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Op-Ed: How Not to Message the Public on COVID Vaccines

— A "cringe-inducing" public service announcement with doctors and nurses

MedpageToday

Jimmy Kimmel had a segment featuring some . It's had a mixed response. , gives his view on the topic.

Following is a transcript of this video; note that errors are possible:

Doctor: Then tell them to shut the (expletive) up.

Doctor: The glabella's right here, by the way.

Rohin Francis, MBBS: Welcome back to another night shift, except this time I'm at home, so let's hope the kids don't wake up again.

Jimmy Kimmel's show [on May 5] had the most cringe-inducing segment featuring doctors and nurses, which wasn't just an epic fail, it was exactly the kind of stuff that really undoes good work that the vast majority of healthcare professionals are trying to do, so I thought I'd do a quick video.

It's another unscripted one, I'm afraid, so it's probably going to be a rambling and incoherent mess, even though, to be honest, I've had a lot of these thoughts in my head for a while. If you saw my video a few months ago about the "Yay Science!" crowd, I threatened another video ... I don't know why I chose the verb "threatened" just then. I guess my videos are some sort of a threat, maybe, to your mental well-being ... a follow-up video about debunking and countering misinformation, so I guess consider this that video.

Now, before I get to the Kimmel clip, the wider issue I wanted to talk about is who should scientists and doctors be countering. Who should debunkers be debunking, and how should they go about doing it?

That may sound like a dumb question. They should counter anyone who's peddling pseudoscience, right? Well, in short, yes, I would agree with that. It's always a good idea to counter misinformation, but that would be an all-consuming, never-ending job, so one has to prioritize in some way, and how do you do that?

Now, this is where I probably admit my own shortcomings as a science communicator online. I'm quite impatient. In fact, my medical subspecialty has a reputation for impatience. Interventional cardiology is a field with instant results and I fit that stereotype.

I certainly don't have the patience of a saint, but many of my medical peers on social media do, people who calmly and patiently explain why even the most wild claims are not true, and I really admire them. I couldn't do what they do. I have to pick my battles with the limited amount of time that I've got.

Let's start with a non-medical example, Flat Earthers. To the vast majority of people, it's completely doolally. I don't think that many people really believe it. Now, there are lots of trained professional physicists on YouTube, people with degrees and doctorates. Should they spend their time debunking flat earth beliefs?

I don't honestly know the answer to that, and I can't imagine it's very intellectually stimulating for them, but flat earth-debunk videos are tremendously popular on YouTube. But, of course, Flat Earthers are unlikely to cause themselves or others harm in any significant way. When it comes to health, that's different.

Remember those happier times when none of us had heard of COVID? I'd often get asked to "debunk" various crazy health fads and a few things would go through my mind each time.

My first thought would be that, "Some of these would make very funny videos." Some theories are so bonkers and the people endorsing them so delusional, and often criminal, that it would make for entertaining video.

I love watching masters like Captain Disillusion dunk on some video fakery or somebody take bogus climate science to pieces in a funny way. But when we make sarcastic videos or we mock people, we're unlikely to be convincing people whose minds aren't made up already.

Now, don't misunderstand me, I'm not saying it's wrong to do that. I've absolutely done it myself, but you're preaching to the choir, it's not changing minds.

Second thought, "Do I need to make this video?" Do normal level-headed people need me to make a video to tell them that cow urine is not a wonder drug? Do they need a video from me to tell them not to drink bleach?

Surely the people who believe things this wacky are so far gone that a video from someone like me is completely pointless. If something is so ridiculous -- I guess this is kind of like the flat earth analogy -- that a debunking video can only take the form of "This is complete madness," then it's not going to convince anyone.

The third thought is, "Would I actually be drawing more attention to some of these?" Some of them are very mainstream and harming lots of people, but some of the stuff that I'm tweeted or sent is really fringe. It's like a Twitter account with 50 followers or a website that no one is visiting, so would I end up actually promoting it?

I see this quite a lot online. People find somebody shouting their quackery into the void, nobody's listening to them, but they highlight them and they share them with their large audience so that they can all go, "Ha, ha, ha. Isn't this person stupid?" But had they not done that, no one probably would've seen that quack anyway.

And my fourth thought logically follows from all that is, "Would my time be better spent debunking or challenging something else?" So how should we decide that? Should we prioritize the most damaging lies, and how is that defined? By the most people harmed or by the most dangerous treatments being proposed?

I don't know, and sorry, I think this video's just going to be me saying, "I don't know" repeatedly. Educational YouTube.

Should doctors be spending their time explaining why homeopathy doesn't work or take on more subtle misinformation like bias or fraud in journals? Should they write blog posts about why essential oils won't cure cancer or expose major financial conflicts of interest inherent to the medical industry?

These are all important things. You could argue that the latter two adversely affect far more people, but it's much harder to get those points across, and the former, I promise you, will be much more popular online somewhere like YouTube.

People love watching quacks getting dunked on and us content creators love getting those likes, but I'm not going to say that one is more important than the other because all of them could result in lives being saved, without exaggeration.

So there's no snobbishness here from me. I just find it interesting how social media lends itself to more attention being shone on some types of misleading information and less on others. There are lies hiding in plain sight that are hugely damaging.

I'm not always sure that focusing so much on alternative medicine is always the best use of everyone's time. But all of those examples that I've given so far, medical and non-medical, are pre-COVID. Of course, the pandemic has changed everything. Now, medical misinformation has the potential to kill more than ever before, and not just the believer, but anyone that they infect.

