This Man Does Not Like You

TikTok is up for sale in America, but Arghavan and Alyssa are not into it. They discuss the implications of TikTok's potential sale and its impact on privacy and social media dynamics. They explore how social media influences relationship norms, particularly through examples of weaponized incompetence in partnerships. The conversation shifts to public health, focusing on the importance of hepatitis B vaccination for children and the challenges posed by misinformation in healthcare. They also touch on the difficulties of academic publishing and the need for accessible information for people outside the medical field.

Joy this week?

The Portland Frogs vs. ICE Agents

American Society of Bioethics and Humanities National Meeting

Thanks for listening to The Present Illness with Drs. Arghavan Salles and Alyssa Burgart!

Follow us on TikTok and Instagram @ThePresentIllness

Credits

• Production by Arghavan Salles and Alyssa Burgart
• Editing by Alyssa Burgart
• Theme Music by Joseph Uphoff
• Social Media by Arghavan Salles

Chapters

• 1:11 The TikTok Dilemma: Privacy and Surveillance
• 3:00 Social Media's Role in Relationship Norms
• 11:45 Understanding Weaponized Incompetence
• 18:56 Hepatitis B Vaccination
• 33:12 The Challenge of Trust in Health Authorities
• 43:25 The Crisis of Academic Publishing
• 44:56 What's Bringing You Joy This Week?

Transcript

Arghavan Salles (00:00)
Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's a little febrile and definitely underdiagnosed. I'm Arghavan Salles, a surgeon scientist in your friendly neighborhood doom scroller in residence.

Alyssa (00:13)
I'm Alyssa Burgart. I'm an anesthesiologist and bioethicist and I track the news and health law like EKGs. The present illness is where we dig into public health, politics, culture and ethics with a scalpel in one hand and a meme in the other.

Arghavan Salles (00:27)
And a huge thanks again to everyone who's been listening, even if it was just for five minutes and you're gonna tune out right now. We thank you anyway. ⁓ Extra love to our subscribers and a welcome to anyone who has just stumbled in from the destruction of the White House.

Alyssa (00:40)
We are glad you're here. Let's get into it.

Arghavan Salles (00:43)
Okay, so here's what I was thinking we could talk about today. As you know, I spend a lot of time on TikTok, on social media generally, but also on TikTok. And I've been closely following all the various changes in what's happening with TikTok. As folks may recall back in, I believe it was January, it was like for 12 hours or so, the app was offline and we thought it was gone forever. And then they just reinstated it. And there's been all these deadlines.

from the government saying, you know, it has to be sold to a US company or entity in order to continue to have TikTok in the United States. And there has not yet been a resolution to that, but a couple of weeks ago, there was some news that perhaps Larry Ellison would be the head of some group of people perhaps buying TikTok. And...

This is concerning to me and to a lot of people because Larry Ellison has some very specific views on privacy. In particular, what kind of stuck out to me was when he said that he believes people behave better when they're being surveilled. And so, yeah, that means obviously that's quite the statement, quite the assessment and easy to say when you're a person who has so much money that you can basically be in hiding at all times and no one will ever know where you are.

because you can buy all the secrecy in the world. But the reason I've been thinking about it beyond the obvious is, as a woman who is on the internet, I've just seen how much women have learned about relationship norms and in particular, people in heterosexual pairings and what those relationships should look like and how the patriarchy has influenced our expectations.

so that a lot of women are putting up with a lot of nonsense in their relationships, but not even realizing that what they're putting up with isn't appropriate. And it's come up in so many different ways. One recent example was a woman who, I think she was a nurse maybe, or nurse or a teacher, I actually don't remember, but she was at work and she had forgotten to bring a lunch. And her husband, she contacted her husband and said, can you bring me lunch?

Alyssa (02:42)
Mm.

Arghavan Salles (03:00)
And he said, sure, no problem. So she makes a video unpacking her lunch. You people do these unpacking videos. Usually they're like their shopping haul, but she just thought it would be cute to do this with her lunch. And so she opens up this giant bag and she starts pulling out the different things that are in her lunch. And I'm just gonna say it's weird. Okay. Like the guy takes a partially eaten can of Pringles and puts the whole can. Do you see what I'm saying? Like he doesn't take out.

some of the chips and put them in a bag and put the bag in her lunch bag. He just says, here's something we've got in the pantry. I'm gonna throw that in there. There was a bag of like some kind of snack mix that was, it looked like it was almost empty. And he had just like taken the bag and thrown it into the lunch mix or lunch bag. And then anyway, it goes on like this where it's like, basically he went into a pantry and just started grabbing things and throwing them in this bag without any sort of thought.

to whether, I mean, I don't know, I suppose, if he thought about whether she liked these things or not, but certainly no thought to portion or like making it seem like a lunch. Also, snacks are not lunch. That's another thing. One of the things that was in there was her Chipotle, which she said was like two day old Chipotle. But as she's like pulling these things out, the pièce de résistance, if you will, is dog food. He has put dog food.

