Oh CRABS! Deciphering Health Information on Social Media with Dr. Jessica Stokes-Parish
Brianna (Bri) Miluk: [00:00:00] Welcome back to The Feeding Pod. Today Tovah and I are joined by Dr. Jessica Stokes-Parish and we are so excited I just told her a minute ago before I started recording that i'm like kind of fangirling about this because I really really love the work that she does and I think it's so so valuable to healthcare providers across, but also even if you're not a healthcare provider, the framework we're going to talk about today that she created can be super valuable for anybody that's using social media.
So I'm really excited about that before we dive into the CRABS framework and kind of go through that whole process of why it's valuable to you and examples of use. Jess, do you want to introduce yourself a little bit, kind of just give a background about where you are and what you're kind of doing right now?
Dr. Jess Stokes-Parish: Yeah, sure. So thank you so much for the invitation and I'm really excited to chat through you know, information and how we process it. So I am an ICU nurse by training and I primarily work in the [00:01:00] higher education setting. So I work at a university, I teach health professions students. And the areas that I teach are things like clinical interpretation skills, and I also teach science communication.
And I, I've been a nurse for, I don't know, 14, 15 years. I still work in the ICU. I have long had a passion for learning and I have a PhD in medical education where I looked into simulation design, so teaching design and how it influences people's engagement. And I also, I really have an interest in science communication.
So most recently I completed a postgraduate degree in science communication, which was so fascinating. And you know, when you do things that when like later down the track, you're not just studying it to get your profession. It's so much more meaningful. I, like, I really enjoyed it and I enjoyed it for the learning sake, as opposed to, you know, [00:02:00] trying to get the degree.
So that's a little bit about me. I spend a lot of time online talking through online content or health content, trying to think about ways to engage with people in the community in a less confronting way than the scientist in the lab coat traditional ivory tower type structures. And I found myself on there. Pre COVID I was finishing my PhD and then as time went on, it just got busier and busier and more and more important as we have had such an overwhelm of information.
Brianna (Bri) Miluk: Yeah, absolutely. Oh, that's so cool. I don't think I realized your postdoctorate was in science communication, which is very, very similarly aligned to what I'm getting my PhD in right now.
Dr. Jess Stokes-Parish: Oh, nice.
Brianna (Bri) Miluk: Yeah, so I, I'm working on it in, mine's in like the Department of Communication and Information Sciences, but it's with an emphasis on science communication and misinformation on social media.
Dr. Jess Stokes-Parish: Cool. [00:03:00] Oh, that's so good.
Brianna (Bri) Miluk: And I feel the same way. Like, it was like a very, like, like, man, this is pretty unconventional for me to, like, enter that space, not coming from a communications background or even, like, a public health background, but, like, from the SLP, like, clinician background into that, but, like, I've enjoyed it so much because of how much I've just learned. Like, I'm like, oh my gosh, there's, like, so much here that I had no idea about, so. I can definitely resonate with that.
Tovah Feehan: I feel like you guys could do some projects together.
Brianna (Bri) Miluk: I know.
Dr. Jess Stokes-Parish: Yeah. Absolutely. Yeah. Yeah. Once she's got her PhD project done, that's, you know, that's a big baby. But I remember when I was doing my PhD, like the ideas that you start having for what you can do now that you start to understand the system of research and how to, you know, you're like, oh, the sky's the limit.
Brianna (Bri) Miluk: Yes. I know. And I feel like that's like. *Talking at the same time.* The hardest part of the PhD program is like them being like, [00:04:00] okay, like funnel it in here, Bri. Like you, you need to be able to finish this project. And I'm like, there's so many things.
Dr. Jess Stokes-Parish: Yeah. A hundred percent. A hundred percent. Yeah.
Brianna (Bri) Miluk: Yeah. Okay. So obviously some of that background probably led to that creation of the CRABS framework, so I want, before we actually explain what the framework is, what kind of led you to wanting to create that?Like, what were you seeing or what were you experiencing that kind of, you know, showed you there was like a gap there?
Dr. Jess Stokes-Parish: I think like I kind of alluded to COVID came and for all of us, it became a time where information was really important, but information was also overwhelming. And I think we've seen this in so many ways. And certainly, I'm sure the parents that you interact with would say that the volume of information that they have to navigate through to make a basic decision about [00:05:00] their child and parenting is overwhelming. Like it is mind boggling how much information we have at our fingertips and because society has moved away from an authoritarian style of science to a more collaborative approach there's this general, you know, cultural sense that you can't just, no, I'm not just going to read what the document says and go, okay, that's what the doctor at the children's hospital says to do. Like, that's just not the culture that we live in now. It's much more considered people are aware that they have choices and things like that.
So I was spending a lot of time online at the time I had a two year old and a four year old and I was, you know, madly helping the hospital get ready for COVID, but then I was starting to see all the rumors of the, you know, oh just take high dose vitamin C, gargle bleach, you know, take [00:06:00] hydroxychloroquine, ivermectin.
And I'm like, like, to me, it was so obvious that this information was inaccurate at best and misleading and deliberately misleading at worst. So, but my whole frame was, I can't just come in and say, well, that's wrong. So just believe me. Because that's not the society that we're, we're living in.
