Vaccine Misinformation From the Perspective of a Family Medicine Physician

SUMMARY KEYWORDS

people, patients, vaccine, mask, misinformation, cdc, folks, pandemic, vaccinated, talk, data, information, wearing, question, risk, trust, point, doctors, anti, medicine

SPEAKERS

Shawn Walker, Michael Simeone, Margarette Shegog

Michael Simeone  00:00
This is Misinfo Weekly, a somewhat weekly program about misinformation in our time. Misinfo Weekly is made by the Unit for Data Science and Analytics at Arizona State University Library.

Shawn Walker  00:11
Today is March 19, 2021. And this is another episode in our series on COVID-19 vaccination misinformation. Today we have a special guest, Dr. Margarette Shegog. She's a family medicine physician. She also provides psychiatric services to her patients. She practices in Northern California and worked with underserved populations. Hi, Dr. Shegog, thanks for joining us. 

Margarette Shegog  00:33
Thanks for having me. I'm glad to be here. 

Shawn Walker  00:35
So let's start out a little bit with COVID. What kind of interactions do you have with your patients around COVID-19?

Margarette Shegog  00:41
So I have a multitude of different interactions. So I'm a full scale family medicine doctor. So that means I do OB care as well as hospital care as well as clinic care. In the hospital, I am not usually on the COVID wards. Thankfully. Some of our older single people who do not have kids have thankfully taken on that responsibility. So mostly in the ward, I'm just making sure my patients don't have COVID, double checking. And definitely making sure that they don't come up with symptoms while they're there. In the clinic is a different situation. There's a lot of screening, there's a lot of testing, there's a lot of communication. One great thing about this whole pandemic is that everyone's using telemedicine now. So I can definitely have telemedicine visits with my patients who have COVID concerning symptoms, and walk them through...Should we get tested? Should we not get tested? And then once they are tested, I can actually still follow up and visit with them and see how are they doing, and if we feel like they need to escalate care and go to hospitalization. Fortunately, I have not had a ton of COVID positive patients who have needed to be escalated to go to hospitalization. But I've definitely had some who we had to intervene and say you can't stay home.

Michael Simeone  01:58
So it sounds like a lot of the work that you do is oriented towards thinking through patient risks, is possibly one way of putting it. It sounds like a lot of your conversations are about screening or prevention.

Margarette Shegog  02:12
So there's screening, there's prevention, there's treatment, and then being the family medicine doc there is the other level, which is just information providing. "Hey, Doc, should I go travel out of the county and go see my cousin? Oh, if my kid goes back to school, how's this change their risk level?" So there's a lot of discussion on informing folks and talking through their specific risks.

Michael Simeone  02:41
Do you often speak with patients as an advisor just like this? Do they have more questions as it pertains to COVID as compared to previous years about other kinds of
sicknesses as an information source? What is that like?

Margarette Shegog  02:56
It is crazy, probably starting last January of 202,0 is when almost every visit had a COVID question in it. And it has not stopped. Whether it's to "When do you think this is going to be over?" to "When do you think I can get the vaccine?" to "Do I have to take that vaccine? I don't trust that Trump vaccine." Every single visit has some type of COVID related question, which is definitely different than the other thing I think about we always compare it to like the flu. Very rarely do I get questions about the flu during flu season. Usually just, "Flu vaccine? Yes, no." Once we get past that question, it doesn't come up again. Versus I saw a patient two weeks ago, they asked me questions about COVID. This week, they asked me a question about COVID. And I'm sure when I see them in two more weeks, they're gonna still ask me a question about COVID.

Shawn Walker  03:47
So thinking about expertise as patients see you as an expert for medical information, I would assume.

Margarette Shegog  03:52
I hope so.

Shawn Walker  03:52
How do you help patients navigate the myriad of experts that they see on TV because they might see emergency doctor on say, Fox News versus primary care physician on CNN versus radiologist at a press conference? So how do you help patients think through this idea of expertise, especially in context of your close relationship with your patients?

Margarette Shegog  04:15
So that is something that comes up regardless of COVID. I've had to take consults from Dr. Google frequently. 

Shawn Walker  04:22
Not Dr. Bing?

Margarette Shegog  04:23
Not Dr. Bang, Dr. Google and Mr. Webb MD both give me frequent consults. And then there's always my cousin aunt's, you know, sister and let's not forget Dr. Oz. Ugh. The first thing I always start with is: What are the credentials of the person talking to you? Is this actually an infectious disease physician? Who are they? What is the source of the information?

Michael Simeone  04:49
This is your coaching to your patients?

Margarette Shegog  04:51
This is my coaching to my patients. 

Michael Simeone  04:52
Okay. 