That he did bother to put in a Ziploc bag. And then he wrote on it, because you're my dog, D-A-W-G. And this video went, the look on your face is one of perplexity.

Alyssa (04:41)
For listeners, I wish I could show you my face right now, but it's, this is horrible.

Arghavan Salles (04:49)
Yeah, agreed. And so this is the reason I give this example is just it's one of the recent ones. But so what happened was she posted this video, which I think she maybe thought was funny. Like she said at the beginning that he was a funny guy. And so that's why she had decided to record it. But the comments were a lot of people saying, this man does not like you. This is not someone who cares about you. Are you sure you want to be in this relationship?

And then we find out that actually at her house was her sister as well. Cause she makes a follow-up video that actually her sister was like helping, I use the word helping quite loosely, helping her husband to pack this lunch for her. At which point people are like, girl, you're not, this isn't making it look better. I think your sister's probably sleeping with your husband. And so anyway, this is just an example of.

how social media and specifically TikTok can like reflect back to people things that they might not be aware of. And this is just one example. There's many, many, there's all these examples of men humiliating their brides at their weddings, whether it's stuffing their face directly into cake, taking a piece of cake, smearing it all over the face. Or I saw one recently that was a couple who apparently were planning to jump into a pool together. He's wearing a tux, she's wearing her wedding dress. They're holding hands and they're running toward this pool.

And at the last minute, as she jumps, he goes off to the side. So he stays dry and clean. And now she's in her wedding dress that she probably spent a lot of money on and her hair makeup all ruined in this pool. And he bailed on the whole thing last minute, which is, of course, again, humiliating for her. There is, you know, a guy who was reading his wedding vows, but on the back of the vows he had written in large black letters, help me. And there was another man who had ⁓

made his entire speech at the, know, his vows, I guess you could say they read more like a speech to me, but they're standing at the aisle with all their friends and family there and all his comments are about sex, basically, and how much sex she's going to have to whatever the things that she's going to have to do in their relationship. And I mentioned these again, there's so many, but I mentioned these because I think they have really taught a lot of people who may not otherwise have had exposure to

what is considered normal outside of like your own personal relationships or maybe your parents' relationships. It's been an opportunity for people to see not only what are other people doing, but then the reaction to the masses who are like, this is not okay. It is not appropriate to make your entire wedding vow about or set of vows about your future wife's sexual whatever endeavors or what your expectations are from her.

sexually in front of your whole family ⁓ or you know all these various humiliation rituals that people are engaging in.

Alyssa (07:51)
It's

the other thing too is it's not only humiliation it's also coercion because you're already in this position where you're in this public place you've spent all this money you're in the middle of a ritual that is supposed to bind you in love and you know cherish each other and all that yeah it's so depressing

Arghavan Salles (08:13)
in that sense it is and like I'm thinking back to when you and I were younger when we were teenagers in our early 20s we didn't have anything like this you know what what I knew of relationships was my my parents who were divorced when I was five I then we moved my mom and I moved to a different country I saw my dad like two times after that I think ⁓ maybe three but like so that wasn't really

a relationship that I witnessed as I was growing up, but then it was basically her friends, my mom's friends' relationships, and then maybe my friends who were my age. And so it was really hard to know what's normal, what's not normal, what's appropriate to expect, what's quote unquote high maintenance. Yeah.

Alyssa (09:00)
Well, what

does even that term mean high maintenance in the way that it's used to decide who's allowed to have wants and desires and who is not?

Arghavan Salles (09:09)
No, that's right. That's right. Because that term is even used to say like, well, you're not allowed to demand respect and kindness from your partner, right? That's what gets labeled as high maintenance in a lot of cases. But now, you know, we have access to so much on the internet. And it's not to say that these conversations can't happen on like Instagram or Facebook or Twitter or whatever, but I just have seen it so much more on TikTok where there's just a lot of honesty coming from

mostly women watching other women's videos saying, hey, you deserve better than this. There was a woman who posted about how her husband needs to be informed, has required that she inform him every time she's taking a shower so that he can join her, I think. And so she makes this video where she intentionally doesn't tell him and she goes into the bathroom and turns on the water and he comes in and he's like, well, are you taking a shower without telling me? And I think she thought it was cute.

you know, cause he like wants to be with her or whatever. And people in the comments are like, this is him trying to control you. This is not romantic. This is not love. This is control. And why the reason I'm bringing all this up is I worry that if this sale goes through and more and more people leave TikTok because they don't feel it's a safe place to share their true stories.

I'm not sure there's a place exactly like it. Like, I don't know, maybe Instagram will become that, but it's such a different place. And then there won't be, I worry that there won't be as much honest sharing. And there was at least one woman I saw who specifically said that after she had posted one video, like one of these, this genre of, here's a thing that happened in my relationship. And then people in the comments told her how messed up it was that she actually did go ahead and get a divorce, eventually.

because she kind of realized that they were right. And so this has been really helpful to a lot of people. And I made a short video about this. And one of the things that came up in the comments multiple times was weaponized incompetence. That was a term that a lot of people didn't even know before they came on to TikTok. Do you want to maybe tell our listeners what that is?