And, and, you know, my personal values are that belief and, and wading through information is, is like hinged on trust. So somebody needs to be able to trust you to be able to engage with the information. So I thought, well, why don't we give people a tool? Like, why don't people think that way? And I'd, by this point, I'd already started writing you know, content about red flags and alarming things. And then I guess the educator in me went, well, hang on a minute. A mnemonic would be really great. It's like-
Brianna (Bri) Miluk: Who doesn't, who doesn't love a mnemonic?
Dr. Jess Stokes-Parish: Ah, so, you know, and there are other mnemonics out there, you know, mine, mine's not the only one. There's the [00:07:00] CRAAP test. There's a whole range of other things. But I, I was kind of working through and I was like, oh, yeah, here we go. So, so that was the background story of, you know, trying to help people systematically assess information in a context of overwhelm and overload.
Brianna (Bri) Miluk: Yeah, and I think that one of the reasons I love your framework is that like in my research and the studies that I've been doing doing, there are quite a few tools for appraising online content, but not social media specifically. Like when we really look at it, and while things like the CRAAP test, I love that as a resource as well. It just doesn't quite align with the platforms of social media and how it changes the way that information is shared on there. And I feel like that's where, like, I flock to the CRABS when I'm talking about social media because it's a little bit more relevant to that landscape.
Dr. Jess Stokes-Parish: Yeah, you're [00:08:00] right. Like, the landscape has shifted, hasn't it? It's not just websites that we're reading now or newspaper articles. It's this, you know, bombardment of you know, a need to know the contextual information behind why somebody might be sharing something. And, and also, you know, there is this culture in social, I, I certainly feel that our junior practitioners feel an obligation in some ways to be on social media and that then comes into it because their naivety coupled with their lack of practice then means that they might make a little bit more black and white statements or they overstep their scope which is really easy to do.
Tovah Feehan: I love your framework for caregivers because especially because on social media, we know that if they get one ad or one thing and, and they, and they watch it long enough, it starts to funnel and, and they start getting more and [00:09:00] more. And then the more you hear it, the more you're like, oh, this is, this is the thing. This is, yeah. And so for caregivers to be empowered with such an easy to use tool of like, wait a minute, what's their credentials? Why are they talking about this?
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: Yeah. I feel like that overlaps with what you're saying Jess too about like, you know, there's like, like, there's like the pros and cons of like, I want patients and like as a, as a patient myself sometimes, right? Like I want to be able to ask questions and challenge and say like, could you explain to me like why this option would be better than this option? Or like,
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: Go through the pros and cons and you know, all of those pieces to really support like getting well informed consent. But at the same time, sometimes it's falling to someone having, like you said, the trust. Trust is a big part. And I, a lot of times when I'm talking in misinformation spaces, I like to say like, perceived trust. They perceive that this is a trustworthy source.
Dr. Jess Stokes-Parish: Yeah. [00:10:00]
Brianna (Bri) Miluk: But is it actually a trustworthy source?
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: Is another story.
Dr. Jess Stokes-Parish: Yeah. Yeah. And I think thinking about the traditional way that science would be communicated, right? We haven't leveraged off of relationships. We, we gravitate against the warm, fuzzy, maternal imagery and visions, right, which we know for the caregivers and people that are in that space online. That's the predominant message. Like, you're getting this idealistic parenthood or motherhood. You're getting this kind of fantasized approach to like mothering and what that looks like.
And I think, you know, as scientists, we just like, oh no, no, we're not going to, we're not going to go down that approach because we're like, we're just here with the information. But I think that's where we have work to do. And I know that's not what we're talking about here today, but like generally we, I think we have work to do around we do have to change the way that we communicate because society has changed, but also we're [00:11:00] swimming against a tide of emotionally manipulative content.
Brianna (Bri) Miluk: Yeah. And that, that's the content that we see over and over gets higher levels of engagement because, you know, fear sells if you are afraid or anxious about something you're going to want to latch on to that. And a lot of times those are the same people that are selling you the solution. Like, well, don't worry about this fear that I actually just made up because I've got the perfect thing for you. Yeah, could go down that whole other rabbit hole, but for the sake of staying on track. Can we have you explain the CRABS framework now? Kind of give us, what does that acronym mean? And what are some, you know, potential examples? And I'll, as we, as we go through you know, if there's things that I think of like very specific to the pediatric feeding space as well, in terms of-
Dr. Jess Stokes-Parish: Yeah great.
Brianna (Bri) Miluk: Buzzwords or things I'm thinking specifically, then I can, I can bring some of those up. But Jess, I'm going to have you lead kind of describing this framework to [00:12:00] everyone.
Dr. Jess Stokes-Parish: Beautiful. So as I've said, CRABS is a mnemonic. So C for conflict of interest, R for references, A for author, B for buzzwords, S for scope of practice. And the idea is that you systematically work through each of those letters when looking at the information that you have at hand.
So conflict of interest, you know conflicts mean that somebody stands to gain from the message that they're sharing and conflicts can be, you know, obviously financial. They're the first things that will come up to people, is there a financial conflict if they bought this person's belief or idea or whatever.
