Clickbait or Cure: How to Spot the Difference Between Good Information, Misinformation, Malinformation, and Disinformation in Health & Medicine

In this insightful episode of Since You Put It That Way, I sit down with Dr. Heather Voorhees to tackle one of the most pressing issues in health and medicine today: the spread of misinformation, malinformation, and disinformation. We break down how to differentiate between reliable health information and the misleading content that floods social media and the internet.

Dr. Voorhees, a researcher in interpersonal health communication, shares her expertise on how people talk about illness, the impact of chronic illness identity, and the dangers of false health claims. She provides practical tools to help you think critically about health-related content, question sources effectively, and avoid falling for deceptive marketing tactics.

Learn more about Dr. Heather Voorhees and her research: https://hvoorhees.com

Intro for "Since you put it that way" podcast.

Outro for "Since you put it that way" podcast

Transcript

Dr. Mary Louder: 0:18

Hi, and welcome to another episode of Since You Put It That Way. I'm your host, Dr. Mary Louder. Today, I'm going to be in conversation with our special guest, Dr. Heather Voorhees.

The title of today's podcast is Clickbait or Cure: How to Spot the Difference Between Good Information, Misinformation, Malinformation, and Disinformation in Health and Medicine. Dr. Heather Voorhees is an associate professor at the University of Montana in Missoula, Montana, and she's in the Department of Communications.

Her bachelor's degree came from Minnesota State University in Moorhead, her master's in strategic communication from the University of Minnesota in Twin Cities, her PhD in communication studies at the University of Nebraska in Lincoln, and a postdoctoral fellowship at the Center for Health Communication at the University of Texas at Austin—Hook 'em Horns, she says.

Dr. Voorhees is a researcher, and her projects and publications can be found on her website, www.hvoorhees.com. Let me spell that for you: www.hvoorhees.com. On her webpage, you'll be able to find all of her research, videos, and teaching on these important topics. This is called translational research, meaning you take the research that you've done and get it out to people to make a difference. It shouldn't be isolated, she says. Research should be for the benefit of us all. So that's why she's created a website, and that's what you'll find there.

Dr. Voorhees is an associate professor of communication studies at the University of Montana, and her research and teaching focus on interpersonal health communication. She is particularly interested in how people communicate regarding the management of illness identity, how individuals seek and offer social support, and how people choose to disclose health-related information. She states that she's a pragmatist, choosing the theory and paradigm based on the question at hand, and she's a mixed-method scholar.

She has researched topics such as infertility, mental health, and chronic pain. Before she was in academia, she worked as a small-town and suburban newspaper reporter and editor, a magazine editor, a corporate communications manager, and an internal communications consultant.

So welcome, Dr. Heather Voorhees, to Since You Put It That Way. This is a great conversation I had with her regarding how to spot real information online and how to watch out for the bad stuff online. That's why Clickbait or Cure.

So sit back, enjoy, and listen to our conversation. We're glad that you're here.

Welcome, welcome to another episode of Since You Put It That Way. This is the podcast that makes everybody pause and think, Hey, let's consider this a different way. Let's think of the same topic differently.

So our guest today—I'm hosting Dr. Mary Louder here—our guest is Professor Heather Voorhees. Now, did I say that correctly?

Dr. Heather Voorhees: 3:45

Yes, it's a very Dutch name. I married into it, so it's, I don't take personal offense if you so that there we go. 

Dr. Mary Louder: 3:50

Thank you, Doctor Doctor Heather Voorhees and I met you online at my alma mater, University of Montana.

 Dr. Heather Voorhees: 4:02

Correct! Yes, I've been here since 2020, since right in the middle of the pandemic is when I started.

Dr. Mary Louder: 4:06

Yeah, and you're an associate professor in the Department of Communications.

 Dr. Heather Voorhees: 4:11

Correct, yeah.

Dr. Mary Louder: 4:12

And then with under that, what's your specialty in that area? What's, what area of communications do you like?

Dr. Heather Voorhees: 4:18

Yeah, so within communication studies, there's different kind of tracks that you can take and I focus on interpersonal communication, which is, how two or three people tend to co-create meaning together, and so even within that, then I specialize in health, interpersonal health communication. So how do we speak with, friends, family members, etc., about health and illness, about diagnosis, about symptoms, about things like that. And then even more specific within that context, I look at  the context of chronic illness. So incurable but manageable illnesses that tend to affect your daily life and go on for, I believe it's 18 months or more, is the, the current definition of that. So yeah, so how do we, how do we talk about those things to friends and family members? 

Dr. Mary Louder: 5:06

Yeah, I think that that's tremendously interesting because it's very difficult to talk about. And within the context of the doctor-patient relationship, that's very difficult. I think when I ran across your information, actually I found you in an article. You were quoted in an article and  and I can't remember the name of the magazine, and it was just a couple sentences I'm like, oh I gotta go find her, must find her. And, and not only just because of the alma mater part about the University of Montana, but just the concept of talking with patients about communication. The heart of the, the relationship with I'm gonna go doctor to patient. I'm not gonna go I'm gonna go doctor to patients is, is trust, is communication is listening, and then the other concept of where, you know, maybe the patient becomes their diagnosis. I think that's really challenging, and I think where or they define or their diagnosis defines them. And they lose their sense of personhood in that. So in, in some of the research that you've done, what have you, what have you found out with some of those topics relative like chronic pain or something like that

Dr. Heather Voorhees: 6:24:

Yeah, so I love that you mentioned that. I mean, chronic illnesses obviously are ongoing, sometimes for years, sometimes for decades, and we do often see people being really encumbered by that and really, really making that a key part of their identity. Illness identity is a term that I focus on in my work in interpersonal health communication, and there are various theories that we use to kind of study that. But the concept is we all have an identity, which is a sense of who we are, but that also includes a sense of who other people think we are, right? Because we're influenced by the way people treat us and the way people talk to us, and the way that people see us definitely influences how we see ourselves.

