Episode 1: Is Social Media Making Us Unwell?

Most people now encounter health advice on social media — and many act on it. In this episode, we examine why people turn to these platforms, how algorithms shape what we see, and who is most vulnerable to anxiety and harm from online health content.

What we cover:
• Why social media is a primary health source
• Engagement vs accuracy in algorithms
• Health anxiety and “cyberchondria”
• Safer ways to engage with health content

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Transcript

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Sonia Singh MD 1:27

You're listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety.

Rebecca Berens MD 1:38

And me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.

Sonia Singh MD 1:43

We're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.

Rebecca Berens MD 1:56

This podcast is meant to be the antidote to your doom. Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion that comes from social media's messaging around health. In each episode, we discuss a health related topic, trending on social media with curiosity, nuance evidence, humility, and compassion.

Sonia Singh MD 2:12

This is not your average debunking podcast. We wanna explore not just what is trending on social media, but why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.

Rebecca Berens MD 2:27

We're so glad you're here. Hi son. Hi Rebecca. So excited to be on the episode with you today. So each week when we talk about our, claim we're going to be addressing it from the standpoint of. A real person who is affected by this. So whether that's maybe a patient that we've seen, a friend or family member who's had an experience or maybe a listener who sent us in an experience that they had. And so what is the story behind this week's claim?

Sonia Singh MD 3:05

Yeah, so this is actually just something that happened last week. So very recent, I had a patient who had taken a certain antibiotic for an infection she had several months before, and she was very concerned about side effects from this antibiotic. So she had been. Searching and being served a lot of content on her algorithm regarding this category of antibiotics. And she came across a video on TikTok that she sent me. And she, at the time that she sent it to me, was in a, in a total panic. And basically the video was from. A surgeon. So it was actually a qualified medical professional, and she basically said, Hey guys, are you bendy or flexible? Do you know anybody who's really bendy or flexible? You know those people who can lick their elbow or touch their thumb to their arm? If you are bendy or flexible, you need to hear this message. And then she basically proceeded to talk about how, Ciprofloxacin, which is a fluoroquinolone, it's a certain antibiotic if given to somebody who is flexible or bendy can cause aortic rupture or aortic dissection, which is deadly and fatal very suddenly and is very, very bad. So, the video, which was less than two minutes basically made it sound as though if you are flexible, you might just go to the doctor for a UTI, an uncomplicated UTI, and you might get an antibiotic that could kill you. And at the end of that video, I could totally understand why that patient was terrified. And one of the things that the fluoroquinolones are known for is that you can have sometimes adverse effects, even after you finish the course. And I had counseled this patient on that, so she already knew about that and this was really amplifying her anxiety. When I responded to her, I tried to emphasize some of the things we're gonna talk about in this episode, which is that social media really does not. Have room for nuance and context. So for example, she was basically calling out anybody who was bendy or flexible. And really what she was referring to was people with very specific syndrome, LERs Danlos syndrome. And within Ellis Danlos syndrome there are like 13 subtypes and one of those is the vascular subtype, and that is the type that is most at risk for aortic rupture. And, ciprofloxacin, which she was talking about, is not even one of the first line medications that are recommended to treat UTIs. So this idea that any woman who has beeni or flexible might go to her doctor and get prescribed something that could kill her is really, in my opinion, fearmongering, even though nothing she said in the video was technically false. To me, this is a great example of the double-edged sword that is health and wellness information on social media. So. The claim this week that we're gonna be talking about is is social media making us more educated, informed, empowered, or is it making us unwell? So basically, content relating to health and wellness on social media often looks on the surface like it's helpful. 88% of social media users are seeing health and wellness content. So almost everybody that's on social media is absorbing this in some way. And in one survey, half of people say it actually influenced. Their behavior, so they're not just passively consuming it, they're actually acting on things they're seeing. Um, can you guess, Rebecca, what the number one source of information is on learning about health and wellness in terms of resources, products and tools?

Rebecca Berens MD 6:19

Oh man. I'm gonna say TikTok based on

Sonia Singh MD 6:21

patient experiences. Well, I think you're probably right, but it is social media generally. And I don't know within that, what the breakdown is. And can you guess what number two is?

Rebecca Berens MD 6:30

Google,

Sonia Singh MD 6:31

you're right. Search engines. So 52% use social media, 37% use Google. Can you guess what number three is? My

Rebecca Berens MD 6:38

friend's aunt, sister,

Sonia Singh MD 6:40

it's doctors, it's us. Oh, yay. We came in just ahead by 2% compared to friends and family. And then, lastly, 30% is health information sites. Things like WebMD. So anyway, the reality is that a lot of patients are going to social media before they're coming to us, and a lot of them are acting on the information that they see there. The next thing we wanted to cover is why is it viral? I'm curious what your thoughts on this is. Like, why, why are people so many people immediately turning to social media before they're going to any other source?