Margarette Shegog  04:53
So, if it is coming from your cousin's, aunt's obstetrician, then I'm not going to trust that quite the same amount as, say, like a Dr. Fauci. Like, those are just two different levels. Similarly, I'm not going to trust the emergency room doctor, because their focus is very narrow. Their focus is: Are you dying? Do you need to be admitted? Or can I send you home? And what is your risk to other people in my ER? So they have a very narrow focus and very narrow job. I'm not going to take their information, the same as I'm going to take the person who is dealing with people on the Intensive Care Unit. So differing sources. So that's the first thing I asked them. The second thing I tell them about is, how informed are your doctors? And this sounds terrible, we all have continuing medical education that we have to do to stay up to date. Some information, and as you get to be an older doc, it's very easy to rely on your old information, rather than taking in that new information. One thing I talked to folks a lot with, and this is a whole nother series that you could talk about the opioid crisis, where people will say, "But my doctor gave me these meds for years, like, why are you telling me now it's bad?" And it's we have new data, we have new information, we didn't have it back then. So with someone is saying, "Oh, we can't trust this vaccine, because we don't know anything about it." I'm like, "but we do now." We have six months data now. We have so much more than we had when this first came up. And we were talking about it in November. Look at the timing and looking at the source of information is the other thing I talked to my patients about. So I would say those, when I'm coaching my patients on what medical information to trust, look at the source, and then look at the timing of the knowledge.

Michael Simeone  06:53
And do you find that in taking that kind of information on balance, because if I'm hearing you It sounds like something like a pandemic where the situation evolves very rapidly, then that kind of dynamic up to date, quality of a physician is especially valuable, and might not be immediately apparent to folks who are just talking to doctors, which doctors are really plugged in and which ones are not. Dealing with a dynamic information situation is just as tough no matter what. Yeah, no, it's the popular read on a lot of this as well, science and medicine are contradicting themselves, therefore, I don't have to trust them anymore. Do you get a lot of that? Or is that just stuff that Shawn and I see a lot of that makes it to Twitter, and other kinds of media outlets. And you never actually see that on the ground.

Margarette Shegog  07:37
So I will say that it's a constant thing in medicine, where they'll be like, "Oh, but things are contradicting themselves." And the thing I relate this most to is obstetrics. Because you want to talk about a dynamic situation that changes rapidly? We can have a lovely delivery where everything is going and fast and things are going great. And then all of a sudden something happens. Medicine always changes. And I think that's one of the things that in lay people they have a hard time understanding the fact that medicine and science changes. Always. 

Michael Simeone  08:14
That means it's working.

Margarette Shegog  08:15
Right! What used to be true may not be true. There are some things that tend to be true. If you had low thyroid, and we didn't take any kind of thyroid supplement, you're gonna still have low thyroid. That's always true. But new things like "Oh, hey, did you know how much your microbiome affects your diabetes?" These are new things that we're coming up with, new ways that we are realizing that medicine is changing. So getting that across to my patients is just a constant struggle.

Shawn Walker  08:47
So going back to expertise for just a second, we're all doctors here, right? Except Michael and I aren't those kinds of doctors. 

Margarette Shegog  08:53
Yes. 

Shawn Walker  08:54
So going back to this idea of expertise, I would argue that some lay folks might not have even known that there were infectious disease doctors before the pandemic, or might not have been aware of virologists or a range of specialties. So how are people supposed to navigate the specialties that they didn't even know exist? They're like, just like a medical doctor is a medical doctor is a medical doctor, right?

Margarette Shegog  09:18
And you're right, that's just hard. And that's when you really want people to be talking to their primary care doctor and touching base with them. Now, if your primary care doctor A) you don't have a great relationship with them, because that happens a lot, or B) they don't seem to know what's going on. I and people may come down on me for this, especially some of my colleagues. I think it's okay to push us. It's okay to be like, "Hey, if you don't have the information, if you don't have the data, please get it." I've used PubMed so many times in the patient room. I can't even tell you. If I don't have it I look it up and I, and that's a part of the continuing education process of medicine. So if you're a patient and you're asking your doc a question, and they don't seem to be informed, then it's okay to say, "Hey, Doc, I really need to have this information and you have more resources than me. So can you please get some information? And we'll talk about this."

Shawn Walker  10:21
That brings a really interesting topic. PubMed, for those that don't know, is a database of medical research articles that have been peer reviewed. 

Margarette Shegog  10:28
Yes. 

Shawn Walker  10:29
In the news, we've seen a lot of research articles referenced, do patients bring that into the room? Because we know some research articles are preprints, meaning they're preliminary and they haven't been reviewed? There could be some problems, they could fly through review, who knows? But do patients bring this into the room with you, but like "this paper says this, so you're wrong," right?

Margarette Shegog  10:50
It's pretty rare that folks are actually bringing in the papers and data. What does happen more commonly, is that people will say, "Hey, I saw this commercial," or "I saw this advertisement about this medication," or, "Hey, I did this quiz online. And it said, I might have ADD. Can we talk about it?"

Michael Simeone  11:11
With something like COVID, do you have people rip stuff from the headlines and say stuff like "I heard that it can spread now." Or "I heard it doesn't spread now." Do they bring in information from secondhand sources rather than primary sources? 

Margarette Shegog  11:24
Always. And a lot of it is the "Hey, they keep saying we're going to have a vaccine. Why don't we have it yet?" "Hey, they said that everything should be open now. Why isn't it open now?" "Hey, I heard that if you're only wearing a mask, you're only protecting other people. I'm not actually protecting myself. So why should I do that?" I hear more of the talking points. 