So illness identity is this concept of how we weave in an illness or a disability. And in particular, in my case, I study chronic illness identity. But how do we weave that into a sense of who I am, how I may have changed since before that diagnosis or that oncoming of symptoms? What are my expectations for myself going forward? Because chronic illness can change that. And then also, how does this change the way that I relate to other people and the way that they relate to me?

So in my work, for example, you mentioned chronic pain. That's one of the contexts that I've studied. What I found is that as people start to feel these symptoms of chronic pain, maybe they're diagnosed, maybe they're not. Maybe they know the cause of the pain, maybe they don't. But obviously, being in pain every day changes who you see yourself to be, right? It changes the capabilities that you feel that you have. It changes the activities you're able to do. It changes the way you're able to show up in the world. But importantly too, it changes the way that other people see and treat you.

So what I found is that sometimes, you know, kind of think of it as a spectrum. On the one end, we have people who have experienced chronic pain who say all of a sudden people in my life treat me like a baby. They treat me like I can't do anything, that I constantly just need this attention, that they stop inviting me places because they assume that I won't be able to go. And then on the other end of the spectrum, you get people who say, well, all of a sudden people started thinking that I was faking it. And they started treating you rougher. And they started saying, oh, you're tired. Well, could you just try to get out of bed for me this one time, right?

So you have these kind of two extremes of the way that this chronic pain influences how other people see you, and then that changes the way that you see yourself very much so.

Yeah, I mean, to me, interpersonal communication is a relationship. It's, again, that co-creating of meaning, and so the way that I feel about myself doesn't necessarily jive with the way that you feel about me. So how do we talk about that? How do we physically move in that space and co-create that meaning together, right?

Dr. Mary Louder: 9:25

Right. Now, have you been able to take the findings that you've had into any training for professionals, physicians, physician assistants, nurse practitioners, any?

Dr. Heather Voorhees: 9:37

Yeah, I'm a huge, huge, huge believer in translational research, right? One thing you should know about me is this is my third career. I came to academics at the ripe old age of 35, but before then I was a newspaper reporter. I worked in internal communications for a healthcare system. So I've seen communication, I've seen its different forms, and I've seen all that.

What really excited me about academia is the ability to access and to build on all of this research. I think most people don't have access to all the amazing research pieces that are out there, and I'm so fortunate to be able to read all of these great works from all of these great minds and to use them in my own research and build off of them. But what really upsets me is that people don't have access to this research. I really, really believe in translational research. I really believe in applied research. It really upsets me when all of this knowledge is held up here away from people who would find it valuable, who could use it, and who should be trusted to read it and engage with it.

So yes, I definitely try my best to bring things that I've learned and researched to everyone. To that end, I do a lot of community work. I did a talk about health misinformation to our ongoing lifelong learning program here in Montana, and I had an audience of 100 people who just wanted to learn about what misinformation is and how they can look for it in their own lives, and that was awesome.

I always bring research down into my classroom for my undergraduates and my graduate students. Research is not scary. Let's learn how to read this. Let's learn how to use it. Let's learn how to argue with it, right? But yeah, I think to your point originally, and I strayed a little bit from that, I think it's really important for communication scholars to bring our work to medical professions because I can study this all I want, but I am not an MD. And I want to share what I've learned with MDs and other practicing healthcare professionals. I want them to be able to share what they know with me.

And then I also want patient voices in there. To me, it seems like we should all be working together because we're all specializing in different things. One of the things that I was really excited about is when I was a postdoctoral fellow at the Center for Health Communication at UT Austin, one of my main projects was working on a white paper and actually some free curriculum for professors of journalism and for medical professionals, future medical professionals, on how to teach people how to talk about mental health and mental illness in non-stigmatizing ways.

Now, as you know, in the past five years, mental health is front and center, and I'm all about it. But we still talk about it in some ways that we could improve, in ways that maybe stigmatize certain people and leave certain people out of the conversation. So I created this curriculum for them to use in the classroom. It's available for free. It's still up online. Anyone can go view it. You can use it wherever you want.

We were also able to publish in some journals that are specifically targeted toward educators and future healthcare providers. Here are some quick and easy things that you can do with your students, your future professionals—ways we can practice that non-stigmatizing language, ways we can practice thinking about these patients in a slightly different way to really, like you said, build that trust, build that empathy, and open up those lines of communication.

So I try to put my research everywhere I can possibly go.

Dr. Mary Louder: 13:38

Right. So yeah, and that was one thing I noted too. So folks, look up—so basically, Google Dr. Heather Voorhees, and you're gonna find Google Scholar, you're gonna find her articles, you're gonna find the information that's right there. It just pops right up.