Rebecca Berens MD 7:09

Yeah, I think part of it is that we're already there. I think sometimes people start getting this information, not 'cause they were necessarily looking for it, but just 'cause it's being served to them. Mm-hmm. Um, and so if you're already there and then it's being served to you. You're absorbing it passively whether you intend to or not. But then I think the other big thing that we have, particularly in the US, is we have a real healthcare access issue. Mm-hmm. And even if someone does have access to healthcare, to go and see a doctor, the amount of time that they have to spend with that person. Is pretty limited. And so I think that's probably a big driver and that's something I've definitely heard from patients.

Sonia Singh MD 7:42

Yeah, I think you hit the nail on the head. I think most people go to social media because they're already there. It's free, it's easily accessible. Doctors are not accessible at all. There's basically no. Good way to ask your doctor a quick question about anything unless you happen to have an appointment with them. And appointments are usually gonna be 15 minutes, so if you have other things to cover that question about a random thing you saw on social media is probably not gonna make the list. Visits, cost, money, visits take time. Resources. About a third of Americans have no PCP, so they really don't even have a relationship with a person that they feel they could ask. So I think that's a huge piece of why people go to social media and that's an unfortunate reality of our healthcare system. The other things that, I came up with is, I do think right now there's also this, growing mistrust and loss of trust and physicians and just the general medical establishment. I think since. COVID and recommendations around COVID and the COVID vaccine. There's been this polarization where it feels like people are either on the side of nature and supplements and diet, or they're on the side of doctors and pharmaceuticals and vaccines, and that's totally a false dichotomy, right? It really does not have to be divided that way, but it feels like there's this backlash against, traditional medicine. So I think that's one thing. Another thing that kind of both of these play into is, I think. A lot of patients have had just bad experiences with the healthcare system, whether that's the doctor or the system like, long waits being misdiagnosed. Having a surprise bill, feeling gaslit. Just the hassle of it all. And so they're just not that motivated to seek answers and care from the medical establishment. So, those are big pieces. The other thing that I came across when I was researching this topic, that I think makes a lot of sense, and I think that we can learn a lot from, is that. Information is so much more sticky when it's relatable and it's coming from somebody that you feel that you kind of know or trust or you know their story. So for example, like an influencer who gets diagnosed with breast cancer and then is urging her followers to go get their mammograms is gonna hit totally different than your doctor's ma going through a checklist and saying, Hey, did you get your mammogram this year? I think we as doctors are at this disadvantage when we don't. Have those relationships with people and we don't, we are not perceived as relatable and we're not sharing personal anecdotes or our own stories to convince patients to do these things. And it's really just, it feels as though it's more of a checklist. So I think that relatability piece and that know, like, and trust factor that comes when you are following somebody for a while on social media really influences behavior more than you know we can possibly do in the clinic. As we've talked about, a lot of these. These trends and concepts are, they start with some negative truth. There's a reason that people are doing this, and so I think we're answering that right now, which is social media, is being used for health information because it's fast, it's free, it's entertaining, it's easily digest. It's relatable. And I think it has the potential to be really validating and empowering, especially when patients share their stories. They advocate for themselves or other people with their condition. They share their experiences. And I think when it's used by qualified healthcare professionals and scientists to share accurate information, it's a great tool. I think you and I have both benefited hugely, in a lot of ways from being on social media in terms of learning things from. People in other fields getting connected with people in other fields learning things from other doctors, in terms of their experiences. So, clearly a lot, a lot of positive things can come from it. I don't know if you would say like, what are some positive things that you've taken from social media, how you think it. It actually is helpful.

Rebecca Berens MD 11:10

Yeah, just as you said, I have learned a lot from my colleagues on social media and even just like you said, getting connected with people. It's not as if, I see a video and now I know all the things about that condition or that treatment, but now I'm like, oh, this is a person that I want to learn more from. Mm-hmm. And seeing that other people are approaching care differently and learning the evidence behind why they're doing that. The, these are things that you don't, especially once you're out of training. Yeah. You're, unless you're intentionally seeking out continuing education, you're not necessarily going to be updated on these things. And then it's also just been helpful for me to see, like you said, what patients are caring about. Mm-hmm. And what is sticking with them because you and I both have the same goal of being relatable and open and talking with our patients to better understand them so we can get them their best outcome. And we can't do that if we don't know what's going on inside their head and what's on their feet. Yeah. You know, and it's really I've learned a lot. I'm able to better connect with my patients and then also just reaching other professionals who are like-minded mm-hmm. Who can support our patients. I think it's really helpful.

