Empathy first, facts later | Dr. Kumanan Wilson

When someone rejects the evidence, the instinct is to hit back with better facts. Dr. Kumanan Wilson, a general internal medicine specialist who has spent two decades studying vaccine hesitancy, says that move can backfire. He recalls trying to change naturopathic students' minds with hard data and a polio survivor's story, and watching the room turn more anti-vaccine. When a belief is tied to identity, arguing against it makes people dig in their heels, and they can reject the messenger, as well as the message.

The conversation makes the case that the way through is empathy and meeting people where they are, the approach that reached vaccine-hesitant communities and the convoy protesters he visited. It closes on an example that challenges what ‘misinformation’ is. During COVID, the people who doubted vaccines would halt transmission were dismissed as misinformed, but given the speed with which variants emerged, in some ways they were right. When defined carefully in terms of best evidence at the time, what counts as ‘misinformation’ can change; and that idea requires careful and empathetic communication.

Transcript

SPEAKER_03 0:03

Welcome to Mythinform Science, a podcast about misinformation, disinformation, and the science of what to do about it. Conversations with experts in the study of misinformation. So, Justin, I I think maybe we've touched on this a little bit in some of the previous episodes, but it it it's been sort of rattling around in my brain a little bit. It's this notion that it's really easy to imagine that the problem of misinformation is just an issue of bad information itself. And it just reminds me of this, I don't know, it was a few years ago, but I remember there was this flap in the US around some Republican pundit being called to task about getting something wrong and them saying, well, there's facts. I'm bringing alternative facts. Right. And this notion, it it caused this huge flap in at least the channels I was talking about, because no, there's no alternative facts. There's facts, and then there's things that are wrong. You know, I I never quite understood that because in the sort of public discourse areas, there's always cherry picking of data, right? There's always people choosing uh findings or results or or facts that support their particular position. And then there's other people who choose other data or or uh ideas that choose their own positions. So from that perspective, alternative facts to me made perfect sense. But you know, as scientists, I think we tend to think that our job is primarily to limit those alternative facts and and and just uh get the message across about what the overall evidence says, this is the truth. That should be enough. We sh as long as people know the truth, that should be that should be our job, right?

SPEAKER_01 2:18

Right. Right. I mean, that solution, that approach, it's super appealing. It's it's clean, it's logical. Um and we even had a recent chat on our podcast about you know how things like reviews of lots of studies of those systematic reviews that could be a powerful way of summarizing what all the evidence says about something. And it feels like the kind of thing that you know that should work.

SPEAKER_02 2:38

Yeah. There's a there's a but coming in there.

SPEAKER_01 2:41

I mean, there's there's definitely a but here. Um I mean, in the in the spaces that we work in, you know, behavioral science, implementation science, um we spend a lot of time thinking and learning that you know a solution can seem, you know, good and sensible, uh a good idea at the time, um, but still not work, still fail, or maybe even backfire. And if we don't understand the context, the people that are involved, the be what the behavior means to them, what drives their decisions and their actions, um uh we might be missing something.

SPEAKER_02 3:11

Aaron Powell Yeah, it's not it's not just the information, it's not just the knowledge, it's it's all these other issues as well.

SPEAKER_01 3:18

Right, exactly. I mean it's not I mean, facts matter, evidence matter, they they really matter, uh maybe more than ever. Um and the role of things like systematic reviews that we talked about instead of relying on you know individual cherry pick studies feels like um you know and a really important step forward, but people don't have beliefs in a vacuum. Um and we explored that in another podcast. There are different information environments that people have to work with and live in. Um and just exposing people to the evidence, to the truth, to the facts, even when it's super strong evidence, um, it's probably not the whole story. Um and and you know, we we've been talking about this. Our beliefs are also tied to our identity, our relationships, to trust, to values, to communities, all these sort of inconvenient human parts of being human.

SPEAKER_03 4:03

Yeah. So when we're trying to get our message out about the evidence, just the evidence, we aren't necessarily dealing with just people who are ready to receive the evidence. We're dealing with an infinite in a infinite variety of humans who have lots of other things to to uh consider in terms of who they trust and what their experiences have been, et cetera, I guess.