There are a bunch of articles and research that you've done that is right there. And I think to that point, how important and accessible your research is, and how actually accessible you are—your student reviews, by the way, are quite good. I saw some of those online too—very good teacher, very good instructor, really reaches out, really works with the students. And so I'm like, OK, this is the whole package, not just research, but teaching about that.

So yes, this is the real thing. But I think to that point, because patients come to me and they say, Oh, I've done my research. And I'm like, Oh, interesting. So do you know how to research? The answer, of course, unfortunately, is not always—and typically not much. But they're looking for answers, and yet I hear in that statement that they’re looking and trying to advocate.

And so they're gonna bump into what really is our topic today, which I'm so excited to get to because that was a bit of a prelude, but here we go into misinformation, disinformation, and malinformation. The dismissing mouths of all the information that people run into online, in the literature, in our culture—how do we navigate that?

I mean, you teach a course on that, and there are certain principles to really learn about this. And when I looked at some of the information behind this, there were some things that were surprising. I'll get to that, but I really want to hear from you—your part about misinformation, disinformation, and malinformation.

We should probably start with definitions of those, because I think people will find them interesting.

Dr. Heather Voorhees: 15:37 

Yeah. Yeah, I mean, I certainly did.

Dr. Mary Louder: 15:42

I did, I did too. I was like, Oh, I didn’t know how to categorize...

Dr. Heather Voorhees: 15:42

You know, scholars like to categorize everything. But I always start every undergrad class with, Let’s all agree on our terms here.

There are a lot of words that we all use that we don’t necessarily agree on what they mean. So let’s ground set here. Let’s level set.

Dr. Mary Louder: 16:02

Yeah

Dr. Heather Voorhees: 16:02 

So yes, to your point, there are three kinds of—I call them flavors of misinformation.

One, there's misinformation, and that's the term we've all heard. Think of that as the most innocuous, the most innocent form of misinformation. This is information that is inaccurate and not necessarily reliable, but it's spread with good intentions, right? The sender does not necessarily know that it is incorrect, and they are sharing it with good intent. So think about, maybe a relative knows that you are really struggling with rheumatoid arthritis, and they forward you a headline that they saw on Facebook—Boiled lemon juice cures rheumatoid arthritis. Now, that is not correct, but it was sent in the spirit of helping. And presumably, the person who loves you did not know it was incorrect, right? So misinformation is not harmless, but it’s definitely not malicious, OK?

Then, kind of in the middle ground, we have what we call malinformation. This is information that starts with a kernel of truth but is intentionally exaggerated in a way that is misleading and therefore causes potential harm. This one fools me all the time. Think about when you see a headline like, 1,400 people poisoned by a bad milk outbreak. Oh my God! Oh no! And so someone spreads that headline, and it shows up on your Facebook or Instagram feed.

OK, maybe that was true—but maybe the headline is from ten years ago. And the person who created that little meme or post knew that. They knew it was outdated information, and they were using that headline as a way to shock you or scare you—typically into buying something, believing something, or getting on their side, right? So again, it stems from truth, but it’s intentionally exaggerated.

Then, on the top of the spectrum, we have disinformation. This is public enemy number one. Disinformation is inaccurate information that is deliberately propagated in order to fool you. It might not even stem from the truth. It might be completely made up, and the person who is spreading it and sharing it is doing it to try to manipulate you, OK?

This is really dangerous because this is when people just straight-up lie to you. And they’re doing it to scare you or to confuse you—because fear and confusion make you vulnerable to whatever solution that person is also probably trying to package with that scary piece of information.

So misinformation, malinformation, and disinformation—they all have slightly different outcomes. None of them are great, but the intentionality behind it is how I can kind of tell the difference.

Dr. Mary Louder: 19:15

Yeah, I think that—I love that you really emphasize the intentionality because that is, I saw, also the key difference between those levels of information. And we have a lot of that right now.

We have, and we've had, a lot of it. You know, I saw some examples of that even from the 1400s.

Dr. Heather Voorhees: 19:36

100%. In the class that I teach, and every time I talk about this, I want to remind people—this is not a new phenomenon.

This has been happening for a long time. I mean, you know the history of snake oil salesmen, right? We know that term—it kind of means someone who's trying to sell you a false treatment or remedy, right?

That started in the 1800s in the Wild West when people were literally selling things they called snake oil.

Yeah. Fun fact—snake oil is a real thing. It's an actual Chinese balm made from the oil of a certain type of snake.

Oh yeah, it’s an actual thing. And when a lot of Chinese immigrants came over to California to, you know, basically build California, they brought this ancient treatment with them. Native Californians—native white Californians—saw this and thought, Ah, how exotic. How exciting.

And so they started just bottling whatever they wanted and calling it snake oil, going from town to town and promising this time-honored healing tradition.

And it was completely fabricated. There were no snakes. In the original snake oil, there was—but in the snake oil we're familiar with today, there is not.

Yeah, so this has been going on for a long, long time.

 Dr. Mary Louder: 20:54

Yeah, and then if you throw in the placebo effect, which is 30%—that no matter what you do, if you tell them this is going to work, you get a 30% cure rate.

That's actually pretty good. So that gave some, unfortunately, inappropriate credibility to the snake oil salesmen.

Yes. And then, if you actually look at it, there's a hyper placebo effect, where you can get 45% to even 60% recovery.

So people really buy into it—the language and intent around how it is presented, and the credibility of the individual.