Almost all medics have found themselves having to do some form of public messaging during the pandemic, and some are better than others. There are many ways to get information across. I'm not suggesting that there's one right way at all, but there definitely are wrong ways, which brings me to Jimmy Kimmel's little segment. I think I'll just play a little bit for you.

Cardillo: I'm a doctor.

Doctor: I'm a doctor.

Doctor: An actual medical doctor.

Male Doctor: Look at all of my diplomas.

Nurse: I worked a second job to put myself through nursing school.

Cardillo: I'm 53 now, and I won't have my student loans paid off till well after I retire.

Doctor: I can name every organ in your body and tell you exactly what it does.

Doctor: Did you know there are between 60 and 100,000 miles of blood vessels in the human body? I know that because I've studied human bodies.

Cardillo: Do you know the human body has 205 bones? Well, you're wrong. It's actually 206.

Doctor: I did know that because I'm a doctor. I've cracked open a chest and manually beat a human heart.

Doctor: Oh, but you read something on Facebook?

[LAUGHTER]

Doctor: You heard what on whose podcast?

Doctor: Is he a doctor? No? Scientist? No?

Nurse: Can he name one of the ingredients in the vaccine?

Nurse: Can he point to his glabella?

Doctor: Then tell him to shut the (expletive) up. The glabella's right here, by the way.

Cardillo: Remember that polio shot we gave your kid and then your kid not getting polio? Well, those two things are related.

Nurse: How about this? You do your job, I'll do mine.

Nurse: Get the vaccine.

Cardillo: Get the vaccine.

Doctor: Just get the vaccine.

Doctor: Grow the (expletive) up and get the vaccine.

Doctor: And tell your friend on Facebook to stick to jewelry.

Jimmy Kimmel: Thank you, medical professionals.

Francis: Something like this reminds me that late-night TV shows even still exist. I don't think they've ever been less relevant. Indeed, a cynic might say this was a deliberate ploy to get people talking about the show again, but I've got to say I've got a soft spot for Jimmy Kimmel. He has fundraised and campaigned for healthcare change in the U.S., shared details about his son's serious heart condition, he's recently helped Mark Rober raise millions for people with autism and intellectual disability, and for personal reasons, all of these causes are very close to my heart -- pardon the pun -- and I think I can see how something like this happens.

You can tell that the doctors and nurses are reading. This was scripted by Jimmy Kimmel's writers. The gags are painfully typical of a writer's room full of millennials trying to write medical jokes by looking up "10 Crazy Medical Facts," and they wrote a bit and they thought, "Wouldn't it be funny if we get doctors and nurses to read this out?"

But what might seem funny to a non-medic who is already convinced and believes that the vaccines work and are safe, like a sassy doctor saying, "Shut the (expletive) up" just ends up sounding painfully embarrassing when said by an actual doctor.

I have got a small degree of understanding in how this works. I took part in a campaign by MediaWise, which is a nonprofit that helps people try to avoid misinformation. Now, that video wasn't intended to be funny or anything, but it wasn't condescending, it wasn't patronizing, and even then the script that I was sent just didn't quite sound right when I read it. From memory, it said something like, "Listen to the experts like me."

Now, "Listen to the experts" is a good message. One of the saddest aspects of society is how the press and politicians demonize experts and expertise. But saying "Like me" just sounded weird, so I cut it out. It gave the impression of an argument from authority, "Listen to me, look at my qualifications, I'm right and you are wrong," which I think is the main problem that people have with the Kimmel bit.

I always try to see the other side. So after tweeting about it ... I looked for replies that disagreed with me, and some said that this is comedy and anybody who thought otherwise is a moron.

I'd be quite interested to know if the people defending this as comedy would also jump to the defense of jokes by people like Louis C.K. and Dave Chappelle, or anyone on a Joe Rogan podcast. I suspect they wouldn't. You can't have it both ways, but that is an aside. I digress.

Now, as someone that's attempted to tell jokes on stage and who is an absolute comedy nerd, believe me, I'll always defend pushing the boundaries of humor, but a golden rule is you've got to be funny, and doctors using humor to express frustration, which we all know and understand happens behind closed doors -- and by the way, I'm not advocating thought police.

I enjoy gallows humor probably more than most as a coping mechanism, but it just sinks like a lead balloon on a public platform. There's nothing less funny than someone saying how great and smart they are and how dumb you are, which is why standup comedians don't come out and brag. They're self-deprecating.

Even if it was meant as a skit, it's more than enough ammunition for the anti-science, anti-vaccine, anti-doctor brigade to hold up and demonstrate what they have said all along, that doctors are condescending, rude, arrogant, paternalistic know-it-alls. The butt of jokes on my channel, for example, are con men peddling expensive treatments, evolution, myself, the English language, other doctors, or lame-ass organs that don't do anything, but never the patient.

One of my friends from across the pond said that I was being a snowflake and explained that I don't fully comprehend how aggressive and reprehensible the anti-vaccine crowd is in the States. A pediatrician online said that I was tone policing and lacked expertise, and maybe all of that is true.

My friend asked, "Do you think being nice and civil will convince anti-vaxxers?" I said, "Of course some people simply won't be convinced no matter what we say, but I do think that there are some floating voters who can be helped in the right direction, and I definitely know that this PSA will not convince anybody to get vaccinated, but it'll reinforce prejudice against the medical community."

So it's got zero chance of helping people get vaccinated and at least some chance of helping those who are against the vaccine. Right now, I'd say that that is a balance that's too far, even for the thing that I hold most dear in this world, comedy. Oh, and my family. Maybe I just don't like it because the doctors in the video just come across like complete and utter, absolute bell-ends on video, and that's my job.

, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won't find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.