SPEAKER_01 4:25

Aaron Powell Right. I mean it's those are they're obviously the big aspects of how people live their day-to-day lives. And so what w we m might see what might seem like uh you know a science communication challenge or a um uh is probably much more relational than just the communication part. We we've heard from again from thinking back to some of our recent guests, that we multiple guests have told us, you know, we just need to have more conversations together in society. Um but what if what we're talking about uh runs a little bit or maybe even a lot against how people see themselves? Um then I guess you know we need to be thinking about how do we even get in the door? How do how do we start these conversations? How do we keep them going? Um, how do we keep a conversation going when you know things like identity and trust and values and community are all part of the mix here?

SPEAKER_02 5:12

Yeah. Yeah.

SPEAKER_03 5:13

I think it was Jeremy Grimshaw we were talking to about it a little bit in the public sphere, and he was saying that um, you know, we want, as scientists, we want to make sure evidence is part of the decision-making process. But there are lots of other factors that go into public health decisions beyond the evidence, and that's perfectly appropriate. And I think, you know, even when we're talking about more personal decisions like vaccination or whatever, that's also true that we want to make sure evidence is part of that decision-making process, but we acknowledge that there's all these other things going on as well.

SPEAKER_01 5:49

Right. And I mean, and that's the challenge, right? For scientists or clinicians, public health leaders, science communicators. Um how do you stay clear about the evidence without turning that conversation into a contest about who's right or not?

SPEAKER_03 6:03

Aaron Powell Yeah. So uh we wanted to talk to somebody who's been thinking about these kinds of things a lot. How to combine evidence with broader discussions, how to get in the door with people who really don't agree with whatever the evidence says for whatever reason, how to stay in the room and have uh useful conversations with people, how to acknowledge these other issues and still have productive discussions and decision-making processes with people. So Dr. Kuumin and Wilson is uh perfect person to talk to. Dr. Kuumin and Wilson is a specialist in general internal medicine and a distinguished clinical research chair in digital health innovation. He's the CEO and chief scientific officer at Breer Health Research Institute in Ottawa. He's also the co-founder and chief scientific officer of CAN Immunize, a science-based technology company specializing in digital immunization software. So, coming up, our chat with Dr. Kuminan Wilson. Thanks, Jamie. When we approached you, actually, when we're push comes to shove and we're actually starting to do this, you sent us a paper which we really think is just fascinating. It's called Preserving Relationships with Anti-Vaccine Parents, Five Suggestions from Social Psychology, which you wrote in 2007 or published in 2007 with Jennifer Fortune. And it's a fascinating topic. It's something that Justin and I have talked about a fair bit. So why don't we start there and just ask you so what led you to want to think about and write about how to preserve relationships with anti-vaccine parents?

SPEAKER_00 8:01

Sure. So maybe I'll go back to the beginning. I went to med school. I believed in vaccines. Never had the slightest idea that anybody would be concerned about vaccines because vaccines are the number two intervention for reducing morbidity and mortality globally. And then I started to meet a few people who expressed contrary viewpoints. This was like 99-2000 time period around the Wakefield scandal. Again, that was relatively novel to me. And then I started doing some work, setting up a science program at the Canadian College of Naturopathic Medicine. And I started hearing a bit more of those contrary viewpoints. And they were very fair about engaging with what they would call an allopathic physician at that point to have the discussion and were open to studying it. And the approach that we should take in science is to be agnostic, to not go in with a viewpoint. And the goal isn't to convince them, the goal is to actually know what's going on here. Because it was fascinating to me. What is going on here? I was just a bit shocking to me that people would be not supportive of vaccination. So we did a couple of studies initially. The one was we just surveyed them, the cross-sectional survey, it was years one to four about attitudes towards vaccine and public health. And we found a steady decline over the years. And simultaneously, at that point, that the College of Chiropractic Medicine published something that showed exactly the same thing that the support for vaccinations declined over time.

SPEAKER_03 9:30

And as you say, this is the early 2000s, right? So it was way before COVID and way before SARS even.

