Episode transcript
Time stamps
0:00 Intro
2:28 Dr. Rubin's Social Media Journey
5:11 Social Media's Role in Patient Education
7:06 Addressing Misinformation on Social Media
9:21 Common Patient Inquiries
11:02 Misconceptions in Allergy Diagnostics
14:00 Use of Specific IgE Blood Tests
16:10 Creating Content for Social Media
19:10 Advice for Primary Care Providers
22:02 Closing Remarks
Transcript:
Announcer [00:00:00]: ImmunoCAST is brought to you by Thermo Fisher Scientific, creators of ImmunoCAP™ Specific IgE diagnostics and Phadia Laboratory Systems.
Gary Falcetano [00:00:12]: I'm Gary Falcitano, a licensed and board certified PA with over 12 years experience in allergy and immunology.
Luke Lemons [00:00:18]: And I'm Luke lemons, with over 6 years experience writing for healthcare providers and educating on allergies. You're listening to ImmunoCast, your source for medically and scientifically backed allergy insights. Hi, welcome to ImmunoCast. We are at the American College of Allergy, Asthma and Immunology with the incredible Dr. Zachary Rubin, who is actually here for a panel called Social Media and Podcasting the Changing Face of Medical Education. You're a little bit social media famous.
Gary Falcetano [00:00:53]: But before we even asked him to talk about himself, Luke, we need to talk about how famous he is.
Luke Lemons [00:00:58]: Oh, yes. Yes.
Gary Falcetano [00:00:59]: 13 million followers on TikTok, almost a half a million on Insta and 43 million likes. That's crazy.
Dr. Rubin [00:01:10]: Yeah. I can't believe that I'm here today. This has been truly incredible, and thank you so much for having me. This has been an experience like no other. I never expect if you asked me five years ago that I'd be sitting here with you guys today, I'd be laughing. I mean, it's just a totally different experience. Basically what happened for me was I finished fellowship right when the pandemic started. So to be able to connect with people when I moved from St. Louis to the Chicagoland area was very difficult because there were no social events going on. Primary care physicians basically siloed themselves off to survive, essentially, and also for infection control. Right at the time, we just didn't have the tools. We didn't have vaccines at that point. And so I decided in order to connect with people, everybody was going online at that point. Everybody was on social media. So I created initially a Twitter account, which is now X, and then I slowly went into video content. I went to TikTok and then Instagram and now YouTube. And it's just been slowly growing since then to the point that today I'm walking around the exhibit hall and people are coming up to me and saying, Dr. Rubin, oh my gosh, I can't believe I'm meeting you in person finally. Can I get a picture with you? You know, I'm a big fan, or my friends a big fan of yours or my staff are fans. We've watching your content for years. And this is the first time I've been in person since the Pandemic started for one of these events.
Luke Lemons [00:02:28]: Oh, wow. I didn't know this was actually the first time, even in person. So you really feel that rockstar energy. People see your bow tie coming down the hall and they're like, oh, yeah.
Dr. Rubin [00:02:36]: Maybe I should have taken it off to be a little bit more incognito.
Luke Lemons [00:02:38]: But.
Dr. Rubin [00:02:38]: But it. Yes, I am that, like, bow tie allergist on social media. And it's created a little bit of a brand for myself, but provided a lot of learning opportunities for people to be able to make allergy immunology more accessible to the general public. Yeah.
Luke Lemons [00:02:53]: And what's interesting is your content is more tailored, I would say, to patients, but you're here with a lot of different types of providers and you still have that sort of fame in a way. But for patients specifically, why do you think your content, which is highly educational, is resonating with them so much?
Dr. Rubin [00:03:09]: I think a lot of that has to do with the fact that people are constantly asking questions about experiences that are quite common, whether it's dealing with food allergies. I'll show a video of a mom who has a baby having an allergic reaction and then showcasing that and then giving a little bit more clinical insight at a level that's appropriate for most people to understand that we're able to break down these complicated concepts in a way that the general public can. Can take in. And I think physicians also resonate with that because it is very difficult not only to master material from the highest level clinically and scientifically, but then to take that information and then communicate that to patients. So that's easily understandable. I found that a lot of physicians have given me feedback saying, the way that you talk in those videos, the way that you break down the material, has been very valuable for me in my clinical practice to be able to showcase that to. That to people. And patients often bring those videos to their providers to talk about something that they didn't think about. F PIE is an example. Food protein induced enterocolitis syndrome. It's not something that's normally talked about in healthcare, and we're able to bring up these concepts that are becoming more recognizable, more common for people to look into as to why this is happening to them or to their children.