Alyssa (11:17)
Mm-hmm. Mm-hmm.

Yeah, weaponized incompetence is when you purposefully either refuse to learn how to do something so that your partner needs to do it for you, or you just pretend to not know how to do it so that your partner will do it for you. And yeah, I think that a lot of people learned that through social media, that concept.

Arghavan Salles (11:45)
Because there would be all these times when, you know, women would post videos that like, look, I asked my husband to do the dishes and here's how he did them. Or like, I asked him to clean the kitchen and look at how looks now. Or I asked him to do the laundry. Anyway, all these different tasks. And they're making a video being like, see, this is why I have to do it, because he can't even do it. And then the people in the comments are like, he's intentionally not doing it. Like he's capable. Listen, I mean, most of us are capable of wiping a counter.

and not leaving a mess behind. That's not a ⁓ super complex task for people who, for most people I should say. And yet without that mirror coming back at you saying, hey, that's not normal. He can do that. He can go to the groceries and he doesn't have to mess up what he's picking up at the groceries. He's just choosing to do it poorly so that you will continue to do that work.

Alyssa (12:41)
And it works. And generationally, right? Like, I mean, this is part of where I think what you're getting to, we are not currently living in the first generation of men to purposefully do a crappy job at something. And women obviously can do these things too. I don't, you know, I don't want people to be not all men, whatever. ⁓ But yeah, ⁓ this is a common ⁓ trope. And it shows also how

It's so fascinating how little is by default in our society expected of men in the home that this has been effective for so long. And I also think that, know, when we look at some of the data out of, ⁓ in particular, millennial heterosexual couples, that millennial men have above other generations so far,

Arghavan Salles (13:17)
Mm-hmm.

Alyssa (13:36)
been more open saying like, wow, I really need to learn how to do some of these things. ⁓ This is obviously not the people who are showing up in these videos you're ⁓ But I also think this relates to the other issue that I've seen talked about on social media is ⁓ what does it mean to be a performative man, to be a man who externally will purport to

Arghavan Salles (13:56)
Mm-hmm.

Alyssa (14:02)
behave or to understand or to know things that are likely to be important and valuable to the women in their lives. And whether or not that's genuine or whether it's a performance is an interesting concept. And I think that's something also I've seen more talked about recently in social media. don't know. mean, TikTok is just the biggest, it is the biggest platform. It is the one that has the most traffic, it has the most users. And so I think there is a real risk of what you're saying in terms of

Arghavan Salles (14:08)
Mm-hmm.

Mm-hmm.

Alyssa (14:31)
who owns it and how is that portion of the ⁓ platform being controlled gonna influence it? And I think that we have seen this, for example, in the collapse of anybody who's not an Elon Musk fan using Twitter, for example. And so, you I have been really struck by the amount of, I mean,

Arghavan Salles (14:47)
Mm-hmm. Mm-hmm.

Alyssa (14:54)
Maybe grief is too big of a word, but like definitely there's been a loss in terms of med Twitter and that was sort of a, you know, a collection of many physicians and nurses and scientists ⁓ interested in medicine and public health on Twitter. And it was this really fabulous way to learn things. It was a fabulous way to get to know people. I have made so many lovely relationships. You and I met through med Twitter many years ago.

Arghavan Salles (15:19)
Mm-hmm. Mm-hmm.

Alyssa (15:22)
you know, it's been such a loss to not have that. And I, I would say that given the collapse of that and the loss, how it's really not everyone's gone to the same exact platforms afterwards. And like not all of the platforms have the same way to communicate, for example, with like group DMS and things like that. And so there really has been a loss of relationships, a loss of education, a loss of some really helpful things in our professional lives that are

are hard to find in a new place. And so I think that we are still now in this period where people are still going like, we ever gonna be able to create anything like that in a different place? And so far the answer has been no. And so I do think that the concern about losing this particular type of education is a real issue.

Arghavan Salles (16:15)
Yeah, and I think to your point about Twitter, I I think a lot of what you're saying, if I could summarize, is we've lost this community. We had a real community of people who cared about, who care, and we all, most of us still exist, but we're just in different places, but a community people who care about medicine and science and sharing information, accurate information with each other and supporting each other and connecting with each other in real life, wherever possible.

Alyssa (16:22)
Mm.

Arghavan Salles (16:43)
And we've kind of scattered to the four winds because like you said, some people went to LinkedIn, some people went to Instagram, some people went to Blue Sky, some people went to Macedon, some people said, you know what, that's it for me. I'm not gonna do social media as part of my professional role anymore. And who knows? I can't predict what's gonna happen to TikTok, obviously, but there've already been people, because they've made some changes to their terms of service and...

Alyssa (16:50)
Mm-hmm.

