Episode 11: Disinformation and abortion, with Dr. Ushma Upadhyay

SYNOPSIS

Speaking to Dr. Ushma Upadhyay, Rachel and Dan dig into misinformation about abortion – who gets them, why they get them, and how they get them. You may be surprised by some of the answers. Dr. Upadhyay describes her research around abortion safety and abortion via telehealth. Rachel proposes the lens “Retraction” and Dan leans on an old favorite, “Personas”.

STORIES OF DISINFORMATION

Y2K hype

• The end of the world in Time
• Y2K Panic in Popular Mechanics

Fraud in Minnesota: A misinformation perfect storm

• Dave Weigel’s post on BlueSky 

INTERVIEW 

• Dr. Ushma Upadhyay 
• FDA directed to review the safety of mifepristone
• Mifepristone in the water

LENSES

⇒ Persona

Everyone makes assumptions about who participates, contributes to, or benefits from a system. Those assumptions are rarely challenged, and therefore become the source of or impetus for misinformation. This lens suggests unpacking assumptions is a crucial step in understanding the system.

• What are your assumptions about who is engaged with your system?
• What are your preconceived notions about who is involved?
• When you use labels to describe your users, does everyone agree on what those labels mean?

⇒ Retraction

Publishing in formal and professional venues includes the capability to correct or retract information published there. This is a crucial part of the process, as new information can change understanding. Moreover, mistakes and misinformation need to be marked as such. This lens invites you to look at the way in which your system supports retraction.

• What are the system’s built-in mechanisms that allow users to retract information?
• How is retracted information treated differently in the system?
• How does the system invite users to challenge information to kick off a retraction process?

CONFERENCE DISCOUNT CODE

Join us at the Information Architecture Conference in Philadelphia in April

Use discount code UNCHECKED to get $50 the base conference fee

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Personnel

• Dan Brown, Host
• Rachel Price, Host
• Emily Duncan, Editor

Music

• Turtle Up Fool, by Elliot

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Unchecked is a production of Curious Squid

Curious Squid is a digital design consulting firm specializing in information architecture, user experience, and product design

Transcript

Rachel 0:00

Whenever we record this podcast, Dan, the sun is kind of setting behind you. Yes. And I am sitting well, not in full sun, because it's Seattle, but the sun is up above me somewhere. We are across the country from each other. So for as much time as you and I spend together every week, we talk to each other a lot, but we're never actually in the same place, except for during the IA conference.

Dan 0:22

Yes. The IA conference, that's the Information Architecture Conference, happens every year. It is a conference that is community run. So it's very chill, as the kids say. It's my favorite conference ever.

Rachel 0:36

It is my favorite conference ever, also. And so we're gonna be in Philadelphia in April.

Dan 0:40

I'm going mostly to see Rachel.

Rachel 0:42

I'm going mostly to see Dan. I'm also giving a talk, though, which I think you are too, and a workshop.

Dan 0:48

I am giving a talk and a workshop, yes.

Rachel 0:50

Well, well, well, well, well. It's the Dan Show. So if you're listening and you want to actually attend the Dan Show Live, also known as the Information Architecture Conference, I've really gone off script here, people. We would love to see you.

Announcer 1:09

You're listening to Unchecked, the podcast about the architecture of disinformation with Dan Brown and Rachel Price.

Dan 1:22

Are you drinking iced coffee?

Rachel 1:24

Um Yeah. How do you not know me this well? There's reasons.

Dan 1:29

There's reasons I don't know you this well, or there's reasons you drink iced coffee coffee.

Rachel 1:32

No, there's reasons I drink iced coffee. First of all, I love the flavor of a homemade toddy. That's so good.

Dan 1:39

What is a toddy? I thought I knew everything there was to know about coffee.

Rachel 1:43

Oh, Dan. A toddy is a cold brew method where the water never gets heated. Oh. So it creates like a coffee concentrate that you then dilute with water. It's cold brew. You can drink cold brew hot. You just like mix it with hot water. Got it. I happen to like it cold.

Dan 1:59

So wait, it's concentrated as an espresso is, but just never the water's never heated up.

Rachel 2:04

Yeah.

Dan 2:05

Fascinating. Or pumped, I would say.

Rachel 2:08

Yeah, it's like making for some reason it's not the same, but I think of it as the same as making sun tea, where you just like put a giant jar of water, fill it with tea bags, and like let it sit for a while. Not quite the same, but you know, uh hand wavy.

Dan 2:21

All right.

Rachel 2:22

Yeah.

Dan 2:23

I should try it.

Rachel 2:23

It's the same commitment in that you have to wait a long time. Like the brew time is slow. It's really more of like a Sunday afternoon situation.

Dan 2:31

But this is it. This is it. Because I depart my desk to go make coffee, and that is like a mini ritual in and of itself. It's not just simply pouring something from the fridge. That's how I break up my day.

Rachel 2:42

One would think with my coffee habit that would be enough for me, but apparently it's not.

Dan 2:47

I prepared a contemporary story. Do you have a story from history?

Rachel 2:53

I do. I do. I can wing it. Oh. It's I do have a story from history that will be won.

Dan 3:01

Fantastic.

Rachel 3:02

Okay, Dan. I don't actually know where the line is between misinformation, conspiracy theory, and cultural panic.

Dan 3:14

Yes.

Rachel 3:14

And so my first question, Dan, is where were you on Y2K?

Dan 3:20

Oh, that's a good question. I don't say it.

Rachel 3:26

Are you filtering? Are you really remembering?

Dan 3:29

I'm not good at remembering past events.

Rachel 3:31

Are you not good at remembering major cultural panic events?

Dan 3:34

No, I really am a not because my memory doesn't work well that way. You can ask me any dog's name in this neighborhood. I will tell you every dog's name in this neighborhood.

Rachel 3:43

Okay, fine. I will tell you where I was on Y2K. I was a teenager celebrating a teenage birthday. Of course. And my dad was a computer programmer. So Y2K was a topic in our household. I was at an interesting age. I think I would have been turning 15, I think. So like I knew Y2K, people cared about it, and I also thought all adults were dumb.