Gary Falcetano [00:04:26]: Sure, yeah. So part of our mission is to bring allergy education to primary care, but we found the. The identical thing. We're here at an allergy meeting and we're hearing from allergists. We really love your content. Even though there is really a secondary audience. But you've found you've really resonated with patients, with specialists and with primary care providers, which I think is just awesome.
Dr. Rubin [00:04:46]: Thank you.
Luke Lemons [00:04:47]: And you had mentioned that the patients are bringing your videos into the office to show their clinicians to talk through these disease states. I'm curious though, thinking about TikTok and Instagram going forward, where do you see that role for patient education actually, does it work the other way? Would a provider say, hey, you have allergies, like Dr. Rubin might be a good person to follow on TikTok? Where do you see that relationship going with social media?
Dr. Rubin [00:05:11]: I really feel that this can go multiple different directions for people. So you can see that people are moving away from watching tv, listening to radio, going on just the general Internet. And we're finding that people are using TikTok, basically like Google, as a search engine for all sorts of different topics. And sometimes it's actually helpful when you see somebody experiencing a certain disease state, like hives as an example, they get an allergic reaction to food and there's actually hives developing on screen. That actually is a little bit more educational because you see that a little bit more in person, in real time, rather than trying to search for these images. So patients can really learn from that by seeing that because they may have experienced it themselves or their children have. And then they go on social media and they're searching for health terms. Almost every adult is now going to social media for health related information at this point. So it is really a repository of information that way. And so I do encourage physicians to go on social media to be a wealth of information to help people get general information because they're not going to these other sources for that. And so learning about new medications, testing, things like that can happen on social media where most people are spending their time. On average, in the United States, an adult is spending about two hours a day on a social media platform. It's about the length of a movie at this point. They're not searching for news as much through newspapers and through television. They're moving to social media. This is becoming a totally different landscape than it was even five years ago.
Gary Falcetano [00:06:47]: So, you know, with that, you know, the massive amount of time being spent, there's a lot of misinformation out there as well. And I think certainly what you're doing is combating some of that. Yeah, but what's the risk? When there's misinformation, you address it, but you're also amplifying it at the same time. Right.
Dr. Rubin [00:07:06]: That that is A constant struggle and debate, which is how do you address misinformation? What is the proper way without amplifying the incorrect information? And I, I don't think there is one right way to do it. I've tried different ways, right? I'll say, hey, you might have heard about X, whatever that may be, and this is what the actual information is versus somebody's information went viral and then showing that and then addressing it or just giving straight information. And so when we talk about posting on social media, we have to address the computer algorithm, that source code that's essentially deciding how does this information get to somebody's screen. And I found personally in my content, it actually works better if you are showing that misinformation but then correcting it so that people who have seen it already, they hear it and then they get that additional information as a supplement to understand from a trusted source why is that incorrect? How did that thought process go wrong and what is the actual true information related to?
Luke Lemons [00:08:07]: Has there ever been any comments from patients that have shocked you based around these misconceptions or things that people will say on your videos that you're like, well, I need to talk about that specifically.
Dr. Rubin [00:08:18]: There's a lot of different examples. I'll give you just a couple of them. Early on when I started doing this type of work, I had a few families come in saying they were using iodine to clean their kids noses. I was shocked by this. And it turned out that there were people on social media recommending this and so I had to address that. I made a post a long time ago talking about that because it's not what we typically do with kids. We don't even know what the real safety of that is in children. It hasn't been studied. So I get really concerned about situations like that. Or there are certain disease states that people are thinking about and assuming that this particular symptom must mean it's this disease, like it's a mast cell disorder or something like that. And in reality we have to look back and look at the entire picture, get a really good history, get a good exam, get the right testing in order to be able to diagnose some of these complicated disease states. Just because somebody has hives on a regular basis does not necessarily mean mast cell activation syndrome as an example. We have to look at the entire picture.
Gary Falcetano [00:09:21]: So you must get a lot of DMs asking you direct questions. What are some of the most common themes that you're seeing?
Dr. Rubin [00:09:28]: One of the challenges is that when I have People directly messaging me about whatever is going on with their healthcare. I hope people recognize that. You could go to your primary care physician if you have an issue with, let's say, a peanut allergy and get a blood test ahead of time before getting access to a specialist. Because sometimes people can wait six months or a year to see somebody, depending on where they live. So they could get that blood test initially to help guide management through primary care. Or let's say they have severe allergies and they can't get access to a skin test. They can easily get a blood test that's a panel for environmental allergens to help figure out what are the things I'm allergic to, what do I need to do to reduce exposure to it, and then what medications and when should I be taking them in order to have more targeted approaches before seeing a specialist.