SPEAKER_00 9:37

Yeah. And they don't teach anything about vaccines at the Naturopathic College. So it wasn't that they were being taught this, it was happening organically. And what we sort of got the sense was individuals were who had different beliefs obviously go into alternative medicine, and they've been told they're strange, they're weird, that your ideas are crazy. And then they come together in a geographic setting, and it they started to realize, oh, other people believe the same thing as us. And I was, I may have been right all along. And it reinforces that belief system. And it actually gets them a little upset that nobody listened to them or heard them before. And that obviously that geographic phenomenon started happening virtually through the use of social media. And we wrote some of the earliest papers on that for YouTube and MySpace at the time and even Second Life about how this was going on. So while I was doing that, we did a study in the final year of the naturopathic college students, and we divided them into two groups. And I thought I was so smart, I know how to solve this problem. Yeah, they just don't see these diseases anymore. This is an easy one. So I went to the March of Dimes and we found a volunteer from the March of Dimes hadn't had polio and was going to come in and talk about their experience with polio and just anecdotally speak to the audience. And we randomized them. One group was going to get that, and I was going to talk epidemiologically to the other group. Polio vaccine came in, here were the race before, here are the rates after, and see which group were we going to have more influence in. And I obviously I was expectation that maybe the anecdotal group would have more of an impact. And we actually found we made a significant percentage, like 25 or 30 percent, more anti-vaccine after that. And in fact, more so in the anecdotal group. In fact, they complained to the head of the National Path of College that this was not an objective presentation of the data, and that this was coercive. And that's when it started to click in. We had been approaching this wrong. This isn't a core identity, a core belief of these individuals. This is part of their ideology. And I was coming in, it's almost like a religious belief, coming in saying, You're wrong, everything you believe is wrong, particularly with the anecdotal person saying this is the truth. And and this then thus they go through a process of cognitive dissonance resolution. And instead of rejecting their entire reason for existence and their belief systems and their friends, the easier to reject the source of that information. And then this is much more complicated than I thought. But then I also realized, you know, obviously this is happening with them, but that's happening with us as well on the public health side. When we get a contrary information about vaccines, are we also going through that same process? And are we rejecting things because it's part of our identity? And that's that's the dynamic I started to see emerge here. And I didn't find it helpful. I think it wasn't helpful on both sides. You were getting entrenched camps that were rejecting data that didn't fit with their world beliefs. And that was obviously happening at a societal level, but was it happening at the clinical level? And was it happening between the physician and the patient? And I was starting to hear more stories about physicians firing patients who for not vaccinating their children. And there was actually a paper published in the American Journal of Family Medicine that said that this was a phenomenon. And honestly, it made absolutely no sense to me. The child didn't make the decision. The the the child, that child is actually at the most risk of vaccine-preventable diseases. So they're the one you should probably should follow. There's no chance of getting the vaccinated if you fire them from your practice. And it suggested the only thing useful a family doctor does for a child is vaccinate them. And so obviously that was evolving out of this reactance. This is the same thing. This is the same phenomenon. But that's what got me started on this and saying, what's going on psychologically there? And how it's easy for us to look at the anti-vaxxers and say they're acting illogically or irrationally or emotionally, whatever, all of those things that we, you know, we say perjoratively to them. But are we making those same mistakes?

SPEAKER_01 14:04

Aaron Powell I mean, part of I think what this flags to me, the conversation is you brought it up already a little bit, is this notion of reactants and thinking about back to the early days of the work that you've done right through till now. I wonder if you could tell us a little bit more about the notion of reactance and how it relates to maybe into preserving relationships or re-engaging with people. And how do we how should we be thinking about reactants as we try to connect with people?

SPEAKER_00 14:31

Yeah, I think it's at the heart of a lot of the challenges we're having now, the death of discourse, the inability to engage with people who aren't exactly like you, and that's the echo chamber phenomenon. And it really is true when it's a core belief, right? When it's an I a belief that's part of your identity. The students at the Alternative Medicine College, they that's what happened. That was a phenomenon. And I've got to give them credit for allowing us to study this and learn, right? That this is a sign that they were maybe that's the approach. They wanted the dialogue, the discourse at the Naturopathic College. I think that study actually made me a better doctor. When we have difficult patients, when we have difficult family members, they're usually difficult for a reason. Somebody may have missed something for 10 or 15 years, and they are very aggressive, and then you get your backup, and then you can't think objectively. You are no longer able to assess the case for what it is. You're you're distorted, you're subjective. When you're assessing these cases, and I've seen that's and I tell my residents, this is where you're gonna make your mistake. It's gonna be those cases. You're gonna be because they usually exaggerate something, or there's something, but there's a kernel of truth there, and you're gonna be blind to it because of your reactance. So I think it's just something we all need to be aware of. I think it's happening societally at certain respects, uh, and it can happen at the individual level as well.