But it's also political. And it's also, you know, status driven. So does this messaging or view stand to benefit the person politically? Are they trying to run for Senate or something? Or are they trying to, you know, lobby government? And, you know, are they trying to benefit by being like the spokesperson for this topic?
[00:13:00] So we've, we've seen lots of examples of that more recently. Certainly in Australia, we're watching the Australian politics or American politics very closely. And, you know, there's, there's lots of examples all over the world of, of where individuals have lobbied a particular view to try and increase their status. References oh, sorry, Bri, you go.
Brianna (Bri) Miluk: With conflict of interest, something else that I would say is, it's not always, like, extremely overt. It's not always, like, very, very clear that somebody may be, and an example of this, I feel like on social media, in a very like mild, quote unquote mild. I feel like anything that's misleading really shouldn't be categorized as mild, but a brief example of this might be somebody sharing information about a specific tool or product that you should get to help your child with feeding or swallowing or X, Y, Z.
And then they include, you know, a link where they get [00:14:00] financial, you know, here, oh, and here you can go to Amazon to get this instead or, or purchase product because they get that. And then that's not to say that like that in and of itself is a problem. But we just have to be aware that like, there is a conflict of interest present in what the person is sharing.
Dr. Jess Stokes-Parish: Yeah. And look, some, you know, some people might view that my creation of CRABS create the conflict of interest, right? Because I get invitations to go on podcasts or I get invitations to give keynote speaking opportunities. And so that does increase my profile. But I'm not, not doing it with the intent of profiting or raising my profile. And it's definitely something that you would think about in the broader context. Like, do I need to temper my view on what's being shared based on this content? For references. So, so references, I guess the first question is one, are there any references to the content that's there?
If there's not, and they're making health claims, you can just dismiss [00:15:00] that, ignore it, forget it, move on. But where it gets messier is that we are seeing increasingly that people are using references as a way of almost science washing. So they'll pop some references on the post so then people go, oh, there's references, I can believe that. But no one's done the background work of looking in to see that there's, the references are bad.
Brianna (Bri) Miluk: Yes, yes. Or even relevant. I feel like there's stuff that I'm like, you know, they put like a DOI link, and of course, I'm going the extra, the extra step, right? To be like, well, what is that article? I can think of one example specifically.
This one like hangs in my mind because I was like, I'm just so utterly confused. It was talking about tongue thrust swallow in kids which can be a bit of a controversial topic. And they were talking about tongue thrust swallow and one of the references was about feeding patterns in autistic kids.
And I was like, this, this isn't even relevant to the argument you're [00:16:00] making to the claim you're making to the, but it looked like, like you said, it's science washing though. So it looked like, but they included references at the end of their slide. But unless you went that step further, you didn't actually know what the study even was.
Dr. Jess Stokes-Parish: Yeah. And I mean, I've seen plenty of times where you look at the study that they put there and it says the opposite to their claim. And you're like um, this doesn't *unintelligible* but the other thing that I really like to mention to people and that's becoming increasingly important. So obviously you're looking at the quality of the journal, like is this a high quality journal?
What's the, you know who are the authors in that, you know, of this particular piece, you're looking into that, but you're also looking to see whether the piece is from what we would call a predatory journal. And predatory journals are publishing houses that exploit authors for profit. So they basically approach authors with these funnily formatted emails and say, [00:17:00] you've got X work.
We want you to publish it, but you've got to provide it to me by next week. And you've got to pay me a thousand dollars to do it. And these publishing houses they're doing it cause they're trying, they're just trying to make money. And there's no quality checks. There's really sketchy editorial boards.
They are increasing. So, so the first time that predatory publishing was kind of identified was in around 2010. So it's actually a really new thing. But we're seeing more and more. And just last week I saw a health professional online that was sharing a research piece and I looked at what they were saying and that they shared like a screen grab of the front of the paper.
And I was like, that looks weird. That doesn't look right. And that was basically using it to support why they were choosing a particular supplement for benefiting their clients. And when I looked into it, it was from a predatory publishing [00:18:00] house. Which basically means you can't like, you can't use it because not only are there no quality checks, half the time the data does not exist and the studies did not occur. So, massive, massive issue.
Brianna (Bri) Miluk: Yeah.
Tovah Feehan: How would someone know who's not familiar with reading research if they looked at something like, oh, that's a predatory journal?
Dr. Jess Stokes-Parish: Yeah. So a couple of things. So when you go to the website, it'll look like a really weird nineties website that's got formatting all over the shop. Like so they're, they're like the obvious ones. There's some that are a little bit more sophisticated. They'll also have, so they'll, they'll be registered publishing houses. So this is where it gets tricky because it's like, oh, but it's got an ISSN, which is like the number that says that it's registered. But there'll be really low impact factors like 0.3 or something like that, which is just bizarre. They'll also be-
Brianna (Bri) Miluk: And that, like, you can just search that Tovah, like you can just Google impact factor of a [00:19:00] journal to get that.
Dr. Jess Stokes-Parish: Yeah. It should be on their website.
Brianna (Bri) Miluk: Yeah.
