When MisInformation Becomes a Health Crisis w/ Dr. Joshua Sharfstein, Johns Hopkins

I think that we're seeing uh increasing numbers of people reject uh evidence-based treatment for fanciful ideas that they found on the internet, um, in part because they're believing mistruths about evidence-based treatment. And it's something that uh is frustrating doctors who are finding that they have to spend more and more time talking patients off a ledge where the patient's about to jump into a world of very self-interested uh people and companies that um are really trying to pull them away from therapies that could really help you. I'm John Marchica, CEO of Darwin Research Group. Before we get into it, if you're on Spotify or Apple Podcasts, please follow the show and leave us a rating. It goes a long way toward getting this conversation in front of the right people. Today I'm speaking with Dr. Joshua Sharpstein, a pediatrician who has run public health at nearly every level of American government, Commissioner of Health for Baltimore, Principal Deputy Commissioner of the FDA, and Secretary of Health for the State of Maryland. He's now a distinguished professor of the practice in health policy and management at the Johns Hopkins Bloomberg School of Public Health. He wrote the Public Health Crisis Survival Guide before COVID-19 and revised it after living through one. And in 2025, he co-authored Information Sick, a book that makes an uncomfortable argument that the collapse of local news and the flood of health misinformation are not a communications problem on the margins of public health. They're a public health crisis in their own right, with a body count to prove it. So with that, Dr. Sharfstein, welcome to Healthcare Rounds.Thanks so much for having me, John. So let's get into uh information sick. Um, you your your your book's title is a is a diagnosis, not a metaphor. You're arguing that a broken information ecosystem makes people sicker in a literal measurable way. And so to start us off, what's the clearest evidence that you have this is a health problem and not just a media problem? Sure, I think there's a lot of evidence of that. Um I think that we're seeing uh increasing numbers of people reject uh evidence-based treatment for fanciful ideas that they found on the internet, um, in part because they're believing mistruths about evidence-based treatment. And that's not just COVID, that's cancer, you know, that's serious other medical illnesses. And it's something that uh is frustrating doctors who are finding that they have to spend more and more time talking patients off a ledge, where the patient's about to jump into a world of very self-interested uh people and companies that um are really trying to pull them away from the therapies that could really help them. In the book, and I have to admit, I've gotten through about a third of it at this point. It's wonderful, really enjoying it. Um, you draw a line between misinformation, so false information spread without knowing it, and then disinformation, which is false information spread deliberately. Does that distinction matter operationally, or do patients experience harm in a, in essence, in the same way? Right. That that's a great question, and I appreciate your point. I wrote this book with Joanne Kennan, who's a journalist, and Lamari Morales, who's in the field of communications. And we have different perspectives on this. I think from the perspective of the patient, what the patient is experiencing, it may not matter whether they got information that was shared intentionally to be false or not. But I think from the perspective of public health, where we're trying to understand what's behind this, it does matter because if there are nations, literally nations, that are sending millions of messages telling people not to be vaccinated or to turn away from legitimate treatments, then you know that is really important to understand. And similarly, if there are very self-interested parties, people selling false cures, you know, snake oil, um, then how those uh are regulated and dealt with becomes extremely important. So I think we're looking at it from different perspectives, but certainly you've got things that are truly unintentionally shared, you've got things that are deliberately misleading, and then there's this area in the middle where people probably know that that there's nothing there, but they are still sharing it, you know, and um that also can can cause problems. It's a mess out there, and it's not surprising that by, you know, on so many different measures, more and more people are confused about what um the evidence says and are uh very open to different kinds of treatments and approaches that put themselves and their families at risk. There's a bunch going on here. Um there are a lot of things. And I when I think about you know, empowering patients, this notion of empowering patients um to take control of their health, to be more accountable for their care, and those kinds of things, that's an old idea. And look, uh I I often bring this up on the show, but when I went back to school in Dartmouth's program in 05, it's kind of a multidisciplinary program, they really were one whole track was on patient education, patient-centered care, patient decision making, right? Getting them involved. Um and so it was it was at that time, from what I remember, it was kind of a struggle to get the patients involved in their decision making. It was kind of like it was still the physician at the, you know, kind of the top of the you know, information pyramid, if you will. And it was all about you know, choosing between um uh let's say lumpectomy versus mastectomy for breast cancer, and and when you get patient involvement, how you get better outcomes, at least in in theory. So now here we are with there's