So you could get this maximum effect from something that is really, truly snake oil—that doesn’t even have snake oil in it.

 Dr. Heather Voorhees: 21:39

The placebo effect gets a bad rap too. I mean, I’m OK with the placebo effect, right? I’m OK with it. If you want to go to, I don’t know, hot backwards yoga for four hours every day—yeah, that’s fine. If that makes you feel better, that’s great, right? If it works for you, that’s amazing.

The problem I have is when people are trying to exploit that for their own personal gain in an exorbitant way, right? Like, if something makes you feel better, that’s fine. There’s absolute merit in that. But if it is actively hurting you instead—and maybe you can’t tell that it’s hurting you, maybe it makes you feel better at first, but in the long term, it’s bad for you—and someone knows that, and they’re intentionally selling that to you, knowing that it’s probably not a good idea…

That’s where I have problems with it.

Dr. Mary Louder: 22:35 

Right. And again, that gets back to the intent of it, doesn’t it? The intent of the individual.

So, where’s our biggest hot button for disinformation right now?

Oh my goodness.

Dr. Heather Voorhees:  22:48

It feels like a trap. It feels like a trick question.

So, you know, I’ve thought about this a lot, and what I want to stress to people is that as human beings and individuals, we have an obligation to ourselves—and a responsibility to everyone else in society—to do our homework, think critically about things, and always give everything a second thought, right?

Like the title of your podcast, the intent of your podcast is to never take anything at face value. Hard stuff—always give everything a second thought. We as individuals have an obligation to do that.

However, the last thing I want to do is demonize someone who has believed a piece of misinformation or disinformation because someone they trusted told them that, right?

I think we often place the onus on the people who fell for the lie instead of the liar who spread it.

And I always tell people, I am not here to shame anyone who has paid $60 for a bottle of supplements that ended up not doing anything, or who put their trust in someone who sounded like they knew what they were talking about and seemedto have their best interests at heart.

I fall for misinformation as much as anyone. Honestly, I do.

We need to stop blaming the victim and start blaming the people who are intentionally spreading malinformation and misinformation—and start holding them accountable.

And I think the problem is, there are just so many people spreading malinformation and misinformation, and it’s really, really hard to know who to trust.

Dr. Mary Louder: 24:37 

It is, and I think one of the things to understand about how this gets propagated is that it’s not just an individual getting something wrong or misunderstanding something—it works through how humans learn, which is through a group, a network. Because we’re social learners, right? We are social learners. So you’re going to run in the pack that feels comfortable to you—because it feels comfortable.

Yeah. And if you get into this pack and all of a sudden you get other information given to you, or you begin to—hmm, since you put it that way—consider something else, it becomes uncomfortable to try and get out of that pack.

Dr. Heather Voorhees: 25:21

Yeah, right. I mean, have you taken my class? Because these are all things—No, I discuss this! Yeah, I mean, we talk about human nature. Humans are pack animals. We are built to trust one another, to trust our tribe, and to trust those people. We are also built—and I think rightfully so—to trust people in seats of authority, people that we have given that power, right?

So we, as a society, have said: Here’s our medical system. Here’s what it takes for you to get an MD, a DDS, or whatever. Follow those things, and then we trust you to have the patient’s best interests at heart. We trust those people. Unfortunately, having an advanced medical degree does not mean that you are incapable of spreading malinformation and disinformation, right?

Think of Plandemic. That was a lie. I'm going to—I feel pretty secure going on record saying—that was a lie. And it was propagated by someone who was in a position of trust. One of the things that became very, very clear to me during the pandemic and afterward was this idea: If you have someone who is supposed to be the smartest, most respected, most trusted person in the room telling you to drink bleach to stay healthy—I don’t for one second blame someone who trusted that person and did that.

Why wouldn’t you? Why wouldn’t you trust that person? Right.

So, that’s what I mean. We all have an obligation to do our due diligence. But at the end of the day, it’s not the victim that’s wrong—it’s the liar that’s wrong. And we, as a society, need to start learning where to point those fingers. We need some mechanisms on how to hold people accountable—which we don’t have right now.

Dr. Mary Louder: 27:10

That’s very fair because it looks like, even more unfortunately, in 2025, the guardrails are coming off.

Dr. Heather Voorhees:  27:18

Yes, right. We, as a society, are saying everyone’s truth is exactly as fair and equal as everyone else’s truth, and everyone is capable of being an authority. And we’re kind of losing our sense of who is trained, who has the right knowledge and know-how, and who should be trusted. And trust is not created equal. Yeah, we shouldn’t trust everyone the same amount. You just shouldn’t.

Dr. Mary Louder:  27:46

No. So, if we wander over to social media and poke at influencers—and when I say poke at them, I mean expose them, open them up—yeah, we’ve got people who are literally saying things that are untrue. And they’re literally going unchecked. Yes.

And if you look at the world of what’s called affiliate marketing—that means you hire someone to sell your product. OK, that could be through Amazon, that could be through Alibaba, that could be through just your own website, Shopify—anything. You just have a network of people who are disseminating and selling your product. In that situation, the affiliates are like the middlemen. We would call them middlemen. Yes, that’s exactly the function they serve. Now, men in terms of gender—it’s neutral, you know, middle people, right?