Sonia Singh MD 12:12

Yeah. So there's clearly a lot of positive and. I don't wanna discount that. We definitely wanna recognize that, but, when you actually look at some of the facts about health and wellness information on social media, it paints a different picture. So as we talked about, social media isn't really built for nuance. It's built for sound bites and very easily digestible little morsels of information. And in. Medicine. As any medical professional will tell you, there's a ton of gray. There's so much nuance, there's rarely complete certainty about anything. And so, it just doesn't feel like a place where that's really captured or acknowledged. The other big thing is algorithms prioritize engagement over. Accuracy. So, the follower count or the number of likes or the little blue check actually does not mean anything. I have a little blue check. I just paid for it. It does not mean that everything I say is right. So, I think sometimes. People feel misled by just looking at an account and seeing that oh, this person has a million followers and this post has like thousands of likes. There must be something to this. But that's really not the case. And there's actually been some studies on this. So there was a study that looked at, over 67,000 TikTok posts and they evaluated that these were posts specifically around health and wellness topics, and they evaluated them for quality. And what they found was that 82% of the posts. Lacked transparent advertising, so meaning of the post that had something, a product that they were advertising, they did not disclose that it was something that they were advertising and getting a kickback or affiliate link for. 77 per percent failed to disclose conflicts of interest. That's very similar. 63% promoted stereotypical attitudes. 55% did not provide evidence-based information, and 75% lacked balance and accurate information. And then 90%, this is so common, failed to point out the risks. Benefits of the advice presented. So I, I want you to ask yourself if you have ever seen an influencer promoting a supplement or detox or intervention where they mentioned the adverse effects. I find that that's very rare. And then they found that a total of 36% of the posts were just completely inaccurate. There was a similar study, oh no, I think this was actually a different study, but they basically found that relating to, in with the, specifically relating to posts around nutritional content, only 2.1% were actually accurate when compared to published guidelines. So basically what this tells us is overall the vast majority of health and wellness content that we're seeing on social media. Is really not accurate or it is misleading in some way, often financially motivated. And then one statistic that I thought was especially interesting was. In the Healthline survey, they said that only 37% of people who took some advice from social media ask their doctor about it before trying. So people are consuming this content, which is highly inaccurate, and they're actually acting upon it and they're not validating that information with an actual professional. And then. The funny thing about it was in that same Healthline survey, 77% of the people who were taking health and wellness advice from social media said they actually had negative feelings towards it in that it was conflicting, overwhelming, hard to validate, confusing. And one third said that they had something positive come from it. So that's more the minority. And then 13% of patients said that they actually had gotten harmful information and learned something that was dangerous from social media. So basically. Yes, a small percentage of people learn helpful information. The majority of people actually don't, and actually feel negatively towards the information that they receive there and the vast majority of the information is inaccurate.

Rebecca Berens MD 15:51

And I can imagine for you in particular, I know you see a lot of patients with health anxiety. I'm sure this is something. That comes up and exacerbates their experience. Yeah. So what have you seen with your patients?

Sonia Singh MD 16:02

Yeah, so you know, one element is just what is the content and is that content accurate and how are people using it? The other, dimension of this is how is that content making them feel? And I think. In my population especially, a lot of them do have baseline anxiety or specifically health anxiety. I have noticed that the more these patients go to social media for answers, the worse they feel. And I will find often that if I tell them, Hey, look, you can text me anytime. Text me first before you go to social media or Google that immediately brings down the level of anxiety. Much more than them, doing their own research first and then coming to me to validate. But there is actually some research on this as well. So there's a study on a new word that I learned, cyber kadria, which is not a DSM diagnosis yet, but it's a pattern of excessive and repetitive internet. Symptom checking behavior. So I'm sure a lot of you know people that do this, which is like immediately going to Google and looking up their symptoms and doing it in an excessive or compulsive way. And what they found in one study on Hypochondria was that patients who already had a moderate or high level of anxiety about illness felt more anxiety during and after searching for information online about that illness. So basically. A lot of these people are going online for reassurance and for education and information, but instead it is making them more anxious.

Rebecca Berens MD 17:27

So what can we learn from this as both doctors and just humans who are. Anxious.