Michael Simeone  11:42
Got it.

Margarette Shegog  11:43
...than the actual articles. And the nice thing about those talking points is that we've all heard them and we've all seen them. So it's very easy to have your prepared answer to come back at. So that's common.

Michael Simeone  11:57
So that's for questioning, we're now at the point where we can start having conversations about vaccinations. 

Margarette Shegog  12:03
Mm hmm. 

Michael Simeone  12:04
How is that going over right now, now that vaccinations are becoming more and more accessible for COVID-19?

Margarette Shegog  12:12
So I would say with my most of my primary care patients, the heavy conversations actually happened around November, a lot of the folks were like, "I don't trust this vaccine, this got pushed through way too fast, I don't trust it." And I was like, "You know what, I'm gonna be honest. I like data and evidence, we only have three months of data, we don't know what's gonna do after three months." And so a lot of what I talked with, with my patients at that point is, "Hey, they're doing health care workers first. By the time we get to you, we're going to have more information, we're going to have more data." Now, on the flip side, there are the people who are like, "I don't trust this, this came out too soon." And most of those are, I'll be honest folks of color. And I get it, I'm Black, I have had in my family members have had very varying non positive relationships with healthcare today. Now, in this day and age, not to mention, like all the history of Black people in America and healthcare, which was really never created for us. So when it comes to those types of conversations, I'm gonna give two different kinds of examples. One is it depends on who the listener is. So in my family, we are all super educated. So we can talk about data and hard facts. And similarly for my patients who are college professors, and folks like that, we can talk about data and evidence. And we can say, "Okay, look, there's been data on mRNA vaccines, they've actually been working on this for the last 10 years. So even though this is the first one, this has been a technology that's been in the works for a long time, and actually looks because we're actually using your own body to make it, there are lower chances of negative outcomes and allergic reactions and things like that." And then also, just looking at the simple fact of what's the risk of actually getting COVID-19 versus the risk of this vaccine. With my super highly educated folks, we can walk down that path. Now with my folks who are not super educated, or for some reason, they don't want to hear it, the conversation goes to a different place. I really like about barriers, what is your barrier? Why is this so negative to you? And if the barrier is just, "I don't like vaccines, I don't trust vaccines," then, you know, then we just have to talk about why they don't trust or like vaccines from that larger standpoint.

Michael Simeone  14:55
When you hear people say that they don't trust vaccines, what are some of the reasons?

Margarette Shegog  14:59
Oh my goodness, every day. I love Oprah. I love Lady Oprah. She is Our Lady of the O, but I will also curse her name every day for giving freaking Jenny McCarthy a platform to start this whole anti-vaxxer ridiculousness. So people talk about, "Oh, there's mercury in it. There's heavy metals in it. We're giving them so many vaccines. Why do we need so many vaccines? Isn't just getting the disease giving your body his own natural immunity better? Isn't that a healthier way to do it? It's more natural, the preservatives in the vaccines, those are such a problem and they're going to interact with my body, I'm going to get the disease if I get the vaccine." All of the things that we've heard a million.

Shawn Walker  15:48
Have any patients come to you with QAnon Plandemic style concerns, like, for example, Bill Gates is putting microchips in the virus or do they cite Plandemic and saying that it should be natural, we need to put our toes in the sand and go by the ocean, and that will naturally heal our bodies. And by putting on a mask and using a vaccine or taking a vaccine, it actually decreases our immunity. Do you ever hear any of that? Or is that just something we see in social media?

Margarette Shegog  16:17
So I get a little bit of that, not a ton. The majority of folks know that is ridiculous. But there are some who are like, "doesn't it make my immunity weaker to take a vaccine?" I hear that pretty commonly. And so that's just means doctor needs to teach. So it just goes back to that understanding of while you might feel like, "Oh, I got the flu vaccine, and then I got a cold and I got the flu." It just goes to the education point of that's actually your immunity ramping up. And increasing and fighting it’s not actually a sign of you being actively ill.

Shawn Walker  16:58
So for these patients, what is your relationship look like? Are you describing patients that you've had a long history with?

Margarette Shegog  17:04
So I've actually getting a lot of new patients recently. So it's a mixture of both. And I cross cover for my other colleagues' patients as well. So it's always a mixture of folks who I've seen and had long conversations with, that's why I can tell you like, oh, we had a conversation in November about the COVID vaccine. And then we talked in January about the COVID vaccine. And then now that it's March, my patients like, "Okay, I'm ready to take that vaccine." Versus I've had folks who I'm seeing them and one of my colleagues never met them before. But they're like, "Oh, hey, Doc, I heard that what we really need to do is actually just go get the virus, and then this will be over." And I can say, "Yes, that is true. We can all get the virus and then it will be over. But how much loss of life are you willing to tolerate to do that?"

Michael Simeone  17:59
When it comes to thinking through some of these notions and conceptions, so in your accounts of your conversations with your patients, it sounds like there's lots of information knocking around in all kinds of places. Shawn and I encounter a lot of things that are on the extreme position, like finding a microchip in your arm or something like that. And I tried to make a viral TikTok video where I took my band aid off and there was a SIM card underneath it. But Sean wouldn't let me post it.