Arghavan Salles (17:10)
Many people feel that it's already been a pretty different experience being on the app since that January shutdown, that there are ⁓ people, well, actually, I know people who have stopped posting ⁓ already, and that will probably continue to happen, and there might be more people leaving with whatever sale goes through, depending on who it's sold to and what the terms are. And it's, yeah, it's unfortunate for many, many reasons, but just the one...

that I've been thinking about lately is what happens to all these women who used to be able to get such good feedback from a large number of people, mind you, not just like the couple of friends you have in your life. Because some people might say, well, you can just talk to the people in your life, which is true. And, yes, that too. And like, I mean, I got to say, when you post something and it gets traction and you get a lot, a lot of people's input, it is helpful to see.

Alyssa (17:56)
Depends on who's in your life.

Arghavan Salles (18:09)
I mean, sometimes it's hurtful, but it also is helpful just to see like, how does someone who doesn't know me in my life react to this information? And you can take it or leave it, but at least you're getting that input and deciding what to do with it. So anyway, I hope that whatever happens, whoever it's sold to, it doesn't end up in the kind of mess that I feel Twitter is in now where the communities that used to be able to connect there, many, many of them.

have dissolved, unfortunately.

Alyssa (18:42)
Yeah, absolutely. And it would be such a loss.

Arghavan Salles (18:45)
Yeah.

Alyssa (18:47)
Well, should we talk about hepatitis? Something lighter, fluffier?

Arghavan Salles (18:52)
Yeah, yeah,

I'm always excited to talk about hepatitis. You read my mind.

Alyssa (18:56)
⁓

I knew that you, I knew you would be interested. So for folks who don't know this, I'm an anesthesiologist and in particular I do liver transplant anesthesiology in children. So there are, and one of the most common reactions I get actually from people who are not in medicine is like, children need liver transplants? And the answer is yes. And there are some very specific reasons for that and.

Some of the most common reasons have to do with anatomy and like certain congenital conditions. But the other reason why some kids need a liver transplant or at least liver surgery is the development of hepatocellular carcinoma, which is cancer in the liver. And one of the things that we do to prevent that as well as to prevent a bunch of other problems is hepatitis B vaccination. And so in terms of

recent news where we have had not only RFK going after the hepatitis B vaccine, but Trump saying, can't, the amount of anger that I experienced when he said out loud to the entire country, children should wait until they're 12 years old to get vaccinated against hepatitis B. I'm like, no, no, that is wrong. That is, it is so wrong and it is so dangerous. And I felt it.

in my own liver. My own liver said, how dare you. ⁓

Arghavan Salles (20:28)
And it's important to note why he said that.

So he said, in those comments, he said, hepatitis B is sexually transmitted. And so you don't need to get vaccinated until you're 12.

Alyssa (20:40)
which I feel like he is very confused with certain other diseases.

Arghavan Salles (20:45)
Wait, wait, wait,

wait. Trump is confused. Newsflash. Okay, anyway, sorry, carry on.

Alyssa (20:50)
I mean, this also goes along with the fact that all these anti-vaccine groups that are like going after the HPV vaccine and claiming, which is a different vaccine. Different vaccine, different problem. There are vaccines also for adults to prevent hepatitis B, which is also very important. ⁓ But the reason that we vaccinate children, and there are different countries,

Arghavan Salles (21:02)
Different vaccine, different problem, yes.

Alyssa (21:18)
that for example, like in the United States, the recommendation is to vaccinate children within the first 24 hours of life. And that is to specifically prevent mother to child infection. Not everybody gets screened. We know that people have this condition who do not realize it and it can be passed. The other problem is that because babies have an immature immune system,

We also have a bunch of kids who get it and there's no evidence that they got it from mother to baby transmission. They got it somewhere else because it's just out and about. The hepatitis B is about.

Arghavan Salles (21:52)
Well,

that's right. And the data from before we implemented widespread newborn vaccination for hepatitis B in this country, we were getting about, I believe it was almost 20,000 cases a year of newborns catching hepatitis B or becoming infected with hepatitis B. And of those, only about half of them were getting it from the birthing parent. And so it's not like just a few cases here and there picked up from

other members in their family or visitors or whoever, it was a significant number of people. And I'm mentioning that because one of the kind of talking points that people use to say we shouldn't be giving newborns the hepatitis B vaccine is, well, you can just test every pregnant person and then only vaccinate the ones where the birthing parent is pregnant. And that's what we used to do. That is exactly what we used to do. And it didn't work.

Alyssa (22:45)
And it didn't work.

We did it.

Arghavan Salles (22:49)
way of

managing things was associated with about 20,000 newborns a year getting hepatitis B. And one of the things we know about hepatitis B is that when a baby is infected with it, the risk of developing hepatocelular carcinoma or cirrhosis of the liver is much higher than if an adult is infected with hepatitis B. So that timing of when the infection happens also is really, really important.

which is back to your point about your job as someone who takes care of children who need liver transplants.

