philosophies perhaps use the mind-body model. or more. But we know that our expectations shape so many different things and symptoms are included. How we experience stuff comes from our head. And it's not to say it's all in the mind. Symptoms are very real physical manifestations. But if we have anxiety, say for example, we're more likely to experience pain. We know how we experience stuff. Our views are going to shape how we experience symptoms. And that is for good and for bad. So placebo is if you believe something is going to help you, then that may help your symptoms. So placebo effect is an incredibly powerful effect.

So testosterone, which we know is being promoted heavily to men and to women, perimenopausal and menopausal women, we know testosterone has quite a strong placebo effect. So if you feel tired or low energy, you have some testosterone, suddenly you feel better. Quite a lot of that is placebo. And that's a very powerful effect. Equally, there's something called the placebo effect. And that is the evil twin, if you like, of placebo. It literally means I will harm. So you will know if you see someone throwing up, you feel sick yourself.

It does not mean that you have that viral infection or bacterial infection. but that very graphic visual image of someone being sick, it can make you feel nausea and that is your mind. Those symptoms of nausea are real, but that is your mind mimicking, if you're like, what you were seeing. If you think about little bugs crawling up your neck, you can feel a little bit twitchy. You know, you can literally feel it.

And what we know is visually seeing something is more powerful than reading about and effect. And when you read the side effects of a drug, it increases your chances of having those side effects. And we're talking things like headache and nausea and fatigue and those kinds of symptoms. And that is something that researchers are starting to look at, which I think is fascinating about how social media shapes how we think about our symptoms or how we feel about our symptoms. And this is where I think some illness forums are a double-edged sword, where they can provide people with support and feeling heard and seen and a sense of camaraderie, cut through loneliness. Equally, if people are constantly talking about their symptoms, what does that do to your expectations of whether you're going to have those particular symptoms connected with a certain condition? And we're sort of in the foothills of really exploring that and the contribution of social media to that nocebo effect.

The last thing you should do if people are having very real symptoms from a nocebo effect is dismiss their experience because those symptoms are real. Just the causation of it might not be physical or it might not be pathological. There might be another reason for it. And they're very powerful. Our expectations are very powerful shapers of how we experience our illnesses. You mentioned social media being this double-edged sword where you have these supportive communities that can be formed and someone can finally no longer feel alone in their experiences. And so it's on the one hand very empowering. But on the other hand, it can lead to these formation of echo chambers potentially or leave people vulnerable to exploitation.

Can you share more about what this means in terms of social media? and the commodification of stress and anxiety? Fear cells. We know that from newspapers, you know, you or headlines, sensationalist headlines, fear cells and stress and anxiety, equally cells. Tell somebody that there might be something lurking beneath them and create that fear, but then you sell the solution. So, for example, full body MRI is, I have a chapter on that.

and influencers have really jumped on that because it sort of makes sense. There might be something inside you. You might feel perfectly fine, symptom-free, but there might be something inside you that is lurking. We have the machine that will spot that. When you give somebody a medical test, when they are otherwise healthy, that is called a screening test. And there are all sorts of problems with that. There are very few screening tests that are recommended at a point. population level, even by the American authorities, the preventative services, task force,

say, for example, even the American College of Radiology, likewise in the UK, we have very similar bodies and their guidelines between them are very, very similar as it happens. But there are very few because of the risk of what we call false positives. And if you see something on a scan, you sort of have to follow it up. You want to follow it up. And that can then lead to a cascade, of care of further investigations that might expose you to all sorts of different harms or risks plus financial harm. But that idea of there might be something within. And Andrew Hooberman is guilty of doing this. Him and Peter are here are guilty of quite a few of these and a lot of the podcasters are. And, you know, he talks about you might be walking around with all these

spots on your brain. Don't you want to see it? Well, do you? Do you? It was also, I think, was that the chapter where somebody went and purchased this full-body MRI and then in order to unlock the results, you had to pay again even further. And it's just sort of like this endless, just parasitic sucking people dry of money more and more and more money grabs that just prey on this anxiety. Once you hook someone, then you've got them. You've got them. You mentioned earlier the algorithm.

them. And social media, this really struck me too. Social media has become so individualized, or it is so individualized rather than social. You know, what I see on my feed is going to be profoundly different from what you see on your feed is going to be different than what, you know, just like every single person's feed has been directed by these tiny decisions, how long you look at a video, whether you like or you share something, it's on my mind all the time now where I'm like, if I just set my phone down with it still open, does it think that I want to look at that video the whole time. But as you write this, this engagement, this algorithm, it can normalize misinformation, this illusion of truth bias. What is this bias and how does the

rewarding of certain engagement, what sort of content is it promoting? So illusion of truth bias is the more you see something, the more true it feels. Now, not everybody is susceptible to all sorts of all biases. And again, we're still trying to understand how this information affects behaviour. And as you said then, it's very hard to study from an academic perspective because everybody's feeds are different. And you need to follow it up longitudinally. And you don't always know what is that little bit of information that you have that tips over a certain behaviour change. because we're bombarded with information all the time. But people are spending a lot of time on their phones.

