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#9: Fighting Covid-19, first virus then misinformation with Dr Dominic Pimenta

#9: Fighting Covid-19, first virus then misinformation with Dr Dominic Pimenta

Fighting Covid-19 on the frontlines to save critically ill patients - what must that be like? As an NHS doctor in the UK seconded to emergency intensive care wards, Dr Dominic Pimenta was right there as the first tidal wave broke over London, UK.

And with that began a mission, first by founding a charity to equip his fellow healthcare professionals with the support and resources they needed. And now by pursuing the misinformation swirling around the topic, misinformation potentially as deadly as the virus itself with the ability to cause of many hundreds of thousands more deaths.

In this fascinating conversation, we hear Dr Dom’s first-hand perspective on the rapidly evolving reality of public health through this pandemic. From the visceral, practical reality of ‘charging through corridors’ setting up new intensive care wards and the emotions from discharging the first recovered patients, into the curiosity of the human condition - why do not just laypeople but also medics, scientists and even epidemiologists find themselves falling for the allure of misinformation.




Automated transcript

Will McInnes 0:00

I am very excited to be here today with Dr. Dom or Dominic Pimenta, who is a doctor but also wears quite a few different hats. so dumb. You're a doctor in your day job. You're the chair of the healthcare workers foundation. Yeah. A director of the modern society initiative. and author of duty of care.

Dr Dominic Pimenta 0:23

That's right. Yeah, that's all. Good. I suppose they can. They can. Yeah.

Will McInnes 0:30

And other responsibilities? Our Yeah. Let's just park the family. And other I guess if we start at the beginning, like with all good stories, how did you end up becoming a doctor? Like, what's your path?

Dr Dominic Pimenta 0:45

Well, I like to tell you that there's some sort of fictional childhood event where somebody was sick. And then the doctor came out nicely, it's really boring. I can't honestly remember why I wanted to be a doctor, I can't remember ever not wanting to be a doctor. So it's like that. I don't have access to have the best. It's a weird thing for doctors that I don't have the best memory. So events that are five to 10 years old, I really sometimes really struggle. So I do wonder if there was something I remember looking out a window once and thinking, Oh, when I die, I don't have any money. This was this because what my family or christian right, so we talked about death and heaven all the time. So I had this idea that when I die, I can't take any money with me. So what's the point in money, which actually is a very bad attitude, I've only just realised that I have. And I need to talk out now because I've got kids. But at the time, I was like, oh, okay, so what will be useful? And then I had this idea vaguely that, you know, after we all die, maybe the people I looked after, or whatever, maybe that's why I don't know, it's very vague. But the really the honest answer is I don't remember. And I was always on this pathway, since I don't know, like five or six. And anybody would say, What do you want? Do you want to be a doctor, and I just, you know, pick my GCSEs A Levels and, and very foolishly applied to for medical schools assumed again, all of them didn't get into it. Now, I've got to tell you, I've got into one of them. And I just assumed I was gonna go to medical school. So I applied for medical school, went to the interview, didn't really prepare at all, and spent the night before the interview just going out with the other interviewees there because you know, this is gonna, I'm going to walk this. And then I sat down, and weirdly enough, I'd read about Oxbridge interviews, right. And I thought, because I came from a state schools, I had no idea. I didn't know anybody. They've been taught to Cambridge. And I read this thing that in Oxford interviews, they want you to be weird and wacky, and show all your different thoughts and make weird connections. But that's probably not the case for medical school interview. So I turned up, and they showed me these pictures, this is the like, thing, right? They showed me these pictures of different like anatomy, I think there's some cells, there's like lots of things that you would make sensible medical connections with. And then I really hadn't really prep very much and had no idea what most of the stuff was. So I made lots of weak connections. And like the last two or three, I actually run out of ideas as well. So I just like, they were like, why did you put these two together with Oh, they're both sort of brown. And they look to me, like, what's wrong with you? And I thought that would be quite abstract and quirky. And they thought that you have just ruined this interview for us. And you know, at the end, they were like, Okay, do you have any questions that are just asked you, and I'm here. And obviously, I didn't get in. And actually, that was quite interesting. For the first time I'd ever sort of thought, Oh, actually, this pathway is not going to work out. And I had a sort of existential crisis. And then very weirdly, on the day of eucast, I was only allowed to apply to one London medical school. And but obviously, because I came from the south coast, and my mom was like, if you go to London, you're gonna get stabbed. So you can only apply to one. And that doesn't make any sense, right? But anyway, that's what that's what that's actually what happened. And on the day of UK, some some Sunday Times list or something came out and then I Imperial was my choice for like, the whole time. And on that single day, I just changed my choice for no reason at all, other than I seen something on the internet about five minutes before from Imperial to UCL. And I got into UCL. And that's where my wife and you know, we have kids and you know, this is funny how life just flips like that. And yeah, and that's when I went to medical school and have a great time really is it's amazing, central London, very different. And then I six years and then so finished in 2012 and went to work in so me and my wife flux of LinkedIn applications together. So we went to work and what we thought was quite a small deanery in Oxford. But very weirdly, we didn't talk about the jobs that we would apply for, doesn't apply for nearly exactly the same jobs. So I actually did, we did the same jobs for two years. So I would do the job. I think I was first I would do it. And then she would be the next doctor following me. Which is really funny because we could be About the same people, right, and you know all the ins and outs when you come into the, into the department. So it was actually it's actually great. And then after two years, we came back to London. And then I became a heart doctor, and was a heart doctor from 2016. And in various London hospitals, up until basically September this year, so about two months ago.