Dr. Jess Stokes-Parish: Yeah. The other things are you, you look at in, in the journal publishing group is like, what are the processes for peer review and who are the people like, do they have any people listed for doing peer review? And often they don't, often they don't mention peer review. And often they'll mention really fast publishing times. They'll say, you know, from submission to acceptance, five or 10 days, like something like that. And the other thing that I would recommend is also just typing the name of the publishing company and predatory in Google, and there's a couple of websites that have listings of what I considered predatory publishing houses or journals and that way, you know, so this one, this particular piece, the red flags were, the methods were really poorly described. I couldn't work out what had actually happened.
There was a very vague mention of ethics. The author, it was a single author [00:20:00] paper for a clinical study in, like, it was just a bit bizarre. And then there was no, there was like, the conclusion was really strong, like this is going to be beneficial for, you know, this particular controversial issue. And there was no comparison group, so they actually didn't have the data to kind of show that.
So it's really, it's really interesting, but this is exactly how alternative medicine practices get published. And they get published in these predatory journals and the unsuspecting individuals that have, you know, less experience with science don't actually realize that this is not valid science. We can't use it, but then it kind of causes this snowball effect.
Brianna (Bri) Miluk: Thank you. That is definitely going to be helpful because it's, and it's unfortunate that this is even like a thing that we have to think about, but not just the fact that like there was a research article published, but like by who, what was the [00:21:00] process for it? And all of those other implications behind it. So, okay, moving to the next one. A is for...
Dr. Jess Stokes-Parish: Author. So this is where you do a quick little dive into who the author is, what their training is, what, but do they have any degrees, where have they worked what's their, you know, background and story. And is it like, is this relevant to the topic that they're talking about, or is this completely left field unrelated?
You know, they're an owner of a a toddler parenting online shop and they are just trying to sell some sort of like you know, supportive device that has no evidence you know, versus is this person a trained speech therapist, et cetera. And they've got, you know, six years worth of practice in this particular hospital.
Like, you know, you can see that that kind of changes the lens and we'll talk a little bit more about scope of practice at the end, but this is your initial, [00:22:00] like who even is this person? Like what we saw during COVID was there was a lot of journalists writing publications that were getting published. And so you kind of just go, like that, that doesn't really make any sense.
Brianna (Bri) Miluk: Yeah. I, I, when I always think about this and I always think about you had this written in your paper, it was like, anybody can write anything like anybody can say anything online, anyone can, can put whatever they want. And there was a recent study I'll put, I'll link it in the show notes.
Cause I can't remember off the top of my head, but I read it. Very recently, and I immediately, I think Tovah, I like sent you an audio message right away. It was about people talking about what is on their resumes. And it was like, you know, there was, and I'm, I'm not going to say the exact quote correctly, but basically it was something like, you know, over 80 percent of the, like, resumes they pull, people exaggerated their experience.
And credentials, which like we all do that one, right? Like, you know, you're going to elaborate a little [00:23:00] about what your role was, but then it was like, you know, around, I want to say it was like around half just like if they had been like fired from a job or something had like missing information. So like left out stuff.
And then over a third just had completely fabricated degrees and credentials on their resume. And I was just so blown by that. But it's also like, these are people submitting resumes, like for a job, right? To get a job, to get a position for a, a, a career. Imagine what people are making up online.
Tovah Feehan: Mm.
Brianna (Bri) Miluk: Where it has nothing to do with, like, they're not really even worried about people fact checking what they're doing. And so that author piece made me, it, it made me think about that article there. And I'll make sure to put in the show notes for everyone to check out. 'cause I was like, what! Like, just go back and get the degree.
Dr. Jess Stokes-Parish: Well. And I'm just thinking of, you know, that really prominent example that we've all seen at some point you know, the, [00:24:00] the German guy Rubio Fuerte, who is a completely made up name and, and now has his other account and it's, you know, plagiarizes people and you know, talks about people online and, and shared parenting stuff, but that was, that's the exact example.
So when you look into it, he was claiming that he was a nutrition scientist, that he was affiliated with Vienna University. And when you looked into it, it was like, oh, he had a, he had a bachelor of science, but he had no nutrition training. He was never affiliated with the University of Vienna. And they made statements saying that they didn't. And yet. He was extremely successful in misleading people and continues to be to this day.
Brianna (Bri) Miluk: Yeah. Tons of followers. And engagement on his...
Dr. Jess Stokes-Parish: Yeah. But like classic example of like, just do like, honestly, five minutes, just five minutes looking into the person and you will find whether there's any red flag. So that moves us on to B for [00:25:00] buzzwords.
And that's a perfect example. Because. The emotive language, the hijacking of your cognition and the ability to think through things by either blaming you as a caregiver or you know, making you feel inadequate as an emotional hook is a classic online strategy. So they're the kinds of things that you're looking for with buzzwords.
Like, are we talking about. Why would you want to harm your child with, you know, doing this? And, and certainly we see that in the sleep space and, and anything to do with caregiving or parenting is, is kind of blaming. But also anything that overstates benefits. So really, you know, this is, this is a hundred percent safe.
There's no side effects like red flags right there. And, and anything that you would think is being a bit of a marketing buzz. Yeah. And the reason for this is that it slows down your thinking processes and it hijacks your ability to actually process information that you're seeing.
