Charlatans fill the halls, while doctors battle it out online. Who will win the fight for health? Episode 118

Monika Rachtan
Hi Monika Rachtan, a very warm welcome to the next episode of the programme. Po Pierwsze Pacjent. And today, exceptionally, I am greeting you from the studio in Wrocław from my home town and I am very pleased and excited to bring you here to Wrocław. I don't know if you remember, but the first episodes of the programme. After the First Patient, which was about 119, 18, 17 episodes ago, were filmed in Wrocław, so I am very happy to be back here and to be recording today's episode. And why Wrocław? Because we are going to talk about a conference and a conference which was my debut in terms of organising big events and it turned out to be a bit of a success. Well, about whether it was a success, whether there is something to improve and why such events that involve not only specialists but also patients, I will be talking to my guest today, and that is Professor Lukasz Rypicz. A very warm welcome to you. Hi.

Prof. Lukasz Rypicz
Good morning, hello, Thank you for the invitation.

Monika Rachtan
That's me thanking you for agreeing to host in our studio, but you had a short drive here to Wrocław. So, I'm very happy that we were able to meet and that we're going to talk about the Influence Med conference. And how did you rate it in general? Did you enjoy it?

Prof. Lukasz Rypicz
I enjoyed it very much. It was a new formula for a conference that I had the pleasure of attending. The conference was aimed at people, to put it ugly, from the street, in other words, every Smith who was actually interested in health topics, so I view it very positively.

Monika Rachtan
I've been wanting to organise this conference for a couple of years now and I remember, you probably associate such a charlatan from the internet, who has various therapies tucked away, hidden and so on. And he organises in one of the big cities in Silesia, I like Silesia very much, also people who watch my podcast know that I just always say that Silesia is the coolest, coolest part of Poland, apart from Lower Silesia of course. But yeah, and I think there was a conference two years ago where there was a two-day conference where there were other charlatans and that charlatan and for two days they just told people all these things that are said on the internet. I was cracking up because there were 1,200 people there and these people were scrambling for tickets. You still had to pay, because at Influence Media you could come for free at our venue in Wrocław. There you still had to pay to listen to nonsense, to listen to horrible things that take money out of people, that cause people in serious conditions with cancer to die because they give up normal treatment. I will say normal, but one that is proven, that is proven to be effective. And I thought we'd do an opposition and we'd do a conference that would bring together people of the internet, but just people who have a medical background, who are doctors, physiotherapists and who can speak on medical issues because they've learned at school and then at university and then in the clinic. And they have experience and knowledge. And tell me in general you work primarily in the public health department, but you also probably meet young doctors. Is how they treat this internet, this being online. I don't mean privately, but just these doctors, influencers, who educate, what is the approach to these people.

Prof. Lukasz Rypicz
Ok, a small correction. I work in the Faculty of Health Sciences. We do indeed train students in public health. Speaking of conferences, I was wondering about that too, because I know which conference you are referring to. Why is it that we are so eager to attend something that is controversial to us, that is completely unrelated to science, but for some reason it fascinates us, interests us. We start to believe these charlatans more than doctors, than science, it's completely incomprehensible to me. And now coming back to the question and to the young generation of doctors, it seems to me that this is the generation that has lived with this internet, with these social media. In fact, they were born in the era of everything we are dealing with today, so for them it is completely natural And they very often use social media to promote knowledge, to educate on the internet about health, so....

Monika Rachtan
And there's such a mission in them that you know they're just reading their professional obligation, which is not only to save people's lives, not only to treat, but also to educate. Well because that's kind of enshrined, let's just say in this medical profession. But on the other hand, when you look at the generation of doctors who are 40-50 years old, who have little time in GP surgeries, it's hard to suspect them of education.