So that person is then taking a message and going out to try and sell as much as possible—because it’s all about the dollar. Right. Then they’ve got a product, however, that doesn’t really work. Or it might cause a little bit of harm over time. So—how do we put the guardrails back on? And who gets to put the guardrails back on in our society about that?

Dr. Heather Voorhees: 29:09 

Yeah, and you know, that’s why I really struggle—because my goal is to give people the information they need to identify misinformation, malinformation, and disinformation. To give them the tools they need to critically assess it. To give them the confidence that they are even able to do that. And to make them into good consumers. But again, I’m not putting all that responsibility on consumers—because there are some really, really convincing liars out there. And we all fall for it. Oh my God, I’ve taken so many vitamins and supplements that I’m pretty sure did absolutely nothing.

Dr. Mary Louder:  29:50 

Well to that I'll say you should try mine then because they were. 

Dr. Heather Voorhees: 29:55

Yeah, and you know, I mean, it’s not a matter of being dumb or smart. It’s not about that. It’s a matter of—kind of, to your point—I don’t think we have enough regulation, quite honestly. I mean, of the industry and of the information industry, because information is a commodity. And there’s power in being able to control that information and having the channel to disseminate it. And with great power comes great responsibility. And not all people use that responsibility.

And right now, we just don’t—not just social media, but all information. We don’t have a way, as a society, to hold these folks accountable. I mean, think about—and you know this—think about the supplement industry. Unregulated. Hard stop. Unregulated. Fun fact: The marketing of your supplement—whatever you make—is more regulated than what’s actually in it. There are more laws that tell you what you can and cannot say on the bottle of your product than there are about what you can and cannot put in the product itself when it comes to vitamins and supplements because they are not considered food, and they’re not covered under FDA or USDA regulations.

So, it’s still the Wild West. Yes, still the Wild West.

Dr. Mary Louder:  31:23

Yeah, I didn’t, I didn’t know that. I did not know that. That’s fascinating. And literally, I’m at a marketing conference right now. Yeah, and you know, yesterday was The Power of Your Story, and I’m like, well, OK, they said the product can be OK, but your story is what’s gonna sell it. Yeah. And I’m like, well, wait a minute—no, the product’s gotta be...

Dr. Heather Voorhees: 31:48 

Raise your hand. Wait a second. Shouldn’t the product be better?

Dr. Mary Louder: 31:50 

I know. And so, you know, talking with people, I've said things like—you always have your elevator speech ready at a convention like this, at a conference like this, right? "Why are you here?" And then I said, "Well, because it works," and they just kind of look at me. And so, you know, that’s what I would say as a physician.

Now, when I help my patients pick the right supplements through my office, which I do, and if you go on my website, there is a list of supplements that I put my name on. Why? Because I vetted those. When it says 250 mg or 500 mg of vitamin C, that's what it's got in it. When it says it has certain purity aspects, and it's curated, and we’ve found the best, that's great—because I can take those doses and use them for patients to supply the nutritional support they need.

As a supplement. And again, it’s a supplement, right?

Dr. Heather Voorhees: 32:48 

And it's really tricky too because I do believe in the power of—I would love to see us get back to more homeopathic, more natural, like let's use what the earth is giving us. I am all about that, but you have these bad actors who are putting, you know, just literal talcum powder and rat poison in capsule form and slapping a label on it.

And now, you know, someone's gonna have a bad reaction to that, and they're gonna think, Well, all supplements are garbage. That's not true. That's not true. That's right. But there's so much noise out there that it's so difficult to tell the difference between what is valid and what is just a marketing line.

Dr. Mary Louder: 33:27

Right. And because it's—you're right—unregulated.

Dr. Heather Voorhees: 33:34

It's bonkers to me, and I understand why. I mean, the FDA does not have the capacity to regulate this stuff, and especially now in 2025, they're certainly going to have limited capacity. So here, let me give you a little cheat sheet when it comes to marketing and identifying some snake oil salesmen.

There are three main features of health misinformation, malinformation, and disinformation, OK? So if you're ever presented with something and you want a quick and dirty process to decide, Can I believe this or not?

Number one: It's typically negative in nature. We're always going to try to tell you that something is wrong with you, that you could be better, that something in the environment is hurting you, that there is some problem. We are creating a problem, OK? Because, as we know, when we are afraid, when we are confused, when we feel uncertain, our brain literally works differently. Synapses fire differently when we experience different emotions. And so when we're scared and confused, we leave more openings for information to seep through. We're less critical of information because that fear and confusion take over. So health misinformation, malinformation, and disinformation typically are going to be negative in nature, right?

Number two: Typically, as you said, it's going to use personal narratives or personal stories. We're going to try to personalize. You'll see a lot of influencers, a lot of marketers saying, I was just like you... blah, blah, blah. Here's how it helped me. Or you'll see a website filled with personal testimonials—so-and-so's cousin tried this, and she had the best results... We're always going to try to make it personal.

Now, there's nothing wrong with that, right? Because, again, we're human beings, and we learn as pack animals, we learn to trust. But misinformation sinks in better if other people are vouching for it, OK?

Number three: They're typically going to sneak an anti-science message in there. A lot of times, we'll see this in Doctors don’t want you to know... or Beat the system with this one simple trick. We're going to try to break down trust in another system in order to make our system look better and more credible.

So, taken individually, these are just marketing tricks, and there’s nothing inherently wrong with these tricks. But when you see something that uses all three of these tactics together for a product or a service that is asking for your money, attention, or time—that’s when you should start thinking, Maybe I should look into this a little bit more, and maybe I shouldn’t just take it at face value on Facebook.