Brianna (Bri) Miluk: Yeah, I think for Tovah and I [00:26:00] could probably go back and forth on a lot of buzzwords in the SLP space, but you know, for us, a lot of the times I find that like, even, even like evidence based practice becomes a buzzword.
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: Because of the over misuse of it evidence based practice is one, or I've also seen like practice based evidence, which is like a fancy way of saying, like, I use my clinical experience, not research.
Dr. Jess Stokes-Parish: Interesting.
Brianna (Bri) Miluk: Practices based evidence. Uh-Huh. But we also have like terms like fascia, tension.
Dr. Jess Stokes-Parish: Yes, yeah.
Brianna (Bri) Miluk: I think those are really, really big ones that come up with a lot of spaces. And then unfortunately, like things like holistic yeah, buzzword when it's like in reality, I hope all of us are seeing patients from a holistic viewpoint. Like that is what our training is, but they use it to mean that like conventionally quote unquote conventionally trained providers don't when it's like that's the foundation of, of what we all do so.[00:27:00]
Tovah Feehan: Root cause is a big one.
Dr. Jess Stokes-Parish: Yeah, yeah.
Brianna (Bri) Miluk: To the root of it.
Tovah Feehan: But of course, like we all want to figure out why and with feeding difficulties, it's not, it's usually a little puzzle. It's usually, there's a lot of factors to consider. So to me, that's a red flag, especially when someone can diagnose you in their reel. Like did your baby do A, B, C, and D? Then they definitely have this and you should sign up for my course and whatever and I'm just like it could be so many things and we have so many more questions to ask before we diagnose someone like maybe watching them eat like it's crazy.
Dr. Jess Stokes-Parish: Yeah. Yeah. And, and also there's this it's, it's so interesting to me because it's contradictory to like the messaging of some of these accounts is so one, they're kind of saying mainstream medicine has done the wrong thing, but then in the same breath, they're pathologizing normal things.
Like how does that work? How do you go [00:28:00] that you're, you know, the medical comp- industrial complex is over treating it's this, that to then going, Oh, by the way, your child must have X, Y, and Z and, and it's a problem. And you need to think like, is that not a, the exact thing that they're going against?
Brianna (Bri) Miluk: And they're the only person that could possibly help in that situation. That's always.
Dr. Jess Stokes-Parish: Yeah, yeah.
Brianna (Bri) Miluk: The cognitive dissonance of it is like, probably one of the most frustrating things.
Dr. Jess Stokes-Parish: Yeah. Yeah. That's interesting. So then so then it goes on to scope of practice. So this one does lead on from, the author part and, and you might've already, you know, discovered this at that point, but it's to explicitly say that somebody's expertise and both from a qualifications and a clinical practice or practice perspective does matter in terms of their authority to talk about a topic.
So somebody who is a [00:29:00] qualified obstetrician and gynecologist that's been working for 20 years is very different to a fourth year out of medical school, obstetrics and gynecology trainee. And, and often you don't get that distinction online because people are unfamiliar with training pathways for particular professions.
So you sometimes get this sense of overstepping scope of practice from practitioners because they're not good at articulating the limits of their, their knowledge. And then like on the converse, you've got like the person with 20 years experience, they don't feel the need to justify themselves because they've got the demonstrated experience.
The other thing with scope of practice that I observed was you were getting people that have like an environmental science, like PhD, where they've studied soil or something. And then 15, 20 years down [00:30:00] the track, they decide, oh, I'm going to be a nutrition expert. And, but they would still use their PhD title or their master's title to promote their company or what they're doing, even though it's completely irrelevant and has absolutely nothing and in fact, if you, if people didn't see that, they would probably just ignore them because they don't have any training or qualifications, but they're using doctor or PhD or whatever they can to appeal to authorities. And then people go, oh, this is a qualified person. And you look into it like, no, they're not at all.
Brianna (Bri) Miluk: Yeah, absolutely. I think too, in the SLP spaces, a lot of times it's like, we have certain things that are considered within our scope of practice, right? Like as a speech pathologist, I can, you know, diagnose and treat stuttering disorders. Does it mean that I'm the person for it? No. So like even within the realm of like, [00:31:00] okay, I, you know, technically that's in my scope of practice, but my, you know, advanced training and my experience, my clinical experiences and everything don't make me necessarily the best person to support that.
And I think that's where like, I mean, seeing things like, I think the nutrition space is a big one. Like everyone thinks they can do a two week or a, or not even a two week, a two hour course, and they're now a nutrition coach. Um, my sister is a registered dietitian and I know that drives her crazy. But it's like, you know, if you see an SLP giving food, nutrition advice, like that should be a bit of a red flag. You see, I know in our space is a big one is like registered dental hygienists giving speech or swallowing exercises.
Dr. Jess Stokes-Parish: Right. Yup.
Brianna (Bri) Miluk: Considerations for therapy. And it's like, whoa, whoa, whoa. Like that, that's not in your scope of what you should be speaking on. So I think even like the over [00:32:00] or like misrepresentation of the credentials.
Dr. Jess Stokes-Parish: Yeah, it's a big one and it's becoming, you know, more and more difficult, I think.