Gary Falcetano [00:10:16]: And that's really a preventative medicine approach.
Dr. Rubin [00:10:18]: Right.
Gary Falcetano [00:10:19]: It's being more proactive, not reactive with just medications and suspected diagnosis.
Dr. Rubin [00:10:23]: Exactly. And I love what I do because most of what I do is preventive medicine. Understanding how do we get people away from urgent care settings, from. From the er, from the hospital, and keeping them as healthy as possible by knowing what is actually ailing them.
Luke Lemons [00:10:38]: Yeah, yeah. And when you said that a lot of people don't have access to specialists, I think there's only about 5,000 practicing allergists in America. So a lot of times primary care is the front line for. For certain allergies. And when it comes to patients coming in and asking these questions, like you had mentioned, are there any misconceptions that you see in a primary care setting or that you've heard about when it comes to, let's say, environmental respiratory allergy testing?
Dr. Rubin [00:11:02]: One of the things that bothers me is sometimes I'll have patients come to me and say my primary care didn't want to do any testing. They said just get an antihistamine and just take that year round. And that's actually not appropriate for everybody. And antihistamines is only one approach to treating allergic rhinitis. When nasal sprays that have steroids in them or antihistamines can be another approach to it. But by knowing what you are sensitive to will really help us figure out what is the appropriate therapy, which they can do ahead of time before coming into my office.
Gary Falcetano [00:11:31]: Yeah. And I think a lot of people don't realize that most people that are allergic to more than one thing, and identifying all of those triggers which leads to a cumulative symptoms, I think is really Important, right?
Dr. Rubin [00:11:42]: Yeah. Most of my patients are allergic to more than one allergen. It's not just dust mite or grass pollen. It's a combination of things that may be seasonal but also could be around at the same time, or they're year round with seasonal worsening. Right. So getting that profile ahead of time can really help people conceptualize what they need to do.
Gary Falcetano [00:12:00]: It's very hard to tell if a dust mite is triggering your symptoms.
Luke Lemons [00:12:03]: Yeah. And on this episode's page, in the description of this video, we'll have a link to the lab ordering guide, which has codes for those respiratory allergy panels that you're speaking about. And it is to the point you had make and you as well, Gary, about preventative medicine and making sure that we know what they're allergic to and then reducing exposure so that they're not just given an antihistamine and pushed out the door.
Dr. Rubin [00:12:24]: And one piece of advice I have for primary care is also, when you, before you order that test, get a good history and understand what are the potential triggers so that the testing becomes even more accurate that you can figure out, hey, maybe there is a small level of pet dander allergy, but they're fine around animals. Right. That doesn't take too much additional effort to be able to ask that type of a question in order to really enhance the accuracy of the test.
Gary Falcetano [00:12:48]: Exactly. Because that's how we make the diagnosis. Right. We correlate the test with the history.
Dr. Rubin [00:12:52]: Exactly.
Luke Lemons [00:12:53]: And so again, go into primary care. Are there any comments that you get on your social media that you think primary care could directly handle or questions that you're thinking, you know what, this is something that all primary care providers should know and be ready to address.
Dr. Rubin [00:13:08]: I think there's a big misconception between food allergy and food intolerance. Right. And so people will order food allergy testing for symptoms that don't line up with it. So food allergy blood testing is very accurate if you have a history that supports the test, as we were mentioning earlier. But for many people, they'll say, oh, I have, let's say, diarrhea and abdominal pain. I need a food allergy test that is not going to give you the right information. You want to do it for a situation where they say, oh, if I have egg, I have hives, or if I have egg, I start wheezing. Some of these other symptoms that are more directed by the IgE antibody that causes that type 1 hypersensitivity reaction.
Gary Falcetano [00:13:49]: And we've talked about this on previous episodes and really detailed the difference between the intolerances and the IGE mediated allergies. And still a concept that a lot of people struggle with.
Dr. Rubin [00:13:58]: Yeah.
Luke Lemons [00:14:00]: So then looking at your practice specifically, how do you use specific IgE blood tests? And we talked about primary care, understanding their symptoms to help with exposure reduction. Probably do the same thing, but it's different being that you are an allergist.