Alyssa (23:20)
Yeah, and so getting vaccinated as a child, as a baby, it reduces the risk of developing specifically hepatocelular carcinoma cancer by like 60 to 80%. I mean, it's not a small reduction. And so in terms of risk reduction, and that obviously then also prevents a bunch of other issues related to chronic hepatitis, which is how you develop cancer. And I am somebody who

has taken care of children, taken care of babies and toddlers who have cancer, who were not vaccinated, unfortunately. And it is a very, very scary surgery. It is a, I love the job. I love doing this kind of work. I am a glutton for that kind of work. But I would much prefer that we did not need to treat

liver cancer in babies if it can be prevented. And we know that it can be prevented, not necessarily 100%, but again, reducing that risk so dramatically. so I really worry that in my, what is left of my career, that I'm gonna take care of a lot more kids who develop hepatocellular carcinoma and need to have either major liver surgery or even to have their entire liver removed and replaced with a different liver.

if they're lucky to get it. And that gets into all of the issues around, you know, not everybody who needs an organ transplant gets it. And so, like, I would, I really want to protect these sweet little babies. I don't want them to get this. I want them to be vaccinated.

Arghavan Salles (24:53)
Mm-hmm.

Yeah, and I think, right,

because it's a lot easier. I mean, it's a lot easier to prevent that harm. And for a group of people who are constantly talking about, you know, getting to the root cause of disease to say, no.

Alyssa (25:13)
We know the root

cause, we know what it is.

Arghavan Salles (25:16)
Yes, and we have a way to prevent it. And yet they're the ones arguing that we shouldn't do a very minor thing to try to prevent something that's actually really, really major. think that the percentage reduction in chronic hepatitis B infection is like 95 % when babies are, when newborns are vaccinated. So it's, you know, like we've talked about before, it's one of these things where

Alyssa (25:34)
Mm-hmm. Mm-hmm.

Arghavan Salles (25:45)
I have a hard time as someone who understands science and is able to read the literature, I have a hard time understanding why someone would expose their newborn to the harm that, and by the way, like the children who do go on to develop hepatocellular carcinoma, it's not when they're 90, it's like in their teens and twenties. So you have a very, or earlier, you have a very young person.

Alyssa (26:05)
Mm-mm.

for earlier.

Arghavan Salles (26:13)
who's got cancer because of a preventable transmission that a vaccine, again, not 100 % of the time, but in many, many cases could have prevented, it's a tragedy that anyone is experiencing that kind of preventable outcome because of misinformation. And for the president, for the president who has no medical or scientific training to...

say this has incredible influence. And I don't know, some people might think, but I mean, everybody knows he's not a doctor. How seriously are they gonna take what he has to say? But I've had numerous people in my comments since that day saying, even when they understand that Tylenol doesn't cause autism, they're still saying, but I draw the line at hepatitis B. Babies don't need a vaccine against a sexually transmitted infection. Also, by the way,

to that point, I see the look on your face, but to that point, sexual assault happens.

Alyssa (27:13)
My face hurts.

Arghavan Salles (27:15)
I could tell. But sexual assault happens, unfortunately, in this country to children. So even if that were the only way, and first of all, coming through a birth canal exposes you to the same set of fluids as does sexual intercourse. And this is why we have 10-year-olds who are pregnant in this country, right? Because there is child sexual abuse that happens. And when we don't...

vaccinate a newborn against even that kind of harm as well, then they're also at greater risk. So we can't live, and we would love to, I would love to live in a world where there is no child sexual assault, but we do not live in that world. And pretending we do and then making policies as though that's true is not helping anybody. And in fact, causing, it would cause quite a lot of harm. So it's extraordinarily irresponsible for the president of the United States to tell people to not do something that is in fact evidence-based and people.

Believe him.

Alyssa (28:14)
Yeah, it's interesting because in my ethics work, I have had many conversations with different families who reject not only this vaccine, but other treatments that are recommended for babies when they're born. And it's hard to have these conversations because these are folks who would rather rely on luck and whether or not they necessarily have put that together in that way.

Arghavan Salles (28:36)
Mm-hmm.

Alyssa (28:42)
I try to have curiosity and open up that conversation, but it is really, really hard when our most basic fundamental public health interventions that are effective at reducing serious morbidity and mortality for children are so callously thrown aside by people who do not know what they are talking about and are wrong.

Arghavan Salles (29:09)
and have no humility about whether they may be wrong. Do you know what I mean? Like they don't even have, yeah, they don't even have the insight to think, am I the right person to be commenting on this? Have I read the literature? Do I even know what evidence is out there on this topic? Like those are kind of appropriate texts to make before making a statement, yet those have not prevented these folks from weighing in on things. They really have no,

Alyssa (29:16)
I do.

you

Arghavan Salles (29:38)
business weighing in on.

Alyssa (29:40)
Well, and this is also something that is really challenging is that, you know, I've been in these conversations, for example, with new parents and they will bring up some claim that I have not heard before from a credible source. But then it's basically this assignment for me to go debunk this information that like, don't know where exactly it came from. I don't know why they found it compelling. You know, I try to, again, ask curious questions.