Prof. Lukasz Rypicz
Yes. I think that in this group of young doctors who use social media, there are those who are primarily concerned with the ethos of the medical profession and health education, but there are also those who are interested in it for some reason. For them it is appealing, this social media presence is some kind of reach, perhaps some kind of profiteering that we do not know about. Perhaps this is how they make connections, create some networking, act, talk about some therapies they are doing, scientific research. I think these motives could be several, but I want to believe that first and foremost it's about this kind of mission, about health education, because these outreaches have, as you probably know, incredible power. We are able to very quickly create some content, some content that can become viral and in a moment the whole country is talking about it. So in terms of health education, health needs and what is important to us. This is something fantastic.

Monika Rachtan
And today, is being a doctor on the internet still a bit of a slur, in your opinion? I remember such a situation 5-6 years ago, when I wanted to invite a medical influencer to a serious conference with serious experts, professors of medicine. I mean, at that time I simply said, what's her name on this Instagram, because nobody is talking about medical influencers yet. And the question came up but is she the one who is twerking on the internet? We're not going to perform on the same stage with her. And what's it like today? Has it changed a bit? Is it embarrassing to be an internet doctor?

Prof. Lukasz Rypicz
I think it still depends on the generation we're asking the question to. Because for people who have grown up, who have lived without social media, without the whole environment, this is really a foreign area and they don't find in this an opportunity to reach a wide audience of educators, to find some kind of opportunity to pursue their profession. On the other hand, those young people who are familiar with it know very well that it is also a way for them perhaps to advertise themselves, to show what I do, why it is important. That kind of way of reaching out to the patient. So I think it depends on the generation.

Monika Rachtan
But I think that the door to the surgery and that list of available appointments on the famous patient registration portal, that it's a bit different there, and that these doctors obviously educate themselves, care about their image on the Internet, care about their image as a doctor, are open, communicative, it's immediately different to such a doctor who speaks to us on the Internet, uses all those difficult words and explains them. We get such a bigger backlash.

Prof. Lukasz Rypicz
We have this conviction that we know him.

Monika Rachtan
That's right.

Prof. Lukasz Rypicz
Because it's someone we follow on social media, so it's a bit like our acquaintance, even though we may not have that relationship with them. An acquaintance, an acquaintance, but still, it's someone we associate with, so it's probably easier for us to talk about difficult things. It's easier for us to ask about those things that we don't understand, because we can see that he's putting this content into practice on this internet, he's explaining, so he's so much more pro patient, right? He is like that.

Monika Rachtan
Human.

Prof. Lukasz Rypicz
Human.

Monika Rachtan
Human Doctor.

Prof. Lukasz Rypicz
Exactly the human doctor, the human doctor of the internet.

Monika Rachtan
Or from Forest Mountain.

Prof. Lukasz Rypicz
Or from Forest Mountain.

Monika Rachtan
And that's how I associate with them. Yes, these doctors are just associated with me. They are so normal on this Instagram, because mainly on Instagram, however, we find these accounts, that I recently watched such a report A day in the life of a gastroenterologist. Nice, nice lady gets up, dishevelled, says coffee drink. You know, I'm also going to the hospital in general and I'm not doing a make up at all and I don't look beautiful, I still have to drive the kids. Suddenly, this doctor starts to take on just such a human face. He is no longer such a statue sitting behind a desk, just clicking on a computer keyboard. It turns out that he... I once even asked professors on my programme whether they go shopping at Biedronka. Well it turns out that they do go, normal people, right? That they also get sick, it's amazing at all, the passage in your head of this, this information that doctors get sick and it's a cold for example and they have sick leave.

Prof. Lukasz Rypicz
They drive their children to school too, don't they?

Monika Rachtan
Well, these are discoveries for our society, because everyone associates the doctor, that the doctor is the one who treats all life. 24 hours a day he's supposed to be available and he's all about the treatment. And this social media, well a little bit shows that though.

Prof. Lukasz Rypicz
We are breaking stereotypes, somewhere the profession, the ethos of the doctor, right? A profession of public trust inaccessible, giving recommendations that you have to follow. Somewhere that distance. This has changed a lot over the years and I think the internet has helped too. I hope it has helped a little bit with communication, because we say all the time that this communication is extremely important, that today we have to listen to these recommendations, but to listen to the recommendations we have to understand them. So this efficient, effective communication has to go both ways. If we don't know something, we should ask, not be afraid to ask questions. And we are often afraid. Because what will someone think of us, that we don't understand something, we don't know what it means and there is a problem.