SPEAKER_01 15:52

So you're so ahead, Johnson. I was just gonna say, how do how would you advise then balancing that sort of opportunistic engagement around a topic that people may not agree on versus that balancing that against the relationship itself? And how would you advise the sort of uh new docs that you might be training or maybe even society at large?

SPEAKER_00 16:12

Aaron Powell Yeah, I think there are two approaches. One you allude to in the article, the superordinate goals. Like what's above this? Obviously, with the patient and with a family member and their child, you're both still truly committed to the health of the child. Even the anti-vaxxers and pro-vaxxers, they do agree. They want children to be healthy and live. They just have a different approach to it. That's still a common in fact, they both feel very, very strongly about it. That's part of the problem.

SPEAKER_03 16:40

Yeah. It's taking a step back and trying to find common ground with the person you disagree with. It's really Yeah. It's pretty common sense discussion as opposed to flat disagreement and trying to one up each other. Trevor Burrus, Jr.

SPEAKER_00 17:00

It's tough to do, uh, right. I think the important thing, the physician's job is to take that punch in order to do the right thing. It doesn't feel good, but that's what our job is. Then people are in leadership position. That's your job. Your job isn't to exert your power, it's to make the right decision. And I have more sympathy for the patient in there or the person in the more vulnerable position. But for those of us in leadership position, that is our job. It's not to show we're right or to be powerful, it's to make the right decision.

SPEAKER_03 17:31

Right. So in terms of the like, you know, the paper was published in 2007. Is there has there been sort of additional research on this kind of relationship building and maintaining, or is it does it feel like that work that you published back then is the extent of it in in terms at least in the vaccine-related field?

SPEAKER_00 17:57

And Justin, you're probably more of an expert on this than I am, but I don't feel we're making progress. I don't think feel much progress has been made. And I think the frame is misinformation, which is pejorative already, right? You're just assuming they're wrong. They're believing the wrong thing. How do I convince them they're wrong? W which I don't I don't think that frame works. I think there's a lot of environmental scans up there, but not a lot of empirical evidence showing what can change a viewpoint. One of the interesting studies I did see that might demonstrate something that could change a viewpoint, going back to my idea of sympathizing but not empathizing, I think it was published in science that generative AI chatbots are able to move people patiently towards a more moderate viewpoint by not getting reactions and listening and not getting frustrated, and obviously having more time. And not just for vaccination, but for a variety of these sort of polarizing topics. I think there there could be some value there in trying to figure out how to use those type of approaches in the this discourse. But I I do feel we're going in circles with uh salad of the dialogue. I don't and I I mean, I think it's the evidence is we're not we're not winning. We lost measles eradication status. I I think that the canary and the coal mine are the extreme religious groups, which is literally the religious belief. That's what we had to deal with, the Mennonites. And anecdotally, what's worked there is finding champions within the community who you can talk to and can then have that trust relationship. And I think analogous approaches elsewhere would probably be helpful.

SPEAKER_03 19:44

Yeah, that I mean it's more time, more instances of just discussion, maybe more people having those discussions and having that exposure to different ideas. Yeah, I it you're never gonna have one conversation that really changes somebody's mind on a core issue like this, are you?

SPEAKER_00 20:08

No, I and you know I remember when I first started studying it, people said, Oh, it's not even an issue. Don't even bring it up. All if you bring it up, you're just gonna cause people like to bully talk about it. And we let's not even talk about it. It's just I mean, they're in charge in the US. They want. This is not a, oh, they're just a fringe. Like they're running the CDC now. They dismantled ACIP. Like how much more evidence do you need that this is a serious issue that requires different approaches? I think we I think somehow we alienated a lot of people through how we engaged on these matters. Obviously, COVID was extreme, and you got to give people a lot of leeway for things that may not have gone right during COVID because it was unusual, but I think that accelerated some of the emerging viewpoints on these topics.