Dan 4:10

Both of those things are true.

Rachel 4:11

And so I both knew about it and thought it would be cool if the world did go dark.

Dan 4:17

Sure.

Rachel 4:17

So like the cultural panic of Y2K is right, like we're gonna hit midnight on the year 2000, and systems are gonna shut down because we had been using two-digit instead of four-digit formats for years, and computers wouldn't know that it was 2000. They would roll back to 1900 and like planes would fall out of the sky and all this stuff.

Dan 4:35

Wait a minute, wait a minute. I'm just realizing you're using this as your historic story.

Rachel 4:40

Yes.

Dan 4:41

Fine.

Rachel 4:43

Um, so my historic story is about Y2K. And at you know, 11:55 p.m. on December 31st, 1999, me and 15 of my friends went out into the middle of the field across the street from my house and waited for midnight for all the lights in the city to shut off. We didn't really think it was gonna happen, but we were all very curious to see what happened. Of course, nothing happened. We went back home. It was Iowa, it was five degrees outside. You know, we went back inside after that. And so my memory of Y2K was like a big old nothing burger. Dan, what do you remember about Y2K? Like the idea of it?

Dan 5:21

I remember a lot of people working really, really hard to make sure our computer systems were up to date and could handle it.

Rachel 5:28

Did you think it was something to panic over?

Dan 5:31

There was genuine worry.

Rachel 5:32

Yeah.

Dan 5:33

But I grew up during the Cold War, like we were worried about all kinds of things. So in fact, I was working at a consulting firm and we were building a website specifically for a client to kind of convey Y2K information.

Rachel 5:46

Okay, you were on a Y2K team.

Dan 5:48

Well, yes and no. And there was a lot of people like thinking about it and thinking that there was a lot to be done. And again, I remember not that it was a nothing burger, but there was a lot of people patting themselves on the back. Like we avoided it. We avoided the the big crash.

Rachel 6:04

So it's about to be the 25th anniversary, right, of Y2K, if you want to say it that way. It's been 25 years since that. And so uh Time magazine and popular mechanics both released these like Y2K lookbacks that are really interesting. I'll put the links in our show notes about one of the prevailing memories of Y2K is like, eh, it was this big cultural panic, and it like wasn't a big deal. But the other quieter memory is like, yeah, it wasn't a big deal because a lot of people worked really hard to make sure it didn't become a big deal.

Dan 6:36

Yes.

Rachel 6:37

There's this kind of note when you think back to Y2K about how that kind of uncertainty, like, is this gonna be a big deal? Are we gonna be okay? Is a really ripe opportunity for misinformation, for conspiracy theories, for all this other stuff. So I'm gonna read a little snippet from this Time article. It's that kind of uncertainty that some religious millennialists are seizing upon and in the process, moving quickly from the plausible to the hyperbolic. In pulpits and on videotapes, on Christian radio stations and internet websites, there are dedicated prophets of doom. They warn of a cascade of Y2K calamities, massive power blackouts, the failure of hospital, factory, and fire equipment, the collapse of banking, food shortages, riots. A Y2K article posted in 1999 on the website of the Christian Coalition speculated that President Clinton might use the chaos that Y2K unleashes as an opportunity to seize dictatorial powers.

Dan 7:35

It's so quaint.

Rachel 7:36

It's so quaint. And I was looking through this time article, and it was like, these are the same things that kind of came out in the pandemic that came out as Trump was taking power. Like all of this stuff just keeps coming back, just like pinned to a new moment of uncertainty.

Dan 7:56

I thought you were gonna connect it to AI. Oh. Here we have technological curiosity, technological unknown, technological uncertainty, a technological problem that is creating a vacuum of information. And there are doomers, right? There are people who are like, this is gonna bring about the end of the world.

Rachel 8:16

Yeah.

Dan 8:17

Then there are those of us who are like, you said that about Y2K.

Rachel 8:20

The other thing in this popular mechanics article, I really love it's a verbal history of Y2K from experts who are doing the work to make sure it was not a big deal. And, you know, one of the things that came out of this was like just this idea that fear was a motivator to solve the problem. Like some of these experts are like, yeah, it wasn't a big deal because we did our job freaking all out enough that you spent a billion dollars fixing it. Right. And we can see this kind of repeated.

Dan 8:50

Yeah, I love that.

Rachel 8:51

So that's my story. What's yours?

Dan 8:53

Mine's very recent. It's very political. And actually, my wife Sarah pointed me to this thread on Blue Sky from Dave Weigel. He's a journalist. And he pointed out this. And what was interesting was the manipulation of an information ecosystem. It's a very complicated story, but I'm going to try and make this really fast. Back in 2022, there were some folks in Minnesota who defrauded the state's food aid program and they netted millions and millions of dollars. It could have been very damaging to the Democrats because it was happening under their watch, but the Dems swept the state elections anyway. It was not a big enough deal to affect the state elections there. And meanwhile, uh, that was when Biden was in office. The Biden DOJ was pursuing this fraudulent activity. But again, it wasn't a big news story. The Republicans tried to raise it during the 2024 election, but it didn't really catch on. So here we have this kind of part of the information ecosystem of the media reluctant to cover this story because the perpetrators, the people who did the defrauding, were accusing the media of being racist by covering the fraud. The people who perpetrated this were largely Somali Americans in the state of Minnesota. And so there was sort of this complexity already of the politics and the potential racism and the media being very cautious about it. Well, Trump started drawing attention to it more recently, earlier this year. The New York Times covers it. Dave Wigel says it was a very fair New York Times story. I don't pay the New York Times anymore, so I don't know that for sure. But suddenly conservative influencers have now picked up on the story. So now we have another factor in this information ecosystem. And they begin hyping the story. One of them even goes so far as to conduct their own independent investigation. And of course, you know, you look for damning evidence, you can find damning evidence, right? Like found these organizations that seem like they were fraudulent, right? The MAGA movement circulates these influencer videos saying they did the work the Democrats refused to do. As a reminder, the DOJ at the time when Biden was president did pursue this and did bring charges against these folks. So things start to escalate and more conspiracy theories start to emerge, like to the point where Republicans in Minnesota were saying, hey, you all need to stop hyping these conspiracy theories. And the story now starts to catch on. And the framing here from the MAGA side is that the Democrats bought votes, right? They allowed this fraud to happen so that the smally American community would vote for Democrats. None of that is true, right? That's just not how it happened. That's wild. But the information ecosystem is what allowed this story to catch on. It's like a perfect storm of like all of these different factors. The journalist Dave Weigell uses this to illustrate how effective the Trump administration can be in manipulating the media. And so you have, again, this kind of collection of factors. I didn't think the Biden administration was particularly good at communications, right? So there's that. The media is easily swayed by accusations of racism. But also, I feel like there's been evidence of the media kowtowing to the Trump administration. Trump administration has this array of influencers or this army of influencers focused not on truth, but on taking down the opposition. And, you know, the perpetrators themselves, the fraudsters themselves, are using the spirit of the times, right? The way the world works at the moment as a smokescreen for the truth. So there's like all of these things happening, which has now led to this false story being more popular and taking more air than the actual truth of it.

