Good Medicine explores today’s healthcare environment through the lens of one essential attribute. Last time, we discussed the importance of advocacy with Dr. Alice Chen. Today, we’re going to explore the concept of “truth” with Amazon Pharmacy’s Chief Medical Officer Dr. Vin Gupta, a practicing pulmonologist and a leading medical contributor at NBC.

As physicians, we seek truth every day. What is the true cause of a patient’s chest pain? Is that a stroke on the patient’s MRI or just an artifact? All of our skills as listeners and diagnosticians are in service of finding the medical truth for our patients. As scientists, we’re also truth hounds. Understanding a key molecular mechanism or unraveling the structure of a novel protein reveals the truth about how we function. But in the last few years, a new toxin has spread in the public health landscape: mistruth and disinformation. I see it everyday when I hear from patients how dewormer can “cure” cancer. My colleagues across medicine report the same. And even Vivek Murthy has diagnosed public health misinformation as a leading public health problem.

That’s why I’m so thrilled to explore the concept of truth with Vin Gupta, a leading medical contributor at NBC. Exposing the truth is hard. And doing it in a way that creates trust for the viewer is even harder.

When planning my meeting with Vin, I wanted to understand how, in front of such a large audience every week, he guides the American public toward truth and away from misinformation. And to ask him more practical questions like: How did you make your way onto the small screen alongside a career in medicine? And in the end, what can all of us learn from him so that we can model the same in our daily lives?

Vin’s story

On the face of it, Dr. Vin Gupta and I have a lot in common; we’re about the same age, we were raised by Indian immigrants, and we both have close family-members in our lives that inspired us to go into medicine. For both of us, it felt almost inevitable. In fact, Vin describes his path into becoming a physician as almost “pre ordained…It was gonna be medicine. I was gonna follow in my brother and my mom's footsteps. And everything I did was to achieve that end.”

But Vin did something pretty amazing in his career besides becoming a doctor; he joined the military - A decision he describes as among the most impactful in his life. He felt a deep need to serve, especially after the horrors of 9/11 which occurred on his first day of college. The experience of 9/11 taught him he needed to “grow up really quickly" and he was inspired by the many in his hometown of Toledo, Ohio who “dramatically changed their plans” so they could serve their country post 9/11.

So he joined the Air Force Reserve Command and served deployments in places like Qatar and Japan. I was curious about some of his memories from those years abroad, where he learned how to deliver critical care in less-resourced settings for seriously ill soldiers. One story has stuck with him through the years. This involved a young soldier who suffered a Traumatic Brain Injury(TBI) from an Improvised Explosive Device(IED) in Afghanistan. He described his mission as sacred, in that his goal was to care for this soldier and transport him to safety in conditions he offered were austere. Docs have to carry all their medical supplies with them, even mix their own medications to help stabilize blood pressure while operating in a very confined space aboard a C-130 aircraft. And unlike in a U.S. hospital setting, Gupta had no brain imaging to guide management - just a clinical hunch and an impassioned motivation to get this patient through the 8 hour journey to Germany.

“It was practicing in that void of information, but also applying the learnings of our training and doing it in a deployed setting, it just forces you to rise to the occasion,” he told me. “For me it was eye-opening as I’m used to [working with] information, certainty and in a controlled environment…without any fear of personal injury. Here everything was the exact opposite.”

On the question of whether or not he advises fellow clinicians to join the military, Vin told me that military medical service is an extremely gratifying job but cautioned that doctors should always speak with military doctors to get a full view of the experience. “Many of the people recruiting for these roles have not served themselves(medically), which means it’s not always clearly communicated what the real benefits and drawbacks are. The military is misunderstood.” One mistruth out there is that your professional and personal life goes on hold to join the military. “Let's say if you have a family or a civilian professional life… it's actually something that is quite possible to do within the reserves. It's tough. It's a weekend a month, two weeks a year, plus deployments. It does add up. But it is incredibly meaningful.” Here, Vin leads by example in that, in addition to his journalism and military responsibilities, he maintains a practice in critical care medicine in Seattle.

Vin’s story made me reflect on service. As a nation, the truth is that the burdens of service fall on a small minority of our citizens. If we stop to reflect, it’s a truly awesome responsibility that our military shoulders for our collective benefit. What should us civilians do? We don’t have to join the military necessarily, but there are so many things we can do to serve our communities. In this era of polarization, I hope we all learn from Vin’s example.