SPEAKER_01 21:05

What's really interesting about some of what you're describing is uh the evidence around what might be helpful and what might work seems to be around identity, right? That either there's a if it's champions, it's you don't need to prove your identity. There's no polarization needed because you're speaking to someone who's part of the in-crowd, or this the lack of a need for self-presentation with the AI chatbots that you can be yourself, don't have to present yourself. So this sort of it positions it it raises the question of where does the where does it position the family doctor or the public health expert when in this broader landscape as if they might inherently be at risk of creating reactants? But yeah, just I guess an interesting thought around just what are the things that seem to be gaining traction and thinking outside the box beyond our our usual way of doing things is what I'm hearing from you.

SPEAKER_00 21:55

Yeah, I I think like so I you know, as you know, I we came up with The idea of vaccine, digital vaccine records, well before the pandemic, and and then we had the truckers who were protesting the digital vaccine passport. I went and talked to them. I went down there, had chats with them. I wanted to hear from them. I wanted to know. I said, okay, I brought this in. Probably may have been a risk having that. But I was open to hearing them and hearing their concerns. And there was a point that nobody wanted to talk to them. I don't think that was helpful. Because what it turned out is I think part of it was the passports, but really it was a metaphor for them being locked out of society. These were blue-collar men whose opportunities and futures were limited. And this was a very concrete example of how they had been shut out. You can't learn that if you don't talk to them. And maybe that opens up the dialogue in a different direction, if you know that. But when you say I'm not going to talk to you, well, you can just create any opinion in your head about what they believe. And there were a lot of crazy stuff going on, being on blogs about how they were militia that were preparing to take over the parliament. And that wasn't the sense I got. I before we just go and say crazy anti-vaxxers over there are responsible for this. Maybe we have to say, why have we given so much money to big U.S. corporations over the last decade to two decades and not seen, we still don't really know who's vaccinated. Like I think that would be, I would ask, people should be asking public health that question. Before they we go after saying, oh, you're an anti-vaxxer. We can there are people who want to get vaccinated, probably don't even know whether they're vaccinated or not. Like there are these simpler things that can be addressed.

SPEAKER_03 23:42

Yeah. I mean, uh so this is a this sort of speaks to the I think one of the goals of this podcast is we're certainly focused on misinformation and in in its different forms. But vaccines and immunization has always been a particular case of or a fertile ground for what I would refer to as misinformation. And we're seeing, we're certainly seeing, I think, misinformation being weaponized in a ways now that wasn't common 15 years ago. But it was, it's still vaccines have a special case in the misinformation sphere. And I'm wondering if you just have some thoughts about what is it about vaccination? What is it about vaccines and immunization that lends itself to these such strong emotions and stu such strong reactants that we see misinformation in other health spheres for sure, but not like vaccines. What is it about the vaccine particularly you think?

SPEAKER_00 24:47

So, yeah, again, I don't like to use the word misinformation because it's it is perjurative. A few aspects to this. So, first of all, you're giving something to a healthy person. In the case of pediatric vaccines, you're making a surrogate decision in many cases, where there's a requirements for vaccination. And both of those elements are can be troubling to a parent that my child is healthy, why should they get vaccinated? Oh may and then we make the argument to protect others, then we know that argument doesn't work. It's all and then they and you may be having they may be trumped in their parental rights to make a decision for their child. But I think if we look at this, when I look at where the controversies have been about vaccines, it's always the reactogenic ones. And so the smallpox vaccine obviously was pretty reactogenic. It's generally, I call it the Buckley thing, right? It tastes bad, but it works. The oral polio vaccine. The oral polio vaccine had vaccine associated paralytic polio. The wholesale protestor vaccine had uh febrile seizures. And the MMR vaccine, we published a paper, one in 180 kids will end up in a merge with anomaly, those type of reactions. So it's not crazy.

SPEAKER_03 26:06

So the treatment treatment can cause some issues.

SPEAKER_00 26:10

It's not a crazy idea that people are saying something seems to be off. There's reacting. And if you say no, nothing happened, when clearly something is happening, it's just the reactogenicity, you know, that's that can get people pretty upset. And then when they change the vaccine, you don't the controversy goes away. So the inacto polio vaccine, the acellular potassium vaccine, you don't hear people saying, oh, the major conspiracy theories around that.