Shawn Walker  18:22
No, not gonna happen. Nope.

Michael Simeone  18:24
So it sounds though, that there's still some unreliable information, making it to people and influencing them enough to be not anti -vax, but vaccine hesitant. 

Margarette Shegog  18:34
Absolutely. 

Michael Simeone  18:35
These ideas about a being not natural, these ideas being that it's not trustworthy, it didn't go through the steps. You mentioned Oprah, what do you think are the primary channels where people tend to pick up information like this, that you wish that they would reform after this. In terms of negative influences that, that you regret a little bit? What are those look like?

Margarette Shegog  18:54
So I regret Fox News every day of my life, that it exists in any way shape or form. And the funny thing about it is because of that, it just seeps into everything. Once they say it, then someone else has to go and talk about it, and then someone else's posts about it. And so it just becomes ubiquitous. So that I think is one huge negative influence. When 45 was talking. That was huge, because again, as the President, he got aired on all of the things. So that got around everywhere. So lots of talk from that. It's actually amazing, since he has no longer has the same platform that he had, how much fewer of his talking points I'm hearing from my patients, and not just from Fox News as from him being like, in the ether. So.

Michael Simeone  19:50
Yeah, we've observed almost a call and response between more mainstream outlets for information and some of the fringe corners of the internet. And they bounce back to one another, but then you can really trip that circuit by removing a key entity. And you know, when it comes to positive influences on it, you had mentioned Dr. Google being one of those things that feels like a mixed bag, but what are some positive influences on people being informed are good sources of information that you've observed people taking up.

Margarette Shegog  20:22
So one that I have been amazed at, Fauci as calm and as glasses-wearing as he is, he's been amazing at getting his face and his name out there. Trevor Noah with the Daily Show has been doing some amazing work literally on a daily basis, talking about COVID-19 getting the data and the facts out there in a humorous way that people can accept. One that really surprised me, the Try Guys on YouTube, they like have an interview with Fauci, they've had so many positive, like repeated, talking about COVID and social distancing and the importance of doing so. And as being really great examples. And I have to say, on our social media, like YouTube, a lot of YouTubers have been really making a point to say, "this video was done with everyone vaccinated" looking at recent concerts and things like that. And performances, were the Tiny Desk concerts that people are doing at their homes, where everyone is six feet away wearing masks. Those images, I feel are just lovely, strong, reinforcers of this isn't just you in your daily life, going to your grocery store or going to your Petco. This is stuff that Dua Lipa is doing with her dancers on the stage where they're all dancing six feet apart, and the dancers have matching rhinestone masks. Like, it's been impressive.

Michael Simeone  21:52
I asked this question out of ignorance and curiosity, not rhetorically to say that we're in a distinct moment in history. It sounds like we have public health celebrities. Like some people are public health officials who are celebrities. 

Margarette Shegog  22:06
Yeah. 

Michael Simeone  22:06
And some celebrities who are becoming kind of de facto mouthpieces for reliable public health information. I'm trying to think of the last time those things happened.

Margarette Shegog  22:19
I don't know if they have happened. I'm gonna be honest, I don't know if that has happened before.

Michael Simeone  22:26
If our podcast had a research staff, they would be googling that right now. Yeah, some snappy answers and conclusions. But because we don't we can just leave it as an interesting question. 

Shawn Walker  22:35
Public Health is becoming sexy in a way. Is that fair enough to say?

Margarette Shegog  22:39
It's becoming way sexier. And I think part of it is because of the pandemic. So if we think about times before when public health has been successful, like when the swine flu came out, that was the last time that there was a big, major new virus that was sweeping, the swine flu actually got really under wraps, and it was really taken care of relatively safely. And remember, what happened is everyone's like, "Oh, this was so overblown. I don't know why they kept making me like, take my temperature before I went to the hospital, and I had to go get my swine flu vaccine. Ugh. It got so overblown." And the reason why was because it was controlled. So public health only gets sexy when we're actually in distress. When public health is working, and people are all safe, it's no longer sexy. It's like infrastructure. Everyone's all excited about infrastructure when, you know, you're in Texas, and you're freezing. But when you're like, "Hey, let's winterize the lines." Everyone's, "Ugh, why? it's summer."

Michael Simeone  23:43
Yeah, I got the swine flu. And at the time, it felt like being part of another world, to walk into the clinic, be triaged for swine flu, have somebody put a mask on your face and make you go stand in a very special part of the clinic. Be seen by physicians that were only seeing patients just like you, and then to be ordered to quarantine in your home for a certain period of time completely alone. That felt like a complete overreach and completely unnecessary, because I had no idea what was going on. And I knew nothing, but to your point, it felt almost comical.

Margarette Shegog  24:20
Yeah.

Michael Simeone  24:20
But in retrospect, I was grateful for it. And nowadays, instead of feeling like, Oh, this is completely out of hand, now we're begging people to do this kind of masking and quarantining rather than feeling like it's some kind of overreach.