Brianna (Bri) Miluk: Yeah, absolutely. Okay, so that is a CRABS framework which is, is just so helpful in so many ways, you know, the conflict of interest, references, author, buzzword, scope of practice. And a lot of the times when I teach about this, I always remind people that like, this is kind of just your quick screening and, you know, as you are going through content, like there might be some sides of it that you're like, oh, you know, this this kind of says maybe there's a red flag, but not every single one means just throw it away. It just means-
Dr. Jess Stokes-Parish: No exactly.
Brianna (Bri) Miluk: Continue to be curious about it. Like look a little further into it. And I think if any of these show up as a red flag, hopefully that will get you to slow down before just sharing it. For just taking it as fact, because I also find on social media, that's part of the reason, you know, misinformation gets shared so [00:33:00] quickly is like, people just take something as is and then they share it.
But the person who now trusts you thinks that that's accurate information, then they share it. And then it, you know, continues to go on. Whereas like using tools like this can really help us to just slow down and be like, do I want to share this or not? And if you're unsure, like it's, my dad always says, he says this about jokes when you're creating jokes, but I think it's relevant here.
So just hang with me. He says like, when in doubt, throw it out. Like if you're not sure if it's gonna land, if you're not sure if it's gonna be good, if you're not sure, like you're giving a speech or something and you're like, oh I thought about putting this in there. He's like, when in doubt, just throw it out.
So, and that's kind of how I think like, when in doubt, just don't share it. Just hold on to it and wait and you'll get more a little bit later. Okay. So I want to kind of walk through kind of as our, as our last little piece here, just kind of like walk through an example together of how this may show up.
[00:34:00] Obviously this is a podcast, so it's going to be difficult because you all cannot visually see what we are seeing. So we're going to explain it. I did not prepare Tovah or Jess with the, the page that I was going to bring up. So they're going to be kind of like live reacting to it. But I have, let me, I'm just going to like take a moment to share in the, in the chat with you all the links so you can pull it up.
Okay. So we're going to look at a post. We will describe the post. We're not going to say the name of the account. But we're just going to look at the information. Okay. So when we are going through, you know, CRABS framework first, let me describe the post to everybody.
So, you know, we're seeing, this is an Instagram post and it says like seven myths about baby reflux. And what's really true and then it goes through it's like a carousel post. So first it says myth reflux is normal truth while reflux is common, it is not normal. I say not like that because it's [00:35:00] bolded holistic health approaches, except nothing less than comfortable, pain free bodies that won't work as we want, expect and need them to being quote unquote normal.
When we stop believing this myth, we start asking more questions. Next myth says it's a disease. I wish you all could see Tovah's face. Next one, myth number two, it's a disease with no cure. Truth, reflux is a symptom, not a disease. By understanding your baby's unique needs, we can directly address the bolded root cause, which is so funny, Tovah you said that earlier, to bring lasting comfort in the rare cases, we cannot do this.
We know how to reduce and ease baby's suffering. I'm not going to go through all of these. Okay. So it goes through three, four, five, six, seven, how many, seven different myths, and then at the very end, it says for more, parents, drop a whatever below to get started on understanding your baby, to get our free, like, link to something.
Professionals, [00:36:00] drop the word expert to join the wait list to get a diploma in a certification about baby reflux. Okay, so, starting out, let's, let's go through CRABS, okay? So, starting out with conflict of interest. What are we observing, Jess?
Dr. Jess Stokes-Parish: I've just seen horror on the website but I can see that there's selling of one to one support that there's a course for health professionals to do. What's really interesting is like the pricing is not particularly obvious, which is, is Interesting. And, and it is sometimes a marketing tactic. Like if you speak to any kind of marketer, like, no, don't put prices because then they have to reach out to you. Oh, they sell a diploma in infant reflux. Again, I'm, I'm [00:37:00] struggling to see a price, but I can't imagine that they sell it.
So it's, I guess, yeah, there's a financial conflict from my perspective, but also looking at their "About Me" story. It looks like there might be a little personal bias around their personal journey and why they started doing this.
Brianna (Bri) Miluk: Yes. Yeah. That's what I noted as, as well. And definitely like the, for example, there's a personal training. I think, like you said, the pricing was, is very hidden. I'm trying to see because I've, I've seen it before when I like went down.
Dr. Jess Stokes-Parish: Well, I've seen, I found that it says that it's valued at 3000 pounds.
Brianna (Bri) Miluk: Yeah. I was going to say,
Dr. Jess Stokes-Parish: But I can't-
Brianna (Bri) Miluk: I remember it being like a couple thousand. So it's probably, yeah, they probably put it just under what it's valued at. Right? And who, who determines the value?
Dr. Jess Stokes-Parish: Yeah. I can't, I can't see that. But anyway, so yeah, that's, that would [00:38:00] be my-
Brianna (Bri) Miluk: And you can see, too, like, on the website, for those of you, like, you know, listening, like, we have SLPs and OTs and, like, people that are taking this course, which we'll talk about later as why is increasing.
Tovah Feehan: Wait but...her title is baby reflux specialist.
Brianna (Bri) Miluk: Yeah so we get into...
Tovah Feehan: What the actual.
Dr. Jess Stokes-Parish: We'll come back to that-
Brianna (Bri) Miluk: Yeah, we'll come back to that when we get to author. *Talking at the same time.* Yeah. Okay, so references, this is a quick one. There were no references to-
Dr. Jess Stokes-Parish: On that post, no.
