Health Misinformation on the Internet: Google/YouTube’s Garth Graham on Their Efforts to Stem the Tide

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[Music]
Female: Welcome to Conversations on Health Care with Mark Maselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care, delivery and the great minds
who are shaping the healthcare of the f uture.

This week, Mark and Margaret speak with Dr. Garth Graham, Director
and Global Head of Healthcare and Public Health Partnerships at
Google / YouTube, where he oversees the creation of credible health
content, aimed at overriding misinformation , circula ting on the
internet . Ensuring that YouTube's , two billion users per month can
trust the medical information they're accessing on the platform.

Dr. Graham has long advocated for health equity for all, and serving as
Deputy Secretary at HHS and Director of Community Health at C VS
Health.

F act C heck.org ’s Managing Editor , Lori Robertson joins in, check ing
misstatements spoken about health policy in the public domain
separating the fake from the facts .

And w e end with a bright idea that's improving health and w ell - being
in everyday lives. If you have comments, please email us at
www. [email protected] or find us on Facebook, Twitter, or
wherever you listen to podcasts . And y ou can also hear us by asking
Alexa, to play the program. Now stay tune for our interview with Dr.
Garth Graham here on Conversations on Health Care.

Mark Masselli : We're speaking today with Dr. Garth Graham, Director and Global
Head of Health c are and Public Health Partnership at Google / YouTube,
overseei ng the creation of credible health content , in partnership with
multiple health institutions.

Margaret Flinter: Dr. Graham was the Chief Community Health Officer at CVS Health,
and before that he was President of the Aetna Foundation. He was
also the Deput y Assistant Secretary at the U . S . Department of Health
and Human Services under Presidents Bush and Obama. Dr. Graham, we welcome you back to Conversations on Health Care today .

Garth Graham: Thank you. Thank you guys for having me again , it was so much fu n
the l ast time .

Mark Masselli: Yeah, it was great. And Dr. Graham, YouTube is as you know, spearheading this effort, really at a great time, when so much misinformation has dominated the narrative about COVID - 19 on the
internet . And y ou've been tasked wit h leveraging the massive
audience of YouTube. And I am always amazed when I hear this
number, two billion users per month r eally to provide vetted , reliable,
science based information to a public that's quite hungry , n eedless to

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say, how many clicks there are coming your way every day . Tell us a
little bit about who your partners are in this endeavor? And how did
you come about taking down this really important task?

Garth Graham: Yeah, I'll start with myself first, and then back into our partners, which
ar e so much more important. So I have just always been, like you and
many of the folks on your show, I've always been obsessed with this
issue of community health and impact and being where people are,
and being , kind of doing the thing that could impact the most people ,
and bring the most positive, certainly positive health impact , not
positive impact overall.

So for me, part of this, what drew me to this role , was again, the
impact , the amount of folks who visit the platform looking for health
information . A nd you know the ability to make a difference in so
many people's lives across the world. So I think, for me, it was this
ongoing, I would say , magnetism or attraction to this idea of
community health impact and reaching people where they are.

Now I think, quite frankly, I don't , I'm not the owner of that idea.
Because certainly I think a lot of our partners feel the same way. And I
think that's why they ha ve decided not to work with us. So, the
American Public Health Association, given that their onus on p ublic
health domestically, the National Health Service, CDC, you know, all of
the different folks have been working with over the past a year , to
bring the health information to scale, I think, share that similar
viewpoint.

Margaret Flinter: Well, Dr. Grah am, two billion people well that's a lot of people. And it
is a reality for anybody who i s in healthcare today, sort of on the
delivery side that we know that before patients come and talk to us,
they ha ve probably already talked to Dr. Google about whatev er the
concern , the symptom or the medical condition is . But with COVID,
there has just been so much misinformation for people to sort
through and of course, a lot of new information because it's new,
sometimes changing. How are you formatting the YouTube COVID
content to leverage the internet's influencers , to get the message
across that we're trying to get across , to billions of people really all
around the world , we tend to think of this as , I tend to think of it as
national but this is really a worldwid e phenomenon that you're trying
to influence?

Garth Graham Yeah, what I like to think of is , gone are the days in public health
where people are looking for information from a flyer or looking to
learn about health and public health from a billboard . They' re looking
for it in the palm of their hands . You know people ask questions, they
wake up at 02:00 AM in the morning , worried about something .
They're not go ing to, they are going to look it up, and they a re go ing
to try to find a source of information tha t hopefully is factual.