Will McInnes 5:25

Love it, that's already a brilliant and interesting beginning, we're going to be talking about misinformation around COVID. And you've written this book, about your experiences on the frontline, as a doctor working in ICU. everyone listening to this will want to want to hear a little bit about that experience. So just give us a flavour of of what it was like whether it's through a story or whether it's just your overall experience. What was it like, being a doctor working on the frontlines of this pandemic?

Dr Dominic Pimenta 6:02

Yeah, I mean, the book decides to quit plug for the book there. So it's, um, it's called duty of care. And actually, if you get out before the 30th of November, it only 99 p on Kindle right now, and actually got, I'm currently in the charts. I'm 28. And Obama is 27. I don't know this Obama guy, the pandemic, I found myself weirdly across lots of different elements of it like right at the beginning. Me and my wife were really super anxious about it, thought it was going to be this catastrophic, global changing event. And then weirdly turned out to be pretty much right about that, which was the curveball, I think, no, everyone else thought that we were insane actually have to say for like four weeks. And there's this really horrible isolating period of going up to people saying, Ah, Covid is coming, have you done the numbers, we're gonna have thousands in it. And they were like, Nah, be okay. But you know, they're completely on the other side of this glass. And we'd already stepped through that, you know, into this weird world. And weirdly, for us, I suppose, when the lockdown came in, you know, and everyone, we were sort of on TV calling for early lockdown. And it's all very controversial. But a week later, there we are full lockdown. Everybody stay at home. It was weird. Like, I mean, lots people wouldn't be very anxious. But for us, it was a big relief, because at least everybody's on the same page. So remember that sort of being the first like transition from the sort of real ish world to something entirely surreal. And I actually remember for like the first, you know, most of March and, and lots of February and loads of doctor's experiences, nobody was sleeping, everybody who was thinking about this was not sleeping, because it's just this gnawing anxiety that you can't do anything about, I talk about in the book of exactly that sensation of like a tidal wave on the horizon. And you can see it and you know, what's going to happen, and it's coming, and about 90% of the people in the beach, do not want to hear it. And that is really like a horrible thing to feel I don't ever want to have to be like it. But once it happened, and then it was sort of like this, you know, and it weirdly, again, it sounds weird, but actually dealing with crisis in emergencies is kind of like the gears that you're taught as a doctor. So actually, that bit is much more not easy to deal with, but you have the gears to deal with it. But having said that, it did feel especially because we were in London, it did feel exactly like a huge wave just crashing. And what's really like different I suppose to how maybe other crises in the past were experienced by individuals was we have access to people's thoughts from WhatsApp. I'm in a WhatsApp junior doctor group. And it was like the whole you know, you could get the sensation of the whole of London I boiling and seething with all of these crazy stories, you know, day one, North Park hospital, we're going to be fine. Day two, black alert, day three. It's like the worst hit country, the worst Hospital in the country. And that happened in just 48 hours. And like people just have never seen anything like this before. And it was exactly I think everybody had that sensation. I we've never seen anything like this before. I mean, I've worked in horrible flu seasons about tonight to you a little bit before I was a heart doctor is one of my rotations. So I had some flavour of it. But really, it was just, you know, we had stories about hospitals closing because they ran out of oxygen or hospitals closings, they had no beds, like situations that had never happened. You know, the idea that the oxygen could run out of the wall was completely insane to like most people if you weren't if you didn't work in the States, you never thought about that. It's like saying, you know that the air ran