Susannah Fox: Rebel Health

We’re excited to welcome to the podcast Susannah Fox, a renowned researcher who has spent over 20 years studying how patients and caregivers use the internet to gather information and support each other. Susannah has collected countless stories from the frontlines of healthcare and has keen insights into how patients are stepping into their power to drive change.

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Susannah recently published a book called "Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care." In it, she introduces four key personas that represent different ways patients and caregivers are shaking up the status quo in healthcare: seekers, networkers, solvers, and champions.

The book aims to bridge the divide between the leaders at the top of the healthcare system and the patients, survivors, and caregivers on the ground who often have crucial information and ideas that go unnoticed. By profiling examples of patient-led innovation, Susannah hopes to inspire healthcare to become more participatory.

In our conversation, we dive into the insights from Susannah's decades of research, hear some compelling stories of patients, and discuss how medicine can evolve to embrace the power of peer-to-peer healthcare. As you’ll hear, this is a highly personal episode as Susannah’s work resonates with both of us and our individual and shared health experiences.

Let’s dive into our conversation with Susannah Fox.

Transcript (automatically generated by Apple Podcasts):

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Please check out all of Artificiality at www.artificiality.world.

We are excited to welcome to the podcast Susannah Fox, a renowned researcher who has spent over 20 years studying how patients and caregivers use the internet to gather information and support each other.

Susannah has collected countless stories from the front lines of healthcare and has keen insights into how patients are stepping into their power to drive change.

Susannah recently published a book called Rebel Health, a field guide to the patient-led revolution in medical care.

In it, she introduces four key personas that represent different ways patients and caregivers are shaking up the status quo in healthcare.

Seekers, networkers, solvers, and champions.

The book aims to bridge the divide between the leaders at the top of the healthcare system and the patients, survivors, and caregivers on the ground who often have crucial information and ideas that go unnoticed.

By profiling examples of patient-led innovation, Susannah hopes to inspire healthcare to become more participatory.

In our conversation, we dive into the insights from Susannah's decades of research, hear some compelling stories of patients, and discuss how medicine can evolve to embrace the power of peer-to-peer healthcare.

As you'll hear, this is a highly personal episode, as Susannah's work resonates with both of us and our individual and shared health experiences.

Let's dive into our conversation with Susannah Fox.

Thanks for!

Susannah, thank you so much for joining us.

We're excited to talk to you today.

Thanks for having me.

Love it if you could start off by telling us what inspired you to write this book.

After 20 years of collecting field notes and talking to people about how they use the internet for healthcare, I realized that I was the keeper of stories.

I was the keeper of so many people's stories that matter.

And I had gotten invited into boardrooms and the C-suite of healthcare, and realized that not a lot of people at the top of the pyramid of power of healthcare have had the privilege that I've had of spending so much time talking with patients, survivors, and caregivers.

So I wrote this field guide to introduce these two groups of people together, the leaders of healthcare and the people on the front lines, the patients, survivors, and caregivers.

That's awesome.

Perhaps for readers who haven't read the book yet, although we hope that they will, can you walk through the four personas that you introduce in the book that's sort of the structure of this community?

Sure, and I'll give a little background about why I wrote it that way.

In looking back, in looking for patterns in the interviews that I'd done and the surveys that I'd conducted over 20 years, I discerned a few key patterns.

I actually first thought that I was going to write a book about the innovation pipeline, about how products and services move through a pipeline toward launch.

And I realized that it was actually more interesting and important to talk about the way that people step into their power in different ways in the Patient-Led Revolution.

The first group I identified are Seekers.

Seekers are people who realize that their questions are not being answered.

They're not getting the information that they need.

And instead of just taking it, there's some spark happens to them, and they go out on the hunt for more information, and they do not give up.

The second group are Networkers.

Networkers are people who learn in community, who, when they find something that works, they can't wait to share it.

But Solvers are people who can't help but take apart a device that's not working for them.