Margarette Shegog  24:34
Like I will say, there are a few good things that came out of this pandemic. One of them is telemedicine and Zoom meetings, because now everyone can meet and we can meet safely and more conveniently. I would say the second thing is people recognize when you're sick, you just stay home, you know, that it's okay to wear a mask. And these are things that, we in the health field will often do if you are wearing a mask around the clinic. And people will be like, "Oh, what's going on? Oh, you have a cold?" Like there was definitely a stigma around wearing masks previously, where now it's recognized as yes, this is a safety measure. This is a reasonable and appropriate thing to do. Just like staying home when you're sick. And I'm glad that everyone has finally learned to wash their hands.

Shawn Walker  25:24
The masks have become a fashion item. You mentioned rhinestone masks, Louis Vuitton's making masks. So it's not just a paper mask anymore. They, again, it's become sexy to wear a mask.

Margarette Shegog  25:34
Yes, and we definitely have like my family, we all have these lovely rainbow masks that coordinate. My husband has, like, rainbow suspenders that he wears with his rainbow mask. Like it is definitely a another moment of expression. Although I do know everyone who wears lipstick is very sad. 

Michael Simeone  25:50
The mask thing is really interesting, because the different focal points around which people have to make decisions based on information that come from heterogeneous sources, with a pandemic is really interesting. Because masks became for all kinds of reasons, a focal point, they became this contested object where not only is it "will they work or will they won't?", but they're a prelude to the vaccine conversation, is that we're also hung up on, what kind of mask? What are its qualities? How do we know it's a good one? So then on the in a bad scenario, you've got someone holding their t-shirt over their nose, thinking that it's fine. And then on the extreme side, we've got people wearing respirators that don't protect the people around them. It feels like there are so many decisions that anybody has to make on a given day of their life anymore because of the pandemic conditions. What are often some deciding factors for them? We think about trying to convince somebody to do one thing or another. What are the appeals that work are people like ultimately, when you talk to them, are they just at bottom, like very rational, and they accept these appeals to reason? And the viewers can't see you laughing right now. What works in helping people sort out all of these daily, exhausting decisions that involve a lot of different information where the objects that the decisions are based around are really contested?

Margarette Shegog  27:08
So to the mask point, and I'll talk about the masks specifically. And then just like all these little pieces in general. To the mask point, I would say the most interesting thing is the part that I have very little empathy for, is the like "oh, but it feels like I can't breathe" this that and the other. And I'm like, I've been in surgeries, y'all, you know that in surgeries, we wear masks for hours. Hours. I've worn masks for days. And I think bringing it to the concept of, "Hey, if you're at home, if you're outside, and you're not with other people in your six feet, it's okay not to wear a mask. But if you are going to be in close contact, if you're gonna be inside, you can wear a mask for a half an hour at the grocery store. You can wear a mask for 15 minutes while you're doing this errand. You don't have to worry about wearing a mask for 12 hours while you're in the OR, in gowns and sweating. And you can't touch your face." So there's that part. And then to the types of masks again, I talk to each patient about what their specific risk factors are. So if this is a patient who is a teacher, and they are now going back to school with children, and the teacher is vaccinated, but these children are not. Or, let's go back to November, because some schools are trying to open up in November, and they were seeing kids in the classroom are doing this kind of weird double thing. And teachers were not vaccinated and kids were not vaccinated, then I would talk to them about having a medical grade filtering mask. Does it need to be an N95? Does it need to be that kind of high level? Not necessarily. But you want something that's going to be more than a t-shirt. So there's that level. I talk to each patient about their individual risk. Now, if this is a, you know, 55-year-old person who's working from home, and they're just going to the grocery store and coming back, then you want a good mask that you can't see through. If you hold up to the light, you can see through it. It's not great, hold up the light, you can't see through it? Probably good to go.

Michael Simeone  29:26
That's fascinating. And people respond well to that approach?

Margarette Shegog  29:30
Yeah, medicine is all about that individual patient. So the more specific you can get about their risks, the easier it is for them to say, "Okay, this is what works for me." Now that may not work for my cousin, my nephew, those other folks. And I tell them, "You can't necessarily apply this to every person in your circle. But for you, this is what we can do for you and your situation."

Shawn Walker  29:57
So often we talk about misinformation as taking advantage of different kinds of vulnerabilities or openings, and one major opening is this uncertainty. And in hearing how you talk to patients on an individual level and help them think through and assess their risk, and then decide what types of protection they need, you're helping them to decrease their level of uncertainty. But what would you say potentially, for people who don't have someone like you in their lives?

Margarette Shegog  30:26
So if you don't have someone to talk through the risks with and you're trying to decide, okay, what masks should I get? There is a pretty good public health information giver out there, called the CDC. And they gave us all recommendations that are good for the general person. And not everyone has experiences where I have where like, I went to Emory. So the CDC was on my campus, so I could go there and see it and have the understanding of what the CDC is, for most folks it is just letters.

Michael Simeone  31:02
It's a place in The Walking Dead. I know that.

Margarette Shegog  31:04
Oh, yes, it is a place in The Walking-- 

Shawn Walker  31:05
That blew up. 