Brianna (Bri) Miluk: On that post at all. There were no references to any of the claims at that post at all. Which, remember, should mean we should just be like, okay, bye. I will see.. *Talking at the same time.* Like this is, reflex is a medical diagnosis. Okay, so author, Tovah. When we're thinking author, so. Credentials.
Dr. Jess Stokes-Parish: Okay. So, I mean, you can hear Tovah giggling in the background, but, but my, you know, what's even worse than this [00:39:00] trademarked name that they have is that their training... They're a mechanical engineer.
Brianna (Bri) Miluk: Yeah, they're a mom that had kids with reflux and a mechanical engineer.
Dr. Jess Stokes-Parish: Yeah, so like that's not.
Brianna (Bri) Miluk: No medical background.
Dr. Jess Stokes-Parish: It also, well, it also says in the bio that they drew from their training in traditional Chinese medicine, but there's no, there's no description of what they're qualified. Oh, here we go. There's a certificate in quantum flow. That's a major red flag.
Brianna (Bri) Miluk: Oh, quantum. What a buzzword.
Dr. Jess Stokes-Parish: Yeah. There's a, some licensure in acupuncture and traditional Chinese medicine. I have no idea what licensure means in this context in this, they've got an MBA and they've [00:40:00] got a master's in mechanical and manufacturing engineering and their undergrad was in mathematics. They do have a diploma in nutrition for food allergies and intolerances, but it's by, I don't know who this group is, but it looks like some sort of private company. I'm just doing a really quick Google right now. So you can see how easy it is to just find. So it's some BSY. Oh, it's a school of yoga.
Brianna (Bri) Miluk: Oh, school of yoga teaching on nutrition, which again, like school of yoga teaching on nutrition that she then took to say that she has expertise in infant reflux.
Dr. Jess Stokes-Parish: Yep. Yep. There's definitely no, there's no qualifications here related to child health. There's no qualifications here related to speech language pathology or speech pathology or oral structures, dentistry, like not even remote-
Brianna (Bri) Miluk: Medicine, [00:41:00] like-
Dr. Jess Stokes-Parish: Like, no.
Brianna (Bri) Miluk: No. I wish everyone could see Tovah's face.
Tovah Feehan: I just, I never got past baby reflux specialist. I read that and I, like, dissociated. I think I had a trauma response. Because it is just, it's my heart, my heart started racing. It just, it makes me sick. But I so the struggle that I have is something you said earlier, Jess. And should I call you Dr. Stokes-Parish?
Dr. Jess Stokes-Parish: No.
Tovah Feehan: She's a real doctor people. So-
Brianna (Bri) Miluk: That's, that's why she says no.
Tovah Feehan: She actually went to like a real school.
Brianna (Bri) Miluk: I feel like that's why she's like, don't call me that.
Tovah Feehan: Well, so no, but you said something earlier about how we have to do a better job in healthcare of communicating. And one thing that I noticed, I read this book, I told Bri about it called Magic Words. And it really was eye opening for me about how really subtle shifts in the words that we use and the way that we speak can really impact how our message is received. And I see a lot of these tactics, probably it could be unbeknownst to them, used in, [00:42:00] on social media to be the confidence that they speak with.
Dr. Jess Stokes-Parish: Yeah.
Tovah Feehan: It's just, it's very-
Dr. Jess Stokes-Parish: The trustworthiness-
Tovah Feehan: Thing.
Dr. Jess Stokes-Parish: Yeah.
Tovah Feehan: Yes. But I almost feel like we need an acronym for healthcare because we are not doing a job, a good job communicating. We are not doing a good job partnering with families and giving them treatment options. And so I feel like we leave them, we leave them more vulnerable. To this space because they're looking for answers that they don't necessarily are they're they're not necessarily getting the support that they need from traditional medicine or science, or the way that we're communicating it is not in a way that that they're feeling good about. And I don't blame them. I told Bri a horrible story this morning, you know, so. Yeah.
Dr. Jess Stokes-Parish: Yeah. I totally, I completely agree with you. Like I completely agree. And we can't ignore the system structure structures that set up this environment of, you know, people are wanting to step in the gap. And actually, I think these people that [00:43:00] do these companies, I think they do do it out of a genuine identification and their needs weren't met and it was resonating with other people. And so then they go, well, someone's got to do it, but in the, you know, they're not helping they're, they're harming when they do it, but there's, there's so much there around the language that we use, how we can engage better.
And also my, my constant critique of health professionals is. They even beyond the communication is they do a really bad job of outlining their expertise on their websites, on their social media. You actually can't find the qualifications of many health professionals that are online. And that's concerning.
And I'll say, you know, people ask me to critique what their content is or their website. More often than not, it's that they haven't actually listed that they've got a bachelor's in this, a master's in that, that they've got this extra training and so it looks like they've got no qualifications whatsoever.[00:44:00]
Tovah Feehan: I need to make some edits to my website later based on some things that you guys have shared today. But I also just want to thank *Talking at the same time.* the two of you because you are you are doing the work, the hard work, on that, in that space that a lot of healthcare providers shy away from. And it's not easy to do what you're doing. And, and I really appreciate it. It's really important work. Yeah.