Sonia Singh MD 17:33

So I think as doctors we need to know and recognize that patients are absorbing a ton of health and wellness information on social media. They're not just absorbing it passively, they're acting upon it. They may not always be coming to us to ask about it. And part of that is because of a failure of the healthcare system and on our part for not being accessible or available to them in a way that makes sense. I wanna emphasize that, that's really like a health system level problem that is not usually an individual doctor problem. Most of us simply don't. Function in environments that allow us to be that accessible to patients. I think as humans on social media, what we can take away from this is that the vast majority of this information is inaccurate or misleading in some way. So we really need to have our radars up. And while some people do find helpful information, maybe a third in the surveys that I looked at, the majority of people are not finding very helpful information and some of the advice can actually be harmful or dangerous. And lastly, if you're somebody that does struggle with health, anxiety or generalized anxiety, be aware that it could exacerbate those symptoms rather than reassure you.

Rebecca Berens MD 18:39

So how would you, or how do you talk to your patients about this?

Sonia Singh MD 18:44

So, I think it's helpful to kind of get a sense of people's baseline anxiety, just through clinical history, or a validated questionnaire, just getting a sense of how anxious are they generally about their health. Inquire about where they're going to get health information. That could be social media, it could be friends and family, various resources. Kind of get a sense of where they're getting their info. You can educate them about. Some of this data that I shared about how misleading and inaccurate that information can be if a patient, is sending me videos frequently. There are a few tips that I would give them about how to navigate social media safely. So the simplest one would just be limiting time on social media. There's like the abstinence only approach, but I think that's probably unrealistic for a lot of us for some reason or another, whether it. To, just keep in touch with your friends or see pictures of your nephews or whatever it is. We all end up, spending some time around, or many of us spend some time on there. So even just limiting the amount of time that you're spending, I think can be helpful. So checking credentials is something that I always talk to people about. A lot of people are surprised to know that the word nutritionist actually doesn't really mean anything. It's not, a standardized label. Whereas registered dietician comes with a certain amount of, education and training and a standard exam and things like that. When people just have doctor Dr. In front of their name, you really don't know a lot about what their training is. They could be an md, a do a PhD, a pharm DA dc. There's. So many different letters that people can put behind their names. And so it's important to know who the person is that is giving you information. And that's not to say just because somebody has an MD or a do behind their name, that that information is gonna be accurate or valid or not misleading or fear mongering. One red flag that I always tell people to look out for is if somebody is Positioning themselves as an expert on something that they don't have any education or training in. An example would be like an ER doctor who is now a hormone expert or an orthopedic surgeon who is now a longevity expert. Doctors are smart people and they're allowed to change their mind. But I think when that person who did not do any education or training in that field starts practicing there and starts giving you advice that is contradictory to what. Actual experts who were trained and educated in that field are saying that is problematic and and is likely a red flag. Um. Next is beware of the discount code or the affiliate link. Um, uh, probably a lot of our listeners, have watched Apple cider vinegar on Netflix. If you haven't, it's a very good watch if you're interested in the whole health and wellness world. But that story in apple cider vinegar is not unusual. I, as a doctor have taken care of people who have followings on social media, and there have been situations in which I have seen. People basically promoting a supplement and saying, this thing worked so well for me, I'm feeling so great. And then behind the scenes, I'm aware that they're not feeling great and they're not any better, and their disease is the same. So, when I saw, when I watched that, series on Netflix, I, felt so validated because I think that actually happens a lot more than we think it does. It's not a wild story. Okay. So next I would say look out for certain red flags. If something sounds good, too good to be true. It probably is. Anything that's framed as a secret or a quick fix or a it worked for me. One size fits all kind of advice is usually not very accurate. Anything that sounds extreme, somebody who's telling you to eliminate entire food groups or do anything that. Sounds extreme is usually not necessary from a medical perspective and probably should be validated by a medical professional. I wanted to say as one of the tips to cite high, look for somebody who cites high quality sources, but I almost feel like that doesn't even work anymore. I'm curious how you feel about this, because I've seen a lot of people who's. Be who spread inaccurate and misleading information that will put a ton of PubMed IDs after their posts. And it looks impressive because they're citing things from PubMed, which is, a, a big database that includes all these peer reviewed studies, but a. I have done this exercise of going through each of the things that they have linked, and oftentimes when you click on those links, they're low quality studies or they're totally irrelevant to the thing that they actually posted about. I'm curious if you've had that experience or how you, how you navigate re people's references and whether they're good.