out in in actual the actual air right? It's just doesn't happen in medicine. So where I was working, we were working in a sort of tertiary hospital. So we would take patients and and we had the, I suppose luxury but we had to close all of our operations, close loads of our normal activity and the doctors I myself were parachuted in to intensive care. So I started in quite early on about the sort of middle of March, end of March. And it was just, it was I thought about the book because we work in shifts, right? And we all shift to a shift pattern, you do not have to three shifts on four shifts, or three shifts, which is quite unusual actually, for doctors, nurses do that all the time. But it had this weird sort of staccato effect where you'd come in and see what's going on. See these patients coming in and sort of that, but it didn't, it didn't come in, like the deluge that you'd expect. It came in big jobs. So you come in, you know, the first shift, I think I worked in one, it was full of COVID patients already. And we're like, wow, that's quick. There's 12 patients. And then the next time I came in, which was almost a week later, so you do four days off, and you come back in, there's two it us, right, so it's doubled. And that's it. But that was happening, right? The the patients were doubling every two to three days. And that was the that was true from the end of February. And that's why you could see this long tail into the future, which was terrifying. And then actually, we ended up having for it like fourth completely new it is in the six it is in total at the hospital, and more and more patients and we started running out of drugs, we ran out of the drug to sedate people out of the drugs to paralyse people for ventilation. But what was really interesting actually was over time, or at least where we worked, that the attitude very much changed. At the beginning, it was very grim. And everybody was very much in the sort of this is going to be horrible and traumatic, and there's actually not much we can do, we'll just try to do our best keep people ventilated, but most of these patients will die that because that was the data we had, right. And we had and from China, and from Italy, about 80% of people weren't surviving intensive care. But over the course of the pandemic, obviously, actually care got much better. And one of the big drivers of that is probably resources. So where places like Lombardi were completely overwhelmed, they had no resources, and then instantly the death rate spirals. And that's exactly why you know, the lock downs we have now so important because there's only in the NHS particularly has various capacity. And anyway, it's coping right now, even we are locked down is the fact that it's already cancelled all the operations, again, to cope basically to any stays in ICU, etc. So over the course of the pandemic, and over the course of this sort of six weeks, you know, locked down for us was a tangible thing, we had this huge expansion, and then this tail off around the end of April, and then patients started getting better again, because we had the luxury of expanding, we didn't have to stop, we didn't have to say we've got no more beds, we just kept going kept creating and creating charging through car doors. So we had the option of having patients on ventilators for 689 weeks. And remarkably, a huge number of those, the ones that we had written off not written off in the sense like that, but like I was particularly pessimistic about go better. And actually, I remember sort of end of April discharging our first patient discharge out of there, like 10,000 patients by now something from one war to another of one, but it's completely and actually, it's kind of the boring thing, normally on a ward round. But we went round, and suddenly it was it was actually me I was the decision making register at that time, that would say you are fit for the ward. And obviously the plan have been for this guy to go to the wards for days for weeks before that. But it just happened to meet me at the end, it was actually like a really, I was actually generally very emotional. Because I was under them. You know, we were all under the impression that we were not discharged. Anybody. And actually there are some there were some hospitals at the time that really struggled. And certainly had very high mortality rates, but we we actually didn't.