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So our goal was to marry the evidence base and the science with the
engagement. So reali z ing that there are a lot of places where,
particularly on YouTube, where people go to , for information and
other things . So what if we could pr ovide evidence based information ,
to folks when they a re looking for questions . You know, who would
have thought, guys that Messenger RNA is going to be a topic at the
dinner table .

Margaret Flinter: 100 %, yeah.

Garth Graham: Yeah, the ability of video to kind of take complicated piece of
information and make it digestible in this way where you utili z e the
influence of the audiences that people have , to bring engaging
information is I think part of like what attracted me, but also part of a
lot of what we'v e been doing during COVID. So I think my goal, I think
our team's goal is to really bring the science out of Ivory Towers and
into people's palms , and into their conversations. And really just kind
of revolutioni z e the way science gets to the public.

Mark Masselli: Well , that's great. You know Dr. Graham, close to 70% of the
population has had at least one dose of the COVID vaccine in this
country. But the anti - vaccination movement is formidable force. You
know, Margaret, I don't remember if it was Dr. Ashi sh Jha or Dr. Peter
Hotez who said to us, “ The biggest battle we have right now, the
biggest fight that we have in our country is the internet. ” And that
was tel ling because these are science people who were at this point
worried about the vaccine and the distribution. And YouTube has
been a hotspot for such activity in the past. And we've seen such a
dramatic rise in vaccine resistance, as the COVID vaccine is now rolling
out all across the United States. Talk to us about your strategy for
countering some of that messaging.

Garth Graham: Yeah, the important thing here is to get science to the public at scale.
So what we've done is we've worked with, we actually just did
something with President Biden and Dr. Fauci and some YouTube
creators , as an example . W e've been doing this with Dr. Fauci, actually
last year since the beginning of the pandemic . Where we try to bring
information to people at scale from science - based viewpoint, but
using the audiences , one of the things we did earlier on was with Dr.
F auci and Trevor Noah, and really broke down a lot of the very
important information that basically the people needed to know
COVID at the time.

But going back to your original question, the whole idea here is to
plan and have information on the platform that is credible, scientific
and evidence based. Now, it's interesting when you had mentioned
one of the earlier comments from one of our distinguished scientists ,
about the challenges with information on the internet, that's where I
see the opportunity, because the truth o f the matter is, wh y there is a

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challenge, because that's where people are. And so we need to go
where people are . We need to be where the community is , be where
individuals are, with information. And I often think , (inaudible
00:08:23) and this is , you know I often think about this issue of
misinformation like a garden . We have to pull out the weeds and pull
out the misinformation. But then you need to plan t , you need to plan t
the pro active information that people will gravitate to. And we've
be en very active on the misinformation front , moving over 800,000
pieces of content that have violated COVID - 19 policies or anything
that is not synchronous with the science that may lead people down
the wrong path. So I agree with much of what folks are con cerned
about . A part of why I'm in this role , is to really help us tackle that
issue and make sure we can get information to scale to the public.

Margaret Flinter: Well, Dr. Graham, health disparities, health inequities were very real
long before the COVID pandemic. But certainly the entire country, I
think has reali z ed this at a level , maybe we never did before about the
gaps in life expectancy, how much harder groups were hit, how much
people's economics plus race and ethnicity factored into whether they
were likely to get infected , and if they were, how sick they're going to
get. You have been concerned with this your entire career as long as
we've known you for many years now at HHS , at the Aetna
Foundation and C VS Health , you were very focused on health inequity
and the social determinants of health . How are you using your new
role in this incredibly powerful platform , to address health disparities,
health in equity, to really engage populations that most need this
information ? You've got this incredibly powerful tool , a s powerful as
your two tools were before maybe this is the most powerful one yet.
How are you putting this in service of those tools that you have?

Garth Graham: Thank you for saying that, you know you're right , I have been , had the
issue of health inequities as a part of the reason that gets me up in
the morning . I got a drive, it has driven my career i n day - to - day
decision. So think about this, think about the ability of platforms like
YouTube , to empower folks from underserved communitie s with
information . Now the re are issues that we have to deal with , continue
to deal with their own social determinants of health , s tructural
r acism , but I view the power of the platform is reaching communities
with engaging information that allows them to make the right
decisions for their communities .

And in fact d uring COVID some of our primary partners were folks
who were tackling health disparities with the pandemic , with the
Kaiser Family Foundation a s well as folks like the Black Coalition
Against CO VID, a nd other similar groups were some of our first
partners in working together , and it's because, like you said you know
this issue of health disparities is real , has been a real for a long time .
But has certainly , COVID I think unearth some visibility on that.

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So working with the partners to reach Black and Brown communities
at a particular point a nd also educating the community, the broader
community about the challenges within Black and Brown
communities , is a big part of our agenda . A nd our work will continue
moving forward.