  Dr. Mary Louder:  36:27

Yeah, those tips are amazing, especially that last one. You know, because you're tearing down a system of trust that's already there. Right. Yeah, which is, you know, that’s—yeah, that’s key. In my mind as a physician, that's key because we see where people give testimony. I did a testimonial of a patient who is a patient, and she said, you know, all of her friends come to see me, and they sat around one evening, and they all had sort of similar diagnoses, but they all had different treatments. And the only common denominator was Me.

Interesting. Yeah, and so, well, because I use genomics. And so we're really putting things together based upon their genome. I think that was beautiful and that was wonderful, and that exactly points to why. So unless the person is doing genomics, you're right, there’s going to be, you know, the common denominator shouldn’t be them. So, OK, so then, I’m thinking of patients buying into some things, trying some things because they’re looking for answers.

For sure. And then we’re thinking of communication. So if we put that together, the patient is often afraid to tell the physician that they’re taking something. Mm. Oh yeah. Hm. And maybe what they’re taking could be based upon just—you know, malformation somewhere in the middle, yeah. And, or, you know, their card club, their running club, their whatever—soccer moms, gym dads, whatever.

So this was a good idea, but it seemed—and it’s always going to be seemed—like a good idea at the time. It might have seemed a little too good to be true, but yet I was desperate. Yeah. So what do you say to folks about disclosure to their physician, to their MD or their DO, and saying, Hey, I'm taking this, I want you to know about it? But then, you know, on the other hand—this is a little complex question—they get slammed by that physician for taking stuff.

Dr. Heather Voorhees: 38:45 

Right. At least once a semester, I will ask all of my classes, Raise your hand—who here lies to their doctor? And my hand is up. I do.

 Dr. Mary Louder:  38:56 

I'm a doctor and I I lied to my doctor 

Dr. Heather Voorhees: 38:57 

Say, you as a doctor probably don't like hearing that, but you probably understand.

Dr. Mary Louder: 39:03 

We are—yes, yes, we do understand that.

 Dr. Heather Voorhees: 39:08

Yeah, we don't do it for various reasons. I'm not proud, but we all do it. And I think that's, it's human nature, and I understand that. And look, I am not here to tell anyone to not try new things, right? Like if you all, my point is, I want you to just think really critically and really carefully about why you're trying it and why you trust it.

And if you really carefully thought through it, it's gonna be easier to talk to your provider about it because you're gonna see your provider as just one more piece of your research, right? If you truly believe in a supplement or an exercise or a diet or whatever, and you looked and tried to read all you can possibly read on it, and you've tried, you've read the critics, and you've taken what they had to say into account as well, and you've done your best trying to vet it and you still think it's worthwhile, consider your provider as one last piece of information, one last resource.

Does my provider think this is a good idea? Maybe they've never heard of it before. Maybe they go, yeah, OK, try it. Maybe they say, well, you know, for someone your age, you know, when your contraindications, maybe we should back off a little bit, but see your provider as one more piece of evidence, right? One more piece of the puzzle because they often have, again, resources and experience that you might not find elsewhere. And yeah, there is a risk that your provider might be a big meanie and might yell at you and say, what are you doing?

Dr. Mary Louder: 40:46 

Yeah, and then you could find a new one. And honestly, those people wander into my office all the time. Yeah, so, you know, they go, I'm just tired of being, you know, whatever—marginalized, ignored, not able to try things.

And there are things that, too, I see things that patients bring in where I think, I'm not sure I would agree with that. What I have them do, and this is interesting, I have them bring in all the stuff they're taking. Yeah, yeah, yeah—the bag. I say, Let me look at it.

Yeah, and then I explain to them why this is good, why this isn’t good. And if someone’s done a really, really good job, I say, Hey, you nailed this. This is awesome. And the other folks, I’m like, Well, here’s where you—I see where you’re going, and I understand why you’re going that way. You might want to consider a different way.

 Dr. Heather Voorhees: 41:36

Yeah. Or you know what I really love too is like when I've talked to a provider about a vitamin supplement or whatever, and they'll say, "Well, actually you don't really need that because you're already getting that in this thing," and I'm like, "Oh my God, you just saved me $35 a month."

 Dr. Mary Louder: 41:49

Yeah, that happens too, and yeah, it took me years to understand this whole aspect. I mean, I was trained in pharmacology, right? And I have a little lady bring in a grocery bag, dump things out on the table, and say, "You're gonna have to help me figure this out." I'm like, "Oh, OK." And that was a year into my practice in the mid-90s, and I still, 25–30 years later, am still learning all the time.

And so, looking at how this industry—if we go back to this dismal misinformation—how does the industry perpetuate this? I'm thinking of things like, well, we'll hit the hot buttons. You know, the tobacco industry, how that was shaped with changing the messaging. All the doctors were smoking Camels in the '50s and '60s, and then they found the research that said, "Hey, actually, cigarettes aren't dangerous," but yet, there was a whole other body of research that showed how dangerous cigarettes were.

 Dr. Heather Voorhees: 43:01

Yeah. Yeah, I think—and we certainly, I mean, that could be a whole 100-hour podcast on its own—but I think it's fascinating when you start looking into the way that social systems influence the smallest decisions in our lives.