So we had this you know, people getting better and and going and eventually the you know, by what time I finished it by the end of August, we had no Covid patients. So we've gone, you know, and we're closing it us and this weird like party atmosphere as we're transferring patients and closing it down and closing it down. But even at that point, you know, even at that point, in augers cases, we're starting to rise again, in the young people. And then we have this weird this kind of a segue into maybe misinformation. But this weird Rise of the, I don't know what to what to call them really Rise of the pseudo scientists, the rise of the COVID denied it. And the first thing, the first time I caught wind of this was as cases arising, people started saying, Oh, that's just because of testing. It's like, but doesn't make any sense. Like, if you just look at it for five minutes, tests have gone up by this much in cases have gone up by two or three times that so it cannot be because of testing. It doesn't make sense. And yet, you know, Daily Mail spectator, Facebook, and my wife so it was some of these I think when you go on Facebook anymore, I haven't for years, actually. But um, she's in one of these doctors groups. And what really shocked me was some of this COVID denialism and, you know, pseudoscience was actually being talked about in all in seriousness by genuine real doctors. As I already think of it, what do you think of this as you're shaping this thing? And I actually I was sitting there because you know, having just done covert ICU, and there's this guy, it's called Ivor Cummins. You may have come across him. He's actually a I think he's actually an agent. up in a Hewlett Packard printer used to work, there was an engineer. Maybe he's got a keto book to sell. Because everybody who, who seems to be in the game has a keto book or a Diet book to sell. And he was making all these videos on YouTube and like gaining like a million views like, you know, and actually they've been taught by so I watched one I literally I've never you know that that spit take, you know, when you spit out that I was what I had a cup of tea about. I watched the first three minutes, I actually spat out on my laptop. And this was like what was like he's literally said about 100 completely factually incorrect things in the first three minutes. This is a 45 minute video. And that's kind of when I just like, you know, I kind of thought is this worth my time to like, look through as an intensive care. I've seen you know, I've seen things also I've seen a very skewed, I've seen the sickest people with COVID I haven't actually seen funnily enough, very well, people with COVID at all, because it just wasn't my department. I wasn't in any, I didn't work on the ward. So actually, I just saw the ones who were really, really sick and I needed to go and like lung bypass like this and called ECMO and the extreme end. But to me, it was like, you know, and the lockdown is like, this is all this is a real like, you know, this, I've seen it seen the numbers I can give you like the typical COVID patient and the number CT etc. And then to hear this guy be like, Oh, yeah, COVID not real, it's just as bad as fluid as like, this just doesn't just insane. But then it kind of really speaks to the fact that and this is you know, I think a big problem in the NHS actually, that because of the the politics and the media view and how politicised you know from from Whitehall. Basically, if you annoy Whitehall's the chief exec, you probably don't keep your job for very long. So, but almost, you know, and that's not to say that the managers and I've saved NHS managers over the course of pandemic, absolutely exemplary like we were working and made like you know, on call 24 seven all the time dealing with a crisis that nobody's trained no infrastructure for and yet still, you know, just doing the absolute best they can. But it does inherently mean that the top echelon is politicised. And actually what happens then? So we have this great, you know, very, very tough discussing with media having people in and there were a few, you know, bbc documentaries, or Channel Four, but mostly it was a closed shop. And there were very few people who were able to talk about it. And as a consequence, I think initially, everybody went with it, but naturally into the vacuum, people will start to insert Well, actually, the hospitals are empty, and they will I've just seen them on Tick tock, you know, I keep getting this is really annoying. just seen on Tick Tock dancing, so nothing's happening, or I've looked up the the NHS stats, and actually it says that the hospitals got loads of beds. So what are they talking about? And that, actually, I think it's very hard for lots of health care workers. I mean, I find it particularly offensive, but I think everybody finds pills like that. Because it's a horrible system. People are actually traumatised from from what happened. And I mean, nurses, more other health care workers more than doctors, I would imagine. Because it's, you know, this thing about being out of control and being powerless. And then you got this Irish guy who's like,

Oh, yeah,

he's got a nice voice. I give him that. Like, I go into it. But he, he talks about, you know, it's not happening, or it's just following natural curve or the pandemic over. And there was this real, I mean, everybody wants it to be over, you know, even people like even even my own sister, she was like, This is not happening. We're not having another way. And she was like, she co founded the charity with me. She was here every single day. She lived with us during a lockdown. She saw I thought, you know, we talked about patients every single day. But she's back to normal life. Everybody did.

Will McInnes 18:45

I'd love to unpack or trace the steps of why we think people may have such an appetite for these mistruths and misinformation, and disinformation. At the moment, you mentioned one driver there with your sister, which is just there's just the understandable human desire for it to not be so that you mentioned also, you know, the kind of seeming connection between these deniers and weird books they have to promote or Bitcoin scams or whatever their particular shell, I think there's other stuff in the mix too. Because for the general population, including me, we found ourselves having to try and compute from what we could read and try and discern for ourselves like what the truth is, because there was a lack of consistent, authoritative, clear information. It felt it felt very fluid. And I feel like that's a driver to the greyness, of everything has left has left all kinds of people with all kinds of theories.