Monika Rachtan
But on the other hand also there used to be a total lack of space in doctors' surgeries to ask questions. Because it was like you were given a piece of paper or you didn't, The doctor there said you're going to do this, this, this, this, this, this, this, this. did you understand everything? And as if you were to go back to what he was saying at the beginning, still repeat that difficult name of the drug that the doctor said, it was as if the patient thought I'll read it at home, maybe I'll grasp something of what was written there. And yet this internet is that, again, this doctor is more human, more communicative, and we are not afraid to ask these questions, because if we can write a comment to him on Instagram, maybe I can also ask him something in the office and maybe he will answer me. But speaking of the Influence Med conference, speaking of charlatans and misinformation. Often when I ask the question to people who are involved in medical topics in some way, why do people prefer to trust charlatans rather than doctors?

Monika Rachtan
Do you know the answer to this question?

Prof. Lukasz Rypicz
I often wonder about this, because out of curiosity, because I'm in public health, somewhere in these social media I also peep at various groups where health advice is given and I see with what ease people upload screenshots of test results, circling their name, home address. But we don't really care about the safety of the doctor anymore, who stamps under such a test and uploads it online, asking for comments. And the group starts living, commenting, saying whether this is good, whether this is bad, whether this doctor is this way or that way. and it comes very easily to us. Very often these pieces of advice are about situations that are probably on the borderline of health and life, because these are often people who are very ill, who are abandoning traditional therapies in favour of what we call charlatanism, which is, I don't know, breast cancer. And someone suggests rubbing castor oil on that breast so that will help and it will help you too I'm sure, so I'm wondering where that comes from. And I attribute it to a lack of health education though, because we don't have this health awareness, and we don't have this health awareness because we don't have the competencies, we haven't acquired these health competencies through health education.

Prof. Lukasz Rypicz
And so the circle closes. How are we supposed to know all this if nobody taught us?

Monika Rachtan
Well, but after all, we learn every day on the internet, listening to different people, accounts on Instagram. And, you know, it's like everyone considers themselves a doctor in Poland. It's not that we don't have this knowledge.

Prof. Lukasz Rypicz
The question is whether this content, which we absorb, in which we move so easily, is actually true, proven, fact-based. It turns out that they are not really. And at school, we know how this education goes. We now had a controversy about health education that swept across the country. The results were reported that 30% pupils nationwide are taking part in health education classes. I think this is still a very optimistic result, looking at what was happening with this subject.

Monika Rachtan
And do you think that the Ministry of Education has, however, let off a bit of steam unnecessarily and that this health education should have been introduced as a compulsory subject? What is your opinion?

Prof. Lukasz Rypicz
Yes, I believe that health education should be mandatory, compulsory. It is not the space to decide whether it is needed or not. We know that it is needed. We see what the health indicators are, we see what our society is facing today. I do not see any space here to deliberate whether it is important or not because someone thinks so. We have research results, we have health indicators, and based on these measures, which are part of health policy, health policy is part of social policy. We make certain decisions to take care of the health of our society. This, of course, will not happen in one year, in two years. The effects will be visible in 10 or 15 years. However, if we do not introduce such a subject, nothing will change. It will not improve, our awareness, our health competence. We will still not know what preventive examinations are for, we will not go for these examinations, because these rates are dramatically low today. This morbidity is very high because we don't have this health awareness.

Monika Rachtan
All right, and still delving into the subject of health education, you work at a large medical university, one of the largest in Poland and probably the best in Poland, because that's what the rankings indicate, the way we in Poland treat the profession of lecturer in general, and even more so the profession of teacher, because we're talking about the subject of health education, which was supposed to appear in schools, so 100% students were basically supposed to be covered by this health education. And it's not that it's going to be some reader lecturing us or some artificial intelligence, it's particularly the subject. Health education should be taught by people who know something about health in general. And also whether teachers, because they too were partly to be delegated to this task. Biology teachers, family education teachers of the time. Are these people whom Poles are able to trust at all? Well, because if we trust charlatans, now that this authority of the teacher is so badly damaged in our country, is there a chance that these people are at all able to entice the crowds to live healthier lives?