SPEAKER_01 26:37

Right. Do you think that part of that is is a consequence of leaning into the numbers side of things too much on one side? That on the one hand, there's lots of stories that have a lot of emotive experiences. And then the react the the counterpoint that a physician or the public health might have is a sort of yes, but it's one in a hundred and eight that are going to get it, or one in a million. It seems to me that it's two very different ways of communicating in effect that that can land. And in a situation where people are regularly buying lottery tickets with a one in whatever, five million chance of winning something and that being significant to them, that it doesn't strike me as out of the realm of possibility that a one in a hundred seems even more likely. And so it sh are we doing ourselves a disservice by focusing so much on trying to convince people with numbers when what is really resonating our stories?

SPEAKER_00 27:31

I think there are two elements to that. One is you're giving vaccines to generally healthy people. So it's all anything is worse than they perceive it to be because you don't know what the future state is. The second is when you hit a certain vaccination rate for the sterilizing vaccines, the game theory approach, the right answer is to not get vaccinated. That is the right decision, rationally. If everybody else is, you're going to be a free rider, right? Everybody else makes a decision. Maybe I can avoid any even a residual risk and ride off the decisions of others. It's unethical or immoral, whatever other frame you want to use. But rationally, it's not irrational if you're looking purely from a self-interest perspective. Obviously, that can change rapidly, and it has changed rapidly in Canada. But you know, it the decision is makes sense to them at that time.

SPEAKER_03 28:30

Yeah. I mean uh so I everything that you're saying is consistent with the paper that you published in 2007. It's all about acknowledging the other side, trying to understand the other side, trying to understand why people can arrive at entirely different conclusions than you do. And whether you call it empathy or not, it's clearly a big that's a big chunk of how you feel we should be addressing these kinds of problems is through that understanding the other side better than we have been.

SPEAKER_00 29:10

Yeah, I think it's even more relevant. There was, I think there's an article in Nature about this. Like these antivasts can be difficult, as we know, and they can be very aggressive and vicious. And that makes that does contribute to sometimes not wanting to discuss some of these topics. So I this is all damaging to the scientific process. This is what we call a policy-oriented learning. We stop, like there could be some, there is probably some really important science here. We learned it with COVID, right? Microcardates only happen in young men with a certain dose of the mRNA vaccine. Why? Like, what's the dynamic there? Like we need to start studying this. Are there subgroups that are having adverse events and others not? Are there subgroups not responding to vaccines and others not? I don't feel there's a lot of comfort in looking at these questions because of this contentious environment we l exist in, and that is probably impeding science and maybe significant scientific discoveries that could extend beyond vaccines. Like in some ways, a vaccine is an immunologic stress test. For those that have a reaction, maybe there's something different about those people. And what is it? Maybe it's an early warning sign for something else. I'm just speculating here, but our inability to actually to just dispassionately look at these things is maybe limiting that science. And the discourse on the other side is definitely contributory to that.

SPEAKER_03 30:37

So let me follow up on one other issue, Kumina, maybe before we wrap it up, is that you were saying that you don't like using the term misinformation because you feel it's pejorative. When I at least when I'm talking about misinformation, I'm trying to link it to the scientific evidence at this at as it currently stands, because we need to be able to communicate that scientific evidence changes and that what might be tr the best possible answer now might change in the future, depending on the accumulation of new knowledge. So, how do we frame information that goes against scientific or scientific understanding now without being pejorative and calling it misinformation?