Brianna (Bri) Miluk: Thanks, Tovah.
Dr. Jess Stokes-Parish: Thank you Tovah, that's so nice.
Brianna (Bri) Miluk: Your language comment goes into that next part of CRABS, though, and the buzzwords. And I think like there's, there was a lot present even in the presentation of these myths and versus the truths and like the emotionally charged language used. Like I feel like hearing like reflux is common, but never normal, but not normal. That's like a really big one I see in these spaces of like when in reality it's like, well, actually something that [00:45:00] is seen more commonly than not would be considered normal. Not to say that all reflux is normal, right? We, we have a crossover. We have we have where it crosses into GERD, and then it becomes not normal, but I think like that language and-
Dr. Jess Stokes-Parish: There's a lot of discussion of cause, finding the cause,
Brianna (Bri) Miluk: Root cause.
Dr. Jess Stokes-Parish: And, you know, the cure, you know, the only way to do this is to cure it, and
Brianna (Bri) Miluk: That was a word.
Dr. Jess Stokes-Parish: Yeah. Yeah. Yeah. And there's lots of, you know, throughout the website, there's lots of emotive kind of language that, that is focused on the consumer. You know, you've been dismissed um, at you know, through countless from countless medical professionals, like you're really playing into that. And, and it's a, it is a real, and this is the tension, right? It's a real concern because people are dismissed.
Brianna (Bri) Miluk: Mm-Hmm. Mm-Hmm.
Tovah Feehan: Well, it's heartbreaking too, 'cause Bri and I will go back and forth and like, share things that we see and
Dr. Jess Stokes-Parish: Yeah.
Tovah Feehan: Sometimes I can't even bring [00:46:00] myself to look at the comments because I just know. That there's going to be dozens of caregivers in there, like, oh my god, I didn't know that my baby had like for this post, I didn't know that this was bad and that I thought all babies spit up sometimes and it doesn't seem to bother my baby. Should I buy your course? And like, oh, it just, it breaks my heart. It's awful. It's awful.
Dr. Jess Stokes-Parish: Yeah. Yeah. And you can see on the website, there's a lot of use of testimonials and, and not that there's anything wrong with testimonials per se, but. In the context of clinical treatment- in Australia, testimonials are really heavily regulated. So you can't actually have testimonials about your clinical practice. It can only be about your communication approach or the experience of turning up for the appointment or things like that.
Brianna (Bri) Miluk: Yeah. Well, I think too, like like if you go on the, this person's website and they have like a one on one support, the first line it says is 99 percent of cases of reflux are solvable within the [00:47:00] online course content in my blah blah, which is why I created the course.
And it's like, and again, not a healthcare provider, has no healthcare provider background to be, you know, booking these, these calls with, with patients. So, yeah, and then I think scope of practice kind of going into that last one, we kind of already touched on this one, obviously, this is beyond scope of practice because we don't even have the credential or the qualification to-
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: Even consider within that.
Dr. Jess Stokes-Parish: Yeah.
Brianna (Bri) Miluk: I think, too-
Dr. Jess Stokes-Parish: Yeah. And that's what you'll find often is scope of practice you don't even need to discuss the S of the mnemonic because there's actually so little that's relevant that it's not even a consideration.
Brianna (Bri) Miluk: Yeah. Yeah. And I think, you know, the, the reason I bring up this example is because there are things like on this person's website or I've seen other healthcare providers share where like they take this person's course. They get a certification as like a [00:48:00] baby reflux specialist and then start to use that as a credential. But the person that they have just learned from the person they took this course from-
Dr. Jess Stokes-Parish: Is not
Brianna (Bri) Miluk: Is not qualified to teach on this topic. And also the whole like certification, like getting a certification in something we have to be really, really careful about approaching those types of programs and recognizing like what exactly it is because if there's not like a third party that's credentializing and they have there's like a very strict protocol that's been created over time and you know, anyone can create a certification on something that does not mean that you are qualified to now speak on.
Dr. Jess Stokes-Parish: Yes, so true.
Brianna (Bri) Miluk: Yeah. So, well, Jess, thank you so much for chatting through this. I feel like I could literally talk to you for hours. And as soon as I finished my PhD, I'll reach out and we'll collaborate.
Cause there's so much overlap and that's where I'm like, oh my gosh, I could talk about this stuff for forever. But I thank you so [00:49:00] much for chatting with us today. I am going to be sure to anybody listening in the show notes will be Jess's website and Instagram. We'll make sure to link that so you can check it out.
You also have that great graphic of the CRABS framework and so I'll link that directly because I find it super helpful and it's something that, like Tovah said, can be really valuable for caregivers as well. You know, just like put that in your lobby. So they take a little peeksy at it when they're waiting to, to come back to your appointment. So. I appreciate you so much. And thank you for giving us your super, super early morning.
Dr. Jess Stokes-Parish: Hey, thank you so much for having me. I've really enjoyed chatting with you and I look forward to seeing ways that we can chat more in the future.
Brianna (Bri) Miluk: Awesome. Thank you.
Tovah Feehan: Thank you so much.
References