Michael Simeone  31:07
Yeah, they blew it up.

Shawn Walker  31:08
Kaboom. 

Michael Simeone  31:08
Yeah. That's the extent of my in person experience with the CDC.

Margarette Shegog  31:14
But there's so much knowledge and caution. And you want to talk about peer-reviewed, heavily edited, like, the things that they put out are so rigorously evaluated. That is what I tell folks to go off of.

Michael Simeone  31:31
That, the point you just made is is really interesting, in that I think most people don't appreciate exactly what peer review means. But then how rigorously peer reviewed CDC materials are, like Shawn was saying the kind of more general and larger and inaccessible the institution, than the harder it is to trust it. Or the less you know about and that sows this doubt or uncertainty and that's a great time to be misinformed. But what you're saying is something that was directly under assault by certain misinformation campaigns, which is the credibility of the CDC. But it strikes me that where you have a lot of folks thinking about misinformation research about ways to inoculate people against misinformation, looking for specific lessons you can teach them or fact checking routines that they can go through. It sounds like knowledge of some of the key institutions that are leadership in a given situation, and that increasing knowledge about these things would really help. If, at the beginning of the pan, there was a three-hour PBS special- 

Margarette Shegog  32:27
Yes! 

Michael Simeone  32:28
-On "How does the CDC offer guidance to people?" Let's take something like that seems like it would have meant a lot. Who am I, who am I to say one way or the other? But I really appreciate you calling attention to the rigor behind what goes through the CDC, because I think even if you're someone who watches cable news all the time, or watches news YouTube all the time, that fact, the rigor of the CDC, to me, this is the first time I've heard an expert call attention to it. Even Dr. Fauci who, it feels like every time he's on television is defending other points. But defending the honor of the CDC, in terms of its integrity, that is a really interesting perspective in this whole misinformation landscape around COVID-19, vaccines, and masking.

Margarette Shegog  33:09
Yeah, absolutely. There's so many people like, "Oh, went through the FDA, but how can we trust the FDA? Because it's so underfunded. And they're just, you know, bowing to the winds of the farming industry" and like all this other stuff. So I completely agree with some of those very key institutions, which have been in a kind of a gray light up to now where they have all this rule over our life. But what does that even mean? But yeah, now the CDC is highly trusted. I dig it. I wonder if there was like a YouTube series that was 45 minutes, because no one's watching three hours of anything anymore. Maybe we all would, because it was home from pandemic, but you might have to have The Tiger King in it.

Michael Simeone  33:52
No, we've just invented a new How Stuff Works series only it's about bureaucracy and government. 

Shawn Walker  33:57
It's actually a Netflix series that we can all binge. 

Michael Simeone  34:00
Yeah, looking forward to the 15 subscribers.

Shawn Walker  34:06
Netflix if you're listening, we have a show idea for you. So when I asked you a little bit about the difference between vaccine hesitancy and anti-vaccination, what do those two terms mean to you? Do you see a difference between them? And is that difference really important? Because on the news at this moment in time, we hear a lot of discussions about vaccine hesitancy. We don't hear a lot of discussions about anti-vaxxers. How do you see those two terms playing out?

Margarette Shegog  34:32
So those are completely different folks. So you're vaccine hesitant people are the people where they come into the office, let's use the one that we all know about the flu. They come into the office, you're like, hey, it's flu season, you should get your flu shot. You're here. They're like, Oh, Doc, I hate getting the flu shot. It hurts. My arm hurts. And I heard that was only 50% effective this year anyway. And that means that you're not going to be sick in bed for two whole weeks, if you get the flu, you might only have one week. So that's one week less that you're going to be in bed sick, not being able to move with high fevers. And you'll actually be able to get up and go to work and do this and that and they're like, oh, okay, so that's vaccine hesitancy, they have reservations. But we can have a conversation about what those barriers are. 

Anti-vaxxers are people who are actively against the concept of putting any other materials into your body, other than the virus or bacteria itself, to generate immunity. Those are the anti-vaxxers. They are the ones who say, there is no other way you can do this other than getting the virus naturally. And by actively putting other things in your body to generate immunity, you're causing more harm than good. And that is a whole different level and a whole different conversation because then you have to go to the this again. I'll I do that all day is talk about risks. So what are the risks of you getting chickenpox versus getting the chickenpox vaccine? Chickenpox sucks. It sucks more as you get older. Okay! If you don't want to get the chickenpox vaccine, and you are willing to get the chickenpox and possibly have shingles, which could give you a neurological disease, as you get older, that continues and risk that. Okay! That's fine. Now, that is a risk that you are willing to take. Now, if we're talking about something, as you know, severe as giving your kid a pertussis, the whooping cough vaccine. Where we know that children have died. Infants have died from their grandparents having a low level of infection, they come over to see the new baby, oh, new baby. Now new baby has whooping cough, because they don't have the immunity and they die. That's a different level to me, because that is literally life and death. And so that particular anti-vaxxer, we might have a discussion about specific vaccines similar to COVID-19. What are the risks and benefits of getting COVID-19 versus getting the vaccine when it's available to you. If you are willing, if you are willing to take the risk, knowing that even as a relatively young, healthy person, you could end up on a ventilator. And have lifelong repercussions. We're still repercussions of diabetes, I say because we've now found that people who have COVID-19 are now having higher rates of diabetes, they're having higher rates of heart disease. They're having higher rates of all of these vessel diseases, because COVID-19 packs the vessels and giving you long lasting ramifications. So is that a risk that you are willing to take, knowledgeably? Knowing that this is a possibility?