Arghavan Salles (29:55)
Mm-hmm.

Alyssa (30:07)
But this is part of what makes it so difficult for clinicians to chase down misinformation and disinformation because it's so much harder to untangle that than it is to prevent somebody from believing it.

Arghavan Salles (30:12)
Mm-hmm.

Right. And I think, you know, we obviously we train for this, like we go to medical school, we do residency, we do fellowship. So we spend a lot of time familiarizing ourselves with the evidence, with best practices, with standard of care. And it's just such a different world that a lot of other people are coming from. And that's normal. Like, I don't want anyone to think that I or anyone else has some expectation that patients will have read all of these things. I certainly don't.

But the problem comes when people who people look up to, like the head of HHS, Health and Human Services, or the president of the country, when those people are saying things about health, I think those of us, or many of us think that we should be able to trust those kinds of people with the information they're sharing with us. And unfortunately, that's just not the reality we live in anymore. There was a time perhaps when that was true, I don't know.

But it certainly is not our current reality, but it's really hard for people to reconcile that. It's hard to tell people, hey, you shouldn't listen to the president, or hey, you shouldn't listen to the Secretary of Health and Human Services. Hey, you shouldn't listen to the CDC. That's not a world that I am accustomed to or particularly want to be in, but that's where we find ourselves. And I think it's really hard for people who don't have.

scientific or medical literacy to navigate in this period of time.

Alyssa (31:53)
And I don't know how we're gonna fix it. I really don't. mean, I'm like the more, ⁓ I know I wish I did. ⁓

Arghavan Salles (31:58)
Wait, you don't have the answer? To like one of the biggest problems in

our society right now, you don't have the answer? I thought you were just holding it in.

Alyssa (32:12)
⁓ I just have so much...

I have so much sadness for the amount of destruction of public health that we are watching every single day. And it's so hard because like way back in 2019, misinformation and disinformation around health care ⁓ was already such a big issue. And it's it's escalated in such a monumental way that I am having a hard time imagining like, OK, well, how do we turn this around?

Arghavan Salles (32:44)
Mm-hmm. Yeah. Can we control, alt, delete on all of this? ⁓ No, I mean, I think that's a great question. I don't, I mean, I was joking because obviously I don't know the answer either. Nobody does or else we wouldn't be in this situation. every, I go to a lot of, know, because we're both at an academic center. And so I go to a lot of different panels and talks and I'm constantly thinking about, I'm honestly like constantly thinking about how do we bridge

Alyssa (32:44)
Where's the reset button? I don't know. Where is the button?

Mm-mm.

Arghavan Salles (33:12)
all the different gaps that are out there today. you know, national coming out day was not that long ago. And I went to a panel on LGBTQ health in the current legal landscape that's impacting in particular gender affirming care. And it comes up in that context as well. It comes up when we're talking about vaccines. It comes up when we talk about preventative care. I mean, it comes up in so many contexts where there are people...

saying things that are really not connected to reality. They're not grounded in data or evidence, but they say it confidently and they say it loudly. And so there are a lot of people who believe them. And those views also, I mean, I know I say this all the time, it's probably boring, but those get pushed. Those are the views that get pushed by all our algorithms and our algorithms are forming our opinions for many people. That's what's happening. And until

Alyssa (34:07)
Mm-hmm.

Arghavan Salles (34:08)
And less than until that changes, I genuinely don't know how we rein it back in. And so a lot of what I'm thinking about when I go to these panels, I talk to people, I ask, what do you think we should be doing? What is the communication strategy that you think for this specific problem that you are an expert on? Like how would you approach someone who is so misguided about it that they think, for example, that we shouldn't provide gender affirming care to anyone, right? What's your approach?

to What's your approach to someone who doesn't believe any vaccines are useful because they're all part of some government or other plot, you know, conspiracy, you know, like, and I ask people and I have to tell you nobody knows, but I try to take some pearls from here and there little bits and pieces to see what can we do differently because I think you and I both feel this is a really urgent problem.

Alyssa (35:00)
Yeah, and you know, in the, again, in the conversations I have with, with families that are struggling with like, some people are very, very certain, regardless, and there's no, there's no convincing, there's no, no curiosity about alternative viewpoints. And I understand how folks get there. It takes so much energy and self control to be able to sit in that discomfort with a family. And I know that

know, pediatricians have been trying to do this for a long time. ⁓ They don't have the answers either. I had a lovely conversation. I was at ⁓ the American Academy of Pediatrics meeting last month, and I had a lovely conversation with a pediatrician I was sitting next to at one of the sessions. And I said, know, how are you, how are you, what are you noticing? What are things happening? And she was saying she was seeing a lot more vaccine hesitancy, a lot more.

And I said, you know, how are you, how are you dealing with that? And she was like, you know, I'm just trying to take it slow, trying to sit with these families and hear them out and trying to provide support and taking that time and investing that time with these families to build a relationship. you know, truly, mean, pediatricians are out there doing, doing this work and family medicine doctors in a way that

Arghavan Salles (36:16)
Mm-hmm.