Rachel 13:10

Wow. It's interesting when you look at this from a systems perspective, it looks so much coordinated than I'm sure it really is. You know, it looks so much more intentional. Human behavior is wild. Yes. I don't believe most organizations have their act together enough to make sense of this while it's happening. Like they're not playing chess. Nobody here is playing chess. But when you are able to step back and see how these factors all influence each other, it looks like chess.

Dan 13:39

Yeah. And I think part of the point that White Gell was making here is that if they wanted to play chess, like the the board is arrayed in their favor.

Rachel 13:49

Yeah. Yeah. Thanks for the really uplifting story this week, Dan. Things are looking up. Speaking of uplifting, we are talking to Dr. Ushma Apady this week. We're talking to her about abortion.

Dan 14:02

Let's do it.

Rachel 14:03

Like end of sentence. That's it. Let's go.

unknown 14:11

Dr.

Dan 14:11

Ushma Apady is a prominent public health scientist and professor at the University of California, San Francisco. Her research is highly influential, focusing on abortion safety and access, medication abortion, and state-level abortion restrictions in the United States. Ushma, thanks so much for joining us.

Dr. Upadhyay 14:30

Thanks for having me.

Dan 14:32

I wanted to cover this for a while because I feel like when we think about the range of things about which there is disinformation or misinformation out there, vaccines come to mind, climate comes to mind. We don't often think about reproductive health. It's not at the top of the list of things that we think of as having misinformation, but as we've discussed, there's tons and tons of misinformation out there about abortion and about reproductive health. But maybe let's set some context first. Can you tell us a little bit about your area of study and the kinds of things that you research and then what happens to your findings?

Dr. Upadhyay 15:06

Sure. So I study abortion access and safety, as you said. I do a lot of work on telehealth abortion. My focus is just publishing the science because when I first started this work in 2009, there were hardly any scientists squarely focused on abortion research. Now there are a lot more, but there were just so many black boxes around abortion when I first started, and there was a huge need.

Dan 15:35

When you talk about abortion, you're talking about literally the sort of medical process of getting away.

Dr. Upadhyay 15:40

Yes, abortion care. Yep. I work in a school of medicine in an OBGYN department. There are lots of MDs, there are a lot of uh physicians that offer abortion care, but the social science around abortion, there's just so much to pursue. When I first started, my first big project was to analyze claims data on abortion safety. So that is a type of research. It's epidemiological research. Most people study other things. There, you know, epidemiologists aren't like, I want to study abortion care. So there was a lot to do when I first started.

Dan 16:17

Wow. So can you talk to us a little bit about what is the most common myth or piece of misinformation out there? Maybe you've got a few in mind, but what's the one that you feel like comes up time and again?

Dr. Upadhyay 16:27

I know you asked for one, but I'm just gonna just rattle off a couple. I love it. People believe that they have a prototype of the abortion patient, but they don't know that most people getting abortions are already parents themselves, and they are having an abortion so that they can take better care of the children they already have. Abortion is super common. One in four women will have an abortion in their lifetime. And the one that I focus most of my time, much of my time, is there's a misconception that abortion is unsafe, but it is extremely safe. So, particularly right now, there's a lot of disinformation spreading about the safety of abortion pills. That is kind of what my bread and butter right now is focusing on bringing science to abortion care, medication, abortion, and telehealth abortion. There's a political article like a couple days ago that there's a mifepristone in our water. And the anti-abortion advocates are trying to get the EPA to list miphopristone as one of those things that all water testing sites should be testing for because they are trying to spread the disinformation that myphopristone is in our water sources and it will harm us all. This is their newest campaign. Yes. This is something that I think your listeners should be aware of and be able to detect that their alarm bells should be going off when they hear about this. Because it's just very alarming and ridiculous. Ridiculous.

Rachel 18:02

Are you okay, Dan?

Dan 18:04

No, that is so bad. The article in Politico. I mean, you're right. It's like literally two days ago this thing came out.

Dr. Upadhyay 18:12

Yeah, it's students for life, and I think they're hoping to get young people who are environmental, climate-oriented, fired up about this.

Dan 18:23

Can you connect some of the dots for us? Help us understand how some of this misinformation, these misconceptions about abortion impact society policymaking.

Dr. Upadhyay 18:33

Yeah. So it is a deliberate attempt. People who are anti-abortion are focused on spreading misinformation about the safety of medication abortion because what they want is the FDA to restrict access. They even want the FDA to remove approval of mithopristone, which is the primary medication in a medication abortion. So that is what they're working on. There are lawsuits right now, anti-abortion groups suing the FDA, and their primary reason, they say, is because the abortion pill is hurting women, it's dangerous. Their purpose is to spread this information, to spread these lies. They're publishing junk science, false narratives, which are forming the basis of these lawsuits against the FDA. And so the more they can spread this disinformation, misinformation, the easier it is for them to get the public to support regulations and restrictions on abortion.

