Interview: Matthew Facciani on fighting healthcare misinformation

[MUSIC] This is Ted Health, a podcast from Ted, and I'm your host, Dr. Shoshana Unger-Liter. Today, we're talking about something that's at the heart of essentially every debate that we have about science, society, and what's true. And that's why do we believe what we believe? And why is it so hard to change those beliefs? My guest today, Dr. Matthew Fetchiani, is a researcher at the University of Notre Dame in the Computer Science and Engineering Department. He's an interdisciplinary social scientist who studies political polarization and moral reasoning across neuroscience, psychology, and sociology. His new book, Misguided, digs into the psychology behind our most deeply held views. Why they feel so personal and why evidence often isn't enough to shift our perspectives. Especially on age when misinformation spreads faster and farther than ever. I find it so valuable to understand how our beliefs shape how we interpret information. And what I love about Matthew's work is that it doesn't stop at diagnosing the problem. He offers a practical and research-driven framework for how we can communicate science more clearly, listen more generously, and engage across lines of difference with curiosity instead of combat. After my interview with Matthew, stick around for a TEDx talk by Karen Daw. Who explains why so many scientific findings we encounter in the media can be misleading. And how anyone, not just doctors and scientists, can learn to judge the reliability of health research more confidently. But before we dive in, a quick break to hear from our sponsors. And now here's my conversation with Dr. Matthew Fetchiani. Matthew, you study why our brains latch onto certain stories and then reject other ones. What do you think is the human side of misinformation? What's happening in our heads and our hearts when we believe something that isn't quite true? So my background is in social science, and I think a lot about the social structures we interact with. So when I think about how we process information, I often think about it through a lens of how does this connect me with my own group or distance me from my own group. So when we think about different beliefs, sometimes beliefs that are not rooted in the best available evidence, we can think, oh, maybe that person's misled by not hearing the right facts or something. But I think that only tells part of the story because we also have to consider is this belief helping that person connect with their group. And if it is connecting with their group, then they may be more motivated to protect it and maintain it. And when you think about someone's day-to-day life, an abstract belief, such as even something like the earth being round or flat, that doesn't impact your day-to-day life every day so much. But if all of your friends believe that the earth is flat, for example, and that gives you a lot of community and emotional support, then rejecting that belief and removing that community can be much more impactful in your day-to-day life. I find that so fascinating. And I think that really opens the door to a deeper truth that you point out often is that believing misinformation isn't a flaw of character, but actually part of being human. I think most of us believe misinformation is something that other people fall for. But your research suggests that it's a universal vulnerability. What are some subtle signs that any of us might be consuming information that's misleading or incomplete? Yeah, so I think there's a few different layers we can approach this. One can be thinking about our own identities, being mindful of how much our own identities overlap with each other. And if we are deriving so much of our self-esteem and social support from a narrow set of identities and meanings, because we know from social science that we're motivated to act in certain ways that are consistent with the meanings of our identities. So ideally, you'd want a really broad set of diverse identities so you're not over-reliant on this narrow lens of meanings that give you all of your self-esteem and support. So you can think of just an extreme example of only having a few identities and all of those identities completely overlap with each other. Let's say you have a religious identity, a political identity, it doesn't matter what they are, but let's pretend they completely align and share 100% of their meanings. And then also your friends and community also are among that place of worship or your church wherever you go to meet those people. So then any information that challenges your politics, for example, is attacking your 100% sense of self, and it can feel very personally threatening, and then you're extremely motivated to reject information that challenges it. Conversely, if you have a broader set of identities, then any piece of information that challenges just one of those identities is not completely attacking your overall sense of self. It's only attacking a small piece of that. So I think being mindful of how our identities are organized and how we're getting our self-esteem and social support can be a good first step. Hearing that, it makes me think about how the public conversation sometimes oversimplifies all of this. When you step back, what feels most misunderstood about misinformation in the public conversation and what nuance do you wish more people knew? I think there's still a lot of emphasis on just sharing the facts as a way to try and reduce misinformation. And as I mentioned, we're all vulnerable to misinformation based on the types of communities we belong to and the identity structures that we have. So I think just understanding that emotional and social component would help advance the conversation in a way that I think is more complete. And then even the word misinformation, I think, can be challenging because it is also incomplete sometimes. Sometimes there is a kernel of truth to what