Michael Simeone  38:20
That's fascinating. Something that Shawn and I talk about too, is just what the value of misinformation is for people who internalize it and make decisions based on it. Like all beliefs people have some capability to choose them. And so, what is the value that you observe to people who are anti-vax? What benefit do they receive, by being so vaccine avoidant? By spreading this kind of information about medical institutions? What's in it for them?

Margarette Shegog  38:52
So the ones I've met, a lot of them are, one, they're promoting natural life, natural, being more natural that these things are unnatural. And sometimes I'm like pediatric death is natural to kids used to die all the time. That's why people would have a dozen kids because about half of them would die. So one of it is being natural. Another one is going against big pharma. I was like, Oh, you get paid for every time I get I don't get paid for nothing, folks, I'm a family medicine doc, we don't get paid. We do it out of the charity of our hearts. Okay, I do get paid. That's a whole another discussion.

Michael Simeone  39:25
There's not a fresh envelope of 20s under your door every time you give a prescription.

Margarette Shegog  39:30
Exactly, exactly the concept that we are getting some kind of kickback or we're getting some kind of benefit from the pharmaceutical companies. We don't even have samples in our office because of the bias that we know that having samples in your office gives you. So that's one of those things that they're like, I'm gonna stick it to the man I'm not gonna get vaccines because that's just a thing for Big Pharma. And then there are those People who hold beliefs that seem ludicrous as well, if I do this, then I will have a tracking device implanted in my body that will follow me around for the rest of my life - 

Shawn Walker
Called your cell phone. 

Margarette Shegog
-And then a lot of people who are like, I want it to be natural, and then I'm like, but you're smoking. Like, there are people who are anti-vax, but they will smoke cigarettes, and I'm like, you're putting foreign substances into your body, don't you don't see. But it's a whole different conversation. And a lot of those folks, honestly, because of the knowledge of anti-vaxxers, a lot of the drill true hardcore anti-vaxxers, they don't go to doctors, they don't go to Western medicine, a lot of them will go see naturopaths. A lot of them will go to other medical practitioners, Eastern medicine, things like that.

Shawn Walker  40:57
So briefly, I want to ask a little bit about children in COVID-19. Because we've talked about vaccines. You've talked about evidence as when the vaccines were initially approved. We had three months of data. Now we have many more months of data. But for children, there's still a lot of unknowns, is that correct?

Margarette Shegog  41:14
So that is correct. They started FDA trials on children in January. So that data and we're not going to have until the summer, the earliest we could get any kind of information on vaccine approval for children would be in the fall. Anything we do for adults, when we start going to the kid level, is tested that much more rigorously, because we don't want to harm children, thankfully. And I think, Michael, much to your point, people don't understand the rigors of going through FDA testing, they don't understand like, there's phase one, there's a two, there's a three, there are four phases They're all these trials. They have to have so much data from all these other places before you even get to the human trials. And then you have to have the small batch. And you have to have the larger batch and an understanding that no child gets a vaccine that hasn't already been tested in a large population of adults. So there's all of this background stuff that people don't see.

Shawn Walker  42:10
So since we're in maybe this waiting period. As we're waiting for more trials, more testing data, does this become an area that's ripe for parents to seek out, maybe? We're more susceptible to mis and disinformation as a result of that uncertainty. And the stress is like, I have dogs, I don't have children. So I have different vaccine questions which we have in another episode, but I can't imagine being a parent and wanting to keep my children safe. But now. Okay, hold on. Let's wait till the summer. So what do we do in the meantime? How do you combat misinformation with patients and help people live through this until we have better data?

Margarette Shegog  42:52
So, I feel like the biggest thing that comes across with the kids is to school or not to school? The homeschool and oh, Sally's been on homeschooling since like last spring she tried it, it don't work. Like she is running all over the place. She needs to be in the classroom. Plus I can't stay home and work and keep take care of Sally and like working in this and the other. The kid problem with COVID-19 is very fraught. As we are in this, the biggest thing that I'm trying to encourage everybody is this ain't over. 