Dan 19:36

So if they can't make the change within the FDA at the FDA level, their hope is to influence the public enough so that the public votes at the local level to restrict abortion in some way.

Dr. Upadhyay 19:47

That's right. A lot of people don't know that medication abortion is the most common type of abortion. Over two-thirds of all abortions are done with pills, and abortion care is increasing. The number of abortions has increased after Dobbs. And people don't realize that. Yeah, the primary reason is because of telehealth. So telehealth came onto the scene during the COVID pandemic. It was first approved. Telehealth is where a patient will contact a telehealth abortion provider. They'll have a consultation either through video or through chat. If the patient is medically eligible, the clinician will be able to mail abortion pills to the patient, regardless of where the patient is. So that has really removed so many of the barriers that existed even before Roe versus Wade was overturned and has made abortion cheaper, has removed a lot of the logistical barriers to abortion, and has contributed to the increase in abortion access.

Dan 21:16

Telehealth creates more access, and people who maybe would not have gotten one before because they didn't have access now do have access to it.

Dr. Upadhyay 21:24

That's exactly right. Right. Wow. Currently, 12 states ban abortion. And even before Roe vs. Wade was overturned, there weren't that many abortion clinics in these states to begin with. So abortion care was already so inaccessible. And now that telehealth is available, it has become more accessible to people in these states with abortion bans.

Dan 21:49

This is very naive of me. So I'm eager to be educated here. But it almost feels like the work that you're doing to kind of study the safety of abortion is almost a reaction. To some of this misinformation. But correct my misunderstanding here. Is it that you would be out of a job if people weren't trying to claim that abortion was unsafe? Or are there other reasons to study the safety?

Dr. Upadhyay 22:13

There are other reasons. So currently, medication abortion has a lot of restrictions on it. The clinician who prescribes myfopristone has to have a special certification. People who prescribe diabetes medication don't have to have a special certification in that. It's just there's a lot of over-regulation right now on myfopristone. So if all this misinformation did not exist, there's a lot of work to do to continue to deregulate the abortion pill. The other thing is that currently it's only approved up to 10 weeks gestation. But we need more research to demonstrate whether it is safe up to 12 weeks gestation, a little bit further, maybe 13, maybe 14 weeks. And then there's also research to be done around over-the-counter access potentially, you know, in an ideal world. It's already so safe. It's very likely to be safe as an over-the-counter medication in the future. There's a lot of proactive research to be done.

Rachel 23:16

We talk about abortion safety, and I keep wondering like the stigma of abortion, like, where does this intersect with the safety conversation? Do you have any thoughts on that?

Dr. Upadhyay 23:26

I do. As I said earlier, abortion is super common, but it's not an experience that people chat about or like you don't tell your coworker, I have to leave early today, I gotta go get my abortion. And so I think the secrecy around it contributes to the misinformation because people don't talk about it. A colleague of mine does research on representation of abortion on TV in the media, and she says that because we don't talk about it, sometimes people think, oh, an abortion on TV is the typical experience. But what her research has found is that it's very atypical. You know, usually the person having an abortion ends up dying or becomes a werewolf or kind of has some like supernatural thing happen to them. And so people don't have a lot of everyday reference points to say, oh yeah, you know, I know that abortion is safe because I had I know five people who had an abortion because people don't most people probably do know five people who've had an abortion. One thing people say is that everyone loves someone who's had an abortion. Very true.

Rachel 24:32

Yeah, that's uh both heartwarming and heart-wrenching. Yeah.

Dr. Upadhyay 24:36

Yeah, it's a it's a normal experience, a very normal common experience.

Dan 24:41

And as you pointed out with something like diabetes, there are opportunities to normalize it even further, right? We don't think twice about the treatment for many medical conditions. So we should also normalize this one too. One of our questions was what's a misconception that people are surprised to learn isn't true? And I think you already said this that most people are surprised that most abortions are not procedural. Why does that myth persist? Why do you think that myth exists in the first place?

Dr. Upadhyay 25:12

Yeah, I think medication abortion is a newer technology. It was approved in the year 2000, so it's been around 25 years, but it only became more common in the last 10 years. And so, as I said, people don't commonly talk about their their abortion experience. You know, there's this recent KFF poll. 24% of people surveyed were aware that medication abortion was the most common type of abortion. But a chunk of people didn't even know that abortion could be had with pills. Wow. It's not something that people learn about in their health classes or, you know, even my kid is in high school and they're not talking about different types of abortion methods. They're talking about contraception, but not really abortion.

Rachel 26:00

Do you ever get the sense that there are efforts to suppress that kind of information?

Dr. Upadhyay 26:04

I do. I think that whether it's intentional or because people don't want to talk about controversial things, it happens subconsciously even among people who are supportive of abortion rights.

Dan 26:18

We started talking about this, but maybe we can take it on more directly. What are some of the harms caused by these myths? What is the impact that this misinformation has on society?

Dr. Upadhyay 26:31

I think that the misinformation contributes to policies, to the over-regulation of abortion. So not just the abortion pill, but you know, another common myth is that abortion causes mental health harm. And that misconception has been the basis of restrictions, laws that say people should not have access to abortion, you know, to protect the health and safety of women. And really, the best studies done show no differential impact on mental health. The best studies have been done comparing people who have received a wanted abortion compared to those denied a wanted abortion, and really no long-term uh impacts on mental health in either group.

unknown 27:18

Wow.

Rachel 27:19

Listeners of this podcast can't see our faces right now. And I wanted to verbally underscore the eyebrows and the eye rolling. You know, Dan and I talked before we recorded this episode about how challenging this topic is for both of us for different and shared reasons. And it's good to have this conversation and to look a little bit objectively at what's going on here, but it's also an exceptionally difficult topic to be emotionally unaffected by when we hear things like, oh, there's this myth that to protect women, yeah, we must not let them control their own bodies. Right. And it's just deeply infuriating.