Prof. Lukasz Rypicz
I think it is very difficult today, as you mentioned, somewhere this trust of our society in these professions of high public trust has fallen over the last years. Maybe it's because today we are quickly able to verify things on the internet, to undermine an opinion, a decision, to make someone who had this authority tomorrow no longer have it. This is very easy today. On the other hand, this health education carried out by teachers without such thorough preparation is very difficult, because it is not simple content, these are difficult topics related, for example, to puberty, to sex education, which has aroused such controversy. The Ministry came up with such a path to educate some teachers in postgraduate studies. And we have indeed launched such postgraduate studies for teachers at the Medical University of Wrocław, where we have enrolled teachers and we teach them this health education. But this is a drop in the ocean of needs. That is eleven universities across the country. And if this subject was actually compulsory and had to be taught in every school, it would indeed be difficult. And it would be a big challenge to entrust such content to a teacher who doesn't have this preparation, because the assumption is that a biology teacher, a P.E. teacher, a psychologist can deliver this content without postgraduate studies.

Monika Rachtan
And it seems to me, leaving aside topics related to sexual life, to puberty, that this is the biggest problem for me, for a person working in the field of health, that somewhere this belief in the subject of health education on the part of parents was not there. Although, I think more so that it was those charlatans on the internet that caused parents to just write these children out of health education recklessly. But on the other hand, when I think to myself about this preparation and let's take a PE teacher like that, who is graduating from the Academy of Physical Education in Wrocław, there is a very high level there. We know that it's not that hard at all in that first year to survive. In the second and third too. And he is graduating, he graduated, let's say, 15 years ago, when a child asks him some more complicated questions about cardiovascular or oncological prevention. It seems to me that this person will not even know where to look for information to give the child an answer. And we know that children can surprise us with such questions. So is one year of postgraduate study enough time to prepare for such an important mission as being a health education teacher?

Prof. Lukasz Rypicz
And yes and no. Because we are not able to convey all the content within such studies. We have some kind of core curriculum that we try to follow. This is always better than no preparation at all in health education. That is for sure. Secondly, these legal conditions also allow for teachers, for health professionals who have teaching qualifications, to also teach this health education.

Monika Rachtan
Just how to encourage them?

Prof. Lukasz Rypicz
Just how do we encourage them when the teaching profession is a difficult profession today? These are not people who also get some kind of financial gratification that they find rewarding, that makes us have a queue of applicants, right? So it is difficult.

Monika Rachtan
But, you know, also about this remuneration, it seems to me that doctors would totally not go to this school for the money, or nurses, or dental assistants, because these are people who are paid in their work, so to speak, and if they had such an opportunity to go there twice a month, to tell these young people about health just so cool, so that these young people would react so cool.

Prof. Lukasz Rypicz
It's often a sense of such a mission these are the people who have a lot of examples from working with patients, so such knowledge, such information also reaches the audience completely differently, because these are concrete examples and not just theory that the teacher is supposed to talk about, right?

Monika Rachtan
And it just seems to me that this is not about money.

Prof. Lukasz Rypicz
I think so too. Also, as you mentioned, a lot of health-related recommendations get outdated so quickly. Every now and then there are new recommendations, whether it's about physical activity or nutrition. For example, that famous food pyramid, which has changed over the years. This needs to be updated, you need to keep up to date, and you need to know where to look for this information in order to provide truthful information. Because today, if we start to say something in class that is not true, in a moment someone might record us and make a funny video out of it and either our authority will collapse in a moment. So that's also what warns us that today it's very easy to verify everything, to undermine everything, but it's also very easy to ridicule someone. And that is also very dangerous.