someone believes even if it's mostly untrue. And I think that's a challenge of using these terms like misinformation where it suggests that it's this binary of true versus false. And you're misinformed, I have the facts, and there's not really a lot of room for discourse. Where in reality, a lot of these claims and a lot of just beliefs in general are pretty messy. A lot of times they exist in more gray areas. So I think we have to be careful about how we approach these topics when we're having one-on-one conversations because it can really be unhelpful to immediately put someone on the defensive by saying you're misinformed, you fall for misinformation. That sounds like a personal attack. And a lot of times it is. So I think just being mindful of how we use these terms in our conversations can be helpful too. - That nuance is so important, especially because the topic gets tied to some of the biggest challenges, I think that we face socially and politically in this moment. And so on that note, polarization is the word of the day, right? From your vantage point as an interdisciplinary researcher, what role does misinformation play in fostering polarization? - So when you think about polarization, the reason that it's linked to misinformation is because we're in such different information environments. But we're getting information from very different sources than someone else. So it can make it really challenging to have productive dialogue with someone who's on a different political aisle than us. And I think that's why I often talk about politics in my book and in my work because it provides such a salient and clean example of how identities can motivate us to process information differently. And especially in the United States, we have this very clear in-group and out-group effect of political polarization. - Your research looks at social networks, digital, and real life, can strong offline relationships actually buffer us against misinformation, polarization? - So when we think about social media, we know that whenever you click on something, you're more likely to see that type of content more often. That's the algorithm trying to keep you engaged online. And that makes it really easy to find communities and people that think just like you do. And now with artificial intelligence, you can find your own chatbot that aligns with your beliefs more and can validate what you already believe. So it really accelerates this process of maintaining the existing identity structures that we have and it can make it more challenging to meet people who think differently than we do. Well, some of my research has found that just having one meaningful connection that has a different political background than you can significantly reduce your political polarization and your political bias and how you process information. So all it takes is just having one person in a list of close associates that has different politics than you. And we find that can significantly improve your ability to objectively process information. So there is this idea of how powerful those offline connections can be because you're able to connect with someone who thinks differently than you consider their viewpoint and also evaluate your own beliefs too. I think that's another big part of it is not only are we able to connect with people who think differently than us when we think about how to have more productive dialogue and consider where they're coming from. But also from our own beliefs, we can be more objective and less biased when we are talking with someone different than us because it forces us to reflect on our own biases and consider how we came to that belief more than just talking to people who already all agree with us. On this podcast and in the public discourse, mental health professionals are talking a lot about stressing. anxiety and overwhelm from being online. Do you see a link between information overload and the way we process or maybe misprocess news and science? - I do, and I feel it in myself too. I use social media, I'm online a lot. And I can feel it emotionally whenever I'm consuming a lot of political content. I really like this term, the conflict entrepreneur. But I think it really sums up a lot of the information we can consume online where there are people who are profiting from spreading outrage and trying to keep us engaged. And it can be really exhausting to constantly consume that. So I think that also does connect to some of this research finding that when people do take breaks from social media, they tend to improve their overwhelm while being because they're just not as exposed to that stream of information overload, a lot of which is very emotionally taxing. - I'd love to ask you, Matthew. You spend so much time translating research for the public. From where you sit, what's one thing that you wish, doctors and scientists were better at communicating with everyday people? I do this, I go on TV and or on podcasts and talk about public health and science. So what could I be doing better? - I think addressing uncertainty too and the research as well as the scientific process. There's some research finding now that when scientists communicate in a way that showcases that uncertainty or explains the scientific process more, their messages are perceived as more trustworthy. As opposed to just confidently saying, here's the answer, it's 100% true and this is something that you absolutely don't have to worry about or you absolutely do have to worry about or something like that. So speaking too confidently can lose trust, especially as the evidence changes. And again, it's challenging because the algorithms, again, rewarding more sensationalist content. So I think it's important for us to try to constantly balance that. I know as I'm saying this, I know there's a bunch of caveats to it and there's no perfect way to communicate because it's going to be trade-offs. So ultimately, you have to be mindful of