Dan 28:04

My wife is an avid listener of a podcast called Pivot, which is really more of a technology and business podcast, but they comment on media as well. And the male host is a guy named Scott Galloway. He's like a marketing expert. And he's been well educated over the years by his co-host, Kara Swisher. And he was watching a Sunday news program on CBS News, very compromised at the moment. And the anchor asked a senator, a sitting senator who's also a medical doctor, the way she asked the question was why hasn't Mephapistone been subjected to safety? The way she asked the question made it seem like there was a controversy as to whether it was safe or not. And Galloway kind of went off because he has come to recognize that really what's sitting underneath this, not too far under the surface, is this kind of systematized misogyny of like preventing women from getting the health care that they need, empowering them to, you know, make their own choices and things like that. But I sense that you see that probably all the time.

Dr. Upadhyay 29:10

I see it all the time during proceedings of um lawsuits or the case against the FDA. There's a lot of citations of reports, not even studies, but you know, references to junk science in the name of trying to protect women. So yeah, it's it is really infuriating.

Dan 29:33

One of the things you told us is that part of your training is not to repeat misinformation. And I love this idea. I love this because it builds on the notion that any PR is good PR, right? And that repetition makes something true. And yet, we know that there's a strong need to push against it, right? That there's a strong need to respond to medical misinformation. Can you give us an example of the mechanisms that you have at your disposal to respond to this junk science and to this medical misinformation that's out there?

Dr. Upadhyay 30:05

Yeah. There's an anti-abortion group that published a paper back in 2021 on the safety of abortion. And basically, it was on emergency department visits related to abortion. And basically, it grossly overestimated emergency departments related to abortion. They actually didn't look at the reasons for the emergency department visits. They just assumed any emergency department visit was a serious adverse event, even though they had the data to actually look at what the ED visit entailed.

Dan 30:40

Right.

Dr. Upadhyay 30:41

This paper was published in 2021 and it was used as the basis of a court case that I mentioned earlier to take methapristone off the market. And it was cited repeatedly when this court case came up in 2024. You know, I had seen it. I wrote up some notes, but I didn't do anything in the moment. But then it started to be cited. A pharmaceutical sciences professor, Chris Adkins, reached out to the publisher of this article, Sage. And Sage underwent a review. I reached out to Chris Adkins, Professor Atkins, and we worked together to publish a criticism about this study. And while it was going on through review, Sage ended up retracting the paper, which is incredible. So it was ultimately retracted in February of 2024. It sometimes is still continues to be cited, but at least now it has that big red flag on it. And we published the critique so that the public now knows all of the methodological issues, all of the tactics that they took in that paper. Interestingly, the same tactics are being used again. There's a new report that's floating around. We call it the Epic Report. It's another different anti-abortion group that published another paper. It can't be retracted because it was published on a website. So when it's in a journal, it can be retracted. But you know, the author of that paper is now suing the publisher for retracting the paper. So that is one of the downsides, is that I think a lot of publishers are weary, are afraid of retracting papers because of the lawsuits that will inevitably follow.

Rachel 32:34

Yeah, I was thinking about something you said in our pre-interview. You said, I try not to let what they do infiltrate my everyday thinking. I try to stay on course with my own data. And that statement really stuck with me because you exist in this space where the misinformation is dangerous and it's pervasive. It's not just academic. You know, it's has a wide impact. And I know as a human, we don't compartmentalize that sort of thing. I'm curious about your professional approach as a researcher who is trying to combat misinformation. What is your relationship with the campaigns that are going on around us every day?

Dr. Upadhyay 33:16

You know, as a scientist, one of the biggest challenges that I see is I am funded to do proactive science. I write research grants. I submit to NIH or I submit to private foundations. And so the work I do has to be financially supported. There aren't a lot of grants to fight misinformation or to replicate an analysis that was done really poorly, you know, replicate the junk science to show that I can do it right. You know, so I think for me, I do try to think about what are the goals that I want to achieve to push the science forward. My research on telehealth abortion, that really began because I did a lot of research on the distances people had to travel to reach an abortion clinic, like in 2016, 2017. And I was thinking, oh my gosh, the logistical, the travel barriers are so huge that telehealth would be a game changer. This was long before COVID, but I wasn't thinking about the anti's, I was thinking about how do we help people get this basic health care? How do we make it easier? How do we remove these barriers? And I think that should always be our priority. And when we can try to address the misinformation, it's so important to do so.

Rachel 34:34

You were describing how actually, like as barriers to abortion do get removed, then you notice this increase in volume of the misinformation. Yeah. And it's almost like, you know, not to put a silver lining on this, but the optimistic outlook on that then is oh, when you see more misinformation coming and that really blossoming, that's probably a reaction to progress being made. Yeah. In the other direction. Or it could be.

Dr. Upadhyay 35:02

That's when you can see what is the what are they scared of? You know, what's actually working? And yeah, they are ramping up the misinformation around medication abortion because they know that people are uh using it to overcome all of the barriers that exist. So yeah, I do see it as a win.

Rachel 35:22

I'd like to believe that the work you do and the folks like you do is just giving them more to be scared of.

Dr. Upadhyay 35:28

I don't think it's ever going to go away. It just keeps coming back again and again. The FDA, just a few months ago, they announced that they were going to do a re-review of the science. Medication abortion has been studied for well over several decades, but the FDA is going to do a re-review of the science. But then just last week, they announced that they were going to review the science after the midterms. They were postponing their review. Interestingly.

Rachel 35:56

Yes. Interestingly. Dot, dot, dot.

Dr. Upadhyay 35:59

Yeah, I mean, they know that abortion is popular, that medication abortion may even be more popular because it is taken earlier in pregnancy. That might be why. And so that could be why they have said that they're postponing the review. The anti-abortion advocates are really upset about this. I think that they're afraid that it could go either way, right? Depending on whether they decide to use gold standard science to do the review or whether they decide to allow junk science to infiltrate their review process.