this glut of different ways of people getting information. You have people who have an agenda, right? Whatever that agenda may be. And maybe on podcasts, hopefully not this one, but it's about maybe getting more viewers by giving them information that might get more engagement, right? That's right. And and then and then there's there's sort of which I think maybe this is your journalist uh contributor on the book, or maybe the communications person, which is look, the cover story, I believe, coming out in the Atlantic this month is the death of reading, that people just don't read anymore. And that's not just books, it's they want short form of everything. They read headlines and all of that. Well, all that is happening, and I think, and I totally appreciate your point that the purpose here isn't that patients should be like sheep and do exactly what the doctors say and the doctor knows best in every situation. There there really should be in engagement and discussion of values and and you know the evidence based on you know the risks people want to take. All that is is completely true. The challenge here is that this is like a whole leap beyond into doctors having to sort through all kinds of claims online that um have no basis, but also that doctors are having their fundamental legitimacy questioned. And so it's not just about is it treatment A or treatment B? It's you're doing this because the pharmaceutical industry has put you up to this. And I can't trust you at all, you know. And I think that is also a fundamental shift. So we're seeing communications in the communications world move from like, let's talk about how you communicate with patients to the actual world being fundamental to the doctor-patient relationship. If patients or patients are showing up after being immersed in you know uh falsehoods, how do you actually take care of them? That's really the shift that's that's happening. As a as a physician, um certainly I know a lot, listen to this this uh this show. How do you and how do you combat that in such a way that starts to build that trust up again? I mean, we could talk about we could spend the next hour talking about trust, right? Yeah. It's a cornerstone of a lot of these issues, but um kind of getting getting to the end. How if you're a practitioner, how do you combat that and how do you build trust? Right. Well, I think you know making the diagnosis is really important first. And it's it's not just the patient in front of you doesn't have trust, but what is behind that? And in the book, we talk a lot about the dec decline in journalism and the fact that reliable sources of information are going away. Thousands of local newspapers have disappeared, many um radio and TV stations have been taken over and really don't do their own reporting, and even national news has now gotten so splintered that you know people don't really have a common conversation anymore. So um, all that's happening in the background, that's an awful lot for a single clinician in a one encounter to overcome. So really it's it's a it's a team sport. I mean, I'll I can talk a little bit about things you can do in the in the in the exam room, but I think we need to realize that uh in health and medicine, we have to work with journalists, we need to build up the media again, we have to come up with ways to engage online more effectively, and then we should really be partnering at an institutional level across communities to give good information to people. So a hospital that, for example, maybe was just doing its job, taking care of patients, now suddenly patients are refusing treatment, they don't want to get vaccinated. What's going on? That hospital should be talking to the health department, it should be talking to clergy, it should be talking to business leaders, it should be making experts and information available in community settings. My personal view is we're losing the war online because of all the stuff that's out there, but we can win the war in real life. Um, we can lose a little less online, but we can win the war in in real life. But you you have to realize that that's the situation that we're in. You know, you you you make this point again and again in the book, and you talk about um the decline of local news. And again, I kind of come back to I think in the last couple of years, certainly, if you go to the big health systems, I bet this is true of Hopkins too. There's lots of places that you can go, and there's short-form videos that explain a certain procedure or that keep you up to date on the news. And that compared to the person who's getting 5 million or 10 million views on YouTube, it's that's the losing battle, right? I mean, that's that's very hard. I'll tell you, I teach a class, right? And and in my class that relates to media and communications, um, we had a FBI expert in misinformation, disinformation come to the class. And he pretty much patted me on the head in front of all my students. And he said, you know, public health, you guys are are so precious, you know, so cute. Because you think if you word the message correctly, if you get the wording right, if it's clear, the people will listen to you. The people will believe you. That's what you actually think. And I said, Well, what do you mean? He said, Well, you're, you know, delicately phrasing, you know, your press release and you're putting it out in the world. Maybe people see it and maybe people don't, but they're getting thousands of messages in other ways. They're getting on their WhatsApp channel, they're getting on Instagram, they're getting on Facebook, they're they're, you know, now they're hearing it from AI, you know, whatever it is. But basically, you are just a speck in the ocean of information to them. And we have to really realize how overwhelming it is right now