So one of the things I like to teach my undergrads—this is such a fun unit—is we look at government oversight and the FDA, USDA, who kind of controls what, what they can’t do, what powers they have, etc. And we talk about the food pyramid. Go to the food pyramid, right? We all grew up with various forms of the food pyramid. That was MyPlate. You know, when I grew up, it was the actual pyramid.

Yes, right. And if you don’t recall, it was the bottom of the pyramid. Do you remember what the bottom of the pyramid was?

 Dr. Mary Louder: 43:57 

I wasn't it grains. 

Dr. Heather Voorhees: 43:59 

It was grains. And do you remember how many servings you were supposed to have of grains? I'm thinking 5 to 6, but I'm getting 6 to 11 servings of grains.

OK. Oh, so if you start looking at the food pyramid, it's just something we grew up with. It's just something that was everywhere. It's something everyone was familiar with. You just kind of take it for granted, but if you start to look at the history of where that came from, it started out in, I believe, World War II. That’s when the government really started getting serious about giving nutrition information to society as a whole because we were going through war, and there were shortages, and people were facing starvation.

And so the government said, "Hold on, we need to help people. We need to give them some advice on what to eat every day." My favorite illustration is the first-ever food pyramid. It was called something like the Big 7, and it was a wheel with seven little sections. One of them was meats, one was breads or whatever, and butter had its own section.

Dr. Mary Louder: 44:55 

Still should we we honor butter,

 Dr. Heather Voorhees: 44:55 

Eat that butter, right? So, at the bottom, it had a little disclaimer, and it said something like, "When given the chance, eat any and all of these in as many quantities as you can." Basically, it was saying, eat whatever you can find because we were in a time of shortage, right?

So that's where we kind of started this idea of the government giving us insight into what we should be eating. Well, if you kind of follow the history, then what happened in America? Ah, well, then farming and agriculture really took over after the war. What happened then? Ah, well, now we have all this dairy, we have all this wheat, we have all these legumes that are being produced, and people just aren't interested in them.

Ah, but what if the government tells them to be interested in it? So the government would create and update these rules or guidelines on what to eat that were based largely on the subsidized crops that the government had too much of at the time. That's right. That's why you get the government telling you that you need to eat five servings of red meat every day or whatever, right? Because they had a bunch of cattle farmers who had a bunch of products, and it was in everyone's best interest for those products to move. Right. So, yada yada yada, you…

Dr. Mary Louder:  46:12

those products to move…

Dr. Heather Voorhees: 46:16

Oh wow, wow, you didn't even hesitate. You just— I just said that to you. You snapped it right up.

Dr. Mary Louder: 46:27 

Gotcha, utter nonsense. Moving right along. Hm, yes, so, OK, does that fall under one of the three? Is that malformation? I mean, there's some intent there.

Dr. Heather Voorhees: 46:40

You could argue that, and I would entertain a healthy debate that that would be because it stems from the truth, right? We should have a balanced diet 100%, but the point here is that the thing that we take, the thing that we trust, the thing from the government that we supposedly trust, that we supposedly elect, that supposedly has our best interests in mind—that we just take for granted.

There are so many machinations going on behind the scenes that we are not aware of that influence what that looks like. And so again, think critically. I don't want to start a revolution here. I don't think people should be in the streets. But I do think, to your point, industry and government have so much control over what research gets out, what recommendations get out, who gets funded, what types of things are hot in the news, and what types of things are completely forgotten.

And we just, we don't necessarily know that because—who looks into this, right? I get paid to look into this, but who has time to sit and fact-check and debunk things that people who they trust are telling them, right?

Dr. Mary Louder: 47:56

Yeah, and then you do have experts telling them where. You know, now we have a lot of physicians, and I'm one of those in that space of communication, right? And one of the things that I struggle with in this space is all these things that we've talked about today and coming from the intent of it.

Yeah, and honestly, my integrity has gotten me in trouble more than doing things wrong, right? So what I mean is, I'm like, "No, I'm not gonna do that," or "No," I call foul, and "No, that smells funny, that looks funny," and they're like, "Who are you? Get out of here." So I've been kicked out of places because I raised a flag.

Yeah. And not in a way that was anything other than, "Hey, this doesn't look right." Right. Wasn't a revolution. And so in this space, my intent is to have the best curated information possible. That the information put forward and the guests we have have integrity. That the information has integrity, it can be backed up, it can be found, it can be transparent, and it doesn't have things tied to it.

Dr. Heather Voorhees:  49:10

Well, anything that is worth listening to is able to be and encourages questioning, right? I always tell my students, "This is me, this is my perspective. You don't have to believe me. Just because I'm standing up here with the PowerPoint and you're sitting down there taking notes doesn't mean that you have to take every single word I say. Question me."

And so it's really fun in my health misinformation class, especially because I encourage them to be critics, right? This last semester when I taught it, I had one student who would Google fact-check almost everything I said. And it was amazing because I'd say something like, "You know, America and New Zealand are the only countries that still allow blah blah blah," and he's like, "Actually, New Zealand just added that last year." So he was always fact-checking me, and I was like, "Yes, this is what we should all be doing."

Because to your point, if something has merit, if something is valuable, if something has credence, you should be able to question it. And if someone says, "That's stupid, shut up," or "Just try it and you'll like it"—wrong, red flag. If someone gets mad at you because you are asking to see evidence of something's efficacy—red flag. If someone is saying, "Well, I don't want to engage in blah blah blah"—red flag. You should be able to question these things.