It could be a medical device, it could be an assistive device.

They're also Inventors.

They're people who say, there could be a better way of doing this, and I'm going to figure out how to make it so.

Solvers also attack problems in systems.

The fourth group emerged from my interviews, actually, with the first three groups.

Seekers, solvers, and networkers all said, what really made the difference was when someone stepped forward who had access to power, who had access to resources that we did not have access to.

And I named that group Champions.

Champions are people who have access to funding or regulatory guidance, materials, or labs, or manufacturing facilities.

And they spot a patient-led team that is ready to scale their product or service.

I'm finding it interesting to just to reflect on these.

I'll jump into the personal connection because I think it frames how I'm thinking about it.

So it's fair to share.

A few years ago, at the very beginning of the pandemic, I was diagnosed with ankylosing spondylitis, which for those who don't know, because it's not a very common disease, it's a autoimmune and autoinflammatory disease.

It's part of the rheumatology world.

And what I found so powerful about the way you are structuring this and thinking about it as patient-led, partially was personal in that I had suffered from the conditions of AS for perhaps a decade.

No one had put anything together.

And then all of a sudden, my eye doctor found it, which is a longer story, but it's not an uncommon thing apparently for AS, that that's how it goes.

And then I go to my GP and he says, well, I really don't know anything about it.

So you're going to know more than I will.

And the ironic part is Helen was sitting there with me and she looked behind him and on the door, there was a big poster and she says, it says Ankylosing spondylitis on the poster.

And he turned around and said, yeah, don't know anything about it.

So it became this journey of somewhat patient-led.

And I've experienced a variety of the kinds of people that you talk in these personas, maybe not directly, but I've seen it in the community as people have driven forward to bring communities together to solve problems, to try and champion new things around, especially I'm very aware of the legislation around drug pricing and those kinds of things.

So it was a very interesting sort of personal connection in reading your book, because I would imagine that there are lots of people like me, mostly because a lot of what happens, and I know you've talked about this also, is there are people who are, they're sort of the visible and the invisible.

When I first read that, I thought about the invisibility of the condition, because that is a challenge, right?

We talk about the silent warriors of chronic ill who no one can see.

Perhaps I'm trying to open up and be, maybe allow myself to be more connected and your book has inspired that by being more public about that.

But thank you, but I appreciate that.

And I'm interested.

I'm curious when you, in all of your interviews, do you have a way of categorizing the people that, not just the personas, but who among us are part of these crowds?

Like how else can we identify and think about them?

Is it based on the kind of condition?

Is it the socioeconomic or demographics?

Or like what kinds of ways do you identify and see and find these people?

I don't discern any patterns in terms of demographics.

What emerged from my research and then re-interviewing and doing fresh interviews with about 100 new people as I wrote the book, I realized that it depends on the problem they're trying to solve.

So if they are at the beginning of a journey where they don't yet have a diagnosis, they have a constellation of symptoms that they're trying to figure out, or they have a new diagnosis, the problem they're trying to solve is one that a seeker can help with.

And I want to immediately say that if someone is ill, they may not have the wherewithal, they may not have the energy to step into the role of being a seeker.

And that's when a loved one can step in.

That's a great role for a friend who lives far away, but is really great at online research.

They can help a family or a friend by becoming a seeker on behalf of that person who's sick.

And so that's immediately one problem that needs to be solved.

Once you have a diagnosis or you realize that Dr. Google or Dr. Reddit has returned all of the information that's possible, that's when you realize maybe it's time to join a community.

And that's when becoming a networker is a good idea.

So for every kind of problem that you might face in your medical care, that's when you might need to either become or recruit to your team a seeker, networker, solver, or champion.

How do you think about the challenge of finding good information among those networks?

You know, we've not just in health, but around the world, we've seen how the ability for anyone to contribute content to the internet, you know, gone are the days that you have to be inside a large media organization to be able to put something on the internet, anyone can post anything.