Dan 36:32

Let's talk a little bit more about your work in telehealth. I'm really curious. Maybe we could talk about it in the frame of disinformation. How do you feel like telehealth can play a role in fighting the misinformation around abortion?

Dr. Upadhyay 36:46

So I did a study on the safety of 6,000 patients who had a telehealth abortion. And we invited the participants to participate in a survey. So 1,600 participants participated in the survey, and we asked about their experience of a telehealth abortion, and we asked about the positives and the negatives. The number one negative that they saw was that it was a legitimacy problem. They didn't believe that it was an actual abortion. That first of all, that it was a website, that they didn't know whether there were going to be anti-abortion people on the other side of the video call. They didn't know if it was a real website or a hoax. If they went through it, they didn't know if the pills were going to be real. And so some of them said, Well, I just wanted a video because I wanted to talk to a real person on the other side to make sure this was a real thing. Not for the safety reason, just because they wanted to know, is this a legitimate service? And so that was the most commonly cited drawback. But the acceptability, you know, they they got their pills, they had a successful medication abortion. 98% of patients said that they trusted the provider, 96% said that the telehealth abortion was right for them versus an in-person medication abortion, and 92% said that they felt cared for. We even compared those who had asynchronous care, which was the is the chat type, texting type abortion service versus the video. And those who got the chat texting service were more likely to say they felt cared for versus those that had the video call. And I think it's because those who did the chat were chatting throughout the whole process. They were texting their with their provider the whole way through. It's a two-day process. Any questions they had, they could text. Whereas with the video call, they may have seen the clinician, but then maybe they were a little hesitant to bother their clinician afterwards if they had questions. And so both groups had very high levels of reporting that they felt cared for.

Dan 38:54

That's great.

Dr. Upadhyay 38:55

So overall, bottom line is that people had a really positive experience once they got over the hump of trusting it.

Dan 39:02

I mean, but we have to do that with every website all the time. I don't think that's limited to abortion care.

Dr. Upadhyay 39:08

Yeah, but with abortion care, this is kind of a decision about the rest of your life. It's true. Whether you get your pills or not is gonna determine your entire life course.

Dan 39:17

Yes. For me, it's the male pattern boldness pills I'm considering. And I think I would want to be able to chat with someone about that. It's different, obviously.

Dr. Upadhyay 39:25

Chat over video.

Dan 39:26

Well, just the the scale of the decision really that I would have to make. But I would still want to make sure I was getting legitimate care. Yeah. You never know what could happen.

Dr. Upadhyay 39:35

The results are not going to be as immediate, right? Whereas with abortion pills, you know, pretty quickly. Or definitive, right? Whether they're you got the real ones or not. You know what, Dan?

Rachel 39:44

To protect your mental health and your safety, I do not want to give you the choice to address your baldness. I actually think it would be better for you if you let me make that choice on your behalf.

Dan 39:56

I feel very disenfranchised all of a sudden.

Rachel 39:59

Welcome.

Dan 40:00

Anyway, are there any other things that you feel like are helpful about telehealth in terms of combating misinformation?

Dr. Upadhyay 40:09

Yeah, I was also gonna say, so in 12 states where abortion is banned in this country, there is a lot of misinformation, there's a lot of distrust. Telehealth is available in those 12 states. It is made available by providers in states where abortion is legal and they have shield laws that protect the clinicians who are providing this telehealth care into states with abortion bans. For the patients, the legality is less clear. But for the patients living in states with abortion bans, the issue is getting information to them that ordering pills in this way is medically safe. And it is also has been legally safe. We have not seen a lot of prosecutions against people trying to obtain abortion pills in this way. So the information is spread through websites, planscpills.org is one of the websites that provides all of this different sources where people can get these medications, as well as just facts about the safety of abortion pills.

Dan 41:17

Do you feel like there's a chance that the anti-abortion activists would come after telehealth as a concept?

Dr. Upadhyay 41:26

Anti-abortion activists are. I mean, that's part of the lawsuit, is that they want to reinstate the in-person dispensing requirement. They are saying that all of these serious adverse of events are a consequence of making medication abortion available via mail. But it doesn't make any sense. Whether you get it in person or you get it through the mail, you go home and you still have the abortion at home. So the plausibility is not there. It doesn't make any sense. And they're relying on junk science to make this case.

Dan 41:58

I had one more question about this, which is I'm really curious as to whether patients show up with misinformation that needs to be clarified for them, and that whether maybe they feel more comfortable sort of having their questions answered in terms of like, I heard this, I heard that. Is there an opportunity to find out what kinds of misconceptions people have when they show up?

Dr. Upadhyay 42:22

That's a good question. I think patients show up, they have questions sometimes about impacts on infertility, or, you know, a lot of people, when they want an abortion, they don't want a child now, but they do in the future. So that is a common question. People are also fearful about pain. So I think that whether they go in person to see a provider or they have a telehealth consultation, it's a good time for patients to ask questions. I think the bigger threat is public disinformation and misperceptions about abortion, because that is really the biggest threat is the restrictions on policies. Misinformation can do the most harm by being the basis for policies that restrict access. You know, even like waiting periods, or, you know, a lot of states have mandated information, and there's a lot of misinformation baked into state laws. Clinicians actually have to provide patients with misinformation about the abortion, which is horrifying. A lot of them will say this is the state mandated information part, they'll read it, and then afterwards they'll say, now we can talk about what is evidence based. And a lot of what I said, there isn't a lot of reasons. I had no idea. Yeah, those are the same states that now ban abortion. And so there are fewer states with such mandated misinformation, but there are still a few.

Dan 44:00

Anything gives you hope for the future of abortion care in America.

Dr. Upadhyay 44:05

It gives me hope that the majority of Americans are supportive of abortion rights. A podcast like this gives me lots of hope that, you know, there's a public desire to defeat misinformation and to spread knowledge and science and evidence-based information. So that gives me a lot of hope. And then I am hopeful that at the FDA that they will take into account science when they continue to make decisions and take into account the evidence-based.