out there for people, and that it's not just about getting those, you know, videos produced. The videos could win awards. But if people don't watch the videos, you know, what are you doing? And and that's a it's a really, really big challenge. It's a big challenge for for everyone. That's why it's not enough just to post them. Now you can go and you know, go to community meetings, go have the doctors talk to their patients about them, have the nurses, you know, it really has to be a full-on strategy to get good information to people. That is absolutely part of the job in 2026. Well, part of it has to be maybe improve spokespeople, right, at some level. So I think of Zeke Manual. Dr. Emmanuel is gonna, he'll be uh uh, I think coming on this show in a in a couple of months. Um very well known, very articulate guy, right? Um sometimes. Yeah, right, of course. So he's he's got that kind of larger than life personality, right? Like uh his like his brother, right? Um, but still not a household name per se. So I'm wondering, and of course he's gonna get a lot of views, but do we go back to the um it's sorry to just like reduce it to this, but sort of the the early Michael Jordan Nike model, where you can adopt a huge celebrity to be pushing forth certain narratives. I see you shaking your your head. I don't think so. I mean, and uh you look, I I um am a big fan of Dr. Emmanuel, I should say that up front, and he's an incredibly effective communicator, um, both to the health policy world and to the general public. There are not that that many of those. But I think sort of the era of the you know famous spokesperson has passed, and it passed in part because of what happened to Dr. Fauci, who's an incredibly effective communicator and was vilified and lied about and persecuted. And I think what it reveals is that it really can't be relying on the one person. And when I started teaching my classes called Crisis and Response in Public Health, this is a different class. We we you know taught the CDC guidelines for communications during a crisis, which is you have one main communicator. And it was really like written like a Dr. Fauci, someone who could be totally trusted. And everyone would align to that. That allows you not to have multiple messengers and multiple messages, there's a whole logic to it. The problem is the information environment is toxic for that, and people who have agendas and financial interests or political interests, you know, have a target to shoot at, basically, at least metaphorically. And the um the better approach now is to have a network of communicators and to be working with business leaders and clergy and others, um and to have people who can be effective leaders of that network, but not to rely on them and just say, well, I just you know recommend that you listen to the Michael Jordan equivalent of communications. Well, that brings up the crisis survival guide um that you had written. And uh I did not get my hands on that book before this. Um and so I'm I'm looking forward to to picking that up. Sure. But but what is the I want to talk a little bit about this this the COVID issue because you brought up Dr. Fauci. Dr. Fauci is somebody that across three different organizations I've been up to COVID, I'd been writing about for 20 plus years, as far as I'm concerned. He's a hero in so many ways. And then, as you said, vilified um and kind of where we are today. What did we really get wrong? So much uh around COVID that maybe exacerbated the the information issue that we're talking about now that made it far worse. What what do we get wrong? I'm gonna use a metaphor here, which is a dog and the tail. Because I think in healthcare, in health, and public health, we like to think of ourselves as the dog. Like if something goes wrong, that's like we're the dog, we should be able to fix it. It was our fault in the first place, we must have knocked it over, you know, we're the dog. Um we don't like to think of ourselves as the tail getting wagged by a different dog, you know, but by just a different entity. And I think it's important when answering a kind of question like looking back on the pandemic, what did we do right? What did we do wrong? To say, like, we like to think of ourselves as the dog, but in a lot of ways we were the tail. We're a very polarized society. There were a lot of um different things happening at the same time as the pandemic, and that came to roost on top of the pandemic response. And so I'll I'll give you what I think public health could have done better, and I absolutely have written about and believe public health could have done better, but I'm not sure there was a you know perfect way through this in the United States. I think of public health as a communal activity. It's defined by the Institute of Medicine as what we as a society do collectively to assure the conditions under which people can be healthy. So we society collectively, if we don't have a strong collective society, if the trust level is low, if there's a lot of polarization, it's really hard to do public health well. You know, it's just it's just a fundamental obstacle. And you could see that in just the vitriol. You know, in other countries, the you know, things went so much better. And it wasn't because they did everything perfectly in a public health basis. It's just that when they were missteps, people trusted and understood that it was gonna get fixed and people could actually engage on it. In the United States, everything became fodder for, you know, a lot of anger and frustration. So that I that to me is a really important frame for the discussion, you know. I I do think that there were a lot of things that were very, very hard for public health to overcome. Having said that, my um my view is that um there was a very, very difficult challenge