Remarks by Commissioner Robert Califf to the National Consumer League Health Advisory Council Winter Meeting November 29, 2023

Speech | Mixed

• Speech by: Robert M. Califf, M.D., MACC

(Remarks as prepared for delivery)

Good afternoon.  I’m pleased to have the opportunity to speak with you today, and I’m sorry I can’t be with you in person.

I’m a big fan of the work of the National Consumers League, in part because as an organization focused on consumer advocacy, with a particular emphasis on issues including food safety, health care and medication information, NCL has a great deal in common with the FDA.  

It’s not just the responsibilities that match up – it’s the missions themselves.  The FDA is, at its core, an agency dedicated to consumer protection and information, particularly in the public health arena. Indeed, one of our most basic responsibilities is to disseminate scientific facts and information to help Americans make informed and hopefully good choices about their health. As our mission statement says in relevant part, one of our goals is to “help the public get the accurate, science-based information they need to use medical products and foods to maintain and improve their health.”

This essential role is one we have embraced and cultivated for many years.  An essential strategy is using straightforward facts and plain language to share information and communicate with the public in a variety of ways on a range of topics that are as broad as our areas of oversight.  It includes informing the public about product safety including but not limited to, medical products that we have approved as safe and effective.  But we also recognize how complicated this mission turns out to be, and our efforts remain works in progress.

This communication mission also involves providing warnings about dangerous or deceptive products, accurate nutritional information, and many other forms of communication to make sure that medicines, foods, and other products are safe for consumers and patients and that the public has the information it needs to make health-related decisions, including basic consumer information on topics from sunscreen to supplements.

I’m proud of our work in consumer protection, but it is a role that has become increasingly tough, thanks in part to what is one of the most serious threats to public health today – the continuing and growing challenge of health misinformation and disinformation.  I’m glad you’re focusing on this issue today, and you have a stellar panel to discuss it. 

For the FDA, the ability to effectively convey facts to the public has been dramatically altered by technology – the digitization of our world and the ability to accumulate and share resources and transcend previous boundaries via the Internet, for one.  This isn’t only because we’re all struggling to keep up with technology and understand the implications of such rapid changes that affect the way people communicate and receive information.  For example, what does it mean if over 40 percent of social media users are on Tik Tok, but U.S. Government agencies are forbidden from using it?

Additionally, there is reason for concern that the disseminators of mis and disinformation not only misrepresent what we produce, but also work to undermine our credibility and trust in what we do and in science itself.   The balance among freedom of speech, the absolute importance of the ability of people to critique the government, and earning the trust of the people is an increasingly difficult challenge.

This is very different from what has occurred in the past.  The use of false and distorted news (or disinformation) is not a new development.  As the Center for Information Technology at UC Santa Barbara has pointed out, it goes back centuries, with everything from fake stories in colonial newspapers about King Louis XIV, to claims that the 1969 moon landing was faked as part of a government conspiracy.  

Underminers of science and health have also been around a long time, including, but certainly not limited to attacks on vaccines.  Indeed, there has always been an anti-science faction as part of our culture.  

What’s different today is the scope and pervasiveness of the problem. Several factors are at work that serve to differentiate the current efforts at misinformation from earlier, more innocuous ones and that make the challenge today much more intractable.

Most significant is the sheer impact and predominance of social media, which gives virtually anyone a broadcast tool at their disposal.  In the, past, proponents of mis and disinformation had been limited to mechanisms such as magazines, newspapers or radio, all of which others generally control.  They also were relatively limited by geography.  But the Internet changed the equation by making it possible for anyone to publish and, more importantly, to connect with other like-minded (or easily influenced) people.

And that is a very significant second distinction.  Many of these false communications have a connection to a political agenda or a cultural identity, which in turn may be tied to the delegitimization of a particular scientific fact or conclusion because that fact or finding may somehow support a political approach or cultural identity that plays into those individuals fears.  This is further complicated because many of these self-publishers and broadcasters have in part a focus on undermining our democratic institutions themselves.

For me, perhaps the most worrisome and quite frankly, frightening aspect of these developments is that they come at a time when we can least afford it.  I’ve spoken before about the catastrophic decline in our life expectancy the United States is currently experiencing.  While Covid 19 deaths, suicides, overdoses, and gun violence are major factors in this decline, it overlaps with an alarming backsliding we’ve seen in the rates and outcomes of many chronic illnesses – chronic illnesses that we have previously made enormous progress in terms of controlling or developing treatments for.

Even more worrisome is that this negative trajectory is based on, or driven in part by, disparities that are a function of race, ethnicity, education, and wealth, as well as where someone lives.  It goes hand in hand with many of the divisions created through the way the Internet is currently being used.  We increasingly have populations living in entirely different information ecosystems.  Precisely at a time when people need more reliable health based scientific information from authorities like the FDA, they’re being distracted and dissuaded from the essential facts we provide.

That’s where all of you come in.  As a recent report by the Reagan-Udall Foundation concluded, this is an immense and frustrating problem for which there is no one magic solution.  It is a challenge that must be addressed head on, in real time, and through collaboration and teamwork across the entire public health and consumer protection sectors.

But it’s also a challenge that neither the FDA, nor the government can solve on its own.  In fact, I would assert, in light of the anti-government frame of mind of many of the attacks on what we put out, that it will require a concerted non-governmental response to defeat this misinformation Hydra.  

Consumer groups like NCL will need to join with other public interest groups, universities, academic medical centers, professional societies, community colleges and businesses to turn this around.  Independently of government entities, I hope that you can create vehicles that penetrate these ecosystem bubbles, thereby communicating reliable scientific information across society to reach populations that are insulated or deterred from getting or believing the state of the science, the way consensus is developed, and the importance of understanding the uncertainty and evolving nature of evidence-based policy and medical decisions.  In short, we need to counter the echo chamber of disinformation.  This means that groups and individuals with specific credibility and expertise in their communities need to share important information – about health and other issues. 

Only in this way can we overcome the worrisome pattern in which our scientific knowledge and technological abilities continue to advance rapidly, but our health outcomes are failing.  We need to do a better job translating our knowledge into actions that result in better health.  Responding to, and preempting misinformation and disinformation, will be a key part of efforts to achieve this.  I believe this is an “all-hands-on-deck issue” and because the technology and culture issues continue to evolve rapidly, in our mutual quest for better health for populations and individuals, we need your best ideas and intense commitment to action.

Thank you, and I look forward to working with all of you on what is one of the most critical issues of our time.