I know lots of people are like, hey, since COVID is going down, let's go hang out. Let's have a St. Patty's Day celebration. Let's start having meetings in person again. And I'm like no, most of the people who are doing these things aren't vaccinated. Thankfully, the people who are most vaccinated right now are the people who are at higher risk. So our elderly and our frontline workers. But most folk are not vaccinated. Let's talk about how we can protect everyone still. And everyone especially we think about our children. I have a two-year old. Is officially time for to start wearing masks. I will tell you, I put a mask on her as we get into the grocery store as we get out of the car. And about five seconds it is off of her face. She kept it on for a whole 15 minutes once when I took her to get my first COVID shot because I want her to see grownups get shots too. We get vaccines just like kids do. And she kept it on for 15 minutes and then it was off of her face and we haven't gotten anything that long since. So it's hard and it is frustrating. But you still want your children to be safe. We still know that kids are definitely unfortunately a big vector for having, passing COVID along. Especially having asymptomatic cases and think about classrooms during cold and flu season. Good heavens! Like you knew if Jimmy was sneezing in the front row, everyone was going to be, have that same cold that classroom was down. so it's that much more. Now with this disease that rapidly spreads, we have variants that spread even faster. And so I do have a lot of patients who I talked to them about their children and mitigating risk. And it goes back to that individual thing. Okay. So you work at home. And you want to send your kid to a daycare so that you can have your work hours actually be work hours, and that hours that you're trying to chase after your kid. Who is in the daycare? Are people at the daycare wearing masks? How big is the daycare? Are they counting kids? Are they counting families? Is this a five family daycare, or this is a five kid daycare? Because if it's five kids from different households, that's five whole different households. This is five kids from two households, you have a lot lower risk.

Michael Simeone  46:13
And your breakdown of this looping back to Shawn's question, makes it sound like the biggest, most dangerous piece of misinformation that can get out there right now, while we're in this kind of ambiguous situation, is that we're in the clear.

Margarette Shegog  46:28
Yeah, we are not in the clear. We are in no ways, zero ways, are we in the clear. I guarantee you, the people who are going and drinking for St. Patty's Day are not vaccinated as so many states are opening up and saying 'Yes, go back to in-dining, eating and doing all this stuff'. They're not vaccinated. Your waiters are not vaccinated. Your servers are not vaccinated. And as this happens, there's going to be a stronger push to start reducing those times where 'Oh, you're sick, maybe you should go to work anyway', that those types of things are going to start getting encroached upon, again. That's how you get whole factories of people, hold restaurants of people, ill.

Shawn Walker  47:10
I see a really important technique that you're using. You're not necessarily offering your patients and people in the community a false sense of assurance. You're actually admitting 'This is really difficult. This is hard. This is hard for me'. So you're offering empathy and understanding and then be like, 'But wait, no, like, we're not done yet. I have a hard time. You're having a hard time, but you're not done. Just sit with me through this. And we're going to make it through six more months. And then it's going to get better'.

Margarette Shegog  47:38
Yes, yes, it is. It is all about Americans really like to be individualistic. And, they have this persona of I can do it on my own. This is one of those few times when actually, none of us can do it on our own. If I'm doing the right thing, and I am protected. That still means like any one person around me who's not doing what they're supposed to be doing can still get me sick. I cannot tell you how many patients of mine right after the New Year, who were in situations where they thought they couldn't get sick, but got sick. And a lot of it is because they're like 'We've been doing this for so long, we can lower our guards a little bit, we can have this little family party outside, we can do this little thing' and, people are getting ill. It is not over. I haven't seen my family either. My family has not seen my two year old daughter since she was six months old. I get it. I am right here with you. But the more we actually work together if we actually just all did what we need to do. And there was no like one group of people going out and doing this anyway. If we actually all get together and do what we're supposed to do. We will actually be done with it. The more people are like 'Yeah. But. I think I am gonna take that vacation to Las Vegas. Well, you know, I think I am gonna throw this party. I put my wedding on hold last year, but this year, we're gonna have this big huge destination party'. Like, the more that happens, the longer this is going to be a thing.

Michael Simeone  49:22
Yeah, and your emphasis on collective action here really sends home just how wonderful of a terrain this is for a misinformation attacker. Right, or even incidental misinformation because the more divided or confused people are, the harder this is going to be. So just your description of the import of collective action and cooperation, I think throws into relief just how appealing this is for misinformation attacks.

Margarette Shegog  49:48
It's kind of like the end of Wonder Woman. I don’t know if everyone watched Wonder Woman, but spoilers skip the next 30 seconds if you don't want to be spoiled and you haven't washed it yet. But at the end of Wonder Woman literally the entire world has to renounce their deepest wish. And I feel like that is where we are right now. We all have to renounce our deepest wish to go out and be with each other and do all these things and celebrate and give hugs. We all need to renounce that. So that the world is not destroyed, literally.

Michael Simeone  50:19
Still haven't seen Wonder Woman. 

Margarette Shegog  50:21
Oh No! I'm so sorry.

Shawn Walker  50:24
It's just gonna be like a hate thing like you hate Jurassic Park 2?

Michael Simeone  50:27
No, not at all. I think it's a brilliant point. And I'm happy to have Wonder Woman spoiled. So that we can have this thought be one of our final thoughts.

Shawn Walker  50:35
I think that's a great place to stop. It's been a lovely conversation, Dr. Shegog. I think we could have this conversation all day, and keep going. But thank you for joining us. And thanks, everyone, for joining us for this session. Be well.

Michael Simeone  50:48
For questions or comments, use the email address data science@asu.edu. And to check out more about what we're doing, try library.asu.edu/data.