The power of medical journalism

Those experiences and learnings catapulted Gupta into a new direction that he would never have expected: Medical journalism. He’s now a regular featured medical expert and commentator on MSNBC and NBC. What started with more of a focus on topics related to lung health- namely Covid-19, the impact of air pollution and vaping, has now expanded. “There’s all these health threats that are posing a direct threat to our lung health,” said Gupta, when asked about his start in television news. More recently, he’s spoken on topics related to President Biden’s brain health and stamina, and the importance of having a strong relationship with a primary care physician. He’s become a recognizable physician that millions tune into and trust, even on issues that have become politicized. And it’s not just on television; Gupta has a robust presence on X (the social media platform formally known as Twitter) and LinkedIn, where he’ll share his views to a riveted audience. Not everyone agrees with his perspectives, but Gupta has learned that’s part of the job.

In terms of the why of medical journalism, Vin cites his goal to have impact at scale. “What I recognized as I got closer to clinical medicine, just through training, is there was something really unsatisfying about not being able to have impact at scale. [In the ICU], it's both incredibly gratifying and also deeply frustrating to be an intensivist because you see in many cases a patient before you that is likely there because the health care system has failed them in some way.” His career wedge, then, was to figure out how to help people by getting them actionable, truthful health information.

“For me it was a question of how I could meaningfully inform people on matters that are important, and to do it in ways that would engage them,” he said.

The formative word here is engage. Gupta has a particular knack for speaking to people in terms they’ll understand. Medicine hasn’t historically prioritized that, preferring instead to talk past patients with esoteric terminology . Gupta has recognized that the best kind of medical communication often requires storytelling, and not just a recitation of facts. When he’s invited to speak, he’ll often draw upon his own experiences practicing medicine at the hospital, sharing what he’s seeing on the ground. That’s what he most enjoys about the work.

Gupta may be a natural but he stressed throughout our conversation that he didn’t plan for any of it. If so, why would he have moved to Seattle, where he’s now based with his wife and two young boys. If he had been gunning for a career on television, then he’d have chosen a television hub akin to a New York or Los Angeles.

That may seem like an aside, but it’s actually a super important point. Gupta believes that the best medical communicators come into it with a goal to make health care better; not to serve their own ego. The ones that tend to breakthrough in his view, are not motivated by fame and clicks. Dr. Gupta acknowledged that being invited into people’s living rooms comes with a huge amount of responsibility. It involves a kind of “magic sauce” that either is there or it isn’t. But when viewers “like what you say and how you say it, you tend to get more opportunities.”

Truth and Anxiety

For years, Gupta told me he’s grappled with anxieties and insecurities about his growing platform. When he started out, he imagined that the legions of “gray haired pulmonologists” with years more experience would judge him. Those fears have become reality, even as many of his peers have championed him. Gupta told me he was directly informed by colleagues he respected that they were “unhappy” to see him on television, given his level of seniority (or lack thereof, in their minds).

Gupta has learned to stop apologizing for that, although it still stings.

He recognizes what a privilege he has to speak from atop a national platform. But he also knows that it’s vitally important that he stays true to himself. In the world of social media and television, that means resisting the call to say outrageous things. Dr. Gupta said there’s a kind of “dopamine rush” associated with being provocative, which is why there’s so many commentators out there that continue to spread misinformation. Some of these outrage machines, as we witnessed during the pandemic, are practicing MDs. Those are the worst kind, in our opinion, because the public tends to trust doctors more than the average television commentator. “It’s a lot easier to become an overnight rockstar (if you say outrageous things) and that’s driving a lot of it,” he said.  Social media, in his view, also has had an outsize influence in empowering misinformation artists. “It's no coincidence that [public health misinformation] has taken off as social media platforms have arisen and have frankly dominated the public discourse over the last 15 years.”

As much as he can, he fights the good fight. But Gupta thinks there’s a lot more work that needs to be done to hold social media companies accountable for this kind of misinformation; otherwise it will continue to put people in harm's way. Part of the problem is that our society treats science in a highly politicized manner, as if it’s a matter of opinion and not fact. Dr. Gupta said that when he shares evidence and research, it’s almost inevitable that he’ll be referred to as a “left leaning doctor.”

That prompted the question, one that’s on my mind every day:

“How do truth-tellers have more impact?”