And so, veracity, you know, relevance, context, those kinds of things can elude us.

How do you think about an individual being able to process that and understand that?

I like to talk about new frontiers in, with a hopefully reassuring metric, which is that there are some things that are very new, and there are some things that we can use the old tools.

And an old school way of fact checking is to make sure that it's coming from a reputable source.

Or if you see something that is posted on an online forum, you can go and see if it's also sourced somewhere that you can truly trust.

You can also tap into another old school resource, which is when the stakes are high, I do recommend talking to, for example, a medical librarian.

A medical librarian can help you navigate this stuff.

I also really believe in open source, open science publication.

The more that we flood the zone with science and make sure that medical journal articles are available and free to everyone, the more likely we are to be able to bat down the incorrect information.

When it comes to disinformation, I think we really need to be on our guard.

This is not just about health information.

This is about all kinds of information.

And we need to get our wits about us before it becomes very easy for, for example, people to use artificial intelligence to create a whole blog or story or Facebook posting that just isn't true.

The space where I have worked for the last 20 years is one in which there's such thing as the medical journals and clinical advice, which is very important, but there's a whole other half of the world, which is known as a community consult and the idea that patients and survivors and caregivers know things that are outside the view of mainstream health care.

And those two things together, I think, are going to form the best basis for decision making.

However, we need to guard against the possibility that people are going to be able to start making things up and have it look very, very credible, have it look very, very human.

And that's a threat to the Patient-Led Revolution.

Sure.

I'm waiting for the next degenerative AI doctor that comes up with the next new whatever text that people attach to and get excited by.

You can see how that could happen.

Do you have any favorite stories about the champion persona that you'd like to share?

I have so many, but I will share one that focuses on the National Breast Cancer Coalition.

When women decided that breast cancer was not getting enough funding and they lobbied Congress to win more funding directed at breast cancer, Fran Visco, who was then the new head of the National Breast Cancer Coalition, went to talk with the director of the National Cancer Institute and said, we want patients to be at the table when you decide where to direct this funding.

And he said, absolutely not.

And she then said to Congress, I would like the money to be directed at the Department of Defense because Major General Richard Travis of the DOD had recognized an opportunity to expand the program that his operation ran in cancer research and he aligned his mission, the Army's mission and the Department of Defense's mission, with the mission of the National Breast Cancer Coalition because people in the Army understand that there's often information flowing on the front line, downrange as they say, that is important and that is out of the view of the generals back at home.

And he saw that opportunity, he saw the opportunity that people who were living with breast cancer were like people living on the front lines and we needed that intelligence in order to direct the research dollars in a way that really made sense.

And so in that way, Richard Travis stepped into his power as a champion and made sure that the breast cancer patients had a home at the DoD.

And it's now a wonderful program and has expanded beyond breast cancer into other types of research and patients, survivors, and caregivers are always at the table when they're deciding where to put that money.

I'm curious about how this, you've been in this a long time, 20 years of research, and this all sits inside of a broader system of erosion of trust and institution, of change in the way that expertise is viewed, of obviously the interconnectedness, hyperconnectedness, the internet and social networks, the rise of Google where you just sit there and press, refresh, hoping to get a different answer.

And so it's pushed a huge amount, I mean, it's about autonomy out into the edges of the network, the patient side of things.

But it comes with that there's not all good news there.

It's the fear of you can spend a lot of time trying to research something that at the end of the day, it doesn't actually apply to you because you missed something.

You didn't know.

You're not a doctor.

You're not an expert.

I remember seeing some quote somewhere.

I think it was on social media when I was going through treatment.

What is it about your Google search that makes you think that my EMD is no longer relevant?

How do we get that balance right in the system, especially when at the same time we're seeing this huge decline in statistical literacy and math literacy?

If you pick up a science, I read a lot of scientific papers, including some medical ones, but a lot of scientific papers, everything's underpinned by statistics.

