After Hundreds of Interviews, Here's John Whyte's View of COVID

; John Whyte, MD, MPH

Disclosures

May 05, 2021

This transcript has been edited for clarity.

Eric J. Topol, MD: This is Eric Topol for Medscape and the Medicine and the Machine podcast. It is a special privilege for me today to welcome Dr John Whyte, who is the chief medical officer at WebMD. Welcome, John.

John Whyte, MD, MPH: Thanks, Eric. It's great to be with you.

Topol: We're flipping the script because John has interviewed me several times during the pandemic. Now I get to interview him. I want to start with John's remarkable background. He had his internal medicine training at Duke and earned an MPH at Harvard T.H. Chan School of Public Health. Then he went to Stanford to do health services research. He has had positions with FDA and CMS, and a stint at the Discovery Channel before coming to WebMD.

You've had quite a diverse career, John. There are marked differences between working in the government and serving as one of our major medical communicators. How was that? How do you span that gap?

Whyte: It's funny because a lot of people see me as a communications expert, but I've always thought of myself as a policy person. I've always seen patients; even now, I see patients 1 day a week. When I was at FDA, they would allow me a single clinical day every 2 weeks. It's a lot of work because I also have a day job.

You're right — the environments of government and the private sector are completely different. With government, you're in meetings all day. Every meeting has about 30 people, unless you are with the commissioner or the secretary, and then it's 40 people. You often think, This is not the best use of time. It's a lot of paper.

If you say, "Something is going to be released in October," people in the government will ask, "What year?" And they're serious. But in the private sector, you mean next Tuesday and why can't it be done this weekend?

It has always been from the perspective of wanting to impact populations of people. I can impact people one-on-one as a physician. But when I worked at CMS, I helped determine what services were covered under the Medicare program. At Discovery Channel, it was about translating research into practice. But I look at it as having a big denominator: One hundred million people have the Discovery Channel; if I can educate a few people on diabetes or heart disease or symptoms of stroke, that's a good thing. In my mind, it all makes sense.

Topol: The common thread seems to be impacting people at scale. You translate the complexities of medical information to the public. Does that mean WebMD is going to be a major resource for the public to get medical information? How do you do it? It's hard enough to communicate to medical professionals.

Whyte: It takes a lot of practice, and I don't always get it right. At Discovery Channel, I learned about the power of storytelling. If you think about it, that's how we train in medicine. We tell patient stories and we learn from them. When I'm writing or reviewing something, I always think, Is this the way I would talk to a patient? We have this parlance — our lexicon. We use words that most people don't use and we forget that they're not used.

For example, the other day I said to my wife, "The refrigerator is malodorous." And she said, "What? People don't use that term." And I said, "Yes, they do," and she said, "No, they don't." We forget that, and we use terms and language that patients can't understand.

The media world has powerful matrices; I can see if a story isn't doing well on WebMD or a video isn't doing well on Medscape, just as I could on Discovery Channel. That tells you something. You have to go back and see what went wrong. Was it too technical? If it was for physicians, was it too simple? The great thing about WebMD and Medscape is that they have different audiences, and you have to stay on your toes. Sometimes content is appropriate for physicians and sometimes it's not.

COVID is a great example because it has introduced many new terms. It's like an immunology lesson every other day. I have learned a lot from reading your tweets, but sometimes I have to do my own research and pull the article to learn more as well. It's a process that I don't always get right, but I keep at it.

Guesswork and Misinformation

Topol: I've been impressed with how you do this, particularly during the pandemic, with so much new jargon. Today the headline of The New York Times was about herd immunity, saying it's not attainable. A lot of people were fired up about that, thinking we were going to reach herd immunity.

There's a lot of confusion. If we could just get an incredible level of containment like what we see in the UK and Israel, that would be good.

But how do you explain a concept like herd immunity, compared with containment, to the public?

Whyte: Sometimes you have to use images. On herd immunity we've used a lot of infographics and images. People can understand the concept that if a virus is looking for someone to attack, they're going to find that weak sheep or person who isn't immunized. That makes sense.