And the thing with the phone and social media is it's so personal. It's in your pocket. It's in your phone. It's the place where you might speak to your grandmother on a FaceTime or your family or you connect with people. And you've got these influences in your phone. You're looking at them feels like eye to eye. But then one of the issues is it's the more sensationalist stuff that gets surfaced.

It's the stuff that grabs attention. I think of the book in the sense of this is what happens when you put health on platforms that are geared for entertainment and for commerce. It's not the dry statistics or evidence-based information that's going to be surfaced in your feed. It is the grabby, the sensationalist, the stories. And we're geared to listen to stories, we're humans. And it's all those that will surface in your feed. And there's one anecdote that I have in there.

It's from some Harvard academics who talk about a young girl who was terrified that young people her age were getting stage four cancer because she'd lingered on a video. Her feed filled with more and more videos of young people with stageful cancer, even though it's incredibly rare for people her age. She felt that everybody was being diagnosed with stageful cancer. Let's take a quick break here. We'll be back before you know it. You've heard the chaos. Now you can see it. Do we want to jump right?

And watch all your favorite podcasts from start to finish right inside the free IHard Radio app. Make some noise. Wooee! Catch every laugh and eye roll on shows like Bestie Listen, Hey Jonas, and Las Culturistas. Now with full video. I'll just leave that there. It's the same hosts and the same chemistry with all the hilarious moments you've been missing right on your screen. Open the free IHR radio app.

Search video podcasts and tap watch. I'm Jake Brennan. And on my podcast, Hollywoodland, I revisit some of the biggest stories from Hollywood history, separating the myths people want to believe from the reality underneath them. Like how the story of Marilyn Monroe isn't just the story of a Hollywood icon. Marilyn Monroe has become so iconic that her death can only be explained through conspiracy theories. And for some fans who can't let go, these stories have metastasized from conjecture to accept. accepted fact. So on August 4th, 1962, Marilyn Monroe died. Then the rumors started, and she died again.

And now, we're going to set the record straight and learn about the way Marilyn Monroe actually died, the third way. Learn more about what happens when fame, media obsession, and conspiracy collide. Listen to Hollywoodland on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Betrayal Weekly is back with brand new stories From threatening text messages disturbing a small Midwestern town It was from an unknown number Who else is getting these messages

Why did it start with us? To long cons and stolen identities Who lies about being this sick? This was the last time I ever believed the word she said New voices, each with the courage to tell their own story He said I have been kidnapped Okay. Just trying at normal. He was essentially on the run.

Every family has secrets. The rug had been pulled from underneath me. Oh my God. It was right in front of my face and I didn't even see it. Listen to Betrayal Weekly on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Welcome back, everyone. I'm here chatting with the wonderful Dr. Deborah Cohen about her book Bad Influence. Let's get into some more questions.

These algorithms reward these extreme stories, these personal anecdotes, these things that are shocking or more shareable. But the two things that the algorithm does not reward are nuance and uncertainty, both of which are foundational to science and medicine. How does this play out in the media representation of scientific research? And is there anything that we can do to make uncertainty and nuance more clickable? more engaging? It's a really good question. And I sort of slightly, I'd love to know the answer to that in many ways. I think there's, I think we have to get better at communicating.

And there are people online that do it very, very well. For me, one of the risks, if people are too robust with pointing out misinformation and individuals, obviously there are bad actors, I worry that that drives people away. So one example, young women side effects of the oral hormonal contraceptives. pill believe they are having particular side effects from the pill like weight gain that isn't necessarily backed by randomized control trial evidence. It might be because the time they're going on the pill, they're going out, you know, they've got new partner, they might be going out for dinners more, they might have just gone to college, there might be all sorts of reasons why they're

gaining weight at that particular time. But they're people as well that, that are turning to social media because they feel that the health profession doesn't listen to them. But by pointing out and saying you're spreading misinformation, doesn't make them think, oh, I'm going to come back to the health system if they're already feeling alienated. So I think we have to do that carefully. There are some very good physicians online, but then there are some that are nefarious as well. Engaging in nefarious activities, selling products, selling don'ty services and everything else. So it's a real minefield for people. My view is someone that trained to be a doctor is that health profession needs to get their act together as well, get their own house in order.