Alyssa (36:26)
for folks, I mean, obviously there's all these wild messages about how like pediatricians are becoming so rich off of these vaccines, which is the most absurd thing ever. They're like the worst paid specialty in all of medicine because we don't care about kids in this country. ⁓ We like to say we do, but I don't know. There's a lot of decisions that do not reflect that. And it's... ⁓

Arghavan Salles (36:33)
You

Mm-hmm. Mm-hmm.

Mm-hmm.

Alyssa (36:50)
they're really trying to navigate this and it is the amount of labor that clinicians who are working in this space on everyday basis, you I only see these when it's like, it becomes an ethics consult because there's some other unusual issue. And so I'm seeing such a small fraction, but you know, people who are having these conversations and you know, internal medicine clinicians having these conversations about adult vaccinations and other things that are really

Arghavan Salles (37:04)
Mm-hmm.

Alyssa (37:20)
valuable for preventing the root causes of diseases. There's so much labor. And I wish that there was some magic solution that would make it so it wasn't so hard, but I agree that the way we think about these things is constantly being groomed by the media that makes it to our eyeballs and the things that are made in the way that captures our attention.

Arghavan Salles (37:21)
You

Mm-hmm.

Alyssa (37:45)
And I don't know, those of us in science communication, have yet to figure out like some magic solution to make these messages more compelling.

Arghavan Salles (37:51)
Mm-hmm. I'm gonna keep asking.

Yes, I'm gonna keep asking, because I feel like maybe at some point I'll come across somebody who's got the magic ticket. I mean, you know, we can do... Oh, hmm. Hmm. Well, I will buy you a very nice gift if that happens. But I think...

Alyssa (38:05)
Maybe Larry Ellison's gonna fix that.

Right,

you do not need to save your money.

Arghavan Salles (38:20)
⁓ Yeah, I think you're right. But I think the best we can do is to keep trying. And there are people who are every day trying to counter misinformation and disinformation specifically related to healthcare. And I think it helps. I do, I do think it helps. And it's probably not quite enough, but.

What are we going to do? Just throw our hands up and say, forget it? No, ⁓ clearly not. We're going to keep fighting and we're going to keep trying to make sure that patients have access to correct, accurate information so that they can make the right decisions for themselves without being influenced by people who are largely trying to make money off of their insecurity and fear. And by those people, just to be clear, I'm not talking about physicians, I'm talking about the grifters who try to sell supplements and such that have no evidence supporting their use.

Alyssa (38:45)
No.

Arghavan Salles (39:11)
⁓ but yeah.

Alyssa (39:13)
You know, this makes me think, have you used, I know that you're not into AI, but like I have to know a lot about AI because of AI ethics and I have to deal with it. ⁓ I have been really struck by a couple of things. So one, we have this huge issue with the information that is most easy for the public to access is limited and it's limited. We've talked before about,

the way academic publishing works and how a lot of the top quality work is behind a paywall.

Arghavan Salles (39:43)
Mm-hmm.

Alyssa (39:48)
Well, so people are now going to things like chat GPT and they're going to Claude and they're going to these other AI algorithms to say, hey, I'm going to ask medical questions. But those do not have access, those algorithms do not have access to materials that include that high quality information or ability to analyze multiple studies and all these things if they are behind a paywall. So there's these new services like

Open evidence, for example, is one of them. And they have a contractual arrangement with ⁓ journals like the New England Journal, like JAMA, the Journal of the American Medical Association, in order to have access to proper citations, to properly assess this data. But you can't just get it as a member of the public. It's designed for clinicians and scientists. And then somebody else was telling me the other day, a colleague of mine,

Arghavan Salles (40:37)
Mm-hmm.

Alyssa (40:45)
who's on TikTok was talking about how she had tried Doximity now has its own GPT. I forget what it's called. I don't know, DocsGPT or something like that. But again, this is not an app that is open to the public. This is an internal, it's just more gatekeeping of the same information. And so I just, it's so frustrating to me. And obviously I have many, many concerns, humanitarian.

Arghavan Salles (41:03)
Mmm. Mmm.

Alyssa (41:13)
ecologically, et cetera, about AI, but then to see it being made and to simply continue to make the same information only be available to the same people is a huge misstep.

Arghavan Salles (41:29)
⁓ Yeah, mean, think, yeah, one of these, should talk about academic publishing ⁓ as its own topic, but I certainly agree with concerns about the gatekeeping. ⁓ And I mean, I think we have a documented literacy crisis in this country. And I don't know, you know, I think people should have more access to information certainly than we have.

And I'm not convinced that having access to Nature, JAMA, New England Journal, The Lancet would solve these problems because this work is kind of hard to read, to be honest, if you don't have training. Like if you're gonna go read an article, even I'll just, I'm happy to admit there are statistical methods that I read in some of these papers where I'm like, I've never heard of that kind of analysis.