Dan 44:40

That was phenomenal. Thank you. Thank you for indulging us.

Dr. Upadhyay 44:43

Well, thank you for choosing this topic.

Dan 44:51

I really enjoyed this conversation with Bushmo. This was a topic that when you and I first started talking about this podcast, it was something I really wanted to cover because I feel like there is so much misinformation about reproductive health in general, and that it is used for such nefarious purposes. There were some interesting outcomes for me here that I was not expecting. I feel like we heard some common themes, like this idea of information environments being high friction, the amount of trust that people can have in the information that they're getting. This is very similar to the nutritionist, too. They're dealing with a lot of mythology, like myths about these things that may have started as misinformation, but then have become so entrenched that we've come to believe these things. And I also felt like you and I talked to her a lot about her work relative to the misinformation. I know I was certainly thinking, does a lot of her work exist simply because she's trying to combat information? And I've I was really appreciative that she said there's work to be done to understand the safety of these things regardless of the information.

Rachel 46:01

Yeah.

Dan 46:01

Anyway, those new ideas were sort of starting to take hold for me. But I landed on a few different lenses. And this actually came from fairly early in the conversation. I'm calling this lens the persona lens. Persona is such a loaded word in our business these days.

Rachel 46:19

Yeah, I'm like flinching a little bit. But continue.

Dan 46:22

She was talking about we all have this preconceived notion of who gets an abortion.

Rachel 46:26

Yeah.

Dan 46:27

And I think the misinformation systems, I should say, exploit this fact that we all have certain preconceived notions about the demographic and the need and the circumstance and all of these things about people who get abortions. And it turns out that that mythology that we have is just false.

Rachel 46:48

Yeah. Someone you love has had an abortion. I still am thinking about that.

Dan 46:52

Oh yeah. And that is true for me. I mean, it is true. It is a true statement. That really spoke to me. I think maybe because it was so personal, but also because this idea that as UX designers, we often design systems to reflect the needs of people. But a lot of those needs of people, even if we do use a research, come from our preconceived notions of who those people are and what they need. And maybe this is just a reminder that we need to constantly question those assumptions because if we structure the information space in a way that presumes a certain kind of person, then that is an opportunity to exploit the system for misinformation.

Rachel 47:37

Yeah, absolutely. I think that we often talk about personas as a tool for improving a user experience and for making it better. What we usually don't talk about, and this is one of the reasons I actually don't like personas at all, personas are a tool for exclusion. And I think that that's not necessarily inherently bad or immoral, but it's just they're a double-edged sword. And we always talk about the benefits of personas for tailoring an experience to a particular kind of person. We don't talk about what it means to then be exclusive of other people by using those personas. Right. You know, none of our listeners would ever do this in their own practices. Definitely. But if sometimes if those personas are using demographics still, then like woof. Right. Right? I mean, at that point I raise an eyebrow that you are explicitly excluding particular people from your experience.

Dan 48:31

Right.

Rachel 48:32

Or explicitly amplifying stereotypes.

Dan 48:35

Yes. It really came out when she was talking about the survey work that she did. And I just think if she had bought into the assumptions, the preconceived notions, then it's likely that survey work would have been skewed, right? And we then perpetuate the misinformation by excluding the wide range of people who have undergone this procedure, who have, you know, used the medication, uh, who have had an abortion, then we don't get a complete picture and the misinformation simply perpetuates itself.

Rachel 49:09

So what would you want a practitioner to do with this lens? I'm sitting here thinking like, how do you take this information into a negotiation about what you will or won't design or, you know, that sort of thing?

Dan 49:22

Aaron Powell I think it's a great question. My instinct is always, if there are preconceived notions to name them. So when we say people who get abortions, right, let's say that that's our target audience, we should have a honest conversation about what that means to every person on the team and at least try to identify the questions that need asking to try and fill in some of the gaps there. And as you point out, this is hard, but if we are taking this lens to the system that we are designing, we should ask ourselves what needs to be true about the user, the person in order for this system to make sense. Because we may state things that we would prefer not to state. For example, looking at the system, I see it is designed for people of a certain socioeconomic class. That must be true in order for the system to make sense. Well, then we need to ask ourselves, is that true? Is that accurate, or are we simply resting on a preconceived notion that the target audience is uh people of that socioeconomic class?

Rachel 50:31

It basically just has us, I'm paraphrasing, say the quiet things out loud, right? And like ask the questions like what do we really mean when we say this? That's what I love about the power of this lens. It's a bit of a challenge.

Dan 50:45

Yes.

Rachel 50:46

Like it's a gauntlet to say, okay, if we are committing to producing this experience, are we gonna talk about the hard stuff here?

Dan 50:55

Right.

Rachel 50:55

Or are we just gonna pretend it doesn't exist?

Dan 50:58

That's what I hope all the lenses are to some extent, is like a challenge because it's too easy for us to rest on assumptions, preconceptions, and to ignore these hard questions. What hard question do you think we should ask?

Rachel 51:12

I came up with a couple lenses, and I'm gonna go with retraction. Going with this one because this is, I think, the first time this really came up in a conversation. So it felt like a really unique thing to think about uh based on talking to Ushma. This lens asks us like, how does the system retract information? How does the system make it clear when information previously published is no longer reliable? How does the system explain retractions? And this lens came to me during the part of the discussion where we're talking about bad science being retracted in journals, and that still has lasting damage. Like the fact that a bad study was published by a journal means it's out there. The thing I do appreciate about journals, academic journals, is that there is this precedence for retraction. There's a mechanism for retraction, there is a mental model for what it means to retract something. Like this idea of retracting exists in journals, and it's about documenting almost the timeline of that information, right? And it's a public undo button. It's not an eraser. I think that's what's important. It's not a delete, it's not an eraser, it is an additional layer with explanation and history and that sort of thing. And I was thinking how rare that is in like any of the systems I work in as a consumer, even. Right. What are even examples where you can see retractions? You can kind of do it if you dig through like the history of a Google Doc or a Word document. You can tell when like a Slack message has been edited, even if you can't necessarily see the original. I think if you're the owner of the message, you can see the original. And I was thinking, like, man, I understand there's this instinct that's like, oh, that's too much information. God, why would you want to like publish your attraction for every edit? But God, the transparency there is such a relief.