Dr. Gupta said the FDA has been clear that medical misinformation is a huge and rising problem. Vivek Murthy has written that “Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.” His proposal? First, he believes that medical governing bodies need to hold doctors to a high standard of conduct and punish the spread of disinformation. “Until we get there, I don't think anything's gonna change.” When I pushed him on the inevitable free speech concerns that would arise in the implementation of such a strategy, Vin was unmoved.

“We as physicians have taken an oath to do no harm and that oath is almost meaningless if there aren’t teeth to it.”

He pointed to his experiences in the military. Military members of course have first amendment rights, but there are “still expectations of decorum. And you can't just do anything you want. You're expected to behave properly. You're expected to be ready for deployment at a moment's notice, meaning there's certain guardrails on your personal behavior.”

I think what Vin describes is the power of culture in the military. More than any rule or disciplinary consequence, the cultural norms of the military reliably dissuade bad behavior. In fact, one could argue their cultural norms encourage model behavior. I think the lesson for us in medicine may be the same; our community of healers must be more involved in creating and cultivating the cultural norms we expect. And that cultivation can’t be just passive- It must be proactive using all the modern tools that disinformation artists use to influence.

Secondly, instead of talking about the benefits of the Covid-19 vaccines on repeat, he thinks we need to get back to the basics. Let’s educate the public about our health care institutions (like the FDA and CDC) and demonstrate what they do and why they are so invaluable. In recent months, he’s done 5 segments at MSNBC and NBC about the incredible innovations that FDA has cleared, like accessible over the counter birth control (no prescription required) and colon cancer diagnostics.

The misinformers may want to castigate FDA and other institutions(And sometimes it’s deserved). But that becomes harder when we move beyond one issue, and instead remind the public about the good things that happen because of these institutions. As Gupta reminds us, sometimes a positive story is the right one.

I would add a third. Somehow, we will have to reclaim truth as an organizing and foundational principle in our society. As Francis Collins so eloquently wrote in the Times recently, there are some things which are simply facts…that are just true. If we cannot agree on these basic atomic units that hold society together, we’re in trouble. We also have to do a better job communicating science, the scientific process, and the why behind public health guidance. We should better articulate where we’re not exactly sure. That’s how we start to regain trust.

What makes for a great communicator?

It’s near impossible to know what will resonate with people, particularly when they’re sitting on the other side of a screen. In a way, according to Gupta, it’s “irrational.” How so? Well, one of Gupta’s heroes is the politician Pete Buttegieg, who came up repeatedly during our conversation. In theory, the voter should be most attracted to the candidate with the most experience, the longest resume, and most compelling policy vision. And yet, so many of us have found Buttegieg compelling to listen to, despite his relative youth. It’s because he’s relatable, wicked smart, operates from a consistent set of values, and is unafraid to defend his worldview (see all his segments on Fox news!)

Gupta relates to that, because he’s also not the “professor emeritus” – he’s still young and has many years ahead of him as a physician. From my perspective, his special gift is that he’s an expert that is also compelling(we this with our experts on Roon as well). He can articulate his message in a way that listeners can really understand. And he conducts himself in a way that garners trust. And therein lies the opportunity for both impact and scale.

“If you do a segment for 5 minutes and it reaches millions of people and you do it well… and maybe there’s this indescribable quality that people relate to,” he said. “You can have (a) real impact.”

But that comes with its own pitfalls. There will be people who don’t respect what you’re doing, or will judge you. But Gupta says there’s real value in clinicians having “multiple logs in the fire,” particularly for those that want to do more than work in medicine.

One thing Vin told me especially resonated. He said that “It’s okay to be misunderstood” when you’re thinking about the risks of trying something new. As an innovator, you can expect that you will be misunderstood by the people around you. That’s why innovation(even at the personal level) is hard but in the end, it’s definitely worth it.

Quick Hits

“Most impactful mentor and why?”

Sanjay Gupta… what he showed me, and this is before I got to know him personally for the last five years, I think he’s probably misunderstood. I’m sure he is. He’s a global household name and has that indescribable quality. People want to hear from him. He blazed that path. I think he’s the OG when it comes to how you humbly handle or manage an impactful platform at scale, and how you are a custodian of it for such a long time that people still want more… You’ve got to create organic demand… people have to want to hear from you.”

“Book recommendation?”

9/11 was an “inflection point” for Gupta, and one of the best books he’s read about that day is the Looming Tower.

“If you could wave a magic wand and fix one thing in health care, what would it be?”

Gupta, without hesitation: “Removing PBMs.” This seems to be an emerging theme on Good Medicine.

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