those trade-offs and try to speak with as much directness but also as much integrity as you can. - I think that piece around uncertainty is a huge one and something that those of us in the science community really felt during the pandemic when many people spoke with so much certainty and in reality, there was, and there always is uncertainty all the time. We often talk about checking sources, right? But I think that can feel unrealistic when people are exhausted or they're short on time or just don't know how to do that. What are some simpler everyday habits that the average person can do to become more resilient to misleading content? - We often talk about media literacy as far as the ability to fact check. And one term that's often thrown around is this term of lateral reading, which is instead of looking vertically within the article that you see online, you open a tab, look laterally and say who the author is, who is funding them, what's his background, what could their target audience be? Is the media outlit platforming them? Do they offer corrections? Do they disclose funding? And that could be a guide to seeing how credible this particular source is as opposed to even diving into the nuances of that article. Like maybe that person is writing in a very charismatic, convincing way, but you can look further on what their background is and see that they have a clear conflict of interest. So that falls into the media literacy bubble that I think can be really helpful. And then the psychological literacy is another pillar that I have discussed and that is focused more on our identities and our networks. And then also I think another component that can be applied to everyday people even if they're not scientists is scientific literacy. So understanding some basics of how the scientific process works, some basic research methods, some basic statistics, sometimes the message in a headline is not actually what the study found. How the study is framed in the headline might not actually be what was found. So there was a recent study about melatonin and heart failure. So there was this abstract, that was a conference abstract that was coming out that found this link between melatonin use and higher risks of heart failure. But there was a lot of confounding variables it didn't account for such as the different lifestyle factors, the amount of melatonin and maybe people that were having more sleep difficulties reported taking melatonin more than those who didn't. So there's a lot of things that were left off in the nuances than the limitations. And then also some of the headlines were like taking melatonin nearly doubles your risk of heart failure. And that sounds really scary. But when you look at the data, the most important thing is what does that nearly doubles actually mean? And-- From two to four out of millions? There's an increase of about 2% between the two groups. So the no melatonin group has 2% risk and the melatonin group had a 4% risk. You might just see that headline of melatonin doubles heart failure risk. And it sounds really scary. But then just checking a couple things, like what was the absolute difference between the two groups, a nice way to check what the study was actually meaning? 100%. And I actually think some of that burden should fall on the news organizations, too, to do their job. I spent a lot of my time working with news because I feel so strongly that we got to be doing better all the way around. Yeah, so that is a challenge. Because ultimately you're asking people to do more work. Even if it's a little bit more work, you're still asking people to add in something to their busy lives. So I think that places the importance on science communicators to try and share their information in a way that can reach people. So developing that network of trusted messengers is really important. And for families that every day resilience starts even earlier. So I want to talk about kids and teens for a minute. Parents often ask how to raise media-literate kids without shutting them off from the world. Based on your research, what practical guidance would you give families trying to help young people build healthy information habits? I feel you would have that in schools. That's the short answer. And there are a few states in the US that have media literacy programs. And there are free resources available. Like the news literacy project, I think, is one that has a lot of free online resources, specifically for kids and teens. And sometimes they're even in more engaging formats, like games, that's something that I've been studying. And I think it could be really effective is developing these media literacy games themselves, which teach these skills as the kid is learning it. There's a game called Bad Vax for Vaccine Misinformation, the Bad News Game, Harmony Square. There's a whole bunch of them that are free and available that anyone can go and play and share with their kids. And a lot of these games are really cool because, again, they're nonpartisan. And they teach you to identify manipulation techniques out in the wild before you're exposed to them. So trying to understand, OK, this headline is going to be misleading me. And I remember reading about that in this game that I played. So I think those are very useful. But again, I think at a higher level, ideally, we would have some of those media literacy skills built in the classroom. So let's talk about high pressure situations for a minute. During moments of crisis, public health emergencies and natural disaster, maybe heightened community stress, misinformation tends to spike. What can people do in the moment to stay grounded and avoid being swept up in emotionally charged or misleading narratives? I think the first thing is to just take a step back and be mindful of our own emotions. So if we see something that makes us feel very emotional online, that to me is a good indicator to pause and reflect on what we're seeing. Is this