Herd immunity is something we focus on a lot. But if we look at it from a scientific perspective, it's really a mathematical guess. We don't really know. And some people out there, including some esteemed people, say it has to be 80% or 90%. We don't really know that. To say that with certainty can misinform people. What we need to say is that we need to get as many people vaccinated as we can. This is how we're going to protect people. People can understand that a virus can't mutate if it can't survive. So don't let it thrive in your community.

People can understand that. Some will think that if 80% of people get the vaccine, then I don't need to get it. And that's not what we're saying. Now we have these stories. Where did the variants come in? And you can go in and out of herd immunity. It's just confusing people and it's unnecessary. We have not always communicated the concept that people need to protect themselves.

I've talked about my pet peeve (and I know it's one of yours too) related to the concept of 6-feet or 3-feet social distancing. We stated that with certainty, as if we really had data, but we don't. It can cause harm when we change things. People don't like that, but we have to change things when we get more information. We shouldn't promulgate certain data points either.

Facing Healthcare Disparities

Topol: In your background in public health and health services research, you did a lot about diversity in clinical trials. I discussed this issue recently with Tom Frieden. The shots are going into the wrong arms, and not enough are getting to the right arms. Those people at higher risk are often the people who are least likely to show up for a vaccination. What do we need to do to reach this last mile — the hardest group of all — to get them immunized?

Whyte: COVID has shined a light on disparities that we can no longer ignore. I was interested in this topic as a resident at Duke when it wasn't that popular. I wanted to look at the differences in care in the management of dyslipidemia. We saw back then that people of color were not prescribed statins to the same degree as Caucasians. Now we see people of color catching COVID at a much higher rate as a percentage of the population, as well as having more serious infections and deaths.

The problem with immunization is that we talk about people, instead of talking with people and listening to their perspectives. I get annoyed when I hear the statistic that "everybody lives within 5 miles of a pharmacy." If you think that's easy, it's because you have a car — or even two cars and an Uber account. Well, guess what? Five miles is pretty far if you don't have a car or any means of public transportation to get to the pharmacy. It's not easy.

In West Virginia and some rural areas, they are bringing the vaccine to people who need it but can't get out of the house or travel to a vaccination site. We need to make it easier instead of this complicated scheduling system. Now that we have more supply than demand, in my area you can go to the local mall and get vaccinated without an appointment. They're doing it at gas stations, and we've talked about the role of barbershops. We also need the influencers in these communities to talk about why it's important to get vaccinated. I often tell patients who are hesitant to talk to a friend who has been vaccinated, and learn why they decided to do so.

Politics and Pandemics

Topol: Another area that's very troubling is the politicization of the pandemic. The most resistant subgroup of all isn't the minority and underrepresented population but the Republican Party, particularly men, among whom 50% are not willing to be vaccinated. How do we deal with that?

Whyte: That started at the beginning of the pandemic with a lot of miscommunication about the virus not being contagious. It was going to be gone by Easter of last year. Now another Easter has passed and we still have a way to go. But I think we are going to see improvements. Despite my role in the public sector, I think the private sector is going to drive immunization in communities.

With respect to younger people who haven't wanted to be vaccinated, 100 colleges and universities are making it mandatory. They want to return to campus in the fall, but they aren't going to be allowed to if they aren't vaccinated. Houston Methodist Hospital just announced mandatory vaccination. I'm surprised that more hospitals haven't done that. I think we're going to see that. West Virginia is giving $100 savings bonds to people age 18-36 who get vaccinated.

And perhaps on travel, if you want to get on a plane or a cruise ship, you're going to have to prove that you're vaccinated. That's going to drive that change. The sides are so hardened that talking about the data and the science isn't going to make a difference. We know that the former president and first lady got vaccinated, but they didn't talk about it. That was a missed opportunity. But when people want to travel and go to concerts and do other things — even back to work — I think that will drive immunization in the next phase.

Topol: You touched on a really important point, which is why isn't it mandatory for all healthcare workers to get vaccinated? There's still resistance among some healthcare workers. Not many hospitals have made this mandatory. The excuse here at Scripps is that the vaccine hasn't received full licensure yet. What do you think about that? It could take months before the vaccine's biologic license application (BLA) is approved.