Monika Rachtan
Speaking of videotaping people and making different videos and posting them online, it's also such a hot topic that's come up recently. It's podcasts about health, which is a great place where we get together with specialists, with medics, with doctors, to talk about what's healthy and what's unhealthy, what you should do and what you shouldn't do, how to treat yourself, how to live and so on. But it turns out that some of the podcasts feature different people who are not necessarily giving information that is actually in line with medical knowledge. And now tell me how you approach it when you've just been invited by a journalist, when you know more or less what you're going to talk about. Well, but on the other hand, there is this concern that this medium, you know, I don't always communicate about things that are in line with medical knowledge. You probably know what podcast I'm talking about at the moment and I'm wondering if I'm confident that the words that are going to come out of your mouth on our show today, you're responsible for them. Whereas I am also responsible for what I publish on my channel. If you would tell me that vitamin C..., I am not allowed to let it go. And how do you approach this? What do you think about it? Or is it that a little bit, you know, we've bent one way again and we've started to create a place where we're giving space to just these kind of emergences of strange people?

Prof. Lukasz Rypicz
This is the freedom of speech that we talk about very often. That is, anyone can get in front of a camera, in front of a camera, and start creating content, publishing, promoting themselves as an expert and saying that it's all true. In the same way, anyone can go on a podcast, if they get that invitation, and start talking about topics that they are real, that they know, that they are considered an expert in. But we as an audience should be educated in that kind of critical thinking. This is extremely difficult, because we would then have to assume that everything that is said has to be verified somewhere in PubMed, in other various database sources. This is obviously impossible to do. It is extremely difficult to keep that rationality somewhere and catch it. In my opinion, today it is probably not doable. We are not able to catch it, especially people who are not involved in this subject. If you are an expert, if you are involved in nutrition and dietetics and you hear someone saying things that are not in line with the latest guidelines, it is very easy for you to catch it. Whereas if I don't know anything about it, I take it as one to one. If this person is still signed that it is a doctor, it is a professor, it is a person from a public institution, then why should I not believe it? I understand that the journalist has verified it, invites an expert in order for me to learn something.

Monika Rachtan
It just seems to me that the authority we should have in health, but also recognising and verifying the sources we get our information from, is a huge problem we face as a society, that we just don't know how to look for it. But on the other hand, if someone titles themselves as a doctor, people immediately think they are a doctor of medicine, right? That the moment they sign up as a professor and we talk about health, well you're probably also a professor who treats people, And that's not the case and that's worth highlighting. It is worth pointing out that a doctor of biology, for example, is not qualified to tell you how to treat irritable bowel syndrome or inflammatory bowel disease, because that is what a specialist in gastroenterology is for, not a microbiologist, a doctor or a professor of microbiology. And it is important that the audience reads this affiliation to the end. That is, no, this please. The only thing that is important there is what comes next. What this person does for a living. In the same way, an editor, well it can also be an editor but you have to check what topics he covers and if suddenly a professor of health comes to the sports editor, that editor will also have a hard time catching the information that is not true. But it's also a bit of a responsibility on the listeners to vet sources and authorities wisely.

Prof. Lukasz Rypicz
Definitely and a few years ago there was such a high-profile discussion about profiles on Instagram, because there influencers who started to build their ranges, often being just a doctor, would write in front of their name, their surname or in front of some kind of profile name that suggested that they were a doctor by training, that they were a doctor, right? And that's how those reaches were built too, because it was content that was supposedly provided by a medical professional. And I think something like profile verification was introduced to actually confirm whether or not this person is the person they claim to be. But I also read recently that China had a huge problem with this and introduced verification of such profiles. There, one has to in turn upload diplomas to these platforms to prove their education, to actually affiliate that someone is a doctor and so on. Of course, there is another topic that comes up, that these diplomas can be fabricated and so on, that this will be overturned in a moment, but this is some element of verification with this freedom of speech. It is probably difficult today to completely verify who is who.