Rebecca Berens MD 22:52

Yeah. It's, it's so tricky. And I think what people don't understand, this is a huge component of our medical training, right. In medical school. Yeah. Learning and understanding evidence-based medicine, learning how to assess the quality of a study, the design of a study. Understanding the statistical significance behind the outcomes, you know? Mm-hmm. All that information. It's actually really hard to learn and understand that. And it can be misconstrued very easily. And you can probably cherry pick and construe data to say whatever you wanna say. Yeah. There's enough small, low quality studies out there to pick data, cherry pick data one way or the other. Just because there is a study that shows a thing doesn't mean that's the gospel. Right. And there's been tons of places in medicine where initial studies showed one thing and. As we do more research and learn more or do better design studies or larger studies studies that are actually studying the population who's applying that information. I think that's a key one. Yeah. That I think people don't take into account. They'll cite some study from another part of the world with a completely different patient population and apply it to here and it's like, it's not the same. Right. So, does the influencer promoting that, understand all of that study design? And then do you and this is not a case of oh, you're so dumb, you can't understand it. You can, but it takes a lot of Yeah. Learning and practice to be able to do that. And, I think it's, it's difficult. To do that, especially in a one minute reel.

Sonia Singh MD 24:15

Yeah, no, I mean, even for me, even for us, I think it is time consuming and like intellectually laborious to look at a study and really delve into it far enough to know whether it's something that you should base a clinical decision on. And this is a hill that I will die on where I always tell my patients when I'm making decisions about a human being. I wanna be basing those decisions on the highest level of scientific evidence. So one study done in like 12 people is not good enough for me. 50 rats still not good enough. A test tube, definitely not good enough. It really needs to be high quality studies. And as you said, it's very easy to link a study that appears to show some association, but. It's also very easy to leave out the 10 studies that showed no association. And so that's very commonly I think what you see in, people who are putting a lot of references in, but the references don't necessarily prove their point. So anyway, I wish I could say look for high quality sources, but I think that's honestly very hard for most people to do. And it's even for us, it's time consuming to evaluate the sources. I think honestly the most important thing that I tell patients and that I try to do myself is to check in with myself about how content is making me feel. So I've been ruthless about this, I even have friends that I have unfollowed because something about their content, I found was bringing up negative emotions for me. Like I have a friend from high school who's. Kind of an influencer and she does a lot of travel and fashion. It's not even around health and wellness, but I just found when I was following her in residency, that it made me feel sad. 'cause she was always gallivanting around Europe. And I was like, spending eight hours a week in a hospital and I love her. She's wonderful and she makes great content, but I just unfollowed her. I just found that it was making me feel sad and anxious and envious and wanting these things that I really, at that chapter of my life, couldn't have. So when that patient sent me that video about. The Cipro and the aortic dissection. I was like, I want you to think about how following accounts like this is actually making you feel. It might be tempting to believe that it's informing you and it's making you more aware so that you know you can avoid getting this medicine that's going to kill you. But the reality was that the statistical likelihood of her. Having that happen to her was almost zero, and it was guaranteed to make her anxious. I think just checking in with yourself frequently about how the people, you're following the accounts, you're following the content, you're looking at social media generally how it is making you feel is key. Absolutely.

Rebecca Berens MD 26:42

So where can people go for more information? Some validated sources that we like to follow?

Sonia Singh MD 26:47

Yeah, so what we'll do at the end of every episode is in our show notes, we'll have a few people on social media that you can follow, and then just a few general websites and resources that you can go for evidence-based, validated, safe, friendly, not fear-mongering information. And that basically brings us to the end of the show. Do you have any other thoughts about. Wellness and health and wellness information on social media generally?

Rebecca Berens MD 27:11

No, but I think we covered a lot. And I think we'll continue to cover this topic over and over as we examine each claim. But it's, this is just such an interesting topic that even when we were in. Residency was totally not happening. Even 10, 15 years ago, social media was nothing like how it is now. Yeah. And with the introduction of ai, I am sure we can do a whole future episode on AI in healthcare, but I mean, this is something we have to continue to examine and try to understand and integrate into the way that we're approaching patient care because it is affecting our patients. Mm-hmm. You have all the statistics to back it up. It's our job as healthcare professionals to make sure that we are still taking the best care of them that we can.

Sonia Singh MD 27:52

Yeah,

Rebecca Berens MD 27:52

absolutely.

Sonia Singh MD 27:53

All right, well thanks Rebecca.

Rebecca Berens MD 27:55

Thanks.

Sonia Singh MD 27:57

Hey guys. Last but not least, we have a very important disclaimer. This podcast is intended for educational and entertainment purposes only. The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation diagnosis. Or treatment. Listening to this podcast does not establish a physician patient relationship between you and the hosts. We are doctors, but not your doctors. Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances. Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health. Medical conditions or treatment options, never disregard or delay medical advice because of something you've heard on this podcast. While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated. Although we do our best to stay up to date, please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions. Medicine is not static and information may change over time. We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this. Podcast by listening to the Antisocial Doctors podcast. You have agreed to these terms. Thanks again for joining us.