But I do think we need better health literacy. And coming from the UK, what's really interesting for me is how we are adopting US-style health system by the back door. Because our national health service is really struggling. We've got this massive rise of private clinics of consumer health that is only really in the last sort of five years that is really taking hold where people, have private general practitioners or private primary physicians on the palm of the hand. That's all relatively new.

So we're in, we in Europe and the rest of Europe as well, because what we've got from the US is direct to consumer advertising and prescription drugs. That is banned across Europe, but it's borderless. A story I'm doing for the BMJ at the moment, actually, it should come out the next couple of weeks is how we've adopted direct to consumer advertising. What's the impact of that? Because the systems are borderless. and we're not used to navigating it in the UK and Europe.

So it's all a bit of a, it's sort of a bit of a shock to the system. Social media and influencers can, of course, be very predatory and nefarious. We have these bad actors. But science and medicine also, of course, have roles to play. There's this long history of medicine being dismissive or paternalistic towards patients. There are these horrifically unethical, scientific or medical experiments. And there's kind of a general gatekeeping of, like, how dare you question me or trust me, I'm the expert here, attitude.

And it seems like these are also contributing to people seeking answers elsewhere. Can you tell me more about that? Yeah, and I think certainly, again, and this comes up a lot in women's health where women's health has been largely underfunded. I think it was 1993 that the NIH sort of said that women could be part of clinical trials that they funded. In 1993, that's when Jurassic Park came out. We had all this great, some computerised films. Only then can we go in clinical trials. And so there's a sense of not feeling seen, not feeling heard. And it becomes really, again, it becomes a double

edged sword because the doctors that I've spoken to and I speak to a lot day to day is they're battling with information that comes up in people's feed when they come into the consultation. And then they're left with even less time to deal with the kind of the issues at hand. And what I'm really interested in going forward, and this is what I'm hoping to actually formally study, is how social media and large language models are shaping doctor-patient relationships and our relationship with the healthcare, particularly when we know the LLMs, people rate them as being more empathic than doctors, which doesn't say, I think it's about the medical professional I have to say. That's rough, yeah. It really is. We need to get our own house

in order again. And so that sense of feeling hurt. But then that's exploited. And that's the challenge again with social media is with influencers. I hear you, I see you, now buy my subploid or buy my dog tea test or come to see me in my private clinic and I'll give you that unnecessary scan. So it's fascinating really. I mean, it does feel quite dystopian, but I do wonder going forward what our expectations will be of healthcare and what the role of the doctor, obviously not just doctors, but you know, health professionals generally will be in that sort of dynamic in the new information ecosystem. I'm going to put pound in the jar or a dollar in the jar. So I hate the term ecosystem, but I've just used it. It's awful. I feel like a chat box saying

Yeah. Just put a little dash in there too. Yeah. Yeah, yeah, he's probably dead box. And these doctors, these physicians are also on social media and they're also being exposed to they have their own algorithm, which might or might not be filled with bad influencers, right? These nefarious actors. But even still, there are many of them that I'm sure are not exposed to the information that their patients are exposed to. that creates more of this gap in saying, okay, well, what is the information I know? What is the information that you know? And how do we communicate and get on the same level in this 20-minute appointment? It's really hard. And one conversation I had recently with the pediatrician, he says when his patients come in, the first thing he does is say, come on, let's chat about what you've looked at, chat GPT today or co-pilot or Claude or whatever. Let's have a conversation. Let's just

get that out of the table so we can talk about it. And one ADHD physician in the UK, she uses what her patients see about ADHD on social media as a way to talk to them. So how do you feel about seeing that? What have you seen on social media today? How should we talk about that? So get them to open up because it's almost got to be part of the conversation. And in one paper that I read, and it was in one of the pediatric journals,