There's a lot of people that don't even really understand that correlation doesn't equal causation.

So how do we protect people from overly researching things that don't actually apply to the need, the perspective of an experienced physician?

Thank you so much for this question because it lets me say that all of the people that I feature in Rebel Health are pro-social and pro-science.

They all consult with clinicians, and they all do their best to fact check and make sure that they truly understand the science behind what they're dealing with before they take a step forward.

However, people are also feeling left out.

People who are dealing with conditions that are invisible to mainstream health care, or people whose needs are not being met, for all sorts of various reasons.

And what's really important is in the model that I am bringing forward, it's up to the people to decide if their needs are being met or not.

Just because you're given a prescription doesn't mean that your needs are being met.

If you have questions, then your needs are not being met.

And it's a mark of a healthy online community of peer-to-peer health care.

If people are more likely to be talking about what questions should I ask at my next appointment rather than what answers am I bringing to my doctor's appointment.

It's so often the case that people, when they get a new diagnosis, feel completely alone, completely at sea, like they don't even know how to spell the condition that they are told that they have.

And Dr. Google can help with the beginning of that conversation, but also a peer-to-peer health community can really help you with, again, the questions that you're going to ask.

And I think that's essential, that people are not going to go off on their own and do a completely do-it-yourself therapy.

People are always in, again, in my book, we're talking about people who are always also in consultation with clinicians.

Yeah, so there's a baseline in your book of evidence-based science, citizen science in that respect, and the networks and the personas are all about how do you educate yourself so that when you go in to see your clinician, you're asking good questions as much as anything.

Then one of the pieces of advice, I grew up in a medical family, and so we had privileged access because my stepfather would call one of his friends who was a consultant and things would happen.

I realize that that is not how most people have access to health care, and even more so today and even more so in the US as opposed to where I grew up.

But I think it's a, you know, I counsel my children when they go to, you know, my adult children, when you go to see the doctor and you're going to be scared, you're going to be vulnerable, at the very least write down your list of questions before you go in because you will guarantee to forget.

And what you're saying is expand that with a greater depth of people connected to that who bring various perspectives, a diversity of how they've looked at the research, a diversity of their own networks, and have a better list when you walk in.

That's kind of how you describe.

Yeah, and the other thing that peer-to-peer healthcare can help with is a way to describe your symptoms so that doctors will be able to hear you, so that the language that you use, you can gain from a peer who has the same symptom or the same diagnosis, can help you describe the symptom in a way that will make clinical sense.

So that's one strength.

Another strength that you can get from being part of a peer-to-peer network is you can borrow courage.

There are a lot of people who are very afraid to go to a doctor's office or go to a hospital.

We feel very vulnerable.

How do we find the courage to ask the questions or find the courage to ask, do I need to get a second opinion?

And that's something that I saw in my research, that people can borrow courage from each other as well as gaining the understanding of the language that can unlock a diagnosis.

And if you don't have that background, you might otherwise not be able to.

What's the experience of people in power here?

What's the, excuse the pun, what's the healthy relationship to have with a clinician if you're in this world?

How would you expect them to respond?

I had an interchange with one of our daughters who was very frustrated with a particular interaction with the clinician.

She felt she wasn't seen, she felt she was told off or something, and was quite surprised at the level of her own reaction.

But it's like, how do you go in and what would you expect on the other side of the table as a healthy interaction?

I think there is an emerging model where clinicians expect patients to participate as equals in their own care.

And what you can do is do your homework, prepare for that appointment like you would prepare for an important meeting.

And I think that the way that I hope clinicians see, and some pioneering clinicians have seen this for many years, that this is an opportunity.

The Patient-Led Revolution and peer-to-peer health care are opportunities for all of us to learn, to try to erase the blind spots that we know exist in medical care and in scientific research and to learn from people about what their real concerns are.

And the more that we can bring that kind of equality and balance of power into the relationship, the better.