that we were facing, a brand new virus, and not a lot known about it. There's obviously a huge misstep in not getting testing stood up quickly, which was a failure of the CDC, and um that I'm very familiar with. And then um there was uh a moment where everybody felt like, okay, we can really, really fight back, and a lot of things were done. And we never really pivoted from that to okay, where are we? And what are our options, what are the trade-offs, and how can we make a decision together? Generally, what happened, in my view, is that government at different levels you know, basically put out here's the new policy. And there wasn't a lot of here's a draft policy, here's the pluses, here's the minuses. Everyone really wanted to feel like they've got the next step. But the experience of receiving that was frustrating because, like, why? And every as soon as you lead with your chin with an announcement like that, everyone's gonna take a shot at you. And so the CDC moves the number of days for isolation from 10 to 5, and everyone wakes up in the morning to and and hears that, you know, or FDA makes an announcement. And there wasn't what I think is really important for successful long-term policy making and regulation, which is here's what we're thinking, here are the pros and cons, give us your comments, and let's think this through. And now we're gonna make a decision and we're gonna explain that decision. There was a lot of decisions, but not a lot of explaining the decision. And I think I think that made it feel like more of an imposition. Um, even though there was a lot of thoughtful, I believe, deliberation behind the scenes, it wasn't happening that much in public. Um, there were some places that were able to do like COVID councils that talk things over, but those kind of went away. And it was really a feeling of people just announcing things, which I just I don't think is a good sustainable um way to do policy. And then the pandemic kept going, so it kept going. I've seen regulatory processes work much better, even on very contested issues. I mean, I've I've done regulations as a state health secretary on abortion. I mean, it's hard to imagine a more contested issue. But we we put out multiple drafts, we met with every group, everyone felt like they had their say, and when we announced what we were going to do, we explained why we didn't do the things that people on different sides of that issue politically wanted us to do. You know, we can't do it this way for this reason, we can't do it that reason, that way for that. Reason everybody got to see everyone else's arguments because it was all public. And when we released that regulation, we had positive comments from both of the major sides of the abortion people who oppose abortion, people who support abortion, um, basically saying that they they appreciated the work that we'd done and understood that we, you know, we had done a good job um putting together regulations. You can do that if you have a process like that. But that was really not the COVID approach. You know, that's ironic though, because what you're describing is what I think of as the sort of Faucian model of what he figured out. And he's talked a lot about this, right, publicly. What he figured out around the AIDS crisis and HIV and all of it, like when he wasn't listening versus when he was, and then when he was bringing in all these different constituents, and that's kind of what turned the tide. I mean, yeah, right. He was at the forefront. He was the guy. And so I read about that in my book. I read about his work on HIV. I mean, FDA had uh was hanging the FDA commissioner in effigy, the the sorry, the protesters were hanging the FDA commissioner and effigy outside of uh the parkland building. Um, but Dr. Fauci let the protesters in and met with them, changed the way clinical trials were done, um, and it had a huge, huge impact. I mean, I do think that there wasn't enough of that spirit. Um, but again, it was in a very, very difficult environment. So, you know, I think if you talked to the decision makers at the time, they would say, Josh, come on, if we were to try to do that, look how we would have been attacked, look how that would have been used as yet another argument to throw the bums out or whatever. I I do think that there was some room to be more deliberative, but I do appreciate that argument. And I do think that you know it's hard for public health to overcome a fundamentally divided society. How much of this is now I know we're we're really branching off into other regions, but how much of this is sort of like our education system in Americans not understanding science or not being not being, I'm not gonna use the word trained, but really, really understanding that in a crisis like what we were going through, that we were gonna get things wrong and that it was trying new things. And I think the reason why I ask that, and please push back on me, Dr. Sharfstein, but I remember going back, it's not that many years ago, and in going through COVID and me being sort of, I think more accepting of some of the mistakes. Again, I was in the minority, but just kind of thinking, well, this is how science progresses. It's kind of like the old, you know, Thomas Kuhn and the, you know, how normal science and breakthroughs and all of this, that whole model. Yes, there were mistakes, but I think I was a little bit more accepting of them having a framework for understanding how the process works. So I did an interesting thing with my crisis class this year, is that we looked at the different narratives about COVID. And there are two predominant narratives, one of which you just stated, which is this was a really big, unusual, unexpected challenge. And there's a whole definition, a traditional definition of crisis, which is you have to