And, you know, experts aren't always right. I'm wrong sometimes. I'm willing to admit that. But we learn together, and I'm not afraid to be questioned because if I'm wrong, I want to know, and I want to correct it. And if it takes someone questioning me and standing up to me for me to correct the record, then so be it. It's face-threatening, but I'm willing to do that because I want to be accurate. I want to be correct.

Dr. Mary Louder:  50:55 

Yeah, and really what that is is, you know, instead of wanting to be right, you want to get it right. 

 Dr. Heather Voorhees: 51:01

Yeah, 100%. Yeah, yeah, that's a great way to put it.

Dr. Mary Louder: 51:05 

Yeah, and so, you know, I think really in looking at this and listening to ourselves today, I appreciate the clarity on what folks can look for. I appreciate the clarity on the tools that you've given so people can know what to look for when they see the three things—the testimony, the knocking down of one system to promote their system, and then the third one was...

It was the third one. There was a third one in there. Do you remember?

Dr. Heather Voorhees: 51:39 

Everything I said was amazing, so it's hard for me to. 

Dr. Mary Louder:  51:43

There's those 13 tools, and you said the three like, "Here, let me give your folks these three things." So it was the testimony, and it had the flavor of science, but not really the full science.

 Dr. Heather Voorhees:  51:58

Oh yes, an anti-science message.

Dr. Mary Louder:  52:01

So, and I saw that too. I heard that, and I also thought of the anti-science message being almost science, but the pseudoscience of it.

 Dr. Heather Voorhees: 52:10 

Yeah, yeah, and I think it's important for me to reiterate that so much of health and well-being and medicine is still just a big, "Ah, the body is very complicated." The human body is a beautiful mess, and there is so much that we don't know about it.

So look, the miracle cures are still out there. There they are. The things that will cure Alzheimer's—they're out there. The things that will improve cancer survival rates—it's out there. So I want to encourage people to try new things and to look into new ideas. I'm never gonna say, "Everything new is terrible."

Oh, 100%. That's not it, because the point of science is to disprove itself. The point of science is to take what we thought we knew, test it, retest it, and figure out if that's actually true or if we need to adjust.

So a lot of times, you'll get these stories like, "This just in—researchers learn that coffee now causes cancer instead of curing cancer," and you think, "Well, those stupid idiots, they didn’t know. They've been telling me for years—they don't know what they're talking about. They were just proven wrong."

That's what science is. That's the job of science—to constantly be re-evaluating what we think we know. So go out there, try new things, look into new stuff, try new treatments, consider new therapies. That's great, but do your homework, question everything, and get as much information as you can. Use your resources, and your providers are resources.

Yeah, so use them, right? Ask questions and think critically.

Dr. Mary Louder:   53:55

Good, and I will throw in there, listen to our podcast and you could get your genome done so you know you and you know your story and your journey so you can follow you and not recreate the wheel and work with who you are. 

 Dr. Heather Voorhees: 54:09 

Right, dogs are so cool. That is such a cool field. It's so neat.

Dr. Mary Louder:  54:13

I mean, it's just really fun to allow them to follow their own story—things that fit for them. So then there is much less misinformation because it's them.

Right. So it's wonderful. Well, you have really enlightened me on some good things in the information world, where we are, and how to enhance the doctor-patient relationship. I feel, in a good way, challenged to let people question me more.

I mean, they do question me a lot, and I spend a lot of time on it, but sometimes I'm like, "You could just trust me on that one," because I have done the work and have provided things with integrity. But this challenges me to be even a little more open about that.

So thank you. I appreciate that.

Dr. Heather Voorhees: 55:00

I think too much questioning, quote and quote, is better than not enough questioning, quite honestly. 

Dr. Mary Louder: 55:05

OK, well then I'll have you do the scheduling and do the phone. 

Dr. Heather Voorhees: 55:09

Yeah, no, I'm good. 

Dr. Mary Louder: 55:14 

Well, thank you very much for being our guest on Since You Put It That Way. We'll post the information for people on how to follow you and look you up at the University of Montana to see more of your research and the projects you're working on because it's really important work that you're doing.

And thank you for making it translatable to us.

Dr. Heather Voorhees: 55:33 

Yeah. Thank you for having me. And I have a website where you can read a lot of my stuff, a lot of my research, posted for free. It's voorhees.com—two O’s, two E’s, voorhees.com.

Dr. Mary Louder: 55:46

OK, and we will post sending the info 

Dr. Heather Voorhees: 55:4

All the research that I've authored or co-authored, I like to put up there. You can download all the PDFs, and you can watch a bunch of my online lectures for free. There's a lot of stuff. I try to make everything I possibly do available to as many people as I can.

So thank you for letting me come on here and share my message. I appreciate it.

 Dr. Mary Louder: 56:05

Absolutely. You're very welcome.

And folks, we will see you next time on our next episode of Since You Put It That Way. In the meantime, go out, be well, be healthy, and enjoy.

Thank you for joining us on the Since You Put It That Way podcast. Today's episode was written and produced by Crowded T Productions. Technical editing by Mallin Long Lopes. Sound editing by Jonathan Feegle. Music: The River Jordan, written and performed by May Erlewine.

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