Dan 53:14

Yeah. This feels like a space where the technology is super antiquated to. Yes. You've named a c a couple good examples, but none of those are perfect by any stretch or even adequate, really. They do something, but they don't do enough to deal with the fact that once information is out there, even if it's been officially retracted, I'm air quoting officially retracted, it's still out there and it can still be used for nefarious purposes. The fact that that study she had mentioned has been referenced in the court cases is extremely concerning. And who's to say that the retraction that the journal created will prevent those things in the future? There's an opportunity, a technological opportunity there to solve that gap.

Rachel 54:07

Yeah. If we can figure out how to take your ebook back off your device for you and allow you to never look at it again because we just decided you don't own it anymore.

Dan 54:18

Right.

Rachel 54:19

If we can lock down music albums, like this is an information object problem.

Dan 54:25

Right. There should be some permanent attachment to a piece of information to indicate what its kind of current status is.

Rachel 54:34

Yeah. And I mean, this obviously calls into a lot of like, okay, who owns the information, who's the authority? You know, yeah, yeah, yeah, yeah, yeah. Good questions, everybody. Right. I'm not going to answer them right now. They're popping in my head too, but just the sense, the vibe, especially in an information system you're designing. You know, I think a lot of us work on user-generated systems, but a lot of systems are not user-generated. Like these are product databases or whatever. In a lot of cases, there is no argument over who is the owner of the information. And in those cases, especially this idea of retracting and maintaining a log of edits or reversals, not technologically hard. Right. It's a cultural norm, you know, I think that feels very academic and feels very archival that I wish more of us could get on board with, or at least think about and consider as an option.

Dan 55:32

I like this lens because it really compels a product team to make retraction not an edge case, but a common use case, right? Or at least sort of challenge them to think of, okay, not just edit something that someone's already put out there, but highlight the fact that it needs to be retracted in whatever that means. It also, I guess, compels the team to think about what does retraction mean in the context of their particular information system.

Rachel 56:01

Yeah.

Dan 56:02

I have sort of a bonus question for you. Go for it. We're recording this at the very end of 2025, even though it will probably not air until 2026.

Rachel 56:12

What would I retract if I could? Okay.

Dan 56:15

Let me get on my list. I was going to ask a different question.

Rachel 56:17

No, go ahead.

Dan 56:18

Having now done this for nearly a year, what are you interested in thinking about relative to misinformation in 2026?

Rachel 56:29

I want to think about misinformation in weird spaces. Love it. So one of the things that has been the most fun is talking to people who exist in spaces that I've never once really thought about a day in the life of that person. Right. Or someone doing that job or, you know, whatever. And so the other thing that this conversation with Ushmo in particular lit up for me is mythology, like cultural mythology. I think that is a very interesting layer in the misinformation space. Like what things do we just believe that just aren't true? And some of them might be very damaging, some of them might have been intentionally campaigned, which I think makes them more in the disinformation space. I think mythology kind of covers a lot of different intents and use cases, which is why I like it. And when I think back to our pilot episode, we kind of on a very lighthearted note kicked this whole thing off with some mythology around swallowing spiders. Yes.

Dan 57:27

Yeah.

Rachel 57:28

And I think that there's this compelling space that I want to explore in 2026, which is like, what are some of the myths that are believed in the wellness space, in healthcare, in vaccines, in all these things? We've we've talked about some myths in our previous episodes, but I think that there's a lot more to dig into there. What are myths when it comes to like for me, parenting? Right. Are there like these crazy parenting myths that are driving all of us crazy that if we all understood these were myths and where that information came from, what would that open up for us?

Dan 58:02

You're getting at mine, which is the misinformation of sort of everyday life, which I think builds on both of those things that you described.

Rachel 58:11

Is this the answer to the design of everyday objects? The misinformation of everyday lives?

Dan 58:16

Yeah. That's a pretty good parallel insofar as I feel like there are these niche topics where we don't think of misinformation existing. One that you and I have kind of touched on the edges of is like personal finance. Oh. Why shouldn't that be similar to our conversation about nutrition, right? We all have these expectations about the food that we put in our bodies. I think we all have this expectations about how we use our money. That's really interesting. And then building on the mythology, I think a lot of our understanding of that is built on things that have been handed down that don't necessarily have a lot of rational backing to them.

Rachel 58:58

But we believe them, we just accept them. We just accept them.

Dan 59:01

Yeah. And I mean, this really came out talking to Amelia on the nutrition episode, but I also think I saw evidence of it here in this conversation with Ushma about reproductive health, which is again, we have these preconceived notions that are not necessarily misinformation, but they're a foundation for new misinformation, right? We can sort of take these myths and preconceptions and we can see how people build additional misinformation on top of them to achieve their agendas.

Rachel 59:33

You know, when we talk about framing as a way for sense making, what is that frame made of?

Dan 59:39

Yeah.

Rachel 59:40

That frame is made of assumptions and beliefs, some of which may be factual and true, and a lot have probably just never been questioned. Like an individual doesn't necessarily know if they're true, but they haven't questioned them.

Dan 59:53

Right.

Rachel 59:53

I truly didn't know that I didn't swallow spiders while I slept.

Dan 1:00:00

And we've come full circle. Well, Rachel, happy new year.

Rachel 1:00:04

Happy New Year, Dan.

Dan 1:00:11

And that was Unchecked. Thanks so much for listening. We really want to hear from you. If you've got ideas for topics or guests or stories, drop us a line at unchecked at curious-squid.com. If you made use of the lenses that we described today in your practice, we want to hear about that too. Hey, check the show notes for any of the links that we talked about today, and it would really mean a lot to us if you shared this episode with a friend and rated and reviewed us on your favorite podcast platform. Thank you.