respond to something that's unexpected on a short timeline, and there's danger, you know, and a crisis story is we face down this virus, here's what we did. We got the vaccine, and that story has a number of key components. And sure, you know, we learned about the virus was is part of it, you know, there might have been missteps, but they're all kind of steps on the story of a crisis that is really defined by the those core elements: surprise, short decision times, and and danger. And there's a whole other concept of crisis out there, and there's a different story. And that crisis, if you think of the word crisis, like this caused a crisis in my faith. Like it's a different kind of crisis. And so um, there's modern theorists of the crisis, there's a whole theory of crisis where they say that a crisis is fundamentally a crisis of legitimacy. And so, you know, maybe there's like an um a certain kind of abuse scandal that causes a crisis for the church, you know, or synagogue or something like that. You know, that that's a different kind of crisis. And the other story about the pandemic is that kind of crisis. It's that people who thought they knew better than us imposed restrictions on our liberty and caused a great deal of harm out of their, you know, hunger for power. And and the key moments of that crisis is not when the vaccine got discovered, but it's, hey, did the NIH fund something that actually led to this virus? You know, and um uh what about when there were social justice protests and the and the um public health people said that those were okay, but the other kind of protests weren't. And those are really written about, you know, and spoken about in those different narratives. And so it's not just two, you know, someone saying half full or half empty. They're really two different conceptions of what a crisp what kind of crisis this was. And you know, you you're in one of them. I'm in the same one. That's how I think about the pandemic, but that's not how a lot of people do. That's really, really helpful because you know, I'm thinking of this as sort of like a the way you framed it is kind of like the the Tylenol crisis from way back when, right? That's kind of that's probably you probably taught that in one of your classes. It's kind of a classic healthcare um, you know, quote unquote crisis. But this got to to more core issues of crisis, as you say. Um I hadn't thought of it that way. Um in today's environment, then, Dr. Sharfstein, as we think about you know, a put another potential crisis coming, and all of these different ways or the two different primary ways of thinking about crisis. What are you thinking about and what are you talking about in the classroom about effective ways of combating misinformation, disinformation, knowing that you've got, you know, sort of these two models that you're working with. What are you talking about solutions with your students or things to think about? Like how do we how do we frame this better for the future? Sure. Well, I don't know whether the the dog analogy really works that well, but but basically we need we we need a healthier dog. You know, we we need we need a dog that's not gonna wag us in every direction. We have to improve our ability as a society to handle information and um to rely on good information. And that is a really challenging task that of course stretches beyond health and health care, but but it's important. I do think that journalism plays a really important role, and the loss of journalism is is a really important thing. I think organizations need to see this as a major challenge, even if it's not their primary business. You know, um I'm there there's an incident we we write about in the book about a nurse named uh Tiffany Dover, who was at a hospital, I forget in which state. She was the first person vaccinated and they put her on TV. And so happened she had a sinkable kind of disorder. She tended to faint, and so she fainted on live TV. And after that, a rumor came up that she had died, but she hadn't died. You know, she just fainted and she was still working. But the hospital never said anything, they never let her talk to anyone. And so the rumor went around and around and around. There was a journalist who tried to debunk the rumor and couldn't find her. She could find that she was posting on Facebook, but she couldn't actually prove that she was alive. And in part, it was because the hospital wouldn't let her talk. They were like, this is not good news for us. We're gonna shut ourselves. You cannot totally understand that instinct, but it was the exact wrong instinct because suddenly millions of people were seeing messages saying that the first person vaccinated had died. And so, you know, it's not just for other people to deal with. I I can't think of anyone who's who's not touching this problem in healthcare. And so trying to figure out if you're a clinician, how you do talk to people who come in with, you know, misunderstandings based on the information environment, if you're a health system, how you partner to get good information to people through places that they do trust, like, you know, uh businesses they rely on the school system, um, clergy, and others. You know, how how do we work together on this and how can we support journalism that that can be trusted too, that can help people distinguish between um truth and falsehood? It's it's extremely important. That's really for the overall environment. Then there are a bunch of specific things that I think are important for us to work on. I think um it's not enough to have somebody who just puts out press releases in 2026 in your communications office. I think you need people who are very fluent in social media, who can monitor what's going on, who can engage and nip things at the butt if there's misinformation