verified by other sources? Is this person trying to keep me outraged so they can profit off of my emotion and attention? And I think that's one thing that we all can do before clicking reshare, trying to pause and think, is this actually true or is this trying to manipulate me? Is a good step that we all can do better at? So Matthew, we may feel ashamed when we realize that we've shared something inaccurate, but shame can shut down learning. So what are healthier, more compassionate ways for people to correct themselves or others without damaging relationships? When I talk about it, I don't speak about them in terms of changing someone's mind. I don't think I should be the goal of how we enter in any types of conversations personally. I talk about it in terms of how can we at least turn down the heat of polarization and increase our odds of being heard. So then the person can absorb what we're saying and then make their own decision later on if they want to update their belief. But once we develop a trusted relationship with them and we know them, I think then there's certain techniques that can be helpful. So the first thing, you have to have that baseline mutual respect. So that's really critical. And that's why it can be very hard to have productive offline conversations with strangers. So that's why it's really challenging and often unproductive to try and debate someone online that you don't know. So assuming you're having a one-on-one conversation with someone who you have this mutual respect with, you can try to relate to shared identities that you both have. What do we have in common? I think focusing on that can be really helpful. So maybe we live in the same neighborhood. So we care about the well-being of that neighborhood. Or maybe we have the same interests in raising healthy children or keeping our community safe or even just broader things like connecting on shared interests even can be helpful and trying to basically show that person that you're on the same team. I mean so much of our conversations I think can be boiled down to does this person think I have their best interest at heart and that can be shown by displaying how much you're on the same team with them. Do you share common interests? Do you share common values? And do you share common identities? And then also when we're actually having discussion about the particular claim that we are disagreeing about we can try to reframe it in a way that fits their background and their values more. So maybe we care about a particular thing because of the justice side of it that really resonates with us. But maybe they might care more about the economic side of it and we can present that case to them as the economic side of it. And this requires to really have a conversation and understand where they're coming from so you can reframe it in a way where they can hear it and hear oh this connects with something that I care about. Maybe they're not going to change their mind on the spot. But though at least hear what you're saying more and then again later on maybe they can update their beliefs if they want. Another big thing is to ask how they came to that particular belief and try to have them explain that particular mechanism. So that could be helpful for them and also for you to understand where they're coming from. And again, all of these things also apply to ourselves. Like we should be constantly trying to be mindful of how we know what we know is true. All of those are helpful ways to try and increase our odds of being heard and reduce polarization. But one conversation is going to be challenging to get all of that in. So often requires multiple times for our perspective to be listened to and heard if it's being presented to someone who thinks very differently than we do. And all this comes back to a core theme in your work trust, right? We've talked about fostering trust here. But what about healing it after it's been broken? What are some steps? Individuals or communities can take to rebuild trust in a healthy and sustainable way. It's a tough question because it requires a lot of time and resources. But I think it's doable. So if we think again about medical institutions, for example, they have lost some trust. Institutions broadly have lost trust. And what we've seen through different social science studies is this lack of trust can be reduced somewhat if people feel more connected to those institutions. So we're actually reducing what is called the psychological distance between the institution and the person. So if you are not trusting scientists, for example, it could help if you actually meet some scientists and work with them to solve a common issue. So in your community, maybe you want to measure air pollution. So you work with some scientists and you measure air quality with them and understand one, how the scientific process works and how it works at a institutional level too. But also you actually meet scientists personally. And that's really the big thing that's important is connecting institutions with their local communities. So more people get to meet people from universities, hospital systems, different scientific institutions. So they can realize, oh, these people are not just what I see presented to me online that might showcase them in a very negative way for someone that is motivated to profit off of outrage. But instead, they are just everyday people trying their best to help their own communities. So reducing psychological distance, I think, is a big one. You're not just speaking at them, you're trying to listen to what their concerns are, address them, and work with them, and developing those social relationships that will rebuild trust over time. But again, it's not something that can be done very quickly or very easily. There needs to be a lot of resources and time poured into this. But if we're really serious about rebuilding trust, then it does require people to spend resources on reaching out to