Dr Dominic Pimenta 19:51

I think I'd 100% agree. So the basic I was talking about with the day so some public health colleagues and yeah, there's Two things that you can do in a public health, especially in a pandemic, where there's not really any treatment, I mean, the vaccine might come down the line in a few months. But there's not, there's nothing else you can do other than public behaviour. And the only way to influence is to maintain trust and have transparency. And at the beginning, you know, even in beginning of February, March, there seemed to be this political battle with, you know, Johnson giving a speech in Greenwich saying, we're going to be the Superman that's going to take off the glasses and champion free exchange, regardless of the medicine or whatever he said. And you know, even you know, privy to some of those discussions about when when lockdown should come in, and this is, you know, talking about herd immunity at the beginning of March. So that already, then there's some confusion, but then they started having the daily briefings and everything sort of coalesced. And there was this very strange moment where everybody in this very divided country seemed to be relatively on the same page for about five minutes. And actually, this I think, I think, the clapping some people found a bit corny, I personally was super cynical, I thought, I would think this is a load of crap. And then my sister was like, do you need to go outside the clapping for you the clapping for those that you know, it's happening for other health care workers, we should go outside at least and, and as soon as I heard it, I was super emotional, because it was that whole thing about about being on the same page everyone together. But you know, the, the actual reality of that was we had the daily briefings, we had witty and van Tam and all those superstars, talking every single day. And everybody was sort of understanding, you know, the basics. This is what the parent is, but then over a period of time, it started to get frayed. There was a lot of grandstanding, oh, it will be over by Christmas. And then we went into the coming thing. And that's exactly when they completely blew up all of that trust all of that transparency. And actually, at the time, I was like, because obviously, I didn't even know it. But famously, I resigned over this issue. And I said, you know, that why would they blow up this trust and transparency, when it's the only tool we have to prevent a second way, or the only is any trust, it's only you know, and if we, you know, create that vacuum, destroy that trust, create that grey space that you talked about? What will come in is going to be ineffective, and we will have a lot more deaths. And that's exactly what happened, sadly. But the but yeah, even at the time, I was like, well, there must he must, you know, there must be something there must be some grand plan for government, there must be some super kompromat that he's got on the whole cabinet. I don't know. But it's got to be good. Because this is all for how much political capital Have you burned for this? How much lives are going to be lost as a consequence? And then he just walked, like, he just walked like 10, like five months afterwards? Because he had a spat with whatever else, you know, Lee cane or whatever. Anyway, I completely digress. But I think you were pointing exactly right. That it is that clear, consistent messaging. And actually, if you look around the world, the countries that have done the best have just been clear and consistent, like Angela Merkel, will, you know, every time she opens her mouth about COVID, it's clear, it's concise. It's on message, it rarely changes. And actually, it's really useful. I was sharing clips from her in German subtitles a look at this, this is probably the best thing I've heard about COVID in months, because it was just so straightforward. There was no this like, flip flopping on mosque flip flopping on whatever else is, and actually, you know, Sweden. Everybody wants to think all Sweden's the best. Actually, Sweden is now having some of the worst tests in the world again, and already had it whereas Norway and Finland comparatively have done completely much, much better, no deaths, and actually no second wave this time around because people actually trust the process. But the one thing that they were really good at was that everybody believed in Anders technical and he would give very good clarifies, he said, this is the strategy. This is what we're doing. This is why you should all stick to it. And what we have done is like completely abandoned that we have almost like government or public health policy by headline, you know, people hearing about the lockdown. And it's I think it's, it's doubling and effective. The first thing is that it comes in a headline. So I was like, Well, why am I hearing about this in the sun? Why haven't someone officially got on the podium and told me, but the second thing is people feel very disregarded. They feel like this is their secondary, you know, they pick up the paper and find out that their house is locked down now. They feel like they're not engaged. They're not part of this process. And it's the countries that have made their citizens part of the process

Will McInnes 24:36

that have done that. Look at Vietnam. Yeah, Vietnam is going to Vietnam one feels is going to be one of those countries that is is the case study. In hindsight. What I'd love to do is is propel from this assessment of how it happened to the amazing point that you made about how you've experienced fellow medics fellow professionals, though who have been brought through the sort of rigour of the scientific school who are also doubting the reality of COVID? As you would see it, what do you make of that? Because we can't sort of explain that away as quite in the same way. It's not, it's not as dismissible, or as forgivable, maybe. Or, like, what, how on earth can fellow medics be unclear about covid?