circulating, um, and uh who can um help uh with different techniques like pre-bunking, debunking, you know, trying to get as good and as much information to people as as possible. Like here at the School of Public Health, uh, we have a big communications effort. We are putting a lot of solid, good information out there, and we're trying trying our best to be part of the solution to this, but it really is a team sport. So given that it's a team sport, has there been, and maybe this is out there and I'm not aware of it, has there been any discussion among you know Hopkins and Gale and Chicago and you know uh University of Washington of kind of coming together with a unified communication strategy? Yeah, I mean there's a lot of sharing of information and uh a lot of discussion at, for example, the Association of Schools and Programs of Public Health. I think it's not so much trying to speak with one voice. I again I think that is hard because it's slow and you have to be moving at the speed of communications to be successful. But I do think that it's important for all of us to to work. And and there are different kinds of repositories where we may refer people to other places if they've really done a lot of communicating on a particular issue or share their information and vice versa. So I would say it's it's not at all competitive this space. We all realize we're up against a very, very difficult challenge here because if people don't trust each other, they don't trust what public health agencies or organizations are saying, then it's really, really hard to to do things that make a big difference. And and we start to see things like babies dying of you know vitamin K deficiency after birth, bleeding out because you know families are confused and are rejecting vitamin K shots. It's just it's astonishing what we're seeing right now. So there's a lot, um a lot to be done, and and we have to, you know, keep keep working together to get there. I mean, this is the a huge challenge. It is not peripheral to the health, you know, enterprise. And I don't think we've solved it. So I think people who are listening who want to try something, see whether it works, it's it's worthwhile. And certainly here at the School of Public Health, we're happy to connect to any any health organization that's that's trying to get good information out to people. Maybe the hardest question yet, Dr. Sharfstein, is what do you do when the government itself is the source of misinformation or disinformation? And the example, you know, you probably know what I'm gonna use, is the revised uh CDC website on vaccines. And I I actually wanted, I literally wanted to do a like a PowerPoint episode on the show, kind of instructing people on uh you know all the false narratives that are in that are in that piece. And I'm not trying to drag you or this conversation into the political, it is just a reality that um with information being withheld or information changing, like if you're the CMO of a large health system, you know, I know we could take this to the individual physician level, but what do you what do you do? The CDC is not reliable on vaccines right now. Uh the information that's provided on vaccines, it's not reliable. I mean, they have shunted aside the actual experts on vaccines. There's ample evidence that there's an ideological, you know, effort to um undermine vaccination through recommendations and other types of changes like stopping promotion of the flu vaccine. Um, and the people who are leaving the CDC are describing all the details of what that looked like. So, you know, that that's a huge challenge because you're right that, you know, our hope is that the flagship public health agency could be relied upon for critical information when that's not the case, and for some things, not for everything, but for some things it's really not the case, you know, what do you do? And you know, I think this really I I don't think there's like a silver line to this, I'll be honest with you. I think it's it's a big problem. It's gonna be hard to build back trust in institutions that have been um undermined like this, but I do think it highlights the fact that we all have a responsibility to be sharing information and and leveraging the trust that we do have to get good information to people. And um academic institutions, professional societies have really stepped up. I'm a proud member of the American Academy of Pediatrics, which has really taken on the vaccination fight um issue and has been providing great information to the public and and through pediatricians. You know, I think that um of course academic institutions, professional societies, they always had a role. But now that role is really highlighted. And so, you know, I think that for the time being, we're in a world where everyone has to do their part to try to get good information to people because it's the difference between a huge measles outbreak and no measles outbreak, frankly. And and we're seeing a lot of huge measles outbreaks around the country. Are there any examples? Um I'm thinking it's probably later on in the book, but are there any examples from the book where um you did in an in some sort of intervention um where um it wasn't just a good idea, but where you were able to kind of turn the tide in turn in information or get people to um improve trust levels. Like, do you have any examples of things that work well? And at the time, you may recall there was a patient in Dallas, and there was a lot of anxiety, and people were saying, you know, there was actually a member of Congress who I think said to the CDC director, I hear you saying that there won't be a major outbreak in the United States, but that's what everyone says in the first scene of the horror movie, you know. And and and so, you know, there was a lot of fear at