the local communities. Wonderful. Matt, you thank you for this thoughtful conversation. I've been very encouraged by your work. It gives us the language and the hope for navigating the world a little more wisely. So I'm really grateful you could be here. Yeah, thank you so much for having me. It was great to speak with you. My conversation with Matthew Fachiani really illuminated how vulnerable we all are to stories that feel true, especially when they speak to our identities or our fears. It's a reminder that misinformation isn't just a problem out there. It seeps into our lives because we're all human. And building on our conversation about why misinformation sticks. I'm excited to share a TEDx talk by health scientist Dr. Karen Duh who offers another toolkit for recognizing reliable research when we see it. Dr. Karen Duh invites us into the messy and fascinating world of medical evidence. The studies we hear about the claims that wash over our feeds and the hidden reasons some of them simply don't hold up. She shows how easily our excitement, our hopes and even our fears can nudge us toward health advice that sounds convincing but isn't built on solid ground. Her talk is a thoughtful reminder that caring for our bodies in a noisy world means learning to pause and get curious and then ask a few smart questions before we trust what we're told. And now here's Karen Duh. Why most public research findings are false? That's the title of a paper that came out when I was roughly halfway through my PhD. I'd spent about 18 months failing to get any of my experiments to work and I was ready to give up. But then I realized to an extent that's just how science works. Science investigates things nobody has investigated before. It's trial and error. So studies start small, maybe too small and what looked like a really interesting finding was actually just a fluke. Most is maybe an exaggeration but certainly some published scientific findings are wrong. What does that mean for you? You currently have access to more health science information than ever before and more ways to consume it. I tick-took Facebook YouTube and I love that. So what's the problem? Well the problem is it might just be wrong. We all know that feeling of seeing a headline that really resonates but maybe sounds a bit too good to be true. How can you tell? I'm a scientist and health technologist. What I do is help companies compile scientific evidence to support their product and then figure out how reliable their evidence is. I work with medical devices for drug delivery. I work with software to help you get better sleep. I work with medicines for the most rare and severe types of seizures. I am not an expert in any of those fields and you don't need to be either. What I do is the science of science. The science of science is a thing and its principles can help you judge health science information in the media. So some scientific findings are wrong. What do we do about it? Well science, self-correct and one of the main ways it does that is through something called a systematic review. Now the origins of the systematic review are maybe not what you'd expect. In the early 1930s a young medical student called Artie Cochran had a problem. In interviews he refers to it as a sexual dysfunction. What Artie didn't know then was that he had a genetic condition, not a psychological one. Psychoanalysis didn't help and he became very frustrated. He was seeing one of Freud's students and he says he believed strongly in intuition. Well I couldn't help asking why? What's the evidence for what you are saying? This experience in Vienna really got Artie thinking about evidence and by the time he returned to medical school he was kind of a troll. He says we started a sort of a club of individuals who would ask consultants what's the evidence that your treatment has any effect? We found this great fun. There was so little evidence available. By the time he left medical school he was obsessed with evidence and it came to define his medical career. Among his many great contributions was the idea that single studies can't be relied upon to make healthcare decisions. He called for research summaries to be produced that compile all the available evidence on a specific question. This is what we now know as a systematic review. The most robust type of systematic review is called the Cochran review. Cochran reviewers judge how good the evidence is using a tool which is this essentially a huge technical questionnaire and no big deal, but it was developed right here in Bristol. Use globally, not just for Cochrane reviews, and it was co-created by the team that I used to work for, so I kind of felt that I was okay to mess with it a little bit. What I wanted to do was take it out of the hands of the professionals and turn into something anyone can use to judge health science information in the media. So what I did was take the core principles of Cochrane and boil them down to just three questions, three questions that I want you to remember and think about the next time, don't worry, I remember them if they go it's fine and you're going to remember them too. I want you to remember them because I want you to think about them the next time you see a too good to be true headline or a weirdly compelling tick-tock. Okay, so has there been a study done in humans? Are we sure it's not a red herring? Has there been a randomized controlled trial? If the answer to any of these questions is no, then it's not bad science, not by any means, but it does mean there's a high risk that in time it'll turn out that the findings weren't reliable. Before we get into it, we need to be aware that it will take conscious effort because we want to believe, I want to believe, I have an autoimmune disease, I'm sick a lot, I'm on immunosuppressant medication, there's no cure and the plan is for me to be on immunosuppressant medication for the rest of my life. So when I see a tick-tock that says it's