Monika Rachtan
Comprehensively is certainly difficult this information about these diplomas that were verified, are verified in China. I think it was in the UMed newsletter that it appeared, because I got a screen shot of an article from so many professors saying that something like this had been introduced and that it was great, that it was needed, that in general we would also like this in Poland. I have been wondering for many years, with the Patient Ombudsman in general, what we could do to verify this information better, to label it somehow, to create something safe for patients, a safe haven from fake health news. But like you said, that can't be done today because there is so much of this content and controlling all of it. So that responsibility There are three of us. There's you who says There's me who listens and produces the content in question and makes it available to my audience. And then there is my audience, who also has to think about what content they are listening to and make decisions based on that.

Prof. Lukasz Rypicz
This is what I wondered some time ago on the occasion of our conference, what we would have to do to stamp out all this fake news and I started to explore the literature somewhere. It turns out that firstly to educate the public, secondly to teach critical thinking, and thirdly to produce true information. Because it turns out that this ratio of true to false should be 60 to 40. Then we have a chance that really true information will reach a wide audience. This is extremely difficult, because today a lot of authorities don't want to speak out on the internet, don't want to be the face of some campaign, to promote different healthy things. They are afraid of heckling, they are afraid of all the things they might encounter. We had such a sample during the pandemic. People who promoted vaccinations, who promoted various epidemiological recommendations, were met with a lot of heckling, with aggression. And this causes people today to approach whether or not to take such an initiative for the general good with a very great distance. Because maybe it's not worth it to them at all if someone damages my car, insults me or assaults me. So what's the point of me saying on the internet what's healthy, what's unhealthy, when maybe nobody will believe me anyway, or someone will attribute some kind of conspiracy to me.

Monika Rachtan
I remember a situation when one of the expert doctors who was involved in promoting educational content encountered such a problem, which affected him very personally, because, like most doctors, he had a private medical practice and was positioning himself on a search engine as most practices do. And someone malicious on the internet set up a lot of accounts and just gave him ones for what he was saying when it came to social media. And that would seem like such a trivial thing. But the minute you have a practice that's Googled at 5.0 or at 4.8, all of a sudden you're getting a 3.5, your patients don't always read what the comments are about, your patients aren't always that inquisitive. They know about the doctor. you had a 4.8 and now a 3.5. what happened? Did the patient die on you? Well, no. Some hater started hating me online and giving me only 1s. And that it's such a big risk for a doctor. Because it's not just a matter of someone saying stupid doctor from the internet, it's actually going to affect his professional life and his reputation.

Prof. Lukasz Rypicz
Totally, it can totally change a patient's perception of such a doctor. Especially since we today, when choosing a doctor to go to, let's not hide, we look at these rankings. That's the first thing we look at when we do a search, right? So first we look at the overall such rate, the rating, and then we go in, read the reviews. It's just like with any other product.

Monika Rachtan
And then competence, let's check.

Prof. Lukasz Rypicz
And then competence. So today it is very easy to undermine, insult, insult. On the other hand, it is very difficult to rebuild this trust. I have also heard that it is very difficult to remove comments which are completely untrue, which may be from fake accounts, and that this procedure takes quite a long time.

Monika Rachtan
Even a few months. I myself had the opportunity to participate in it.

Prof. Lukasz Rypicz
And meanwhile, someone is already acting against us, insulting us or undermining our competence. So this is also very dangerous.

Monika Rachtan
And what were you afraid of when thinking about organising the InfluenceMed conference well because you were with us a little bit when we were recording the videos, you saw how the programme was shaping up. We talked about what it was all going to look like and did you have any inkling that, apart from running out of chairs, that something like that might happen that might blow up this conference for us?

Prof. Lukasz Rypicz
Maybe not that I was afraid, but I reckoned that there might be organisations that are against such events.

Monika Rachtan
I used to dream about it at night.

Prof. Lukasz Rypicz
Anti-vaccinationists who can invade such conferences and events. And disrupt the whole proceedings. So that's what I was reckoning with, that something like this could happen.