that time. And people were saying, you know, should we um is this coming from immigrants? Is this about immigration, you know, what's what's happening? And it's very interesting. Governor O'M was my the governor here in Maryland when I was working as the health secretary, and he was he's a very, very talented communicator, very passionate. And what he said was um, we need to do a press conference about this, all these questions being asked. We actually had the patient from Dallas came to NIH, which is in Maryland, to be treated. And there was so much anxiety, I'll just tell you, um, they I got a call from an elected official who said this patient from Dallas is coming to the airport out in rural Maryland. I said, yes. They said, and they're gonna be met by a special ambulance that is a special air chamber, so that you know it'll be perfectly safe to take her to the NIH. I said, yes. He said, and that that that ambulance is gonna have a police escort, and I said, yes. And and he said, but what if that ambulance breaks down? What are we gonna do then? You know, I mean, so that I mean there was a lot a lot of anxiety. But what governor said is we need to talk. And it's not just us. He was ahead of his time in this regard. I want you to call every major hospital system, the hospital systems that people depend on in Maryland, and have them send somebody. And we did a press conference where the governor opened and I said a couple things, but then uh I believe it was uh Lisa Marigakis from Johns Hopkins and there was someone from the University of Maryland. Um, I I don't want to get it wrong, so I'm not gonna say it is, and then somebody from Med Star, the three major hospital systems, were there, they were all in their white coats. They said, we're prepared, we can take care of a patient. There is not reason for people to be worried, we have trained for this. And we actually had someone who represented the African diaspora, who was sort of a community-based organization that supported African immigrants, who was there and said, here's how we're supporting families, here's how we're getting the word out, in case there's anybody who's concerned, so that we can reach out to them. And in other places, I'll I'll just tell you, there was finger pointing between public health and health care institutions. Well, who's gonna take the first patient? People were saying, Well, I'm not taking the patient, well, I'm not taking the patient, you know. And and in Maryland, it's like we are gonna work together, we're gonna take care of any patients that come in. And I mean, that really quieted things down. I mean, we had a lot of, you know, political and media talk, and that that really helped. And so I I felt like getting out in front of it, but but really where it was a little bit ahead of its time was let's have the people who are trusted already. This isn't just gonna be the governor and Josh up there, you know, saying, trust us, it's all okay. We have the organizations. That's why if you're you know running a healthcare organization, you're listening to this podcast, that's you. You know, you've got to be there for this. You've got to volunteer, say, like, how can I help make sure that people get good information? Because otherwise, it's really chaos for your frontline staff and ultimately more illness in your own community. Well, you you asked, you already answered the question, I guess, that I was gonna ask is what you know, what are health systems CEOs or what are health systems, um, what is their role in all of this and and and uh in in being more effective communicators, whether it's a crisis or not? I I I have kind of a uh an oddball question I wanted to ask, which is, and it's only because we work with some of these uh uh firms, can or does the pharmaceutical medical device, we'll say pharma industry, which is another lower trust, you know, it's it's in its ups and downs, but still pretty low, beyond the commercials that we see uh in basketball games and on Sundays, that can the pharmaceutical industry um build trust by being another one of these arbiters of information or providing information, whether it's to consumers or being a better steward of information on real-world evidence to health systems, like I I understand as as an academic and coming from a leading academic institution, you may have a certain view on this. But um I'm just curious your thoughts if if they can improve their their role as communicators, because they have a lot of data, they have a lot of information that they could share. So I think um the most effective communicators are going to be fully disinterested parties to the extent possible. You know, I think it's it's hard for a company that makes a product to be the most visible communicator about about a product. Um but I do think that that you know companies have been um the subject of a lot of disinformation and misinformation, um which is unfair. Um and I think that the the most important thing that they can do is to try to support those institutions and agencies that are playing that role. And you know, for example, um the FDA um should be providing good information and transparent information to the public. And people then can rely on and trust the FDA. Sometimes companies are very comfortable with the FDA sharing information and explaining what it thinks about their products, other times companies are not that interested in that and you know assert that it's confidential, and then that makes the agency look like it won't say anything. And I don't think it reflects very well on anyone and it Undermines ultimately the bigger trust picture. And an example of this that I have used before is how pediatric COVID vaccines were developed. There was a long period of time where we were waiting for pediatric COVID vaccines. And in that vacuum, a