Mark Masselli: We're speaking today with Dr. Garth Graham, Director and Global
Head of Health c are and Public Health Partnership at YouTube. Dr.
Graham , I was thinking as you were talking about the garden, prior to
COVID - 19, we had sort of only one variety of plant in there, which was
in - person visits, right we only had one thing in the garden. And
obviously, with COVID - 19, coming along, we've had this dramatic shift
to an adoption of Telehealth . And I think about the population we
care for 90 % to 95% of them live at or near poverty .

The ability to simply use your phone, you didn't necessarily have to
have a smartphone , you could do telephonic , was so important, so
transformational. And now we're getting to this point where there is a
COVID 2.0 delivery model using Telehealth and other things. And I'm
wondering what your thoughts are on it and you've been in the
forefront for so many transitions and transformations in healthcare.
But how does YouTube's content help better communicate to patients
online? And what might that system look like, as you look down the
future?

Garth Graham: Oh yeah, that's a big part of what we're thinking about now. So thank
you for asking that. So if you think about it, what Telemedicine really
is, again is this idea of reaching patients where they are . You don't
have to get up and put on your clothes and your shoes and socks and
go to the doctor . Your doctor is coming to you in your own home. And
that Telemedicine is a gift that we should have been unwrappin g a
long time ago. So thank you , COVID for allowing us to move fast er.
And as you know, it's been moving way too slowly for a long time. So
that's a good thing.

So we see our platform as a compl iment to that , t his idea of getting
information. So if the cli nical visit is over, and there i s other things
that patients need to read about , w atch, understand, and listen to,
that's where they go to places like Google and YouTube , to get
information and what we want there is to have scientific information
that comp l i ments much in terms of what they would have had in that
clinical encounter.

Similar to how you know in the old days, I say the old days, like last
year was o ld days , but I think going to in - person visits , when they are
out o n the visit. You know, there a re other things that are , in fact
impacting how they made that decision. And in a digital realm, this is
where you see platforms like ours and others, you know be able to
supplement that information, making sure that again, it is evidence

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based credible in formation. But that is an engaging w ay of presenting
the science.

So really all of these tools are compl i mentary a nd certainly as you just
pointed out, COVID has accelerated that. But I don't think we'll be
able to go back because now patients and individu als and consumers
know what it's like . And they know that we can do it. So I think we'll
have to continue to evolve , to meet people where they are.

Margaret Flinter: W ell, Dr. Graham sort of, I think continuing somewhat along that
theme, all s cience, all d ata points to a real escalation in behavioral
health issues , mental health issues across the lifespan, but particularly
in our teenagers and our younger children as well. Everyone i s very
concerned about this. You were joined by experts from Harvard
School of Public Health recently with some influencers and some
teens. I think , we still call them Digital Natives , although I think that's
getting to be kind of an old fashioned term already. They've been
accessing the internet since pretty much they were old e nough to
point their finger.

They're pretty comfortable. It seems sharing their feelings online and
getting help through Telehealth . I know you've been studying this
issue . W hat other solutions , do you think Telehealth might have to
offer , as we confront r eally a gap between not just getting teens to
use Telehealth , which I think is the easier lift , but just the enormous
perhaps gap between the demand and the supply available to meet
it?

Garth Graham: Yeah, it's a very good question. Right now, as you just pointed out,
across all populations, we are seeing increases in incidence of
depression, anxiety, certain substance abuse, all of those things that I
think as a sequel to the pandemic , and you have seen that across the
world. So you know, right now what we have to think about is, as
people , w here are folks, again, how do we reach them with
information? How do we get ? How do we link them to resources?
How do we link them to, you know, the kinds of things that are
coming out from SAMSA, the Substance Abuse an d Mental Health
Services Administration, the kinds of things that are coming out of
community groups who have created resources, that are viable and
impactful, in general? So a big part of, as you just mentioned, what
we've been working on . Is this idea of connecting people to resources,
and also ways in which for, the less serious end of the clinical
spectrum?

How can we educate people on coping techniques, and the kinds of
things that help improve their daily life? But once you get past a
certain level of challenges, how to connect people, have them
understand where to go and see k (inaudible 00:16:45) . B ut you are so
right , y ou know, when you look at some of the search criteria that

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we've been seeing a spikes on over the last couple of months, it is just
e mblematic of the fact that this pandemic left a lot of folks , socially
and emotionally burdened . I'm digging our way out of this is going to
take us a long time and w e have to be there for people where they're
at to be able to help them on this journey.