Monika Rachtan
I, like I said, dreamt about it at night and we were terribly afraid of it. and it was such a thing in general that determined our decision a little bit as to whether we decide to organise this conference at all or not. Well, because we know that movements of people who promote health education, who do some podcasts on the internet, who have accounts, well, these are normal, cool people who you can go for a coffee with. And rather, if there's a conference in Silesia, most of us won't go there with banners and tear gas, and will not measure it. But here, on the other hand, it seemed to me that these people might be more determined and might come here and pitchfork us a bit. And so I wondered, but fortunately, if you weren't watching, that didn't happen. So that next year we hope that you won't come either, in terms of those people from anti-vaccine organisations. On the other hand, that people who are interested in health issues will come to the conference. You know what else I was afraid of? I was afraid that despite the fact that I knew the speakers, despite the fact that I had mainly invited people with whom I had had contact before, despite the fact that I knew the scientific materials and the reports that they published, I was afraid that someone would say something that would go viral on the Internet and that everyone would hex us. That's how it was and there was that one thing, but I don't think anyone noticed it. On the other hand, do you think there was a panel that was groundbreaking, that moved people a little bit in terms of the topics we covered, what stuck out in your mind at all?

Prof. Lukasz Rypicz
I think those panels where specific patient examples were given. They are probably the ones that are the most touching. Stories of oncology patients. Where Dr Jola Grzebieluch was the moderator. That stuck out to me as she read a post from one of the patients at the end. So actually all these stories, they're very personal by virtue of the fact that we're dealing with this too. I think all of us know people who are cancer patients, cardiac patients, neurological patients. We have different ailments, don't we? On the other hand, if we are able to help the other person in some way and someone cites such examples and says that this prevention is self-examination, it is extremely important because it saved my life, and I have two children and so on, and that this is the meaning of existence for me. Well, it's very much so personal, personal, moving. So every story or panel with rare diseases are such touching stories that are worth talking about.

Monika Rachtan
And I had the opportunity after the conference to meet one of the panellists, Dr Kasia, who was on a panel about overweight in children. Also the campaign of the Medical University of Wroclaw Nabieramy Odwagi, we met with Kasia for coffee, until I was stupid to order a cake during this meeting. But you know, at the conference there wasn't a bit of time to go over all these cases they have just in Milicz. What does that look like? But at the meeting we talked about these, about these patients, where, of course, without any details, because Kasia didn't give me any details either, but I'm also sort of trying to tell the exact situation of the patients here, but I was very horrified by the stories of children who are seven years old and weigh 69 kilos. And let me tell you, it's so scary and so. You don't have, I mean I'm not aware as a mother that such things are happening at all, that such things are happening, that I'm walking down this street in Wrocław, I'm looking at these children, I'm looking, some are overweight, some are not. But that a child can weigh 69 kilos at the age of seven, it was so very overwhelming for me. After she started telling me about children who have hypertension, and children who have type two diabetes or some sort of onset of diabetes, it scared me terribly. And also just in terms of the public health debate, this is the kind of topic that should electrify us a lot today. This epidemic, this pandemic of obesity, which is not only among children but also among adults, that these are the kind of issues that will soon grab us by the throat and say, well, gee.

Prof. Lukasz Rypicz
Well, we are already caught up. In fact, I don't think we realise, because still this issue of overweight and obesity is treated as an aesthetic defect, not as a disease. And this campaign from the University of Medicine also talks about this, that obesity, overweight is not a cosmetic defect, it's a disease that needs to be fought so that you don't have these different consequences, complications in the future. So it's about taking care, investing in your health. That's the first thing. Secondly, it is indeed this obesity that is a huge problem, But again, I will hook you on health education. We are not able to build a system that is optimal and that works perfectly straight away, are we? We're not able to, nor are we teaching all teachers to do health education and we're not going to create legal solutions, we're not going to ban adverts on TV. On the other hand, at some point we should put some kind of boundary, some kind of line. Let's separate what was and start building something new. And this health education is the perfect space to start building this awareness and health competence. We are not going to fix everything at once, we are not going to eliminate all the temptations that lie in wait for us, for example those related to unhealthy lifestyles and diets, but we do need to start building this health capital in some way. This is the first step. In a little while, we will add some legal solutions to this, perhaps banning advertisements for unhealthy foods that tempt children. That will be the next step, because there are a lot of allegations. And what is health education for if I don't know? Children carry heavy backpacks or there are hamburgers and cola on billboards. Okay, but we're not going to do everything at once. Let's do something basic. That basic step is to educate. In a while, we'll add other elements that will have some effect. It won't happen in a decade or two, as I mentioned. On the other hand, if we do nothing, it will be even worse.