How do you, as you talk about this book and your research and your advocating for this, for change, how do you balance patient-led and sort of self-discovery and solvers trying to come up with new ideas that work for them with what can become, we call it as woo, you know.

And I've gotten plenty of recommendations of, oh, no, don't take the medicine, just eat this one spice or something, right, like these kinds of things.

And there's something about, like, I'm firmly on the science-based side.

At the same time, finding courage from a community is really helpful, finding innovative ideas, things that might be non-prescription.

I've changed my diet.

I've focused a lot on stress reduction because stress creates flares.

You know, those things are real, but then there's these other things that I think are just kind of fantasies.

And I wonder whether you get, whether those things somehow get conflated as you tell this story, is that some people could expect the sort of, you know, fantastical thinking, and that's what you're advocating for when it's really the opposite.

You're not advocating for fantastical thinking.

Definitely not.

I am, again, I personally am very pro-science, and the people that I profile in the book are very much on that side.

And I will draw people's attention to something called personal science.

It's also, the Quantified Self Movement is part of personal science.

And it's this idea that if you have a mystery that you want to solve about your own health, you can find the tools, you can learn the ways of scientists to conduct N of 1 trials at home and make small changes and measure to see if it makes a difference.

So often people are dealing with issues dealing with health issues that can be solved by, for example, figuring out how to get a better night's sleep or figuring out the best kind of exercise for your level of fitness, figuring out what are the foods that seem to agree or disagree or actually cause a flare for me.

So much of health is personal.

And we now have so much more information about how to conduct personal science and figure out at home the simple changes that we can make, as well as the more complex changes.

I talk in the book about people who were able to create a do-it-yourself open source artificial pancreas system.

And they're using medically approved algorithms to loop together a continuous glucose monitor and an insulin pump.

But they make sure that it really works for their body, for their diabetes, for their blood sugar management.

And that is super exciting because diabetes, for example, is a really, really individual disease that requires constant management.

But a lot of us live with health issues that require constant management.

How might we start to become a nation of solvers, a nation of people who understand how to track symptoms so that we know when we're sick, so that we know when something is working?

That's my hope.

I like that idea because each of the kinds of ideas that you'll read may be working for some, but it doesn't mean that they work for you.

And allowing that to be an okay equation on both sides is important.

That this works for me, it may not work for you is a nice way of making a recommendation.

So if you had a magic wand, just to throw out fantastical thinking, what kind of big picture structural changes, what would you advocate for?

I would say that anytime someone visits a doctor and gets a new diagnosis, they should immediately be recommended a community or a health peer.

And they're actually doing that in National Health Service in the UK.

They're called Link Workers, people who work at a doctor's office who help connect someone newly diagnosed with a community of people who have that same condition.

So structurally, I would like to see that become the way of the world so that people aren't going home and going on Facebook or going on some other social media platform and doing their own search, hoping to stumble into an expert patient community.

We should help people with that.

So that's one structural thing.

I also think that patients and survivors and caregivers should become part of product teams.

Anything having to do with health care delivery should have patients and survivors and caregivers on that team.

I think that right now we're leaving half the team on the bench by not bringing people into the conversation.

Anyone who runs a hospital, you should not only be listening to the nurses and doctors and people who work in the cafeteria, you should be asking the caregivers who spend so much time in your hospitals about how to improve care.

Same thing is true for drug development.

A lot of clinical trials don't go forward because they can't recruit people to be part of them.

And that's because very often the clinical trial is designed by the clinicians.

Not with patients in mind.

How can we make this easier on patients?

How might, for example, the blood draws happen at home?

How might we empower people to do the tracking of symptoms at home and not ask people to travel for a very short appointment just to collect some data?

Speaking of data, because we have to, have you seen any stories or data or promises even of being able to discover scalable modes and scalable patterns of interactions that actually work that can be generalized across a broader group of patients, or things that are discovered from the edges that are more scalable and useful, whether it could be something as wonderful as cure, quote unquote, a treatment, or that's worthy of further investigation, or something that just sort of works in terms of a pattern of interaction.