Dr Dominic Pimenta 25:29

Because they're human. And you see, I mean, it's not even fellow medics, right. You've got seen a senior epidemiol infectious diseases, epidemiologist, professors of evidence based medicine. I mean, I'm not sure what that means. But whatever. But you know, and these are people that are not nothing. And it's hard to know, sometimes if there is an agenda. For some, for some academics, I think they have literally just planted their flag in this in, in in the, in a hill. And that's the hill that choosing to die on. And it's not about anything else other than proving the point. I suppose the problem is that, and I think medics especially, I mean, I know obviously, I've compiled community of medics, just human beings. I remember a great conversation I actually have, which still illustrates this idea to me, right, right. About a week, week, 10 days before we lock down. I was sitting in the office with a colleague of mine. And I said to him, oh, you know, how, you know, do you think your research is, is going to be cancelled? And he's Oh, no, I'm going to go fly off to wherever it was Amsterdam or something, and all my research is ready to go. And it's like, for about COVID. Like, in two weeks time, we're going to be in it or whatever. Like, we're going to be inundated. And he's like, Oh, well, you know, I don't think that's gonna happen, really. And I was like, but look at the numbers like the web, you know, this week. Look at them. Look at somebody right now. Like it's boiling over when we're two weeks behind. He's like, yeah, I've seen all that. And I was like, okay, what's the connector? And then he and then I said to him, so so what do you still think that this is going to be fine? And he's like, Yeah, no, I accept that. It's gonna be bad. But I just think I'm going to still go to reset. And that's it. But why it is that Well, I suppose is a combination of optimism and naivety. I really think that illustrate that, that everybody wanted to not this not be the case. Right? And I still think that's true. And I still people want to not not be in this world.

Will McInnes 27:27

Absolutely. Have you come across the Stockdale paradox? No. So I think he may have ended up as an admiral or something. But he was a fighter pilot for the USA, flying over Vietnam was shot down, taken to a prisoner of war camp and held there for a really long time. And what he famously the phrase that he coined was the the optimists die first. And it was that all the people who thought they would be out at Christmas, which suffer a real kind of blow to their morale, they then say, we'll be out by Easter, they then say, maybe, if so and so becomes president, or if this accord is reached, and bit by bit, they were, they set themselves up to be destroyed. Whereas his his view, which seems, you know, pretty negative, or pessimistic or whatever was, you know, we're not getting out quickly. We, we might as well dig in for the long run. And at least I guess your example is, they were self aware enough to know that they were being hopelessly optimistic. But there is definitely optimism has been tested. I mean, wow, what a year 2020? Like, if there was a year to test anyone's

Dr Dominic Pimenta 28:42

Yeah, well, resilience wise, I think, is a really good point. Because actually, you know, why, you know, you say why on why could medics, you know, not see the science or something. And I think fundamentally, what I've genuinely realised maybe even in the course of this year,

Unknown Speaker 28:59

even this, this

Dr Dominic Pimenta 29:00

idea of cognitive dissonance, that human beings, I actually think that's the normal state for human and actually, I think, in my everyday life, I am so inconsistent, and I think everybody is, and I don't think that people would end up one of the biggest problems is people, you know, these professors is very good example. They stake their, you know, they stake their flag, and that's the hill they want to die on. But we did it in our everyday lives all the time. You know, we say, I don't know, I'm a, I'm a frugal person or I not you know, I'm an angry person, that Bina you tell yourself that this is who you are. And then you just, it's the opposite, you start to behave to justify a Brexit is this great example, once the decisions be made, it's much harder to convince people of despite, you know, complete self immolation of some of the mean. And but I actually fundamentally think we, I think, give ourselves too much credit in a way or maybe put too much pressure on ourselves to be consistent. And individuals when I actually think human beings are just messy, and not at all like that, I couldn't

Will McInnes 30:05

agree more. I mean, the Kahneman Thinking Fast and thinking slow and effect, effectively my takeaway from the book, which I didn't finish, and I don't think lots of people do, but was that there's a, there's a, we think the brain is telling us what to do when actually, the brain is inventing a narrative for what we've just done. And that that, for me was brilliant, because because in business, which is more my domain, some of the people who've proclaimed themselves to be the most rational, in my experience are the most irritatingly irrational. And, and but they're wedded to this identity, like you say they've chosen the hill. And that gets in the way. So the project that you've now started, you got interested in misinformation around COVID. And being the go getter, that you are the person who then finds extra time and resource on top of already a busy life, you've, you've started to do something about it, can you pick up that story and tell us like, where you started? And where you're going? Actually, I