definitely going to cure me, I want to believe, I want it to be true, I don't want to question it. So it takes conscious effort to stop, think and ask, has there been a study done in humans? This first one's super easy and a real killer question and once you start asking this question and listening out to the answer, it'll filter out a lot of health claims. All medical breakthroughs have to start somewhere and a lot of them start by growing cells in petri dishes in a lab. That doesn't mean that all cells in petri dishes are destined to become great medical breakthroughs. A really good way to remember this is that cancer cells grown in a dish in a lab can be very effectively killed with a hammer. All kinds of things will kill cancer cells in petri dishes, but that doesn't make them a viable cure for cancer and we know this because 90% of candidate drugs will fail when they get to the clinical trial stage. Mostly this is because once we put them in real life humans, they just don't work in the way the evidence suggested they would. So if we ask this question, has there been a study done in humans and the answer is no, we can say, okay, that's super interesting, but maybe it'll turn out to not be reliable finding. If we ask this question, has there been a study done in humans and the answer is yes, we're going to take it up a notch, we're going to say, are we sure it's not a red hearing? In the context of medical research, what we're talking about here is confounding. Confounding happens when something is related to both the health factor that we're interested in and the health outcome, causally related to both those things. Now we know what firefighters do, we understand that system. We often don't know what health factors do and we don't necessarily understand the underlying system. This is why it's so important to ask, how was the study done? What was the study design? So what study design would avoid red herrings confounding? That would be randomized control trials. Last question, has there been a randomized control trial? Randomization is the key to getting rid of red herrings because then the red herrings occur as much in the treatment group as they do in the control group. Well, war two. Archie Cochran found himself as a prisoner of war. As a medical officer, he was in charge of the health of around 8,000 British prisoners, their diet was awful. Archie noticed everyone including himself was beginning to swell, they were getting very, very sick indeed. Archie suspected it was thiamine deficiency, but Archie is a prisoner of war. He is not a doctor in a hospital, he can't just order up a bunch of yeast, which is what they need. Archie needs to convince the guards beyond all doubt that yeast is the treatment they need. Archie manages to get a small amount of yeast on the black market. He numbers the soldiers and he sends the odd numbers off to the treatment group, the even numbers off to the control group. The treatment group get yeast, the control group get a placebo, but it was vitamin C. He might have been tempted to give the sicker patients the yeast, but then they're not randomized and then yeast isn't the only difference between the groups. What if the yeast doesn't help but because the sicker patients are too sick? What if the sicker patients are sick because they also smoke? What if the sicker patients are more sick because of some fundamental genetic difference? When you're a prisoner of war trying to convince guards to buy you a yeast, there can be no what it's. When we are spending money and resource on thousands of very sick patients in clinical trials, there can be no what it's. Within three days, there was a noticeable difference between the groups. Archie wrote up his findings and told the guards, "The next day he woke up to heaps of yeast. The whole camp got better because of what was essentially one of the first ever randomized controlled trials. It was even blinded. The patients didn't know if they were getting the treatment or the placebo. This is another really important thing about randomized controlled trials. The expectations and hopes of both the patients and the researchers impact results. In trials that aren't double blinded, the treatment effect can be exaggerated by as much 17%. Archie Cochran changed the face of medicine. By not accepting what he was being told, by asking tough questions, even if people of authority and experience. Ask tough questions. Even if people are wearing a white coat in their video, even if they have the word doctor in their username, even if they are stood on a red dot giving a TEDx tool. Ask tough questions. The best advice I can give you is that if you see a too good to be too headline or a compelling TikTok, go to the Cochran online database. I'm not affiliated by the Cochran by the way I should just say, but at this time they are considered the gold standard in healthcare evidence and they are used globally to make policy and healthcare decisions. They may, from already, ask the tough questions for you. But if there isn't a review already on what you're interested in, we can all be more like Archie by asking the tough questions ourselves. Has there been a study done in humans? Has there been a randomized control trial? Change how you listen to this information. Because if you're listening to something really interesting and the answer to all these questions is yes, then you might want to pay attention. Thank you very much. That was Karen Dott at TEDx Bristol in 2024. And that's it for today's episode. Thank you so much for listening. TED Health is a podcast from TED. And I'd love to hear your thoughts about this episode. Send me a message on Instagram @ShoshanaMD. This episode was produced by me, Shoshana Unkerliter and Jess Shane, edited by Alejandro Salazar and fact checked by Vanessa Garcia Woodworth. Special thanks to Maria Lagis, Faraday Grunge, Danielle Balerizo, Constanza Gallardo, Tansica Sangmarniwang and Roxanne High Lash.