A sort of throwaway line at the end was doctors now need to start asking their patients about what they're seeing on social media. And it was sort of a throwaway line. And I thought, wow. You mentioned the commercial and digital determinants of health, which I feel like that's going to be a big thing moving forward. How would we even begin to measure or incorporate that into understanding people's health and how it is influenced by their social media experiences? it's a really going to be a really hard area to study. First of all, there's no transparency from the tech company. So getting data and I know there are ways of potentially sharing data, but as it stands, as an example in the book, one academic I spoke to said if he wants to do a study, let's say on TikTok,

they will want to see the protocol. They will want to see everything before they release any data. and then on top of that, they will want to see the final publication before it goes anywhere. Now, we've learned over years, let's say with the drug industry, that if they subsidise research or fund research, then you have to have sort of walls in place and protocols in place. So that research isn't there for influence before it goes to publication. There has to be an element of that. And I feel that, again, we're very much, there's a bit of tech exception, there's an amount. at times that we can race ahead and do things. And again, if you think about what science is,

we have the null hypothesis. We assume something doesn't work unless shown otherwise. Tech feels to me like, let's just get it out. We'll assume it works until it doesn't. And it flips scientific thinking on its head, but we sort of have just come to accept that is what happens. But is that good science? I would counter probably not. We've touched on a few times ADHD throughout this conversation so far. And this is a condition that has received a lot of attention on social media. And that's been very positive for some people who have found community and a greater understanding of their own experiences, people who are getting diagnosed or going to their physician and saying, is this what I've been experiencing? How can I manage this?

But it is more complicated than that, of course. Their diagnoses are increasing. but there might, does that also mean that it might be over-diagnosed in situations? Like, how do we know where to draw the line between help and harm in this context? It's really difficult. And I think you can have two things together at the same time. So you can have people being missed. So you can have under-diagnosis.

And we know they're largely in certain ethnic groups. So African-Americans, Hispanic people. There's a massive social gradient there as well. and that's mirrored in the UK. So if people of lower socioeconomic groups are less likely to get the diagnosis that they need to access treatment and help, meanwhile you have people that perhaps have more access to healthcare,

more wealth, that are getting diagnoses that may not be robust. So there we might have missed diagnosis, but also we've got this idea of perhaps over-diagnosis. So the expanding definition of what counts as ADHD, and that is always subject to debate in healthcare. And I don't come down either way. But what I do think is that, and I hear it amongst my friendship groups,

that people's way of describing their ADHD has taken on social media element. People talk about rejection sensitivity to sporia, like it is a certain symptom, a well-described symptom of ADHD, ADHD. As it stands, experts are still debating it. Is it part of ADHD or isn't it? We don't know because there isn't the evidence there, but that has come down into clinical notes and that has sort of been born out of conversations on social media. Other medical or psychological terms have been co-opted by influence, like object permanence, which is a Jean-Pierge stage of development where a child realizes that if a parent isn't in the room or something isn't in the room, they still exist,

just because they can't see it, that person still exists. And that's been co-opted by influences to me, I don't miss things. And those terms go viral. And again, people talk about it like it is a definite part of ADHD. And so, and I hear that in conversations just day to day, I've got rejection sensitivity dysphoria or I've got object and permanence because I don't miss people. And then if you think about how we do field studies or we've, validate our questionnaires when it comes to ADHD diagnoses. If people are saying, well, this isn't how I see ADHD, we haven't got all these different conditions I'm seeing. What does that then do further down the line to how we see ADHD? And I don't know. It's an open

question. Yeah. How does social media shape diagnoses in a medical context? I mean, it's not it's not a one-way relationship. This is all kind of interesting. intersecting and feeding into each other. Absolutely. And health is defined socially and culturally. There's a lot of healthcare that is defined. And I think what often surprises people, even diagnoses change, what the threshold, the cutoff threshold is.

Sometimes it's so many standard deviations away from the mean is what you consider abnormal. That's often a surprise to people. It is not fixed in stone. And over the years, we've seen the idea of pre-diabetes come about as we move the goalposts of who needs treatment. Healthcare is constantly iterating. And it's not all pure hard science. It's real where arts and culture and society meets hard science.

It's that strange interface. And health optimization, I feel like, is a key part of this too. It's doing whatever you are told is the best thing to do to opt. optimize your health, and there's a huge market for this. I got sucked into it with a smart watch, and then I realized that I hated it. It made me miserable, so I stopped using it. Can you discuss the optimization trap, which is what you call it in your book, and how this market both over promises and underdelivers? So if you think about it, it's obvious. If you've got a market, if you're a company, where's the bigger market, a sick person or a

well person? So if you take, if you take continuous gluten, And there's been a big trend for them. They were designed. So Abbott is one of the big companies that makes it, US company that makes them. They were designed principally to help people type 1 and type 2 diabetes who use insulin to monitor their blood sugar levels so they could adapt their insulin to get optimal dosing. Because we know in the short term, if you've got the right level of insulin, you're less likely to have hypos and hypoglycemic attacks. And in the longer term, it reduces the risk of long-term health complications. But there was a pivot.