Ma rk Masselli: You know, you started this conversation of, talking about one of the
reasons you took the job was really giving you this incredible
platform . I noted that you were at a Harvard event recently look back
away forward with Dr. Fauci and Karen D e S alvo, who you work with at
Google Health , and Harvard's Michelle Williams. Talk to us about the
engagement though, with the user, how does a user play a role in
making the internet better or making YouTube better? What does
that engagement look like , b ecau se that seems to be pas s the folks
that we all look up to. It's really about us as a community working
together.

Garth Graham: Yeah, I love th e way that you asked that question. We are used to
healthcare being very system centric. So we think of healthcare
system and how we get care to the person . We rarely, there ha s been
a lot of talk about patient - cent e red care . We haven't done a good job
of doing that as a as a National Health Care Community. And that's
where you think , and the funny thing about , when y ou , the tech
industry, and the way in which a lot of the technology products are
made is they're very user centric. So you start to look at this from a
totally different lens where you start with the person's journey, and
how they're going to interact with the system. And then how does the
system change and maneuver ? How does a platform deliver
information? How are things created from a patient - cent ric, user -
centric standpoint?

You know, if there's one thing , I'm so glad you asked the question,
t here i s one thing I hope that these conversations inspire , is this idea
of switching the paradigm from not how we as a system deliver care,
but thinking about people as they receive information as they receive
care. So a big part of our work starts with the individua l, sitting and
looking and searching and thinking through their journey. And I think
for us, and for me, personally kind of having this healthcare
experience and no w understanding, you know how we utili z e these
tools better, I really do think that , now it' s time for healthcare as an
industry to evolve to truly patient - centric care.

Margaret Flinter Well, I really appreciate that note of optimism and forward progress.
We're speaking today with Dr. Garth Graham, Director and the Global
Head of Healthcare and Public Health Partnerships at
Google / YouTube. You can follow his work by going to
www.blog.youtube.news/covid - 19education . Dr. Graham, we thank
you for your commitment to advancing public healt h, for sharing your

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vision for how technology platforms can enhance the goals of public
health and for joining us on Conversations on Health Care . Thanks so
much.

Garth Graham: Thank you.

[Music]

Mark Masselli: At Conversations on Health Care we want our a udience to be truly in
the know when it comes to the facts about health care reform and
policy. L ori R obertson is an award winning journalist and Managing
Editor of FactCheck.org a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U . S . politics.
L ori , what have you got for us this week ?

Lori Robertson: Randomized controlled trials, the highest standard of evidence have
found that Hydroxychloroquine, isn't beneficial in treating
hospitalized COVID - 19 patients. Y et, s ocial media post s are claiming
the drug works and conservative outlets have touted an unpublished
and much criticized observational study as evidence of the drug’s
effectiveness.

A randomized controlled trial is considered the gold standard in
evaluat ing whether treatments are effective because it reduces bias
by randomly assigning participants to treatment or standard care
groups. Participants can be blinded, meaning they won’t know to
which group they are assigned and researchers can also be blinded.
They can more confidently evaluate whether a treatment led to
different effects.

Data from such a trial among other evidence led the Food and Drug
Administration in June 2020 to revoke an emergency use
authorization it had issues three months earlier, giv ing some patients
easier access to Hydroxychloroquine and Chloroquine, if they couldn’t
participant in a clinical trial.

The antimalarial drugs also used to treat Lupus and rheumatoid
arthritis were pushed by then President Donald Trump as early as
March 2 020, for treatment for COVID - 19. Despite the l ack of scientific
support for the drug, Trump said in a June statement that he was right
about several things including “Hydroxychloroquine works. ” Social
Media post have made similar claims about the drug. But no new
randomized controlled trials have emerge d to show
Hydroxychloroquine works as a treatment for COVID - 19.

Conservative outlets have recently publicized an observational study
that hasn’t been peer reviewed as having confirmed the drug’s
effectiveness . But experts who have studied the drug told us the
paper has several flaws, particularly with the way the statistical
analysis was done. And again they pointed the stronger evidence from

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randomized controlled trial. One meta - analysis published by the
Jour nal BMJ , provides a look at the combined findings of such trials of
several drug treatments for COVID - 19. It continues to be updated
when new findings emerge. That meta - analysis concluded that
Hydroxychloroquine and some other drugs including the antibioti c
Azithromycin , “ do not appear to reduce risk of death or have an effect
on any other patient important outcome. ”

The only FDA approved treatment for COVID - 19 is the antiviral drug
Remdesivir , which the FDA approved for COVID - 19 patients , 12 years
of age and older requiring hospitali z ation . As of late June , 11 d rugs
and biological products have emergency use authorization from the
FDA for COVID - 19. And that's my fa c t check for this week. I'm L ori
Robertson, Managing Editor of F act C heck.org .