Monika Rachtan
When I think back to the individual episodes of the First Patient programme, I remember an interview with Kamila Kadzidłowska, who is the president of the Parents for Climate Foundation. And so at first glance, when you say the name of this foundation, you'd probably think to yourself that they're concerned with the climate in terms of the environment, and they're concerned with the whole climate of life that surrounds our children. And Kamila once said one very important thing just in this programme, that this is how we go, we say adverts, no this, no that. And it's really enough to start from your home, to come to your home, to look around constructively, to look at your fridge, to think about how many steps you take, for example, in the afternoon when you come back from school, from work, what your day looks like, do you stay in front of the TV or do you move around the house a bit, do you give yourself some activity? It's not about suddenly putting a treadmill around the house and running 5-10 kilometres on it, it's about keeping ourselves busy, being active all the time. And that if we start from our house, so much in this life of ours is already going to change, is it? 3%, not 10%. It's just that it's already 20, 30% of all the things that we can change to reduce all these risks of an unhealthy lifestyle, of being overweight, of being obese.

Prof. Lukasz Rypicz
A drop drills the rock. And these are the kind of small actions that we are able to implement in this smallest community of ours, which is the family. And indeed, as you say, if everyone transferred certain healthy solutions to their own small community, the effect globally would be quite large. It's just that we have to talk about it all the time and educate. Without that I don't think we can change these realities.

Monika Rachtan
Luke just to finish, please tell me who would you like to see from medical influencers or maybe professors next year? At the InfluencMed conference? Because the good news is that this conference will take place in 2026. We don't know yet in what format, what formula. Of course, we would like it to be as accessible as possible to the grey man in the street, as you said. That it gathers as many experts as possible, that more medical influencers come to us. We simply need them here very much to make health education famous. But do you have any such internet celebrities of your own that you would like to see at the conference?

Prof. Lukasz Rypicz
Maybe not a celebrity, but I think such a good influencer would be a doctor who does family medicine. Because this family medicine is, I think, totally important for public health. It is usually the first link where we meet, where we encounter various problems in the health care system. A good family doctor is really a treasure. And I know there are accounts of doctors who promote family medicine, and I think it is a great idea to promote health education and prevention through family medicine.

Monika Rachtan
And you know, I've also read such research. I won't quote the author now, sorry, but maybe I'll look for it. No, because it's actually something I've read, but my husband suggested to me that just having one family doctor for any length of time in your life and being faithful to him or her is something that affects our health at all, improves our lives and can extend that life. If that's the kind of doctor we have close to us.

Prof. Lukasz Rypicz
And it supposedly improves that whole adherence, or compliance, because it's good, high confidence. And that doctor knows that patient very well, so it has tangible benefits and.

Monika Rachtan
I also know the whole family very well, that is important. My dear friends, if you are actually interested in health topics or you have any doubts, you look at various accounts on Instagram and you do not know whether these people should be believed or not, I invite you today to the InfluenceMed conference, which will take place next year in Wrocław in 2026. But we are already in December in our programme. So it's already time to talk about this next year and make plans. Probably a lot of talks with experts, probably medical influencers, probably Luke, who will also appear at our conference. So you're very welcome to attend. And how would you encourage our viewers to come to Wrocław? Because some of them have actually come to us from the other end of Poland.

Prof. Lukasz Rypicz
I would say that this is a great place to face the real facts about our health and medicine.

Monika Rachtan
Ladies and gentlemen, this was the Patient First programme, and my guest today, but above all your guest, was Professor Lukasz Rypicz from the Medical University of Wrocław. Thank you very much.

Prof. Lukasz Rypicz
Thank you also.

Monika Rachtan
This was the programme First. Patient. My name is Monika Rak and, as always, I wish you good health. Thank you very much.