lot of misinformation flourished. And you didn't really hear the FDA talking. What's going on with those trials? Why are they taking long? There was not a significant briefing about that. Occasionally there'd be news stories and they were like sourced to anonymous sources in the government and to the companies. And I think that was a strategic mistake for everyone involved. I think that the FDA, because the FDA, the people at the FDA are great. They have very well thought-through, you know, ideas about how to do regulation. And, you know, sometimes studies take longer. Explain why they do, you know. But allowing all this misinformation and not having a clear voice from the agency that's really supposed to be, you know, responsible to the public, I think was a mess. And I think it made it much harder in the end to get understanding of the value of pediatric vaccines, which are significant, particularly for the young babies. Well, that's an important framing, and thank you for that example. Dr. Sharfstein, before we end, um I just want to give you an opportunity to kind of wrap this up. For the leaders that may be listening, I think we're all aware of the problem. But as individuals, as institutions, what would you recommend going forward on how all of us can can best address this problem of information sick? I think it's important to have someone in your organization who's thinking about this. You know, as a leader of an organization, you can't be thinking about everything all the time, but somebody who is really thinking about what is the information environment in our community. Um, here's another example. We had a measles outbreak in in Baltimore, and it turned out that one of the best ways to get information to people was through a WhatsApp group. People sometimes get it's not even a website, an Instagram account, it's a WhatsApp group, it's a closed membership group. But everybody in the community where there was measles or a lot of people were on this WhatsApp group. And there's a great hospital that took care of this community, and they they figured out how to talk to the religious leaders and get into that WhatsApp group, you know. So, how do you really understand not just how you're putting out information, but how people in your community are receiving information? What is out there that is true and not true about your institution or about the therapies that you're doing? And who can you partner with to get good information out there? Because when it comes for you, it's fast, you know, these days. If you know, like everybody is like one day away from a story like uh, you know, I think the vaccine I got at this place caused some horrible damage. And then what do you do? Do you have the partners to get on the phone with and say, hey, here's you know what we've been doing, you know what we stand for? Do you have the understanding of where people are going to hear that message? How can you, how can you be prepared to respond? Because it can be very, very hard. And it's hard for your workforce to be hearing that and and anxious, you know. How do you address their concerns? How do you give them in good information and good ways to communicate? All that is is really important. I think this is un unfortunately, I do think it's unfortunate that some of this stuff is now everybody's job. But if you don't do it, you wind up like the hospital in in for Tiffany Dover. There's a podcast, Tiffany Dover is dead, um, which uh kind of goes through that story, which is a really harrowing listen. But people who are interested in this can listen to you know how that was handled. We don't want to be like that. We want to be able to let people know Tiffany Dover is not dead. Here she is, you know. And here's you know what we can learn from this experience, and here's somebody trusted to answer questions and everything that you know that you can do to be there. It used to be that communications was thought of as just a tool in the toolbox. You know, let's pull out a good communications uh video or or um information sheet, we'll give it to people, that'll help. But we really have to think about communications as integral to the environment that we're we're working in. And if we're not able to clean up that environment a little bit, we're going to be suffering all kinds of different consequences from it. Communications has really become a determinant of health, and it has to be looked at fundamentally differently in 2026. And that means our jobs are changing, but it creates different kinds of challenges and certainly different kinds of opportunities for more direct community connection, better relationships, and hopefully a really strong basis for trust to ultimately improve. Well, Dr. Sharfstein, this has been wonderful. You know, I I said before we even started, this is a topic that has interested me pretty much my whole career. I mean, I when I go across the things I've studied and um companies I've had, it kind of comes back to getting the right information, the correct information, unbiased information to the right people at the right time and all of that. And so I thank you for spending time with us and hope it's not the uh the last conversation, but the first of others. Thank you very much for having me, and I really appreciate your devoting time to this topic. Thank you. That's Dr. Joshua Sharpstein with Johns Hopkins. I'm John Marchica with Darwin Research Group. Thanks for joining us today on Healthcare Rounds. If this episode made you think differently about who you trust for health information, please share it with a colleague who needs it. And if you're on Spotify or Apple, make sure to follow the show and leave a rating. You can always use it. And it helps people find the show who otherwise might not. Again, I'm John Marchica and we'll see you next time.