There's good news, and that is we have about 40 years of evidence that shows that peer-to-peer health care connection with other people like you helps immensely in behavioral health.

So in the United States, the VA, SAMHSA, the American Psychiatric Association, everyone acknowledges that peer support is a valid way for people to deal with behavioral health issues.

And that is in, whether it is serious mental illness or substance use disorder recovery, eating disorder recovery, management of depression, we have so much evidence in behavioral health that connecting with other people like you can make all the difference in the world.

And so that's a pattern that I would like to see spread to other conditions.

I think also diabetes is another area where there's a deep and wide evidence base that connecting with other people who have the same diagnosis can again, you not only can gain emotional support and say, I'm not in this alone, but you gain tactical strategies for living with a condition like diabetes.

How might we spread that to people living with heart disease?

How might we spread that to other very common chronic conditions that do not yet have that deep tradition of connecting people peer to peer?

So much of the book and so much of the work you've done points so strongly to the power of being in connection with another person.

It's not about a connection to a machine.

It's a genuinely human, as Dan Denner would say, intentional stance.

You know that someone's suffering like you.

You know their conscious experience is some phenomenological experience of whether it's pain or emotional or physical pain.

The fear, that's what was critical for me.

My diagnosis was actually just confronting the sheer fear and uncertainty.

And having another person who is absolutely in that same position really matters.

So something you could, you know, how far could a machine go to replace that?

Putting another spot here.

I appreciate the question because it brings up some advice that I got from a mentor who said, you, Susannah, are irrationally optimistic.

And you are also someone who can't help but talk to strangers.

I chat with anyone everywhere.

I love meeting new people.

And this mentor said to me, not everyone is like you.

There are a lot of people out there who are pretty suspicious, who might be introverted, who may have had a bad experience.

And they're not going to be eager to connect with other people.

And she said, what do you have to say to them?

When you look at your research, what do you have to say to them?

And I appreciated that critique because it allowed me to broaden my view to include, for example, seekers and solvers who don't want to be networkers, who don't want to join a community.

However, they could benefit from, for example, listening to a podcast where someone tells their story or reading a book or reading a blog where they can immerse themselves in someone else's story that parallels their own.

And that's a way that they can gain courage without having to talk to anyone or join a community if they don't want to.

And I could see to sort of pick up on your question, it might be possible to have a machine, an AI that has maybe some of the sensibilities of Pi, but is well-versed and trained on people's stories, to be able to share some of those to be a comfort.

I find myself feeling like it's not, it's always the struggle of could it actually ever replace a human who can truly empathize?

Probably not.

But might it be something that could be helpful as well?

Just to have somebody there that you can chat with.

It might be interesting, for instance, for a patient to be able to journal their experience and to have an AI respond back to it.

Just to have a little affirmation, to have a little response, to reflect on patterns that the individual may not see, but they might be documenting through a journal.

Because an AI is quite good at seeing patterns that we can't see.

It could relate those patterns to other things, help them in their journey of seeking to go understand other things.

You could see how that might be something that could be helpful, although never replacing the role that each of us have played with each other as caregivers.

I would not find the same comfort.

I'm going to kind of munch two questions together here, or two ideas together, or two points of my own curiosity together.

One is your original background as an anthropologist, which I always find fascinating when it comes to complex systems, because anthropologists bring an integrated human-centered view that's often quite unusual, and have some interesting techniques.

But they're also concerned a lot, from what I can tell, with power and shifts of power.

This is kind of the ultimate shift in power in many respects, because when you are newly diagnosed, and if you are sick at the same time, and feel pretty horrible, and can't think straight, and then on the other side of the desk is someone who is well, and who has all of the knowledge.

How is this power balance changing in our modern world, and where do you think it's going to go?