Dr Dominic Pimenta 31:12

think it goes a bit further back. So for a number of years, and this is why, you know, maybe my political hat. So when I first started working, I worked in a really terrible hospital. And I just couldn't work out why somebody in a perfect, you know, health secretary in or civil service, would make all these decisions that were so obviously detrimental, you know, on the ground, like the pay cuts, but also a local hospital close when we was my first year of medicine. And suddenly, RNA was completely flooded, and we couldn't cope. And I said, Well, how did this happen, and every struggle is just what happens, as I but that's, you know, and then and but this is constantly trying to explain that to people who didn't really understand the realities. And this is a concept of medicine of informed consent, right? This is the bedrock. So you cannot say yes to a procedure or whatever it might be even as simple as an injection of x and vaccination. Without understanding the risks and the benefits and, and kind of my role, I think, in my public facing sort of Twitter, whatever it is, for the last five years, has been trying to explain just like the, you know, the fundamentals, like what's going on with NHS? Why does it need more money. This is why you know, your vote is important, because this is what will happen. And in regards to the deficit, and to the NHS, nurses, etc, etc. And what really struck me Actually, especially, you know, over the Brexit time, and over the last couple of years, is how different discourses now, and actually wrote this whole, this whole essay, which nobody read about how this base bit is based. It's basically an update from my point of view of this, but if you read the book called The Shallows was on my shelf and recommended someone, basically, this guy wrote it in 2008, Nick Carr, in 2010. And it was in the New York Times bestseller list. And it's all about how the internet, and even the very basic functions of the internet is a great example of where it talks about hyperlinks, but it also talks about how they distract, and then actually start to rewire your brain. So a lot of people don't know this, but your brain is super plastic, like it can make connections depending on what you do on a day to day basis, like physical connections, and is a phrase in neuroscience called neurons that fire together wire together. So basically, your behaviour actually determines your biology, which is the first point. So the problem is if we start filling our brains with super distracting, you know, attention grabbing constant content. And this was in 2010, when basically the internet there was no social media, really, there wasn't much in the way of people being on Facebook, there's not a lot of video content. But he talks about this great example, that actually, when people invented the internet, they thought that connectivity would be much better for our brains. This is great