I don't know what that means. So I actually don't know if it's appropriate or inappropriate that they analyze it in this way, because I'm not a statistician, right? That's not my expertise. We learn certain things like I learned certain things in grad school. We learned certain things in medical school, but that doesn't mean I know like all that there is about statistics. So anyway, I think it would be helpful though. I don't disagree. It would be helpful to have summaries of that are a little bit more accessible of certain, especially like

key papers that have really influenced medical decision making. I think that would be a really helpful tool. ⁓ But who's going to push these publishers? mean, again, that's a whole separate topic because they're making so much money, so much money off of our labor as academicians, as scientists who write these papers, who put all our time and energy into doing the work. And then they charge however much they want to charge per article or per subscription. And

That's a whole, whole different ball wax.

Alyssa (43:25)
Well, and I have an essay that was recently accepted. And to get it to be open access, it's going to cost like over $3,000. $3,000 if you want like. No.

Arghavan Salles (43:32)
Mm-hmm. Mm-hmm. Yeah, but do you know how much it is for Nature? It's like 12 or 13,000.

Yes. Yes. I mean, I've never published there, but this is what I see online is people sharing that it's... Someone, listener, correct me if I'm wrong, but I've seen people posting that they just paid over $10,000 to publish their article in Nature as open access.

Alyssa (43:44)
That's gross.

can you afford that in this economy?

Arghavan Salles (44:02)
in this economy. I mean, that's what the grants, by the way, people who want to complain about federal grants, that's part of what they're paying for, is to pay these journals. So you want to change the journal policies that would bring those costs down.

Alyssa (44:15)
Well, and I mean, also the biggest fanciest journals are making a lot of money, but there's a lot of like smaller journals. They're barely, they're barely breaking even. it's also like, anyway, we should talk more about academic publishing and what a hot mess it is. You heard it here first folks, academic, academic publishing. is a dumpster fire. You did not hear it here first. This is known amongst our people, but we're glad to share it with you.

Arghavan Salles (44:30)
What?

Yeah, you heard it here again.

Alyssa (44:47)
my goodness. Well, listen, I think these were good topics this week.

Arghavan Salles (44:53)
We did pick them. I hope they were good.

Alyssa (44:56)
⁓ Yeah.

so, so Argevan, I am curious because, you know, we are living to a degree in a joyless cesspool. So what is giving you joy this week?

Arghavan Salles (45:08)
Okay, here's what I'm gonna say. I've been really enjoying all the people wearing various animal costumes and going to like ICE detention centers and like walking up directly to a line of armed masked people and being like, here I am in my frog costume, come and get me. Or I'm a unicorn, how do you feel about that? I'm a dinosaur, you know? And they're doing in some places coordinated dances and so on. And I love it.

so much because they are really doing a great job of showing the absurdity of our government turning on its own citizens and the people who live here and they're giving them these protesters are giving them the levity or the gravity i should say that they deserve which is none

Alyssa (45:57)
You're going to have to send me at least one of those videos so I can look at it.

Arghavan Salles (46:01)
Wait, have you not seen these?

Alyssa (46:02)
No.

Arghavan Salles (46:03)
Oh my God, yes, that's my, I apologize. I am derelict in my duty as your friend. I will be sending you several post-haste. Fear not. And so what's, so, oh yeah, yeah, we absolutely should do that. What has been bringing you joy?

Alyssa (46:13)
Excellent. Excellent. shall include them in the show notes.

Well, by the time this episode comes out, I will be at the American Society for Bioethics and Humanities National Meeting. So I have been preparing for a bunch of things. And so I am currently getting joy out of the sheer anticipation of seeing a bunch of my friends, seeing a bunch of people that I love getting to work with. I've got some panels coming up with some just fabulous, fabulous people that I cannot wait to see in person.

Arghavan Salles (46:39)
Hmm.

Alyssa (46:49)
And it's gonna be great, and it's gonna be in Portland. Who doesn't love going to Portland?

Arghavan Salles (46:52)
Well, you can go see that's where the protest originated in Portland, so you could just go say hi in person.

Alyssa (47:01)
I'll keep my eyes out.

Arghavan Salles (47:02)
As well you should. That's it for this week's episode. If you didn't like what you heard, this has been the House of Pod. If you liked it, don't forget to subscribe to The Present Illness. Leave us a review and tell your friends or anyone else in your life if you can. We'd really appreciate it.

Alyssa (47:17)
You can follow us on all the places we have a TikTok and an Instagram. It is @ThePresentIllness and you can stay on top of all of our TPI related news.

Arghavan Salles (47:27)
We'll be back next week with more headlines, hot takes, and doom scrolling wrapped in hopefully some laughs.

Alyssa (47:31)
Until then, agitate, hydrate, take a nap, and I'll see you next time at The Present Illness. But remember, folks, do not take advice from random people on the internet. This show is for informational purposes. It is meant to be fun, and it is absolutely not medical advice. So make sure you take your medical questions to a qualified professional.