That's only a small market. There's a much bigger market in well people. And if you can encourage them that they need to constantly monitor their glucose in the absence of evidence. And the NIH have done some brilliant studies and there's some brilliant clinical trials in this. Kevin Hall, who was no longer at the NIH. but he's on some fascinating trials showing that you get different readings. The same device can give different readings or different devices give different readings and your blood sugar level will change according to what else you've eaten,

what else you've done at the same time. And so they're not really reliable because our bodies and healthy people have homeostatic mechanisms. Our blood sugar goes out, we release insulin and it comes back down again. it goes too low, we release glucose gone and the blood sugar goes back up again. We're in this constant state of homeostasis. We don't know what abnormal looks like in a normal person.

Because if you're out of range, your blood sugar goes up and people say, oh, I've got a spike, you're like, yeah, just eating banana. Of course you've got a spike. If it comes back down, that's what you're interested in. And guess what? It comes back down. And then what happens is that then potentially creates more harm.

So we don't know spikes have any issue in the long, certainly in the short term and certainly not in the long term. But then people change the diet accordingly. So right, I'm not going to eat banana, but I'm going to eat a burger because burger doesn't spike my glucose levels. So people then become wedded to this metric. And the thing when you look at one metric is you're not looking at all the other things that you might be ingesting.

So if you have a burger, you might be eating loads of cholesterol or fat or salt and all those other things. but you're so sort of wedged to this one metric, in this case is glucose. You might be watching one very well-monitored tree and missing the wood around it. And that's the problem is if you can measure it, you fixate on it. And in some way we saw this in the pandemic a little bit without getting too controversial, is we really, certainly in the UK, we focus very much on COVID deaths because we can measure them. We could see it.

But everything else around it was far more complicated to measure, you know, the impact on education, the impact on psychology and all those other things. They're just harder. So it's very easy to focus on that one metric if you can see it and it's easy to measure. And there's a tendency, I think, in medicine to think the more parameters we measure, the better our health. And that just isn't true. There are so many science and medical or wellness influencers out there, like the health podcast rows that you mentioned throughout your book. And they come with not only these, impressive credentials, but also these substantial ties to health industries or supplement industries or the wellness industry. How can a consumer know when to trust a source or can

they? Can educational entertainment be trustworthy or be something that is viable? It's really hard balancing out because we know people don't want to pay for stuff. People don't want to pay for their media content and it needs to be funded. And who's going to have the biggest interest in funding a health podcast is the people that are going to benefit from it. There's a phrase that I heard a lot is, I only work with the companies that I believe in or I use personally. Well, what happens if there's evidence that suggests that that company, that product isn't very good, but you've become financially dependent on it? Do you suddenly drop it? So for me, it's a nonsense term. It's a nonsense expression. And we have seen certain podcast

Spirose pivot, you know, I don't like glucose monitors. Oh, look, I've just spoken to somebody that works for one and they're sponsoring my podcast and now I recommend them. Oh, I don't like this, Ora Ring, go look, then I'm going to, I'm going to start backing it and putting it on my podcast. And guess what? I'm going to be a paid advocate and I'm going to try and get it into medical journals and I'm going to advocate for it in academic studies. It's that that was blown open in a court case between ORA and Peter Atia is his relationship. with the company and it sheds a light on these commercial relationships that podcasters have with companies. And I think it becomes more problematic in many ways when it's a medical

professional that does it because it sort of gives it more of an endorsement. And there's one UK podcaster, Dr. Angan Chatterjee, and I took him out the book and I'm kicking myself for taking him out the book. But he's sponsored by AG1. And our regulator, Offcom, They don't regulate podcasts, but they did highlight this as an example, is when it's a health professional that is working with a company, even if they say they declare it, it looks like an endorsement. And in many ways, I think health professionals have to have an even, well, they should do have a higher standard. We're a regulated profession. You know, you've got your state licensing boards where you have the General Medical Council in the UK. And it's really difficult.

balancing act. How do you get the funding and remain independent at the same time? It's tricky. Does accurate scientific information have a place on social media and what does that place look like? I think it has to because that's where people are going. I think we need to be more skeptical. I think we need to have better health literacy. But even then is somebody going to be able to interpret a systematic review or a meta-analysis or randomized control trial. That's a difficult task. I think health professionals have to do better or have to sort of meet people where they're at. And there are some people that do it very well.