Dr. Rubin [00:14:13]: So I use it in a couple different situations, depending on whether it's environmental or food. So food. I'm very targeted to saying, if I have a patient that is specifically allergic to peanut or tree nuts, whatever it is, I get blood tests on a regular basis to track whether or not there's a chance they may outgrow this and to understand what is the level of risk of having a reaction. We can never really predict is this going to be severe or not. And people need to understand that even if the level is very high, you could still have just mild symptoms. We don't know that. That's the. That's not the point of the test. The point of the test is to identify who is allergic, who is not, and who may be able to eventually eat this, especially for younger kids, and track that and be able to intervene and do an oral food challenge and actually see in the clinic if they're actually allergic to something like that. So that's the food portion. For the environmental allergy portion, it may be I don't have the right extract for the skin test anymore. Like, I used to be able to test for feathers or cockroach, and now I may get that as a blood test for specific people based on what their home environment is, or they have dermatographism and they can't do skin testing or they can't get off antihistamines. So I will do blood testing in those types of situations as well.
Luke Lemons [00:15:28]: Yeah. I think that's another misconception too, is that you have. You can't run specific IgE blood testing if they've been taking antihistamine. But you can.
Dr. Rubin [00:15:36]: Right? You can do that. You can do that. If somebody is taking allergy medications, they can't get off of it. And I get that on a regular basis. I'll just get a blood allergy test and then have them come in and we'll interpret it together and go over the history and tell them what the meaning is behind it.
Gary Falcetano [00:15:49]: Yeah. And the clinical utility is really very similar between the blood and the skin testing. And I think that's one of those myths. Right. Or dogmas that have been a hold over from years ago.
Dr. Rubin [00:16:00]: Yeah, I use both on a regular basis. There's advantages and disadvantages to both, but I think they're both important tests to be able to consider.
Luke Lemons [00:16:10]: Yeah. And it's all about the patient making sure that they get the care and understand what they're allergic to. And that's again, your content. It does such a good job at that, at letting patients know their options, letting them know information that isn't, for lack of a better word, dumbed down. You respect your audience and you, you give them that level that you talked about earlier of education that they can understand and it's impactful. And that's obviously why one of the reasons you're on this panel later today, the social media podcasting panel. And so while we're recording this, you're doing that tomorrow, so you're not going to spoil anybody. But is there any topics that you're planning to address on that panel?
Dr. Rubin [00:16:47]: Yeah. So we have several allergists, including myself, on the social media subcommittee from the American College of Allergy, Asthma and Immunology. And so we've done a bunch of posts together over the last couple of years as collaborative posts to educate people about various allergic diseases. And so what my role is in this panel is to showcase what it's like to be able to make content on social media. What does that creative process look like? Because I encourage anybody to post on social media to provide education, whether you're a patient, to tell your story right, or you're a provider and you want to educate people or dispel misinformation or even connect with people. There's barriers to people wanting to do that. Whether it's time or what I've seen is people are afraid to get on camera and showcase that. So I don't have a theater background. I'm not an actor by training. Uh, my background is when I was a kid, I made home movies and I made little presentations and I would used to edit on VHS tapes. And so I had that kind of background with technology and video editing that translated pretty well to today's modern digital age. And I've come up with a process that makes it rather quick. So in the presentation, you're going to see me making content and you'll see that it's really much more approachable than people may think. Because I've had so much feedback over the last couple of years. I've given talks about the role of allergists in social media, and I get questions on a Regular basis from doctors saying, I don't have time for this, or I don't have my makeup on, or I don't have X, Y and Z to be able to do this. How do I actually do it? And it really, for me is something that I can create a piece of content that will go out to a ton of people within 20 to 30 minutes.
Gary Falcetano [00:18:35]: So you're actually going to do that tomorrow during the presentation?
Dr. Rubin [00:18:37]: Yeah, I'm going to show it.
Gary Falcetano [00:18:38]: That's true.
Luke Lemons [00:18:39]: That's great to show, to see how easy it could be to do that kind of thing.
Dr. Rubin [00:18:42]: So I'm really excited to see feedback from the audience on it. It's my first time doing it this way.
Luke Lemons [00:18:46]: Yeah.
Dr. Rubin [00:18:46]: So we'll see how it goes. Man.
Luke Lemons [00:18:47]: First time in person, you're going on stage, you're making content. You are a rock star coming out of the.
Gary Falcetano [00:18:53]: So, you know, as we wrap things up, we do have an audience of patients as well. That's certainly not our primary or secondary audience, obviously, primary care and specialists. If you could give one piece of advice to each of those three groups, what would that look like? What would that be?