SPEAKER_00 31:26

I think uh easier said than done, and you guys are the experts in this, so I should really ask you. But you know, we're Bayesian thinkers, and I think that's what it is. So here's a mistake we made at the beginning of COVID. And it was an understandable mistake, but it was a reluctance in us on the public health side to truly reflect the uncertainty. We assumed the vaccine had sterilizing immunity. Right? We told everybody if you hit a certain rate, you're gonna get hurt immunity because it's gonna prevent transmission to other people. The end the they were saying no, it doesn't. There's no evidence of that. We immediately said they're crazy, there's misinformation, stop saying that. They were right, right? That there was limited of any sterilizing immunity. You were getting vaccinated, protect yourself, which is a very important reason. There's huge protective immunity benefits, but eliminating transmission, which is what was the basis of a lot of the mandates, that wasn't there. And but we were calling that misinformation when they were saying that. And in fact, even after it was pretty clearly established, I kept hearing some of our public health officials talk about herd immunity. And I said, Oh my gosh, we know they were now the misinformation. The misinformation was on our side, right? So I look, there's uncertainty with everything. And how much uncertainty? That's the question. How do you demonstrate uncertainty? What's the the conference intervals? I think we just need to say the, you know, I unfortunately, you know, for example, even in medicine, right? Someone said, are you sure if that's the diagnosis? Well, I have to say I'm pretty certain that's what it is. We don't know for sure, but that's our working hypothesis. As more information comes in, we will readjust and evaluate. And I think that's how we exist as humans. And continuing to think that way would probably be helpful as we move forward on these discussions.

SPEAKER_03 33:25

Fantastic. Kuhn and Wilson, thank you very much for the your time. This has been really interesting. Thanks. We need your help. Figure it out. Kuhn, it's great, right? Fabulous. Yep. I so many things to come out of it, but just uh I still come back to this notion of of empathy, right? Just no matter how strange the conclusion that the other side seems to have arrived at, they probably got there by some fairly reasonable means. And uh yeah, I just it seems to pervade all of his thought on the uh uh on the topic, right? Aaron Ross Powell, yeah.

SPEAKER_01 34:12

Maintaining the relationship or strengthening the relationship is paramount, and that's the empathy is at the core of that. The one thing, Jamie, that really struck out to me early on in the conversation was and it relates back to our work in implementation science generally, is of this notion of don't jump straight to solutions, even if those solutions seem to have seem very logical. So the the the experiment that he did with the naturopathic medicine students of randomizing seems sensible to say bring in a polio, a patient that has been stricken with polio to talk about that narrative experience and that should change their minds is a to me, it's a good example of very well-intentioned idea and tested rigorously. And a lot of the work that we do is in implementation science is to think about we can't jump straight to solutions because even getting really smart ideas, jumping right to those solutions without really understanding the setting and the decision to be made might lead to the wrong solution. And so to me, I know he didn't frame it that way, but it just seemed like a really neat example of let's just dive in there with a really clever, good idea that didn't work and had backfired. Yeah.

SPEAKER_03 35:15

And the yeah, it was clearly there were some unintended consequences there. And in in implementation science speak, it suggests that we need a dark logic model of intervening against these kinds of opinions, right? Because dark logic models are all about trying to anticipate and understand the potential unintended consequences of interventions like this. Yeah, exactly right. It's a it's kind of intervention that would that makes perfect app sense a priori beforehand. You just think, yeah, this should work. And yeah, that's what's fun about science, isn't it? You really get surprised sometimes.

SPEAKER_01 35:55

I think that's the thing, is that it's uh giving ourselves, giving our us generally society, permission for that. This is about it being okay to be wrong, and we test that wrong or rightness against what we know. And some of what we know is pretty extensive, some of it is not so much. And doesn't need we don't need to be digging our heels in reactive ways to just be right about our things. That uh I don't know how we quite give permission for people to be wrong, but I feel that's just liberating in my mind to just be able to make decisions based on what we know with the idea that we might be wrong and we just try to be better.

SPEAKER_03 36:27

At risk of seeming self-serving, I think like discussions like we want to have in this podcast are part of the solution because it puts us as scientists where we can chat and talk about being wrong and talk about, you know, where we're sure, where we're not sure, as opposed to a typical media interview where we're asked to be an expert and test say what's known. And that's a role I've never been terribly comfortable with because I am always more self-aware of the stuff that I don't know than the stuff that I do know, right? That's part of being a scientist. So yeah, I do think that these kinds of conversations between scientists talking about important sort of public health issues when this fear of misinformation is what we need to be doing, or at least part of it.

SPEAKER_01 37:30

This podcast is produced in collaboration with Podcraft Productions.

SPEAKER_03 37:34

For links to the research discussed in this episode, go to the show notes.

SPEAKER_01 37:37

If you enjoyed this episode, we'd love your support. Subscribe wherever you get your podcast, leave a review at a five star rating. It helps others find our show. I'm Justin Presseau, and I'm Jamie Berho.

SPEAKER_03 37:48

Thanks for listening.