experiment, where they showed hyperlinks, right? And you know, the, the basic block of internet 1.0, whatever it was, and they said, here's an article or something hasn't gone reform or something. Here's a pro and here's a anti article. And here's what I wanted, one group just had to read one in the meet the other. And the other group had hyperlinks all the way through both articles, so they could click back and forth. And they hypothesise that this would be in great synergy and they comprehend much better. And actually, the what actually happened was the group that just read one plain article and then read the other one had much better comprehension of the subject than the people had flipped between them. And they actually what they hypothesised The cause was was this concept of macro distraction. So you actually, you know, the idea that you can only hold like five or seven items in your brain at one time. Well, if you're reading a piece of text, and you come along a blue underlined word that you think is a hyperlink, what are the mechanics in your brain that actually tells you that is a hyperlink and then your decision making to click on it or not? Well, you have to see it's blue. See, it's unlocked. You have to understand what it is, you have to then make a decision whether or not you want to pull yourself away from here and go back or come back. And actually all of that micro distraction completely shreds your ability to retain what you were just reading. And now imagine the internet, right? Like when you that video that doesn't go away. And when you scroll down the page, and it takes a long to load. And you know, some pages are so complex now that every time I go on The Daily Mail website, and now I've had to put that in writing that I sometimes do my in my actual laptop overheats. I don't know what it is. There's something running in the background that's so intense anyway. So I've always been about misinformation. And there's loads of evidence that smartphone use causes depression, anxiety, body dysmorphia, suicides, suicide is up massively, especially in young people over the last 10 years. And one of the big drivers people think is this social wired world that we live in. And the caveat to that, and I think nobody really saw this coming is having access to all of the knowledge of humankind at your fingertips has all that meant is people are less informed, because they're overwhelmed. There's like white noise, you can't even stop for five minutes to comprehend anything. Because there's 15 people giving their opinion about it another 15 sharing something else about it. And I just it completely destroyed. Actually, it was interesting, I just watched the social dilemma on Netflix a few months ago. And it really sort of encapsulated this, but it's the same point. And essentially, you cannot have a society or democracy or any of the norms, you know, and then back to informed consent. How can we make informed decisions as a society, when we don't even agree on what reality actually is like when we think we're informed. And that's the irony, it's not that we're uninformed. We're not like, Oh, I don't know pick anything. And that's not that's not what happened. people now have very strong opinions about everything. And they have to, because that is the nature of social media. If you see something, you have to like it, or comment or share it or not. So it forces you to have decisions. And I actually think this is one of my wacky ideas. But great, great to like have a button that just says I don't know about this, I don't, or I have no opinion about it, or I don't care about it. And not just to feed the algorithm, but just to tell people that it's okay to not actually be, you know, completely on top of this subject and have anyway. So, we need we need from Brexit, that this world has really started to verge and people live in their bubbles, and all of the social media algorithms completely embed you in the bubbles. And actually what's really interesting about the COVID world and as I was on a panel actually a few months ago with the World Health, world public health Congress, and on the panel was Carol Cadwallader. And they asked us the same question about misinformation. And she, I mean, she was of the opinion, she's been studying this for years that lots of these networks are now focused on COVID and utilising it in a very deliberate way. And actually, I'm starting to think that these networks have become organic. The algorithm itself, trains you to be outraged. And initially, you might be outraged about a particular subject, whether it's vaccines, or Brexit, or Republican or Democrat, or whatever it might be. And then that sort of funnels, you know, like one of those balls that sort of bounces down and ends up in a pocket, and then you're in this outrage pocket, and you're ready, all your responses already trained to be to be outraged, or whatever. And I think what happened with COVID is COVID came along. And that bubble just got attached to a new source of information. And then you would see people sharing outrage, but about COVID. And then they're in the same bubble, the same group that you are, and then you just gravitate towards them. And then all that's happened is you just sort of migrate different topics, same anger, and the same sort of lack of, you know, shared information and resources. And we have seen this and this is fascinating. So if you there's a study recently looking in America at Google Trends, right, so it's just what people are searching for. And if you saw this is super interesting. So when COVID was announced, you could look on Google and by state depending if you voted Democrat or Republican, in democrat states, they will searching for hand sanitizer, and searches for hand sanitizer republican states was statistically much lower. Now, there is no earthly reason for that, like doesn't make any sense. COVID is not a political issue. Everybody wants to live like there's no, and I actually almost don't think, you know, unless you're extreme bad actor, and you're trying to like sink another country, but at the same time trying to preserve your own country. I don't think there may be some truth to that. But there was almost no human intent why people would want to mess with that. Like, it doesn't really make sense. Other than the algorithms naturally push you in these directions. And it got me thinking like, how, how do we sort of interrupt that? And there's a few things like the first thing I started doing was actually just saying actually, a lot of the you know, these Ivor Cummins characters to do science heritage, they're actually very good at presentation and we sort of named this a long time in medicine because if you people look at you know, the people are very ready to dismiss. homoeopathy is like quacks and natural path. But we have to take a step back as a profession and say, Well, hold on, why are they successful? Because it's, you know, it sure is shit isn't the fact that doesn't work, it doesn't work. And we all know it doesn't work. And you have horror stories time and time and time again of the man with cancer going to the homoeopath, you know, the man with terminal disease. So why don't these horror stories put people up, and it's because of their presentation, you know, you go and see a homoeopath, they spend 60 minutes with you, you know, you're paying for it, but they spent 60 minutes with you, they talk to you about all your problems, they want to know you in the round, they want to know about your family. And actually, we could learn a lot from that we could learn a lot that actually a lot of medicine, you know, a lot of the ways that we practice in our very hectic modern medical world isn't doesn't suit the patient at all, you know that 50% of patients don't take their medicines 50%. So essentially, if you're sitting there adopting, you either do pretty good job today, probably save 75 to 80%. Now you didn't, half your patients are not even going to take the tablet, so you give to them. So you've done nothing for them. So this idea that you know, the presentation form. So we started doing this thing where we just I just emulator but I basically just went to a video and just talk through it. And actually, I found that cut through in a different way. Because people are so used to like live comments on tweets, the condensed form that can without context is useless. And then I took another step, I've got even angrier because I think I saw something else about think about herd immunity actually, about being a real strategy for the winter. This was in September.

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