Dr. Rubin [00:19:10]: I think for everybody is just find out who your local allergist is and reach out to them. And I would hope that my colleagues would be willing to come into like the primary care clinic and give a little talk and give some pieces of education related to food allergy and environmental allergies so that they know that there's a resource there in case they weren't aware and get a good understanding of some of the basics of what can be done in the primary care setting before referring. Because a lot of patients struggle to get in to see the allergist because there's few of us, but it really will help get them a leg up.
Gary Falcetano [00:19:40]: And what about for allergists? What about your allergist colleagues? What piece of advice would you give to them?
Dr. Rubin [00:19:45]: They need to start posting. I actually grew a lot of my clinical practice through social media, just through the education. And I can't tell you how many patients have come up to me and said, I follow you on social media and you're local and this has been fantastic. Be able to actually meet you in person and have you help me. It's been truly wonderful way to connect with people and then you establish that rapport. Even though you've never met them, they feel like they've known you for a while and now they feel more comfortable with you because you've taken the time to explain these concepts that often we don't have enough time in the clinic setting to do.
Gary Falcetano [00:20:15]: Exactly. And were you comfortable with social media before the pandemic?
Dr. Rubin [00:20:19]: I used it personally on not that much of a regular basis, to be honest. I just. What actually happened? After I went from Twitter about to go to TikTok, a medical student had said to me, you do a great job writing, but I think you'd be even better on camera. And I didn't believe her at first. I was like, oh, no, it's a kids dancing app. And then they're like, no, no, go on. Okay. So I just slowly started making content, and it just snowballed from there.
Gary Falcetano [00:20:42]: You're also a semi pro hula Hooper, I believe.
Dr. Rubin [00:20:45]: Yeah. Oh, yeah.
Gary Falcetano [00:20:46]: Where did that come from?
Dr. Rubin [00:20:47]: Okay, so it's a silly story, but growing up being Jewish, there's these bar and bat mitzvah parties that they would do, these contests where kids would hula hoop and they get a prize if they were the last one, being able to hula hoop and keep it going, even if you did tricks or whatever it was. And I kept losing, and I'm like, I want to win those prizes. They're actually pretty cool. I had my mom take me to a sports store and I bought two hula hoops, and I said, I'm going to figure this out. So I locked myself in my parents base room basement and taught myself how to hula hoop one day, and I just kept going with it, and I won all these different prizes and games and whatnot. And then when the pandemic hit and I'm making content, I was like, I see people dancing out here, but I've never seen somebody do what I do, and I haven't really showcased this. So I was like, let's do it. And they got a lot of eyes on the screen, and it's just a silly way to showcase that I'm human. I'm not perfect. I'm not sitting on an ivory tower. I'm just like everybody else. My profession is allergy immunology. I was originally in pediatrics. I know a lot. I also don't know everything. And I'm fallible, just like everybody else. And I can be goofy and silly. So the hula hoop is a symbol of that. And it's also a symbol of if you put your mind to something, you can teach yourself that you can accomplish. Really, anything that you put your mind to is different as grouping can be.
Luke Lemons [00:22:02]: Yeah.
Gary Falcetano [00:22:02]: Yeah, yeah. Thank you so much for taking the time to sit down and talk about all these wonderful and increasingly prevalent diseases of allergy, but also your wonderful approach to really helping everyone out there become more knowledgeable and more trusting, I think of our medical professions as well. I think you do a good job with that as well.
Dr. Rubin [00:22:25]: Thank you so much. I really appreciate it.
Luke Lemons [00:22:26]: And we're going to have in the link of this episode's description all your socials out there. So if you're out there and you want to share some of Dr. Rubin's content as patient education like we had talked about before, or you're just interested to see how you can approach social media as a provider, great example here. Incredible doctor, incredible social media person. Really grateful to have you on the podcast and thank you so much again.
Dr. Rubin [00:22:47]: Yeah, thanks again for having me.
Gary Falcetano [00:22:48]: Yeah, thanks so much and we'll see you next time.
Luke Lemons [00:22:50]: Thank you.
Speaker 3:
ImmunoCAST is brought to you by Thermo Fisher Scientific, creators of ImmunoCAP™ Specific IgE diagnostics and Phadia Laboratory Systems. For more information on allergies and Specific IgE testing, please visit thermofisher.com/immunocast. Specific IgE testing is an aid to healthcare providers in the diagnosis of allergy and cannot alone diagnose a clinical allergy. Clinical history alongside Specific IgE testing is needed to diagnose a clinical allergy. The content of this podcast is not intended to be and should not be interpreted as or substitute professional medical advice, diagnosis, or treatment. Any medical questions pertaining to one's own health should be discussed with a healthcare provider.