Whyte: Pfizer and Moderna both had announced that they were going to submit their full BLA. At one point they said it was going to be April. That hasn't happened. Their focus is getting the vaccine approved for ages 12-15. Where I do my clinical work, it isn't required. I was surprised because for influenza, they come to the clinic and do it. I think that will change, and at the end of the day, we will have hundreds of millions of people vaccinated.

Not Black and White but Gray

Topol: We had an extraordinary interview with key players at the FDA, namely Commissioner Stephen Hahn and Peter Marks, who oversees the vaccines as well as convalescent plasma and many other aspects of the pandemic. I wanted to get your sense because you have inside FDA experience. What is your feeling about how they are doing throughout the pandemic, and seeking approval for 12- to 15-year-olds to be vaccinated? Let's get your appraisal about the FDA.

Whyte: The former leadership had challenges in terms of communicating about the science and standing up for science and data. There is a reason why we move cautiously even during a pandemic.

The year 2020 saw the second highest number of drug approvals in the past 10 years. They did all the work on COVID and their day jobs too, in terms of approving new drugs. They have done better than we might have hoped, working around the clock, and through the weekends, across the different centers.

The challenge is that the data are often gray; they aren't black and white. These decisions aren't easy. To a certain degree, there is interpretation in how you evaluate risk. People don't realize the amount of work that this takes. They look at every piece of data; they corroborate every piece of information. Not all regulatory agencies do that. And at the end, they often have to make difficult decisions that are gray.

So I think they've done a spectacular job. It hasn't always been communicated well. Convalescent plasma and hydroxychloroquine are two examples. That erodes confidence. It's the same for CDC. Some of their guidelines were changed back and forth. But I feel we have more steady leadership now. You and I both know Dr Janet Woodcock, the acting commissioner, who is very much about data and science. You may disagree at times with interpretation, but there are data to support decisions. It's the same at the CDC, except with their recent guidelines on masks: Whenever you need a flowchart to explain something, it's not simple.

Topol: Did you happen to see that Trevor Noah takedown of the CDC's new color-coded mask guidance?

Whyte: Don't they use focus groups? Didn't they ask someone else to look at it?

Topol: Your expertise in explaining complex matters to the public is an extraordinary strength. Maybe the CDC needs to consult with you before putting information out.

Whyte: Having worked there, I will tell you that just to put out a press release, 25 people had to sign off on it. It's gone down to 14 or so now. You know what happens? Everybody's a writer. Everybody's an editor. That's what would have happened with this graphic. By the time you get a document back, it's been passed around so much and undergone so many iterations and changes, that you can barely understand it.

CDC doesn't use focus groups. They don't ask other people to look at these documents. You think about how much time they spent on this, and I'm still confused on point two and three on the unvaccinated side — is that one person or multiple people? By now, 100 people have looked at it, so how can it not make sense?

They need to use what I use with my patients, the Teach-Back test. After I tell them the plan, I say, "OK, what's the plan?" Half the time they don't know. And then I write it down and we go over it again. I just wish CDC did a better job with communication. CDC has not done as well as they could. It's almost like an afterthought. They just need to use regular language.

I tweeted the other day, enough with the virtual backgrounds. Just be a regular person talking to us about what we need to do. You don't need notes. You don't need sound bites. Just be practical and explain it. That's what people want and are yearning for. And that's why other people on the internet are doing well, sadly. They are giving misinformation but they are using a language people can understand.

Keeping It Simple

Topol: That's an important point. You've been talking about how we can communicate effectively about the science and complex matters. The other problem is disinformation. Peter Hotez has called for an active counteroffensive to disinformation being put out by hundreds of websites, including Russia. Is there room for that? Can we mount a counteroffensive?

Whyte: I don't know if we can actually accomplish that. You provided a great example when you coined the term "scariant." It makes sense. It's a variant and it's scary, but are we overdoing it? It has to be something very simple that people can remember and understand.

Part of the challenge is that every piece of good news is countered by some bad news, and people are just getting frustrated.