It's not all bad. And I'm obviously doom and gloom. The book titles, Doom and Gloom for me is about think critically about where our information's coming from and what is shaping our healthcare and what incentives and what are the interest shaping our healthcare and our health information system. And then the next challenge, obviously, it's going to be the large language models and how the information on them are being shaped.

And we know companies were already trying to make their information prioritised by the LLMs. You know, it used to be search engine optimized. Now it's geoengine optimized or I can't remember the exact term. But there is, there's a whole cadre of people that are working on information to make sure the bots pick up on their content. And that is going to be the people with the deep pockets that are able to shape their content accordingly. And who knows what deals going on behind the background?

I wouldn't want to say. And that would be pure speculation on my behalf. But already we know that if you do a Google search, it's the sponsor content that comes up to the top of your feed. But it's going to be less transparent. So that's another question that I had is that if we can make educational, content, reliable, accessible, interesting to people. There's still the issue of this flood of misinformation or information that is in the gray area or that isn't backed by these robust studies and people who have financial ties. How can we incorporate regulations or just health literacy

training to get people to recognize when what they're seeing is being promoted by these bad influencers? There just has to be a lot more skepticism. So one of the things I would say to people is don't dismiss someone's story, but ask why they're telling you it. Ask why they're stepping onto a platform in the first place to tell you about their condition or to tell you about this product or treatment. That's the first thing you should ask. Why is this person telling me this? Why should I believe you? And equally, why should people listen to me or believe me? I got asked that the other day at the Edinburgh Science Festival. The first question I was asked by a pediatric radiologist. Why should I believe you? And I said, well, I sort of have to be accountable,

but equally you can dismiss me. You know, if I'm on the BBC, I'm regulated by offcom, you know, regulator or if I write something in a BMJ, I have responses that, oh, you can literally come down on my door and hammer down the door. But there's no accountability here or very little accountability, if any at all. And if someone's only telling you the benefits of something, why? aren't they telling you about the harms? Because every treatment has benefit and every treatment has a heart. We don't necessarily know whether you're going to be the person that benefits or gets the harm. You know, medicine again is quite slow moving and that precision. If I give you a statin and to prevent a heart attack, as a doctor, I cannot tell you whether you will be that person

that benefits from that statin. It's all statistics. And that's the problem. If someone's over-sert. then they're, you know, they're probably not right. So it's just those little cues. You know, if you're thinking about a treatment, what's the benefits are doing, what's the risks, what the alternatives, and what if I do nothing? They're the decisions that go into stuff. And who's behind this information, really?

So it's just being a bit skeptical. And in terms of provision of information, whether you're the preventative service task force in the United States or the NHS in the United Kingdom or the Institute of Medicine or whoever you are, perhaps you need to think about presenting your information in different ways. It's really tricky because, again, you're held to a different standard of accountability if you are those institutions. And let's say you mess up, rightfully you're going to be held to account. And I think it's very difficult for people to, to, I feel in the UK that we've got something called the Royal Colleges. So they're Royal College of Surgeons, or Collegians, or College of Obstetrics and Gynaecology.

I feel that they need to do some kind of campaign about, you know, consumerisation of health and all these tests and treatments that you see, be careful before you buy. Because it's a pretty unregulated market in the UK. I think the United States possibly even more so than the United Kingdom. but equally we're going that way. What should change here? If people are being offered egg freezing that isn't indicated or statistics that are wrong, where's the regulation going on here? It's who's protecting consumers.

What we're talking about in, I think, in this particular instance, is who's protecting consumers? And there isn't a huge amount of consumer protection going on. It's the new snake oil. That's what it is. It's the new snake oil. Absolutely. Dr. Cohen, I really appreciate you chatting with me today. This has been such an eye-opening conversation and your book has so much food for thought. It was fantastic. Thank you.

Thank you so much for inviting me on. A big thank you again to Dr. Deborah Cohen for taking the time to chat with me. If you enjoyed today's episode and would like to learn more, check out our website, this podcast will kill you.com. We'll post a link to where you can find bad influence, how the internet hijacked our health. as well as a link to Dr. Cohen's website where you can find her other work. And don't forget, you can check out our website for all sorts of other cool things, including but not limited to transcripts, quarantini recipes,

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