What's the sort of anthropological explanation or description of this general power shift that's kind of underway?

Well, I would love for more people to study anthropology because I do think it's a way to be professionally and politely curious.

It trains you to enter in a community with humility and to listen first, which helped me immensely as a researcher, to listen to patients and survivors and caregivers.

Before I ever asked a question, I would always spend time listening.

And the power imbalance that you, the picture that you just painted is so stark, this idea that someone is very ill, they might actually just be wearing a gown, it might even be made out of paper.

They're sitting there in a doctor's office with someone who's fully clothed and standing and has all of the knowledge and power behind them.

And that picture shifts if you think about that that patient is not alone.

They have people who love them, who are surrounding them with information that they with their phone can be recording or they could be FaceTiming.

There could be a group of people who are virtually with them in the room.

And that immediately creates a shift in power because when you are alone, you are vulnerable.

But when you are together with your loved ones or with your community, especially if it's a community of expert peers who have been through that diagnosis, who have been through that treatment and are going to be with you every step of the way, giving you advice, then you can start to sit up straighter, ask better questions.

And that for me is the hope that no one feels alone.

One of the things that I like to say is that there are people who would love to help you if only they knew how to find you.

And it's up to us to step into our power and to also help people connect with a peer community when they need it.

And to the doctor who seems to be holding a lot of power in that situation, they're going to want to hopefully in the future share their power.

They want to be able to explain what's happening or at least know that that person is going to go home and do the research that they need to do to better understand.

And sort of keep...

I think it was Richard Dawkins.

I'm not sure if it was Richard Dawkins, but I'm pretty sure it was Richard Dawkins who said that the minute alternative medicine works, it ceases to become alternative medicine and just becomes medicine.

I'm pretty sure that was him.

I think it was a great quote.

What have you seen in the research and in your own research about the power of these groups to keep people grounded in reality, to not be thrown around by the spice of the day that's going to be the cure, and also the power of placebo, which clearly is a very real effect and can be hugely advantageous?

How do you think about that sort of morass?

I'll talk first about the staying grounded in reality.

There have been some wonderful studies of online communities where they do analysis of the material that's posted over a period of time in an online community.

I'm thinking here of one study of a breast cancer forum that found when misinformation, when false advice, when bad advice was posted, the community actually swarmed it, like antibodies swarming a virus.

And within hours, that information was taken down or explanation of why it was wrong was posted underneath.

And it was just a very few postings of bad advice slipped through the cracks.

That's the kind of peer-to-peer healthcare community that you really want to be part of.

You want to be part of a community that's very active and that can cite their sources and is likely to attack the bad information that gets posted.

Now, unfortunately, there's so much information that's flowing by that you could dip your cup into the river of information at just the wrong moment and read a posting of false information.

And that's where we have to take responsibility for ourselves and fact check everything that we see before we take action.

Regarding the placebo effect, I am very intrigued by it.

I don't have research related to it, but I think that it's definitely an area where I think personal science could again play a role, where people are able to measure for themselves really what happens when they're given the opportunity.

I find that to be a fascinating area, especially when you have a complex condition like mine that is inflammation can be caused by all kinds of things, and stress is one of them.

Including thinking about your inflammation.

Including thinking about it, exactly.

And so you end up with there's so many alternative choices that you can make, and I don't mean alternative in the world of alternative medicine, but although that is maybe perhaps the same in that there's so many different ways that the body works, it is a truly complex system, and how you and your body interacts with the world around you is also a complex system.

And so each individual has their own pathway.

I want to thank you for joining us.

This has been really fascinating.

It's also been very personally nourishing.

Very happy to have your book out there to validate and encourage the personal connection and the power that a caregiver gives to help, you know, reinforce that for people.

And the value of good questions.

And the fact that people can help you ask a better question, which is awesome.

So thank you very much for joining us.

Thank you.

And I want to say thank you for being caregivers.

Thank you.

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