I understand Peter's point. We've talked about negative news. We need to talk about what's going on in India because of its relevance globally, but give us a day or two to acknowledge that even though it's not 3 million shots a day, 2.6 or 2.7 is still pretty good. Eighty five percent of the population over the age of 65 have received at least one shot, and 75% are fully immunized. We should be pointing out the 7-day decrease in new cases, the 7-day average in new cases, deaths, and hospitalizations, mapping that to immunizations. Point out why immunizations work. That's why numbers are going down. Let's point out where new cases are still going up. That's an issue of a lack of vaccination and variants.

You counter disinformation by having a balance. How many times do we have to say these vaccines don't change your DNA? When we say the vaccines don't cause fertility issues, we parse our words carefully. There are no data whatsoever. I still get that question about fertility. That's going to be a challenge for the younger population as we try to get them vaccinated if we don't adequately address that in a way they can understand.

A Glass Half Full

Topol: No question about it. I want to comment about a quality of yours that I find especially infectious: your humor and upbeat attitude throughout the pandemic. You've always kept the ability to inject humor and to smile. You see the brighter side of things, which is really healthy and important.

Whyte: Over the years, people have said they thought I was humorous. I've never thought I was funny. I have two young children, and they keep me on my toes. My older son is asking me riddles nowadays, which are very stressful because as Dad, I want to know the answer.

I have focused on trying to control what I can, and the rest I try not to get too concerned about. In general, I'm probably more of a glass half full than half empty person. And, you know, honestly, with all the challenges, I've been very grateful for the fact that I haven't traveled anywhere over the past 16 months. I have had almost every meal — breakfast, lunch, and dinner — with my family. Otherwise I wouldn't have been able to do that. My two sons are much closer. So I try to look at those bright spots. I know there's a lot of unhappiness and sadness, but I'm trying to focus on the bright side going forward from here. I can't control what has happened in the past. I don't want to repeat the past; I want to improve upon it. That's the focus that I take.

Topol: It's a very important quality, and it's helpful for people at a time when there is such tremendous despair. You have had an extraordinary and diverse career in medicine and experience in communicating difficult, complex data and information. We can all learn from you. I hope that in the future we'll see better output from our federal agencies. You are a "go-to" for me in terms of the best way to communicate important information. Thanks for what you are doing.

Whyte: Thank you. I've been a big fan of yours for a long time, but I've always tried to play it cool. When I was a resident, you were very prominent even back then in terms of cardiovascular outcomes and being a leader in cardiac care.

I've read all your books. It's been an honor for me to be able to get to know you during this pandemic. I've looked to you and your Twitter feed, as well as our conversations over the past year to help guide us at WebMD and Medscape in terms of what we need to be covering. I've asked for your counsel many times on what the evidence shows and how to say certain things. I appreciate the opportunity to work with you.

Topol: One last question. You've interviewed a lot of high-profile people. Who has been the most interesting person you interviewed and who do you want to interview?

Whyte: It's always great to interview Dr Fauci, especially during a time when we really need his guidance. I had a great conversation with Dr Francis Collins at NIH, in which we talked about the concept of faith. And he thought it was all going to be about COVID, but I wanted to talk about faith. As you know, he was an atheist at one point. We talked about how we balance this idea of faith and afterlife and resurrection with science and biology and chemistry. That was a great discussion.

But I have to tell you, some of the best conversations I've had — and I've been lucky that I get to interview interesting people every day — are with young go-getters. I interviewed a high school senior in Texas last year. He said he wasn't alive during September 11th, but he remembered people saying they ran to the fire instead of away from the fire. His name was Taft Foley, and he wanted to run to the fire. So he set up a mobile testing lab.

I like inspiring stories. I interviewed a bunch of folks who signed up for vaccination back when we didn't really know what was going on. They stepped up and said they wanted to make a contribution. Those are some of the most interesting people I've talked to over the past year. And I've interviewed 250 people.

Topol: That is really impressive. Keep up the great stuff. The Medscape audience will appreciate learning more about you and your background, and what you are up to on the WebMD side of the operation.

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