Margaret Flinte r: FactCheck.org is committed to factual accuracy from the c ountry’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania . I f you have a fact that you'd
like checked, email us at www.chcradio.com , w e'll have
FactC heck.org ’s Lori Robertson check it out for you here on
C onversations on Health Care.

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communiti es and everyday lives. Charles
Slaughter learn ed the value of entrepreneurship , from an early age ,
first as paperboy growing up in Connecticut. Then with a bicycle repair
business, he started at Yale. Later he took the passion globally , as a
Field Organi z e r for microfinance company Trickle Up.

Then came his first successful venture TravelSmith a $100 million
online clothing supply company for serious global travelers. But his
travels also showed him another stark reality . The number of children
dying in thi rd world countries from treatable diseases , due to lack of
access to basic medicine.

Charles Slaughter: On average, in the countries we work somewhere between 50 and
th
100 out of a 1000 kids will fail to reach their 5 birth day . There i s only
three or four sort of major causes of this , diarrheal disease, malaria,
and pneumonia. What is shocking , is that all of those things can be
addressed at extremely low cost. But the barrier is effectively
delivering what we know works.

Mark Masselli: He wondered how we c ould put the power of healing in the hands of
villagers themselves . And he reali z e d the successful model , already
existed.

Charles Slaughter: The challenge is how can we reinvigorate this idea of door - to - door
healthcare , make it both more impactful and fin ancially viable in
places where financial resources are extremely limited . I'm thinking

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about that I go, w ait a minute, hold the phone, isn't there a business
model that excels at that, and you start to think about Amway, and
Avon and Tupperware. Further r esearch, I actually went out and
enrolled as an “ Avon lady ” and try to learn it from the inside.

Mark Masselli: After training as an Avon lady himself, he founded Living Goods , a
company that sells not makeup, but lifesaving essentials like drugs to
treat malaria, and diarrhea and solar lights .

Charles Slaughter: In a sense, what Living Go o ds does is quite simple. We recruit, train
and support networks of community health promoters, who go door -
to - door every day , teaching families how to improve their healt h and
wealth a nd then making a living by selling high impact health products
like simple treatments for malaria and diarrhea , healthy fortified
foods, high efficiency cook stoves , solar lights and water filters .

Mark Masselli: Sales associates go from home to home in their villages, not just
selling the goods, but teaching the families in the entire community
how to use these life - saving essentials.

Charles Slaughter: Every agent works as an entrepreneur , un der the Living Goods brand.
We typically partner v ery closely with a local government. So where
we operate, we are the government's Community Health Army . And
now perhaps most importantly, they get a smartphone. And that
smartphone has a Living Goods designed application on it that can
help them with a gu ided diagnosis of childhood diseases that enables
them to register and support pregnant women , and reminds them to
follow up with those customers.

Mark Masselli: There are now Living Good sale associates serving the needs of some
5 million residents throug h Sub - Saharan Africa. And the results are
quite impressive. In some cases, infant and child mortality is down
25% in the communities being served .

Charles Slaughter: I think within 10 year s ’ time it's possible that every community , who
needs a community he alth worker , can have one , to make sure that
that kid doesn't die of malaria, or pneumonia, or something else
ridiculously simple that they need in time .

Mark Masselli: Living Goods , a simple grassroots business model, facilitating the
distribution of low cost, life - saving materials to families living in low
resource areas.

Female: Most of the health cent e rs are very fa r . And these mothers , the se
fathers do not have access to these health cent e rs. But with the Living
Goods , we are always there for them. Any time they come across you ,
you're ready , you have the medication, you give the treatment .

Mark Masselli: Generating income while saving lives , and improving the health of
communities as well. Now that ’s a bright idea.

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[Music]

Mark Masselli: You’ve been li stening Conversations on Health Care. I’m Mark
Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Peace and health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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[Music]

Female: COVID - 19 is impacting the world and changing the face of healthcare .
Conversations on Health Care with Mark M asselli and Margaret
Flinter, welcome ’ s the greatest minds in health policy, technology and
innovation from Dr. Anthony Fauci .

Dr. Anthony Fauci: There are going to be more than one vaccine that's going to be
approved by the FDA .

Female: Surgeon General Vivek Murthy.

Vivek Murthy: If we really want to get treatment , right , we have got to integrate it
with primary care.

Female: We are bringing these experts straight to you , Saturday and Sunday
mornings at 0 8 : 30 , on the Federal News Network . Conversations on
Health Care is a production of Community Health Cent er , Inc.